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July 1996, Vol 150, No. 7 >
Article | July 1996

Effect of a State Law on Reported Bicycle Helmet Ownership and Use FREE

Richard A. Schieber, MD, MPH; Marcie-jo Kresnow, MS; Jeffrey J. Sacks, MD, MPH; Edwin E. Pledger, MPA; Joann M. O'Neil; Kathleen E. Toomey, MD, MPH
Arch Pediatr Adolesc Med. 1996;150(7):707-712. doi:10.1001/archpedi.1996.02170320053009.
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Objective:  To evaluate the effect of a state law on reported bicycle helmet ownership and use.

Design:  Multistage cluster random-digit-dialing telephone survey.

Setting:  Georgia, June through November 1993.

Participants:  Adults who reported the behavior of bicyclists 4 through 15 years old.

Intervention:  State law mandating helmet use after July 1, 1993, for all bicyclists aged younger than 16 years.

Main Outcome Measures:  Bicycle helmet ownership and use.

Results:  Reported helmet ownership increased from 39% before the law took effect to 57% afterward (+46%, P=.06). Reported use increased from 33% before to 52% afterward (+58%, P<.05). About 7% of riders changed from "never-wearing" to "always-wearing" behavior. After the law took effect, in those households in which the law was known, 69% of riders owned and 64% used a helmet. By comparison, in those households in which the law was not known, only 30% owned and 25% used a helmet (P<.01). Reported ownership and use were 93% concordant, inversely related to rider age, and directly related to household income. Multivariable analysis indicated that race was an effect modifier of reported helmet ownership and use. In black riders, knowledge of the law appeared to be highly associated with both reported helmet ownership and use but was not significant in white riders. In white riders, though, age and income were significantly associated with reported helmet ownership and use.

Conclusions:  This law appeared important in increasing reported helmet ownership and use, particularly in black riders. Since knowledge of the law was associated with increased ownership and use, additional publicity about the law might further increase helmet use. Because most riders who owned helmets used them, giveaway programs targeting areas of low ownership may also increase use.Arch Pediatr Adolesc Med. 1996;150:707-712

