Trends in pediatric and adult bicycling deaths before and after passage of a bicycle helmet law. Bicycle safety helmet legislation and bicycle-related non-fatal injuries in California. Bicycle helmet prevalence two years after the introduction of mandatory use legislation for under 18 year olds in Alberta, Canada. Police enforcement as part of a comprehensive bicycle helmet program. Impact of mandatory helmet legislation on bicycle-related head injuries in children: a population-based study. Trends in helmet use and head injuries in San Diego County: the effect of bicycle helmet legislation.
The goals were to examine bicycle-related mortality rates in Ontario, Canada, from 1991 to 2002 among bicyclists 1 to 15 years of age and 16 years of age through adulthood and to determine the effect of legislation (introduced in October 1995 for bicyclists <18 years of age) on mortality rates.
                The average numbers of deaths per year and mortality rates per 100000 person-years for the prelegislation and postlegislation periods, and the percentage changes, were calculated for each of the 2 age groups (1-15 years and >/=16 years). Differences before and after legislation in the 2 age groups were modeled in a time series analysis.
                There were 362 bicycle-related deaths in the 12-year period (1-15 years: 107 deaths; >/=16 years: 255 deaths). For bicyclists 1 to 15 years of age, the average number of deaths per year decreased 52%, the mortality rate per 100000 person-years decreased 55%, and the time series analysis demonstrated a significant reduction in deaths after legislation. The estimated change in the number of deaths per month was -0.59 deaths per month. For bicyclists >/=16 years of age, there were only slight changes in the average number of deaths per year and the mortality rate per 100000 person-years, and the time series analysis demonstrated no significant change in deaths after legislation.
                The bicycle-related mortality rate in children 1 to 15 years of age has decreased significantly, which may be attributable in part to helmet legislation. A similar reduction for bicyclists 16 years of age through adulthood was not identified. These findings support promotion of helmet use, enforcement of the existing law, and extension of the law to adult bicyclists. The objective of this study was to determine whether the bicycle safety helmet legislation in California, enacted in 1994, was associated with statistically significant reductions in head injuries among bicyclists aged 17 years and under who were subjected to the law. The study used 44,069 patient discharge cases from all public hospitals in California, from 1991 through 2000, and a case-control design to make direct comparisons between those subjected to the law (Youth) and those who were not (Adult) across the pre- and post-legislation periods. An aggregate data analysis approach and a pooled disaggregate data fitting technique using multinomial logit models were applied. The legislation was found to be associated with a reduction of 18.2% (99% confidence interval: 11.5-24.3%) in the proportion of traumatic brain injuries (Head-TBI) among Youth bicyclists. The proportions of other head, face, and neck injuries were not significantly changed across the pre- and post-legislation periods in this age group but there was a corresponding increase of 9% (5-13%) in the proportion of all other injuries. On the other hand, there was no statistically significant change in the proportions of injury outcomes for Adult bicyclists. The youngest riders, aged 0-9 years, had the greatest decrease in the proportion of Head-TBI. The reduction was the same for motor vehicle and non-motor-vehicle-related incidents. The bicycle safety helmet legislation was associated with a decrease in the likelihood of Head-TBI for non-urban residents but not for urbanites, for males but not for females, and for Whites, Asians, and Hispanics, but not Blacks and others. To determine changes in helmet use in cyclists following the introduction of a bicycle helmet law for children under age 18.
                Cyclists were observed by two independent observers from July to August 2004 (post-legislation) in Edmonton, Alberta. The data were compared with a similar survey completed at the same locations and days in July to August 2000 (pre-legislation). Data were collected for 271 cyclists in 2004 and 699 cyclists in 2000.
                The overall prevalence of helmet use increased from 43% (95% CI 39 to 47%) in 2000 to 53% (95% CI 47 to 59%) in 2004. Helmet use increased in those under 18, but did not change in those 18 and older. In the cluster adjusted multivariate Poisson regression model, the prevalence of helmet use significantly increased for those under age 18 (adjusted prevalence ratio (APR) 3.69, 95% CI 2.65 to 5.14), but not for those 18 years and older (APR 1.17, 95% CI 0.95 to 1.43).
