Objective: To assess the effect of a community bicycle helmet education and subsidy program and the further effect of a bicycle rodeo on helmet ownership and use among elementary schoolchildren. The unanticipated effect of a child cyclist fatality was also measured.
Design: Helmet ownership and use were measured in two ways: a questionnaire was sent to all elementary schoolteachers asking about helmet ownership and use by their students; and volunteers counted the children riding their bicycles to school.
Setting: Elementary schools in the town of Goderich, population 7400, and the town of Kincardine, population 6227, both on Lake Huron in southwestern Ontario.
Participants: More than 80% of the 1050 elementary school students in Goderich and, for comparison, more than 90% of the 1439 elementary school students in Kincardine.
Interventions: An extensive education campaign with programs, assemblies, teaching aids, speakers, and a colouring and poster contest, coupled with a discount helmet offer in October 1991. Incentives to helmet use, such as bicycle rodeos, took place in May 1992 and 1993. A child cyclist not wearing a helmet was fatally injured in September 1992.
Main outcome measures: Teachers polled students on helmet use and student volunteers counted children riding bicycles and noted helmet use.
Results: A total of 250 helmets were purchased, and helmet use was observed to increase among 5- to 14-year-old children from 0.75% to 12.8% during 9 months. Program effect was significantly greater on younger children, and girls used helmets more often than boys did. The cycling fatality in Goderich was associated with a dramatic increase in helmet use (to more than 50%), a significantly higher rate than in Kincardine. A second subsidy and rodeo did not further increase helmet use.
Conclusions: A small community with limited resources can mount a bicycle helmet education and incentive program with high exposure and participation rates by children. Despite an initial 17-fold increase in observed helmet use, more than 87% of cyclists still did not wear helmets. The cycling fatality was associated with a significant increase in helmet use.