REFERENCES

1 +
1992 Mortality Tapes . Hyattsville, Md: National Center for Health Statistics, Centers for Disease Control and Prevention, Public Health Service, Dept of Health and Human Services; 1995;.
2 +
Baker SP, Li G, Fowler C, Dannenberg AL. Injuries to Bicyclists: A National Perspective . Baltimore, Md: Johns Hopkins University Injury Prevention Center; 1993;.
3 +
Sacks JJ, Holmgreen P, Smith SM, Sosin DM.  Bicycle-associated head injuries and deaths in the United States from 1984 through 1988: how many are preventable? JAMA . 1991;;266:3016-3018.
4 +
Thompson RS, Rivara FP, Thompson DC.  A case-control study of the effectiveness of bicycle safety helmets . N Engl J Med . 1989;;320:1361-1367.
5 +
Rogers GB, Tinsworth DK, Polen C, et al. Bicycle Use and Hazard Patterns in the United States . Washington, DC: US Consumer Product Safety Commission; (June) 1994;. Publication 1994-376-299/10414.
6 +
Cote T, Sacks JJ, Lambert-Huber DA, et al.  Bicycle helmet use among Maryland children: effect of legislation and education . Pediatrics . 1992;;89:1216-1220.
7 +
Dannenberg AL, Gielen AC, Beilenson PL, Wilson MH, Joffe A.  Bicycle helmet laws and educational campaigns: an evaluation of strategies to increase children's helmet use . Am J Public Health . 1993;;83:667-674.
8 +
Macknin ML, Medendorp SV.  Association between bicycle helmet legislation, bicycle safety education, and use of bicycle helmets in children . Arch Pediatr Adolesc Med . 1994;;148:255-259.
9 +
Public Health Service. Healthy People 2000: Midcourse Review and 1995 Revisions . Washington, DC: US Dept of Health and Human Services; 1995;.
10 +
Mandatory Helmet Laws: A Summary . Arlington, Va: Bicycle Helmet Safety Institute; (June 22) , 1995;.
11 +
DiGuiseppi CG, Rivara FP, Koepsell TD, Polissar L.  Bicycle helmet use by children: evaluation of a community-wide helmet campaign . JAMA . 1989;;262: 2256-2261.
12 +
Siegel PZ, Frazier EL, Mariolis P, Brackbill RM, Smith C.  Behavioral risk factor surveillance, 1991: monitoring progress toward the nation's Year 2000 health objectives . MMWR Morb Mortal Wkly Rep . 1993;;42( (No. SS-4) ):1-17.
13 +
Bureau of the Census. Detailed Housing Characteristics, 1990 Census of Population and Housing . Washington, DC: Bureau of the Census; 1990;.
14 +
CACI Marketing Systems. The Sourcebook of Zip Code Demographics, Census Edition . Arlington, Va: CACI Marketing Systems; 1991;;1.
15 +
Shah BV, Folsom RE, La Vange LM, Wheeless SC, Boyle KE, Williams RL. Statistical Methods and Mathematical Algorithms Used in SUDAAN . Research Triangle Park, NC: Research Triangle Institute; 1993;.
16 +
Agresti A. Categorical Data Analysis . New York, NY: John Wiley & Sons Inc; 1990;.
17 +
Vulcan P, Cameron MH, Watson WL.  Mandatory bicycle helmet use: experience in Victoria, Australia . World J Surg . 1992;;16:389-397.
18 +
Cameron MH, Vulcan AP, Finch CF, Newstead SV.  Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia—an evaluation . Accid Anal Prev . 1994;;26:325-337.
19 +
Thompson RS, Thompson DC, Rivara FP, Salazer AA.  Cost-effectiveness analysis of bicycle helmet subsidies in a defined population . Pediatrics . 1993;;91: 902-907.
20 +
Massey JT.  An overview of telephone coverage . In: Groves RM, Biemer PP, Lyberg LE, Massey JT, Nicholls WL II, Waksberg J, eds. Telephone Survey Methodology . New York, NY: John Wiley & Sons Inc; 1988;:3-8.
21 +
Sackett DL.  Bias in analytic research . J Chronic Dis . 1979;;32:51-63.
22 +
Hu X, Wesson DE, Parkin PC, Chipman ML, Spence LJ.  Current bicycle helmet ownership, use and related factors among school-aged children in metropolitan Toronto . Can J Public Health . 1994;;85:121-124.
23 +
Otis J, Lesage D, Godin G, Brown B, Farley C, Lambert J.  Predicting and reinforcing children's intentions to wear protective helmets while bicycling . Public Health Rep . 1992;;107:283-289.
24 +
Gielen AC, Joffe A, Dannenberg AL, Wilson MEH, Beilenson PL, DeBoer M.  Psychosocial factors associated with the use of bicycle helmets among children in counties with and without helmet use laws . J Pediatr . 1994;;124:204-210.
25 +
Winn GL, Jones DF, Bonk CJ.  Taking it to the streets: helmet use and bicycle safety as components of inner-city youth development . Clin Pediatr . 1992;;31: 672-677.
26 +
Dannenberg AL, Vernick JS.  A proposal for the mandatory inclusion of helmets with new children's bicycles . Am J Public Health . 1993;;83:644-646.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
