Free bike helmets increase use by children

Community-based programs that combine cycling safety information with distribution of free helmets increase the use of those helmets among children, according to a new review of programs involving more than 60,000 children.

Programs based in schools and those that provide subsidized, but not free, helmets also work, although apparently not quite as well, say Dr. Simon Royal of England’s University of Nottingham Medical School and coauthors. The review appears in the April issue of The Cochrane Library.

The Cochrane Library is a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

According to a 1999 Cochrane review, helmets were found to reduce head and facial injuries for bicyclists of all ages in all types of crash. The latest review “will help those who are thinking about running a helmet-promotion campaign locally decide on the best way to do it,” says Royal.

Community-based programs are typically organized by schools, health departments, hospitals, police departments and fire departments, says Royal. They often include a media campaign and local events.

The reviewers included 22 helmet-promotion programs targeted at youngsters up to 18 years old in their systematic review. More than 60,000 children participated in campaigns in the United States, Canada, the United Kingdom and New Zealand. Two of the authors have conducted a similar study, but it was published only recently and was not included in the review.

Children were more than four times as likely to be seen wearing helmets after taking part in a community-based promotion campaign or a free-helmet distribution program. They were only about twice as likely to wear helmets after exposure to programs set in schools or those distributing subsidized helmets.

One weakness of the studies, note the review authors, is that most recorded results within two weeks to one year after the promotion campaigns. Thus “the sustainability of any positive effects cannot be evaluated,” they say.

Another question that still remains is whether the same types of helmet-promotion campaigns are effective in low-income localities and countries as in the high-income areas studied. Studies have shown that the frequency of cycling injuries and deaths is significantly higher among the poor than the affluent.

The review focused specifically on the best ways to encourage children to wear helmets in areas where legislation does not require them to do so. “Cycle helmets arouse very strong emotions and opinions in people,” says Royal. Some groups, including the British Medical Association, believe helmet legislation discourages people from bicycling and encourages riders to take greater risks, thereby reducing overall public health.

“We certainly do not wish to clothe our results as proving that cycle helmets were effective overall or were a health benefit,” explains Royal. “Further work is needed in this area,” write the authors.

In the United States there is little organized resistance to bicycle helmet legislation, according to Randy Swart of the consumer-funded Bicycle Helmet Safety Institute. There are, however, “impassioned individuals who feel very strongly about the personal freedom issue,” he says. “They’re just outraged that someone could tell them how to ride a bicycle.”

Swart adds, “Our message is always that it’s better not to crash than it is to crash with a helmet. We provide parents with a pamphlet that’s about teaching your child how to ride. It’s not just putting them on a bike and sending them off.”