Effectiveness of AS tate Law Mandating Bicycle Helmet Use Among by S1S5Pyq

VIEWS: 14 PAGES: 21

									Effectiveness of a State Law Mandating
Use of Bicycle Helmets among Children:
     An Observational Evaluation



Dafna Kanny, PhD
Richard A. Schieber, MD, MPH
Vickie Pryor, RN, MPH
Marcie-jo Kresnow, MS

AJE 2001;154(11):1072-1076
          Learning Objectives

• Identify the scope of bicycle helmet use among
  children and state legislation
• Describe the effectiveness of a state law for
  bicycle helmet use among children
• Provide recommendation for such legislation
Bicycling in U.S. Children
        5-14 Years
  • ~28 million riders
  • Pedal cyclist injury
    – 200 deaths
    – 100,000 ED visits
  • Brain injury
    – 125 deaths (65%)
    – 20,000 ED visits (20%)
     Helmet Use in U.S. Children
             5-14 Years
• Helmets reduce
  risk by 69% -88%

• 50% own a helmet

• Only 25% always
  wear helmet
    Bicycle Helmet Use Legislation

  Study                  Pre-Law      Post-Law
Maryland, USA            4% (1990)    47% (1991)
(Cote et al., 1993)

Oregon, USA              25% (1994)   49% (1995)
(Ni et al., 1997)

Victoria, Australia
(Cameron et al., 1994)   36% (1990)   83% (1992)
   Bicycle Helmet Use Legislation
             in the U.S.

• Only 18 states and
  ~80 cities have
  helmet laws
           1997 Florida Law

• Children under 16


• 64 of 67 counties
  adopt the law

• 3 counties legally
  “opted out”
Elementary School Observations in
     Florida, Four Counties
     • Pre (1991):      5% helmeted
     • Post (1992):     15% helmeted
     • Intervention:
       – Education
       – Policy
       – Media promotion
       – Helmet distribution
Elementary School Observations in
      Florida, Duval County
  • Pre (1996):        13% helmeted
  • Post (1998):       73% helmeted
  • Intervention:
    – Education
    – Helmet distribution
    – Legislation
             Purpose

• How well do Duval County results
  represent the state?
• How beneficial was the state law?
• Which counties have the greatest
  need for intervention?
              Inclusion Criteria

• Any Florida public
  elementary school with:
   – Grades K-5
   – No prohibition against
     cycling to school
   – At least one rider
          Study Population

• 55/64 intervention counties with a law
• 3/3 control counties without a law
• Total 1,015/ 1,064 schools (95% response rate)
• Total 21,763 children (unit of analysis)
         Observation Methods
• Spring 1999

• Unobtrusive
  observations by school
  official of bicycle rack

• 1 day 1 time only

• Variables:
  – Bicycle helmet use,
    gender, race (W, B, O)
                Helmet Use by Law
                                Helmet
                              (Outcome)
                  +                       -
            +    16,907 (79.3)      4,406 (20.7)   21,313
   Law
(Exposed)
            -         148 (32.9)      302 (67.1)    450



Crude Prevalence Ratio (PR) = 2.4 (2.1 - 2.8)
              Helmet Use by Gender
                                  Helmet
                       Yes                 No

   Boys           10,941 (77.5)       3,180 (22.5)   14,121


    Girls          6,114 (80.0)       1,528 (20.0)    7,642

 2 =18.7, df=1

p < .001
          Helmet Use by Race
                              Helmet
                   Yes                    No
White       13,274 (82.2)         2,880 (17.8)      16,154


Black          1,893 (60.8)       1,220 (39.2)       3,113


Other          1,888 (75.6)            608 (24.4)    2,496

 2 =714.9, df=2

p < .001
  Summary: Helmet Use by Law
                 Prevalence
                    Ratio     (95% CI)

Crude                2.4      (2.1, 2.8)


Adjusted              2.3     (2.0, 2.6)
(Gender, Race)
                Conclusions

• Children from counties with a state bicycle helmet
  law were twice as likely to wear bicycle helmets

• Gender and race did not confound this
  relationship
            Limitations

• Few covariates possible
• No pre-law data collected
• School policy and its enforcement were
  not reported sufficiently
           Advantages

• Statewide survey, nearly all schools
• All elementary grades
• Observational, not self-reported
• Comparison group
• Gender and race also considered
              Recommendations

 Encourage the implementation
       and evaluation of
 Healthy People 2010 objective:
  All 50 states should have laws
requiring bicycle helmets for riders
         (Objective #15-24)

								
To top