Canada: Bicycle Helmet Wearing – Six Years After Legislation

Although numerous studies have shown that comprehensive bicycle helmet legislation increases helmet use, no study has observed the impact of legislation on wearing for more than three years. Macpherson and her colleagues at York University, the University of Toronto, and the Hospital for Sick Children have been observing children’s helmet use since 1990. Helmet legislation was passed in 1995, and, as expected, helmet use among children under age 14, shot up. But what is happening six years later, and does a child’s family income level impact on wearing rates?

Here’s what the researchers did to find that out. In the Toronto community of East York, there is a population of about 108,000, and about 11,300 are school age children. East York is a diverse community, and after the researchers conducted their annual observational study of children on bicycles at 111 different sites, they stratified their results based on the income level of the neighborhoods where the observations took place. For simplicity’s sake, they grouped the observational sites as being in a low income, middle income, or high income area based on published government census data for East York.

In all income areas, there was an initial increase in helmet wearing. This increase was sustained for all six years of the study only for those children living in the high income areas. For those children in mid- and low income areas, four to six years after the introduction of legislation, helmet wearing declined to the pre-legislation levels.

Some have hypothesized that decreased bicycling rates accounted for some of their observed wearing rate differences. The researchers examined trends in cycling rates in East York before and after the introduction of helmet legislation, and they concluded that the year-to-year variation in cycling rates is more likely to be associated with factors such as weather and random variation in bicycling patterns rather than legislation.

Implications for prevention
Helmet wearing legislation has a powerful initial effect increasing helmet use. Although this effect seems to be most powerful among children from mid- and low-income areas, the findings of this study suggest that other strategies are needed to sustain helmet use after legislation, especially in children from mid- and low-income areas.

References: Macpherson AK, Macarthur C, To TM, et al. Economic disparity in bicycle helmet use by children six years after the introduction of legislation. Inj Prev 2006;12:231-235.

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