Increasing the Use of Bicycle Helmets

The goal of bicycle helmet programs is to increase the use of bicycle helmets, thereby reducing the number of head injuries and deaths caused by bicycle crashes. State and local health departments are in a unique position to undertake bicycle helmet campaigns because of their a) knowledge of the specific problems affecting their states and communities; b) ability to provide technical expertise and credibility in health matters that affect their states and communities; c) ability to work with community groups that are involved with health issues; and d) ability to place bicycle helmet programs within the framework of other injury and health activities.

State- or Local-Level Programs

State and local health departments may be responsible for the following tasks when conducting community campaigns:
· Collecting and analyzing data relevant to a bicycle helmet campaign or providing assistance to the local program in this task. These data include deaths and injuries attributable to bicycle-related head injury, age-group-specific rates for helmet use, and barriers to helmet use. In addition, state and local health departments can collect and provide information on programs or organizations responsible for similar or complementary activities.
· Overseeing the development of a coalition of individuals, agencies, and organizations that is interested in bicycle helmet programs; has the resources to support a bicycle helmet campaign; or has the influence necessary to establish credibility and support for the campaign in the community.
· Identifying resource needs and sources, including funding and training.
· Providing assistance to local programs in planning intervention activities and in developing educational and promotional materials.
· Developing a statewide process for program evaluation and collecting and analyzing data on the program to evaluate process, impact (i.e., the change in helmet- use rates), and outcome. This process should begin before the program is implemented.
· Conducting statewide educational campaigns to create an awareness of the need for and value of bicycle helmets.
· Developing legislation in conjunction with coalitions and local leaders that requires the use of bicycle helmets (Appendix A).

Community Programs

Educational and promotional campaigns for bicycle helmet use are usually most effective when conducted at the local (i.e., community) level. At this level, strategies that encourage persons to wear bicycle helmets can be adjusted to the needs of a specific community. Several organizations publish materials (e.g., program guides, videotapes, and training materials) that communities can use for developing a bicycle helmet program (Appendix B). Components of a community program include building a coalition and planning, implementing, and evaluating the program (Appendix C).

Legislation for Bicycle Helmet Use

Legislation that mandates the use of bicycle helmets effectively increases helmet use, particularly when combined with an educational campaign. Education often facilitates behavioral change; however, education alone is rarely effective. Laws mandating helmet use supplement and reinforce the message of an educational campaign, requiring people to act on their knowledge.

Several states and localities have enacted laws requiring bicycle helmet use (e.g., California; Connecticut; Georgia; Massachusetts; New Jersey; New York; Oregon; Pennsylvania; Tennessee; several counties in Maryland {Howard, Montgomery, and Allegheny}; and the city of Beechwood, Ohio). Other groups that require helmet use include the United States Cycling Federation -- the governing body of amateur bicycle racing and Olympic training -- and the Greater Arizona Bicyclist Association.

Once enacted, bicycle helmet laws should be enforced. However, enforcement of helmet laws should be carried out through education rather than punishment. For example, local police officers could tell persons who violate the bicycle helmet law about the benefits of helmet use and provide them with discount coupons for the purchase of a helmet. Fines for the first citation could be waived if the person shows that he or she has acquired a helmet.

Bicycle helmet laws contain stipulations concerning enforcement. For example, in the California and New York legislation, the first violation is dismissed if the person charged proves that a helmet meeting the standards has been purchased. Otherwise, the violation is punishable by a fine of not more than $20 and $50, respectively. Other areas have a fine for the first offense of $25-$50 and a fine of up to $100 for any subsequent offenses. The fines for noncompliance vary among jurisdictions.

Regardless of the specific penalties that are used to enforce the law, enforcement must be accompanied by the active involvement of the law enforcement community (e.g., participation in community education). This involvement should begin when the state or community is developing and advocating for a bicycle helmet law.

Evaluation of Legislation and Community Programs

Both community bicycle helmet programs and the legislation mandating helmet use have been evaluated Table 2. Although these studies indicate that bicycle helmet campaigns increase the use of helmets, the relative merits of any individual component of the campaigns are more difficult to assess. The studies do suggest, however, that community campaigns must include several strategies; single interventions do not have the same impact as multiple interventions. Furthermore, some studies indicated that helmet ownership and use were greater among children from high-income than low-income families (38,39). Potential barriers to increased helmet use among children from low-income families may include both the cost of helmets and language barriers (39). These studies highlight the importance of considering other issues that may influence the purchase and use of helmets (e.g., perceived risk of bicycle-related head injury) when planning a community-based bicycle helmet program.

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Bicycle Helmet Legislation
Organizations that Provide Information on Bicycle Helmet Campaigns
Components of a Community-Based Bicycle Helmet Campaign