Parents overestimate their children's use of bicycle helmets and seatbelts

In a survey of 731 fourth and fifth grade pupils and 329 of their parents, researchers found that while 70 percent of parents say their child always wears a bicycle helmet while riding, only 51 percent of children report wearing a helmet. One-fifth of the children said they never wear a helmet, while only 4 percent of parents said their children never use one.

Vehicle safety practices had similar discrepancies: Parents say their children use a seatbelt 92 percent of the time, but children report using one only 70 percent of the time. And while 80 percent of parents say their children always sit in the vehicle’s backseat, only 43 percent of children say they always sit in back.

The study appears in the current issue of the journal Injury Control and Safety Promotion.

“There’s a real void between the availability of good safety devices and actual use by parents and children. This study shows the need to target injury prevention programs to parents and children together. We can’t rely solely on parental reports of children’s safety behaviors. Injury prevention must be treated as a family issue,” says Peter Erlich, M.D., M.H.S., a pediatric surgeon at UMHS. Ehrlich, clinical associate professor in the Department of Surgery at U-M Medical School, conducted the study while at the Children’s Hospital of West Virginia.

Traumatic injuries are the leading cause of death in children, with 500,000 children hospitalized annually due to injury. Motor vehicle crashes account for more than half of all injuries and traumatic deaths in children, and bicycle accidents account for another 10 percent. Seatbelts, car seats and bike helmets have all proved successful at reducing the frequency and severity of injuries in children – but only if they are used.

In the current study, the largest matched analysis on injury prevention, researchers surveyed children from eight West Virginia elementary schools and sent home questionnaires for the children’s parents to return by mail. Surveys were coded so that the child’s and parent’s responses could be matched.

The answers collected from the children is consistent with national data on bike helmet and seatbelt use, suggesting their answers are closer to reality than the parents’ answers.

In addition to the discrepancies reported by parents and children, the study also found a strong correlation between parental behavior and the child’s behavior. Among the matched parent-child responses, 15 percent of the children said they never use a bicycle helmet – and 88 percent of those children’s parents also report never wearing a helmet. Further, children who said they ride their bikes with their parents were more likely to report helmet use than children who do not ride with their parents, 70 percent compared to 40 percent.

Seatbelt use followed a similar pattern, with children of parents who always wear a seatbelt nearly three times more likely to wear a seatbelt and sit in the backseat. Parents who seldom wear a seatbelt were twice as likely to have children who sit in the front seat unbelted.

“The time-tested mantra that ‘actions speak louder than words’ clearly held true in our study. This suggests the need for injury prevention programs to stress the importance of parental role models,” Ehrlich says.

Some children said they refused to wear bicycle helmets at all. Of the 13 percent of kids who did not use helmets, the most common reason was they thought they were too experienced to need one. Other reasons were that helmets were uncomfortable or uncool. The researchers conclude that injury prevention programs must counter the myth that experience makes safety measures unnecessary.

The research was funded by a grant from the West Virginia University School of Medicine. In addition to Ehrlich, study authors were James Helmkamp, Ph.D., Janet Williams, M.D., Arshadul Haque, MPH, and Paul Furbee, all from the Center for Rural Emergency Medicine at West Virginia University.