                Extension of legislation to all age groups should be considered. Bicycle-related head injuries cause >150 deaths and 45 000 nonfatal injuries among children in the United States annually. Although bicycle helmets are highly effective against head injury, only 24% of US children regularly wear one. Georgia mandated bicycle helmet use for children, effective July 1993. During that summer, 1 rural Georgia community passed an ordinance instructing police officers to impound the bicycle of any unhelmeted child. We evaluated the effect of active police enforcement of this ordinance, combined with a helmet giveaway and education program.
                During April 1997, approximately 580 children in kindergarten through grade 7 received free helmets, fitting instructions, and safety education. Police then began impounding bicycles of unhelmeted children. We conducted an observational study, unobtrusively observing helmet use just before helmet distribution, several times during the next 5 months, and once 2 years later.
                Before the program began, none of 97 observed riders wore a helmet. During the next 5 months, helmet use among 358 observed children averaged 45% (range: 30%-71%), a significant increase in all race and gender groups. In contrast, adult use did not change significantly. Police impounded 167 bicycles during the study, an average of 1 per day. Two years after program initiation, 21 of 39 child riders (54%) were observed wearing a helmet.
                Without enforcement, the state and local laws did not prompt helmet use in this community, yet active police enforcement, coupled with helmet giveaways and education, was effective and lasting. Childhood bicycle-related head injuries can be prevented through the use of helmets. Although helmet legislation has proved to be a successful strategy for the adoption of helmets, its effect on the rates of head injury is uncertain. In Canada, 4 provinces have such legislation. The objective of this study was to measure the impact of helmet legislation on bicycle-related head injuries in Canadian children.
                Routinely collected data from the Canadian Institute for Health Information identified all Canadian children (5-19 years) who were hospitalized for bicycling-related injuries from 1994-1998. Children were categorized as head or other injury on the basis of International Classification of Diseases, Ninth Revision, codes. Rates of head injuries and other injuries were compared over time in provinces that adopted legislation and those that did not.
                Of the 9650 children who were hospitalized because of a bicycle-related injury, 3426 sustained injuries to the head and face and the remaining 6224 had other injuries. The bicycle-related head injury rate declined significantly (45% reduction) in provinces where legislation had been adopted compared with provinces and territories that did not adopt legislation (27% reduction).
                This country-wide study compared rates of head injury in regions with and without mandatory helmet legislation. Comparing head injuries with other non-head-injured children controlled for potential differences in children's cycling habits. The strong protective association between helmet legislation and head injuries supports the adoption of helmet legislation as an effective tool in the prevention of childhood bicycle-related head injuries. The purpose of this study is to evaluate the effect of California's bicycle helmet law on bicycle-related head injuries in San Diego County with a year 2000 population of approximately 3 million people. The study design is an ecological trend design based on observational data from a Trauma Registry. Outcome measures include helmet use compliance, site/severity of injury and abbreviated injury scale (AIS). There were 1116 bicycle trauma patients recorded in the San Diego County Trauma Registry between 1992 and 1996. The percentages of pre-law and post-law helmet use were 13.2 and 31.7%, respectively. Over the whole study period, the overall helmet use increased by an average of 43% per year with an averaged 84% rate increase in helmet use among children. Only 16.1% of patients with serious head injury used helmets, compared to 28.2% in those who did not have serious head injury. The odds ratio of helmet use against serious head injuries is 0.43 (95% CI 0.28-0.66) after adjusting for age, ethnicity and time. The p-values for comparing pre- and post-legislation serious head injury rates are p=0.764, 0.4 and 0.194 for the overall, adult and child populations, respectively. Helmet legislation increased helmet use in the targeted child population and the effect was carried over to the adult population. Helmet use has a protective effect against serious head injury. Probably due to several of its limitations, the current study did not confirm that helmet legislation alone significantly reduced head injury rates in San Diego County during the study period.
Bicycle helmet legislation appears to be effective in increasing helmet use and decreasing head injury rates in the populations for which it is implemented. However, there are very few high quality evaluative studies that measure these outcomes, and none that reported data on possible declines in bicycle use.