1992 Mortality Tapes . Hyattsville, Md: National Center for Health Statistics, Centers for Disease Control and Prevention, Public Health Service, Dept of Health and Human Services; 1995;.
2 +
Baker SP, Li G, Fowler C, Dannenberg AL. Injuries to Bicyclists: A National Perspective . Baltimore, Md: Johns Hopkins University Injury Prevention Center; 1993;.
3 +
Sacks JJ, Holmgreen P, Smith SM, Sosin DM.  Bicycle-associated head injuries and deaths in the United States from 1984 through 1988: how many are preventable? JAMA . 1991;;266:3016-3018.
4 +
Thompson RS, Rivara FP, Thompson DC.  A case-control study of the effectiveness of bicycle safety helmets . N Engl J Med . 1989;;320:1361-1367.
5 +
Rogers GB, Tinsworth DK, Polen C, et al. Bicycle Use and Hazard Patterns in the United States . Washington, DC: US Consumer Product Safety Commission; (June) 1994;. Publication 1994-376-299/10414.
6 +
Cote T, Sacks JJ, Lambert-Huber DA, et al.  Bicycle helmet use among Maryland children: effect of legislation and education . Pediatrics . 1992;;89:1216-1220.
7 +
Dannenberg AL, Gielen AC, Beilenson PL, Wilson MH, Joffe A.  Bicycle helmet laws and educational campaigns: an evaluation of strategies to increase children's helmet use . Am J Public Health . 1993;;83:667-674.
8 +
Macknin ML, Medendorp SV.  Association between bicycle helmet legislation, bicycle safety education, and use of bicycle helmets in children . Arch Pediatr Adolesc Med . 1994;;148:255-259.
9 +
Public Health Service. Healthy People 2000: Midcourse Review and 1995 Revisions . Washington, DC: US Dept of Health and Human Services; 1995;.
10 +
Mandatory Helmet Laws: A Summary . Arlington, Va: Bicycle Helmet Safety Institute; (June 22) , 1995;.
11 +
DiGuiseppi CG, Rivara FP, Koepsell TD, Polissar L.  Bicycle helmet use by children: evaluation of a community-wide helmet campaign . JAMA . 1989;;262: 2256-2261.
12 +
Siegel PZ, Frazier EL, Mariolis P, Brackbill RM, Smith C.  Behavioral risk factor surveillance, 1991: monitoring progress toward the nation's Year 2000 health objectives . MMWR Morb Mortal Wkly Rep . 1993;;42( (No. SS-4) ):1-17.
13 +
Bureau of the Census. Detailed Housing Characteristics, 1990 Census of Population and Housing . Washington, DC: Bureau of the Census; 1990;.
14 +
CACI Marketing Systems. The Sourcebook of Zip Code Demographics, Census Edition . Arlington, Va: CACI Marketing Systems; 1991;;1.
15 +
Shah BV, Folsom RE, La Vange LM, Wheeless SC, Boyle KE, Williams RL. Statistical Methods and Mathematical Algorithms Used in SUDAAN . Research Triangle Park, NC: Research Triangle Institute; 1993;.
16 +
Agresti A. Categorical Data Analysis . New York, NY: John Wiley & Sons Inc; 1990;.
17 +
Vulcan P, Cameron MH, Watson WL.  Mandatory bicycle helmet use: experience in Victoria, Australia . World J Surg . 1992;;16:389-397.
18 +
Cameron MH, Vulcan AP, Finch CF, Newstead SV.  Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia—an evaluation . Accid Anal Prev . 1994;;26:325-337.
19 +
Thompson RS, Thompson DC, Rivara FP, Salazer AA.  Cost-effectiveness analysis of bicycle helmet subsidies in a defined population . Pediatrics . 1993;;91: 902-907.
20 +
Massey JT.  An overview of telephone coverage . In: Groves RM, Biemer PP, Lyberg LE, Massey JT, Nicholls WL II, Waksberg J, eds. Telephone Survey Methodology . New York, NY: John Wiley & Sons Inc; 1988;:3-8.
21 +
Sackett DL.  Bias in analytic research . J Chronic Dis . 1979;;32:51-63.
22 +
Hu X, Wesson DE, Parkin PC, Chipman ML, Spence LJ.  Current bicycle helmet ownership, use and related factors among school-aged children in metropolitan Toronto . Can J Public Health . 1994;;85:121-124.
23 +
Otis J, Lesage D, Godin G, Brown B, Farley C, Lambert J.  Predicting and reinforcing children's intentions to wear protective helmets while bicycling . Public Health Rep . 1992;;107:283-289.
24 +
Gielen AC, Joffe A, Dannenberg AL, Wilson MEH, Beilenson PL, DeBoer M.  Psychosocial factors associated with the use of bicycle helmets among children in counties with and without helmet use laws . J Pediatr . 1994;;124:204-210.
25 +
Winn GL, Jones DF, Bonk CJ.  Taking it to the streets: helmet use and bicycle safety as components of inner-city youth development . Clin Pediatr . 1992;;31: 672-677.
26 +
Dannenberg AL, Vernick JS.  A proposal for the mandatory inclusion of helmets with new children's bicycles . Am J Public Health . 1993;;83:644-646.

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