Influence of Socioeconomic Status on the Effectiveness of Bicycle Helmet Legislation for Children: A Prospective Observational Study

Abstract

ABSTRACT. Objective. To evaluate the influence of average family income in a geographic area on the effectiveness of helmet legislation on observed helmet use by children (5-14 years).Methods. The study was conducted in East York, a health district of Metropolitan Toronto, in collaboration with the East York Health Unit. In 1996, the total population was 107 822, 11 340 of which were children 5 to 14 years. Census data were used to group the 21 census tracts in East York into 7 geographically distinct areas. The boundaries of these areas are natural barriers to travel, such as expressways, ravines, railway tracks, and hydroelectric power lines. The areas were also ranked according to average family income (based on Statistics Canada data). For analytical purposes, areas were defined as low-, mid-, and high-income areas. Census data profiles of the areas have been previously described. For each consecutive year from 1990 to 1997 inclusive, direct observations of children riding bicycles in East York during the months of April through October were made. In 1995, observations were completed before the introduction of the law on October 1, 1995. Only children who were between 5 and 14 years of age and riding a 2-wheeled bicycle were included in the study. In total, 111 sites across all 7 areas were selected for observation. Observational sites included school yards of all elementary and middle schools (kindergarten to grade 8) and all parks in East York. In addition, 5 major intersections and 5 residential streets from each area were randomly selected. Observers were trained and used a standardized data collection form. A pilot study showed that the data collected by observers were reliable and valid. Observers remained at each site for 1 hour and collected data on helmet use and sex. Ethical approval for the study was obtained from the Hospital for Sick Children Research Ethics Board, the East York Board of Education, and the Metropolitan Separate School Board. The proportion of children who were wearing a bicycle helmet was estimated by year (1990 -1997, inclusive), sex (male, female), location (school, park, major intersection, residential street), and income area (low, mid, high). For estimating the effect of legislation on helmet use, data from the year immediately after legislation (1996) were compared with data from the year preceding legislation (1995). The relative risk (RR) of helmet use (after vs before legislation) was calculated along with a 95% confidence interval (CI). Logistic regression analysis was used to adjust for potential confounding variables (sex and location).Results Conclusions. This study showed that bicycle helmet use by children increased significantly after helmet legislation. In this urban area with socioeconomic diversity and in the context of prelegislation promotion and educational activities, the legislative effect was most powerful among children who resided in low-income areas. Pediatrics 2003;112:e192-e196. URL: http://www. pediatrics.org/cgi/content/full/112/3/e192; socioecono...

The prevalence and reliability of visibility aid and other risk factor data for uninjured cyclists and pedestrians in Edmonton, Alberta, Canada

“…This is consistent with other literature demonstrating that only a small percentage of cyclists and motorcyclists use high visibility clothing (Mayr et al, 2003;McGuire and Smith, 2000;Reeder et al, 1996;Wells et al, 2004). We have also found that most observed cyclist and pedestrian characteristics have at least substantial inter-observer agreement, consistent with the findings of other investigators (Coté et al, 1992;Parkin et al, 2003;Puder et al, 1999). Finally, a major trunk color of orange, red, yellow or white appears to be a consistent predictor of observer assessed visibility in both cyclists and pedestrians.…”

Bicycle helmet use four years after the introduction of helmet legislation in Alberta, Canada

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Education was associated with injuries requiring hospital admission

“…Our data show that a reduction of educational inequalities in injuries resulting in hospital admission can be achieved if injury prevention programs are able to reach those in the lower educational groups. It has recently been shown that lower socio-economic groups could benefit more from specific injury prevention measures than higher socio-economic groups [49]. More knowledge is required about the explanation of these inequalities before implementing prevention programs.…”