Objective: To determine the association between bicycle helmet legislation and bicycle safety education and the use of bicycle helmets by children under age 16 years.
Design: Anonymous questionnaire and direct observations of bicycle helmet use.
Setting: Four predominantly white, upper-middle class suburbs of Cleveland, Ohio.
Participants: All students in grades 1 through 7 attending public school on the day of the survey and children riding bicycles in a direct observational study.
Interventions: Beachwood had bicycle helmet legislation and safety education. Orange had only bicycle helmet legislation. Pepper Pike and Moreland Hills did not have bicycle helmet legislation or safety education.
Results: In Beachwood, 416 (67.6%) of 615 children who owned a bicycle reported always wearing their helmets, and 72 (85%) of 85 children directly observed were wearing bicycle helmets. In Orange, 103 (37.2%) of 277 children who owned bicycles reported always wearing helmets, whereas 41 (17.9%) of 229 children in Moreland Hills and 78 (21.5%) of 362 children in Pepper Pike reported always wearing helmets. Helmet use was significantly (P < .001) higher in Beachwood, with legislation and education, than in the other communities; helmet use was significantly (P < .001) higher in Orange, with legislation alone, than in Moreland Hills and Pepper Pike, with no programs.
Conclusions: There was a dramatic association between reports of increased helmet use and bicycle helmet legislation plus education; the association was stronger than that found with legislation only.