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Bicycle Helmet Promotion Programs -- Canada, Australia, and United States

The use of bicycle helmets substantially reduces the risk for serious head injuries during bicycle-related crashes. Despite this benefit, epidemiologic data indicate a worldwide low prevalence of helmet use (1). Strategies to increase the use of bicycle helmets in the United States and other countries include subsidies, legislation, and education. This report summarizes information regarding three strategies to increase bicycle helmet use and the impact of implementing these approaches in Canada (helmet subsidies), Australia (legislation), and the United States (education).

Canada. To assess whether the provision of bicycle helmets at reduced cost increases the use of helmets, the Division of General Pediatrics, Hospital for Sick Children, in Toronto conducted a randomized, controlled study in Toronto from May through September 1992 (2). Students in three elementary schools in low-income areas were offered bicycle helmets for $10 U.S. These students were compared with students in similar low-income areas who were not offered subsidized helmets. Reported helmet ownership increased from 10% to 47% among students in the schools where subsidized helmets were offered, and reported helmet use increased from 6% to 34%. However, there were no statistically significant differences in rates of observed helmet use between these areas (3% before to 18% after the study) and the areas where no subsidy was offered (1%-21%).

Australia. In July 1990, the state of Victoria enacted laws that made bicycle helmet use compulsory. Specifically, these laws required that all persons cycling on roads, footpaths, or separate bicycle paths, and in public parks wear a securely fitted, approved bicycle helmet. During the 10 years preceding enactment of these laws, the state conducted promotional activities to increase helmet use, including educational campaigns, rebate programs, and publicity campaigns on radio and television. Direct observation surveys indicated the prevalence of helmet use among persons aged 5-11 years in Victoria increased from 26% before enactment of the law to 80% following enactment (3).

United States. During 1986, the Children's Bicycle Helmet Coalition in Seattle implemented a community-based education program to reduce bicycle-related head injuries among children by promoting the use of helmets (4). Components of this program included public and physician education, school safety programs, an outreach campaign for low-income populations, extensive media coverage, and informational brochures in monthly insurance and utility bills. An evaluation of the impact of this program indicated that, from 1986 through 1992, helmet use among 5-15-year-old children increased from 5% to 38% (4). In addition, the number of children in this age group treated for bicycle-related head injuries at the regional trauma center in Seattle decreased 50% from 1990 through 1992.

Reported by: P Parkin, MD, L Spence, X Hu, K Kranz, D Wesson, MD, Hospital for Sick Children, L Shortt, East York Health Unit, Toronto. F Nassau, A Anderson, P Leicester, VIC Roads, Victoria, Australia. A Young, FP Rivara, MD, DC Thompson, RS Thompson, MD, Harborview Injury Prevention Center, Seattle. Office of the Director, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: Among the 96 million cyclists in the United States (5), approximately 950 fatalities and 580,000 emergency department visits occur annually as a result of bicycle injuries (6). Approximately 62% of these deaths and 32% of the injuries involve head trauma (6). Helmets are effective in reducing head injuries: the estimated risk for head injuries among persons not using helmets is 3.9-6.7 times greater than that among persons using helmets (7). However, fewer than 2% of U.S. children and fewer than 10% of all U.S. bicyclists wear helmets (8).

The Injury Prevention Program of the World Health Organization is coordinating a worldwide initiative to increase the use of motorcycle and bicycle helmets (9). The initiative focuses on three approaches: developing and testing helmets, promoting helmet use, and evaluating helmet-use promotion strategies. During the Second World Conference on Injury Control, to be held May 20-23 in Atlanta, scientists and public health professionals will focus on promoting and evaluating helmet use.


  1. Weiss BD. Bicycle helmet use by children. Pediatrics 1986;77:677-

  2. Parkin P, Spence L, Hu X, Kranz K, Shortt L, Wesson D. Evaluation of a subsidy program to increase helmet use in children of low-income families. In: Program and abstracts of the Second World Conference on Injury Control. Atlanta: May 20-23, 1993 (in press).

  3. Nassau F, Anderson A, Leicester P. The introduction of compulsory bicycle helmet wearing and the effect of this regulation on cyclists in Victoria. In: Program and abstracts of the Second World Conference on Injury Control. Atlanta: May 20-23,1993 (in press).

  4. Young A. Bicycle helmets: from research to community program implementation and evaluation. In: Program and abstracts of the Second World Conference on Injury Control. Atlanta: May 20-23, 1993 (in press).

  5. Bicycle Institute of America. Bicycling reference book, 1992-1993. Washington, DC: Bicycle Institute of America, 1992.

  6. Sacks JJ, Holmgreen P, Smith SM, Sosin DM. Bicycle-associated head injuries and deaths in the United States from 1984 through 1988. JAMA 1991;266:3016-9.

  7. Thompson RS, Rivara FP, Thompson DC. A case-control study of the effectiveness of bicycle safety helmets. N Engl J Med 1989;320:1361-

  8. Anonymous. Bike helmets: unused lifesavers. Consumer Reports 1990;55:348-53.

  9. World Health Organization. WHO helmet initiative. World Health Forum 1992;13:266-7.

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