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X. Injury Prevention and Control

FY 2000 Performance Plan - Revised Final FY 1999 Performance Plan

Bicycle Helmet Usage and Head Injury Prevention

Bicycle riding is a popular American past time. An estimated 66.9 million Americans ride bicycles and about 29 percent of U.S. households have one or more bicyclists. Bicycle riding also has accompanying risks. Each year over 600,000 people are treated in emergency departments (EDs) for bicycle-related injuries and 824 die from this type of injury. Head injury is the most common cause of death and serious disability in bicycle-related crashes; head injuries are involved in about 60 percent of the deaths, and 30 percent of the bicycle-related ED visits. Many of these nonfatal head injuries produce lifelong disability from irreversible brain damage. Societal costs associated with bicycle-related head injury or death resulting from head injury were more than $3 billion annually.

American children, in particular, are avid bicyclists--an estimated 33 million children ride bicycles nearly 10 billion hours each year. Unfortunately, an average of 384 children die annually from bicycle crashes, and 450,000 more are treated in EDs for bicycle-riding related injuries. Each year about 153,000 children get treatment in hospital emergency departments for bicycle-related head injuries.

Bicycle helmets are a proven intervention that reduce the risk of bicycle-related head injury by about 80 percent, yet bicycle helmets are not worn by most riders. Only 19 percent of adults and 15 percent of children use helmets all or most of the time while cycling. Universal use of bicycle helmets by children aged 4 through 15 years old would prevent between 135 and 155 deaths, between 39,000 and 45,000 head injuries, and between 18,000 and 55,000 scalp and face injuries annually.

At the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control, the Division of Unintentional Injury Prevention (DUIP) works to prevent these injuries and deaths by developing and disseminating injury control recommendations on bicycle helmets; collaborating with the National Highway Traffic Safety Administration, other federal agencies, private and voluntary agencies to promote helmet use and bicycle safety; and providing grants to state health departments to implement and evaluate programs that promote helmet use. In 1994, CDC began funding programs to promote helmet use within funded communities.

Measurable increases in helmet use has resulted from the implementation of these interventions. For example:

  • In California, where the program targeted low-income school children in one city, helmet use increased from 22% in 1994 to 64% in 1996.
  • In Rhode Island, where a law was passed requiring children 8 years old and younger to wear bicycle helmets, helmet use in this age group increased from 11% to 27% in the three intervention communities.
  • Washington State targeted 3- to 5-year-old children in the Head Start program. The project distributed more than 11,000 helmets, and observed helmet use increased from 41% to 91%.

These outcomes serve as the basis for developing performance measures aimed at reducing the incidence and severity of injuries related to bicycle accidents by increasing the use of bicycle helmets by children.

Performance Goals and Measures

Performance Goal: Reduce the number and severity of injuries related to bicycle-related head injuries by increasing the use of bicycle helmets by children in CDC-funded projects.

Performance Measure:

FY Baseline FY 1999 Appropriated FY 2000 Estimate
123,475 bicycle-related emergency department visits (1995). The number of bicycle-related emergency department visits will be reduced by 5% per year from 123,475 in 1995. 1  
Florida 69% (1997).
Colorado 30% (1994).
Oklahoma 3% (1998).
Rhode Island 14% (mean) (1997).
California 20% (1997).
The use of bicycle helmets by child bicyclists will be increased from 25% in 1994 to 30%. Increase by 25% in FY 2000, the use of bicycle helmets by child bicyclists in CDC-funded project areas.

123,475 bicycle-related head injuries (1995).


Reduce by 5% (to 117,301) the number of bicycle-related head injury emergency departments visits by the year 2000.

1 This measure will not be carried forward in FY 2000. CDC has limited ability to achieve this activity without significant increase in funding.

Performance Goal: Provide quality data for public health programs to determine the medical and social impact associated with traumatic brain injury (TBI).

Performance Measures:

FY Baseline FY 1999 Appropriated FY 2000 Estimate
1 (1997) TBI Registry. The number of population-based TBI registries will be increased from 1 in FY 1997 to 2 by FY 1999. Monitor project progress on population-based traumatic brain injury registries, provide technical assistance and document results.

0 Guidelines (1998).

Guidelines for the use of population-based registries for collecting follow-up data on disabilities among persons with TBI will be developed by 2002.

Guidelines for the use of population-based registries for collecting follow-up data on disabilities among persons with TBI will be developed by 2002.

Verification/Validation of Performance Measures: The Youth Risk Behavior Surveillance System, National Hospital Discharge Survey, National Electronic Injury Surveillance System, and National Health Interview Survey will be used to verify and validate these performance measures.

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