Evaluation of a subsidy program to increase bicycle helmet use by children of low-income families

Pediatrics. 1995 Aug;96(2 Pt 1):283-7.


Objective: We have previously shown that an educational program was not effective in increasing bicycle helmet use in children of low-income families. The objective of this study was to evaluate a combined educational and helmet subsidy program in the same population, while controlling for secular trends. The secondary objective was to complete a third year of surveying children's bicycle helmet use throughout the study community.

Design: A prospective, controlled, before-and-after study.

Subjects: Bicycling children 5 to 14 years of age from areas of low average family income.

Setting: A defined geographic community within a large urban Canadian city.

Intervention: In April 1992, students in three schools located in the area of lowest average family income were offered $10 helmets and an educational program; three other low-income areas served as control areas.

Main outcome measure: Helmet use was determined by direct observation of more than 1800 bicycling children.

Results: Nine hundred ten helmets were sold to a school population of 1415 (64%). Reported helmet ownership increased from 10% to 47%. However, observed helmet use in the low-income intervention area was no different from the rate in the three low-income control areas (18% versus 19%). There was no difference in the trend in helmet use during the period of 1990 through 1992 in the intervention area (4% to 18%) compared with the control areas (3% to 19%). Helmet use rates from all income areas have increased from 3.4% in 1990, to 16% in 1991, to 28% in 1992. In 1992, helmet use in the high-income areas was 48% and in the low-income areas was 20%.

Conclusions: There has been a trend toward increasing helmet use in all income areas during the 3-year period. Despite encouraging helmet sales and increases in reported helmet ownership, the results of the observational study do not support the efficacy of a helmet subsidy program in increasing helmet use in children residing in areas of low average family income. Strategies to increase helmet use in children of low average family income remain a priority.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Bicycling / economics*
  • Bicycling / education
  • Child
  • Child, Preschool
  • Evaluation Studies as Topic
  • Female
  • Financing, Organized*
  • Head Protective Devices / economics*
  • Head Protective Devices / statistics & numerical data*
  • Health Education*
  • Health Priorities
  • Humans
  • Income
  • Male
  • Ontario / epidemiology
  • Outcome Assessment, Health Care
  • Poverty*
  • Prospective Studies
  • Social Class
  • Urban Health