Programs that promote bicycle helmet use for children include bicycle safety education for children and parents, media campaigns, or free or subsidized helmet distribution. Such programs are delivered in school, community, or health care settings (Cochrane-Owen 2011*). Respondents to a national 2012 survey of bicyclists reported that 45% of children always wear a helmet, and 18% never wear a helmet (NHTSA-Schroeder 2013).
Expected Beneficial Outcomes (Rated)
Increased helmet use
Reduced fatal and non-fatal injuries
Other Potential Beneficial Outcomes
Reduced health care costs
Evidence of Effectiveness
There is strong evidence that helmet promotion programs increase children’s likelihood of wearing helmets while bicycling (Cochrane-Owen 2011*, Nauta 2014*, CG-Health communication). Wearing a helmet can reduce fatal and non-fatal head and face injuries for bicyclists (Olivier 2017*).
Programs targeted at children under age 12 can increase helmet wearing more than programs for children of all ages (Cochrane-Owen 2011*). Both community- and school-based programs appear to increase helmet wearing; however, community-based programs may increase helmet wearing more than school-based programs (Cochrane-Owen 2011*). Programs that give helmets away appear to increase helmet wearing more than programs that subsidize helmets or offer education only (Cochrane-Owen 2011*, Nauta 2014*).
Children from low income families appear to use helmets less than their higher income counterparts. A UK-based study suggests that providing free helmets and school-based education to children in low income neighborhoods can reduce inequalities in helmet ownership (Cochrane-Owen 2011*).
Some bicycle safety educational programs can also increase children’s knowledge and practice of how to wear helmets correctly (McLaughlin 2010, Cusimano 2013, Hooshmand 2014*); correct helmet wearing maximizes protection against head injury and fatality (Cusimano 2013).
Researchers estimate that helmets save an average of $440 over five years in medical and insurance costs. One analysis suggests that HMOs offering a children’s helmet subsidy would save money if helmet use reached 50% among those they insure (Miller 2000*).
Impact on Disparities
There are many bicycle helmet promotion programs in the United States. The North Carolina Department of Transportation, for example, provides free helmets to low income children through its Bicycle Helmet Initiative (NCDOT-BHI). The American Brain Foundation and American Academy of Neurology also hold a free helmet giveaway event in Minneapolis annually (AAN-Helmet giveaway).
Citations - Evidence
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Cochrane-Owen 2011* - Owen R, Kendrick D, Mulvaney C, Coleman T, Royal S. Non-legislative interventions for the promotion of cycle helmet wearing by children. Cochrane Database Systematic Reviews. 2011;(11):CD003985.
Nauta 2014* - Nauta J, van Mechelen W, Otten RHJ, Verhagen EAL. A systematic review on the effectiveness of school and community-based injury prevention programmes on risk behaviour and injury risk in 8-12 year old children. Journal of Science and Medicine in Sport. 2014;17(2):165–72.
CG-Health communication - The Guide to Community Preventive Services (The Community Guide). Health communication and social marketing: Campaigns that include mass media and health-related product distribution.
Olivier 2017* - Olivier J, Creighton P. Bicycle injuries and helmet use: a systematic review and meta-analysis. International Journal of Epidemiology. 2016;46(1):278-292.
McLaughlin 2010 - McLaughlin KA, Glang A. The effectiveness of a bicycle safety program for improving safety-related knowledge and behavior in young elementary students. Journal of Pediatric Psychology. 2010;35(4):343-353.
Cusimano 2013 - Cusimano MD, Faress A, Luong WP, et al. Evaluation of a bicycle helmet safety program for children. Canadian Journal of Neurological Sciences. 2013;40(5):710–6.
Hooshmand 2014* - Hooshmand J, Hotz G, Neilson V, Chandler L. BikeSafe: Evaluating a bicycle safety program for middle school aged children. Accident Analysis and Prevention. 2014;66:182–6.
Miller 2000* - Miller TR, Levy DT. Cost-outcome analysis in injury prevention and control: Eighty-four recent estimates for the United States. Medical Care. 2000;38(6):562-82.
Citations - Implementation Examples
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