Conclusion: Convincing evidence for effectiveness
There is consistent evidence that an intervention program (i.e., school-based educational programs, non-legislative interventions, community-based interventions, media campaigns, educational sessions) that contains elements like discounts on purchase of helmets and give away programs, can increase helmet use. Interventions may be more effective if provided to younger rather than older children. Multiple programmes are more effective than programmes focusing on single interventions.
In three reviews it was found that all the studies found that the interventions programmes lead to an increase in helmet use and a decrease in bicyle related injuries. A subgroup analysis in one of the reviews indicated that the effect might be greater for community-based studies and those providing free helmets.
Another review concluded that of the 12 studies 7 reported a significant increase in helmet use, 1 reported a decrease in bicylce related injuries. 2 studies found no difference in helmet use and 1 study found no difference in self reported risk behaviour. The use of multiple strategies targeted at different audiences was most succesful.
It was also found that there is a protective effect on risk on head injury during a crash, but no protective effect was found for injuries to the lower face. Furthermore, there is an increased likelyhood of neck injuries (2 studies).
One study examined the readiness for community-based bicycle helmet use programs. They found that community readiness and individual readiness to prevent injuries through use of bicycle helmets differed across groups, but the findings of this study provide a better understanding of interactions between community perceptions and individual attitudes and behaviors and can help improving the succes of community-based prevention programs.
However, these studies were mostly performed in non-European countries and seem to be more effective for younger children (first grade school children). It should also be noted that some of the studies are more than once reviewed. Thus, some of the results contain the same studies.
Recommendations (for research & practice)
More research should be conducted to gain insights in:
- the effectiveness of interventions to promote helmet use in European countries;
- determinants of behavior related to wearing or not wearing helmets, that can be used in the development of tailored interventions;
- which elements of an educational program are most beneficial in getting children to wear their helmets.
- whether there are differences in the results for children and adults;
- the effect of interventions in countries with existing bicycle helmet legislation and in low and middle-income countries;
- the effect of providing subsided as opposed to free helmets, and of providing interventions in healthcare settings as opposed to in schools or communities are effective.
Alternative interventions (e.g. interventions including peer educators, interventions to develop safety skills and interventions aimed at improving self esteem or self efficacy) need to be developed and tested, particularly for 11 to 18 year olds.
Recommendations for practice and policy:
- interventions may be more effective if provided to younger rather than older children;
- there is insufficient evidence to recommend providing subsidised helmets at present.
Review Date: 17/04/2012
Articles (reviews) and reports were included that were published between 2000 and 2011, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.
Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).
The outcomes of the study were reviewed by an expert in the field of child safety in the spring of 2012.
Non-legislative interventions for the promotion of cycle helmet wearing by children (version 1.0)
R. Owen, D. Kendrick, C. Mulvaney ...[et al.] (2011)
Readiness for community-based bicycle helmet use programs : a study using community- and individual-level readiness models (version 1.1)
Itsumi Kakefuda, Lorann Stallones, Julie Gibbs (2008)
Impact of a comprehensive safety program on bicycle helmet use among middle-school children (version 1.2)
R. Van Houten, J. Van Houten, J.E. Malenfant (2007)
Promoting bicycle helmet wearing by children using non-legislative interventions : systematic review and meta-analysis (version 1.0)
Simon Royal, Denise Kendrick, Tim Coleman (2007)
Using social marketing to increase the use of helmets among bicyclists (version 1.0)
Timothy D. Ludwig, Chris Buchholz, Steven W. Clarke (2005)
Community-based programmes to promote use of bicycle helmets in children aged 0-14 years : a systematic review (version 1.0)
A. Spinks, C. Turner, R. McClure ... [et al.] (2005)
Bicycle helmets : a review of their effectiveness : a critical review of the literature (version 1)
Elisabeth Towner, Theresa Dowswell, Matthew Burkes ... [et al.] (2002)
Community-based injury prevention interventions (version 1.0)
T.P. Klassen, J.M. MacKay, D. Moher ...[et al] (2000)