Report: United States of America: Pediatric Injuries Decrease…. was it the Helmet Law?

A recent study published in the Journal of Trauma Nursing described a decline in bicycle-related head injury over a five-year period following passage of compulsory helmet wearing legislation for children less than 16 years (1). But the results of this study are inconclusive in identifying why the number of injuries was reduced.

Following anecdotal reports of increases in bicycle-related pediatric trauma presenting to an emergency department at a children’s hospital in Ohio (United States), researchers from the hospital analyzed the hospital’s discharge data set. They noted an 82% increase in bicycle-related injury from the previous year despite an active hospital-based, low-cost bicycle helmet programme and a community-based bicycle training programme. With the support of the local SafeKids Coalition, they prompted the city government to adopting an ordinance that would require children younger than 16 years to wear a bicycle helmet while riding.

As part of an evaluation process of the ordinance, the researchers began following and reviewing hospital bicycle injuries for the year prior to the passage of the law and the five years following the law’s passage. One year after the legislation passed, the overall bicycle-related injury rate decreased by 27%. Five years after the law, the injury rate was down to 24%, compared to the year prior to the law. The head injury rate five years later was down to 19% for 5- 9 year old boys, and 37% lower for 10- 16 year old boys. Female head injury rates also dropped during the same period, but for 10- 16 year old girls the rate declined only slightly while the rate of extremity injuries for this group increased. This suggested that these older girls may be riding more.

Prior to the enforcement of the law, there was a public awareness campaign to explain the benefits of helmet wearing and the impending new law. The authors of this study concluded that the awareness campaign was successful, as indicated by the major drop in head injury rates during the first year.

Because the head injury rates continued to be lower 5 years after the law’s passage, the authors believed that the law requiring helmets to be worn was also effective. But how effective was unclear, since no information on enforcement of the actual ordinance was available. In addition, police said that there had been a decrease in the number of annual bike rodeos, and that there had been no referrals to diversion programmes as the result of repeat offences for not wearing helmets.

Editorial comment: There are two major flaws in this study – no information is provided on changes in cycling use, there are no data on helmet use – that make it difficult to draw scientifically valid conclusions about helmet law effectiveness.  The authors’ conclusion, however, makes a point that I feel is valid, namely that legislation requiring helmet wearing, even when it is not enforced, has an impact on increasing helmet use in children. How does this work?  At least two facts are important. One, the impending implementation of legislation increases public awareness of the appropriateness of helmets in reducing injury while bicycle riding. Somehow the official imprimatur of a government’s requirement that helmets must be worn gives them credibility to the public, especially to concerned parents. Two, helmet legislation seems to be effective by providing parents the tools they need to require their use in children. Parents don’t have to combat a child’s reaction to peer pressure (“none of the other kids are wearing helmets!”), and can instead fall back on the law to enforce wearing.

So, even without enforcement, helmet laws seem to work. What do you think? Send us your opinion.

(1) Pardi LA, King BP, Salemi G, et al. The Effect of Bicycle Helmet Legislation on Pediatric Injury. J Trauma Nurs 2007; 14(2): 84-87.

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