Promote Bicycle Helmet Use with Education

The purpose of bicycle helmet education and promotion is to increase use of helmets and thereby decrease the number of severe and fatal brain injuries to bicyclists involved in crashes. This countermeasure involves conducting single events or extended campaigns to promote helmet distribution and use among children and adults. Studies have found disparities in helmet use among young people based on race or socioeconomic status, suggesting a lack of access to a helmet is a significant hindrance (Gulak et al., 2015; Kraemer, 2016).

Promotions can target various barriers to helmet use, including absence of a helmet, child and families’ lack of understanding of the importance of helmet use, cost of helmets, and negative attitudes or beliefs about helmet use. Programs that provide helmets can include sponsoring organizations and often involve law enforcement and schools to deliver helmets, fit the helmets, and teach proper fitting and use. Promotions can be conducted through single events or extended campaigns to promote helmet distribution and use.

Helmet promotions should include adults. Expanding helmet promotions to adults requires an expansion in focus, and perhaps different sponsors. However, adding adult-oriented riding tips may increase the appeal of the program. Other adult-oriented strategies should also be included, such as peer-based interventions on a college campus (Buckley, et al., 2009).

Regardless of the target audience, bicycle helmet promotions must include instruction on how to properly fit the helmet and the importance of wearing helmets on every trip. Programs might also need to target differences in tendency to adopt helmet use for different riding purposes (recreational versus commuting), or riders who identify as only one type of rider (Kakefuda et al., 2009). All bicyclists could benefit from using resources that demonstrate how helmets work to reduce injury. Moreover, further efforts are needed to encourage parents and authority figures (e.g., law enforcement officers, school officials and staff, and health-care professionals) to reinforce and model desired behaviors in children including the use of a properly fitted bicycle helmet every ride (Maitland, 2013). Trained and skilled cyclists may also be more likely to adopt helmet use (Kakefuda et al., 2009), so adult bicycle training programs that incorporate the importance of helmet use may help increase wearing by adult riders. A U.S. survey of attitudes toward bicycling and walking indicates that about 34% of respondents who had ridden a bicycle in the past year used a helmet for all or nearly all their rides (Schroeder & Wilbur, 2013).

Use:

Most States have conducted bicycle helmet promotions for children within the last few years, although only a few have ongoing or regular programs. Some States have conducted bicycle helmet promotions for a general audience. 

Effectiveness:

Bicycle helmets are proven to reduce injuries and fatalities. Helmet promotions are successful in getting more helmets into the hands of bicyclists. Rouzier and Alto (1995) describe a comprehensive program of presentations, media coverage, messages from doctors to patients, as well as low-cost helmet availability, which significantly increased helmet purchases and use for all ages. A peer-led, social marketing program on a medium-sized college campus also raised observed helmet use, at least for the short term (Ludwig et al., 2005). A school-based injury-reduction program targeting 13- and 14-year-olds incorporating opportunities for instruction, demonstration, rehearsal, feedback, social reinforcement and practice was associated with a 20% increase in observed rate of helmet use among this challenging target age group at 6 months follow-up (Buckley et al., 2009).

A Cochrane systematic review and meta-analysis of twenty-two studies evaluating non- legislative helmet promotion programs aimed at children under 18 found the odds of observed helmet wearing were significantly greater among those receiving the interventions (Owen et al., 2011). The study found the more effective programs were community-based (rather than aimed at people), provided free rather than subsidized helmets, and were set in schools. A Canadian program, Operation Headway, involving enforcement of bike helmet legislation, education, rewards for wearing and economic penalties for non-wearing, and provision of helmets to low-income groups was evaluated by Lockhart et al. (2010). The researchers found the program increased wearing rates (based on observations pre- and post-intervention), increased knowledge and commitment to wearing a helmet, saw greater public awareness of the law through media tracking, and improved relationships between police and the public (based on anecdotal evidence). A related theme of these studies is that population-wide, multifaceted, integrated, and repeated prevention programs are needed, which should include distribution of free helmets and safety information and strategies to increase peer and parental pressure.

Programs that increase proper use of helmets would be expected to reduce injuries in the event of a bicycle crash. 

Costs:

Some States provide free or discounted helmets to some children (or parents if requested). The cost for underwriting large numbers of helmets can be high, including supporting communications and outreach material. Helmets that meet safety requirements can be purchased for under $20. When considering the costs of providing helmets, agencies should consider the benefits. A NHTSA summary of helmet laws reported that “every dollar spent on bicycle helmets saves society $30 in indirect medical and other costs” (NHTSA, 2008). Purchase of large quantities of helmets by businesses, hospitals, or through partnerships with merchants for example can also lower the cost per helmet and make free or subsidized distribution of helmets to at-risk segments of the population more feasible.

Time to Implement:

A good campaign, including market research, material development, and message placement, will require at least 6 months to plan and implement.