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Effectiveness of a State Law Mandating Use of Bicycle Helmets among Children: An Observational Evaluation

Effectiveness of a State Law Mandating Use of Bicycle Helmets among Children: An Observational Evaluation. Dafna Kanny, PhD Richard A. Schieber, MD, MPH Vickie Pryor, RN, MPH Marcie-jo Kresnow, MS. AJE 2001;154(11):1072-1076. Learning Objectives.

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Effectiveness of a State Law Mandating Use of Bicycle Helmets among Children: An Observational Evaluation

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  1. Effectiveness of a State Law Mandating Use of Bicycle Helmets among Children: An Observational Evaluation Dafna Kanny, PhD Richard A. Schieber, MD, MPH Vickie Pryor, RN, MPH Marcie-jo Kresnow, MS AJE 2001;154(11):1072-1076

  2. Learning Objectives • Identify the scope of bicycle helmet use among children and state legislation • Describe the effectiveness of a state law for bicycle helmet use among children • Provide recommendation for such legislation

  3. ~28 million riders Pedal cyclist injury 200 deaths 100,000 ED visits Brain injury 125 deaths (65%) 20,000 ED visits (20%) Bicycling in U.S. Children 5-14 Years

  4. Helmets reduce risk by 69% -88% 50% own a helmet Only 25% always wear helmet Helmet Use in U.S. Children 5-14 Years

  5. Bicycle Helmet Use Legislation Post-Law 47% (1991) 49% (1995) 83% (1992) Pre-Law 4% (1990) 25% (1994) 36% (1990) Study Maryland, USA (Cote et al., 1993) Oregon, USA (Ni et al., 1997) Victoria, Australia (Cameron et al., 1994)

  6. Only 18 states and ~80 cities have helmet laws Bicycle Helmet Use Legislation in the U.S.

  7. Children under 16 64 of 67 counties adopt the law 3 counties legally “opted out” 1997 Florida Law

  8. Elementary School Observations in Florida, Four Counties • Pre (1991): 5% helmeted • Post (1992): 15% helmeted • Intervention: • Education • Policy • Media promotion • Helmet distribution

  9. Elementary School Observations in Florida, Duval County • Pre (1996): 13% helmeted • Post (1998): 73% helmeted • Intervention: • Education • Helmet distribution • Legislation

  10. Purpose • How well do Duval County results represent the state? • How beneficial was the state law? • Which counties have the greatest need for intervention?

  11. Inclusion Criteria • Any Florida public elementary school with: • Grades K-5 • No prohibition against cycling to school • At least one rider

  12. Study Population • 55/64 intervention counties with a law • 3/3 control counties without a law • Total 1,015/ 1,064 schools (95% response rate) • Total 21,763 children (unit of analysis)

  13. Observation Methods • Spring 1999 • Unobtrusive observations by school official of bicycle rack • 1 day 1 time only • Variables: • Bicycle helmet use, gender, race (W, B, O)

  14. Helmet Use by Law Helmet (Outcome) + - + 16,907 (79.3) 4,406 (20.7) - 148 (32.9) 302 (67.1) 21,313 450 Law (Exposed) Crude Prevalence Ratio (PR) = 2.4 (2.1 - 2.8)

  15. Helmet Use by Gender Helmet Yes No 10,941 (77.5) 3,180 (22.5) 6,114 (80.0) 1,528 (20.0) 14,121 7,642 Boys Girls 2 =18.7, df=1 p < .001

  16. Helmet Use by Race Helmet Yes No 13,274 (82.2) 2,880 (17.8) 1,893 (60.8) 1,220 (39.2) 1,888 (75.6) 608 (24.4) White Black Other 16,154 3,113 2,496 2 =714.9, df=2 p < .001

  17. Summary: Helmet Use by Law Prevalence Ratio (95% CI) Crude 2.4(2.1, 2.8) Adjusted 2.3 (2.0, 2.6) (Gender, Race)

  18. Conclusions • Children from counties with a state bicycle helmet law were twice as likely to wear bicycle helmets • Gender and race did not confound this relationship

  19. Limitations • Few covariates possible • No pre-law data collected • School policy and its enforcement were not reported sufficiently

  20. Advantages • Statewide survey, nearly all schools • All elementary grades • Observational, not self-reported • Comparison group • Gender and race also considered

  21. Recommendations Encourage the implementation and evaluation of Healthy People 2010objective: All 50 states should have laws requiring bicycle helmets for riders (Objective #15-24)

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