Japan: Do School Regulations For Helmet Use Work?

Can school regulations that require helmet wearing make a difference in reducing head injuries? Yes, according to a soon-to-be published study by Masao Ichikawa and Shinji Nakahara from the Graduate School of Medicine at the University of Tokyo. They looked at school insurance claims data from 56 schools in the Saitama prefecture and found that in schools with regulations that require commuting students to wear bicycle helmets, there were actually fewer head injuries.

There have been a number of reports examining strategies to promote bicycle helmet use. Studies from Canada and California that have comprehensive legislation requiring helmets resulted in a reduction in head injuries from pre-legislation to post-legislation periods. Non legislative strategies to increase helmet use have also been examined: providing free helmets was more effective increasing helmet use than subsidizing the cost of helmets, and education alone has been shown to have no significant effect on helmet use (see Royal ST et al. Non-legislative interventions for the promotion of helmet wearing by children. The Cochrane Database of Systematic Reviews, 2006.)

In Japan, helmet wearing for children or adults is not a legislative requirement. Some junior high schools, however, oblige their students to wear helmets during their journey to school. This can be done because responsibility for school safety rests with the school administration. In Japan, school health insurance is comprehensive, and a record is kept of any claim greater than 5000 yen (US $45). Ichikawa and Nakahara, using the insurance data, calculated rates of head injuries and of injuries to other parts of the body from bicycle crashes and then compared these rates between schools with and without helmet use regulations. They found that overall head injury rates were significantly higher in schools without the regulations. When the researchers examined the rates of all other injuries from bicycle crashes, however, they found there was only a slight and not significant difference between the schools with and without helmet regulations.

Although there were three significant limitations of this study (head injury data had not been professionally coded, travel distances could not be determined, and only one-quarter of the schools in the sample were studied), these Japanese researchers concluded that school helmet wearing regulations did result in significantly lower head injury rates. They felt that this finding should be taken into account when considering legislative and non-legislative interventions to incorporate helmet use and to reduce head injuries among bicyclists.

References: Ichikawa M, Nakahara s. School regulations governing bicycle helmet use and head injuries among Japanese junior high school students. Acc Anal Prev 2007. In press.

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