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A hospital led promotion campaign aimed to increase bicycle helmet wearing among children aged 11 - 15 living in West Berkshire 1992-98

Lee AJ, Mann NP, Takriti R. Injury Prevention, 2000; 6:151-153

Original paper

 

Authors' abstract

Objectives: To evaluate the effect of a bicycle helmet promotion campaign on helmet wearing among cyclists less than 16 years of age from 1992-98.
Setting: Reading, West Berkshire, UK.
Methods: A hospital led bicycle helmet promotion campaign targeted at 5-15 year olds. The campaign focused on education with active involvement of the children, parents, schools, and safety organisations. Local media and children's celebrities raised the profile of the campaign and a low cost helmet purchase scheme was also set up. A self administered questionnaire survey of 3000, 11-15 year olds was carried out over the period of the campaign. A control group of 3000 teenagers was obtained from a neighbouring area without a helmet campaign. Accident and emergency (A&E) figures were obtained from the local hospital within the campaign area on all children aged under 16 years, attending with bicycle injuries. Unfortunately, no figures were available from the A&E department in the control area.
Results: Self reported helmet use among 11-15 years olds living in the campaign area increased from 11% at the start of the campaign to 31% after five years (p<0.001), with no change in the control group. Hospital casualty figures in the campaign area for cycle related head injuries in the under 16 years age group, fell from 112.5/100 000 to 60.8/100 000 (from 21.6% of all cycle injuries to 11.7%; p<0.005).
Conclusions: This hospital led community bicycle helmet promotion campaign directed at young people showed an increase in the number of children reporting that they "always" wore their helmet while cycling. There was a significantly higher rate of helmet wearing than in the control area, and a significant reduction in head injuries.

BHRF Commentary

The paper is based to a considerable degree on opinion and conjecture rather than scientifically verifiable fact. References are restricted to those supportive of the authors' admitted bias.

Claimed benefit from helmets not plausible

The authors credit a reduction of nearly half (from 22% to 12%) in cyclists visiting an A&E department having injuries to the head to an increase of only 20 percentage points (from 11% to 31% of all cyclists) in helmet wearing. This would be implausible even if helmets were 100% effective in preventing head injuries and suggests that other factors were at least in part responsible for the decline in head injuries.

A previous paper by the lead author (Lee and Smyth 1996) shows that the percentage of cyclists reporting that they always wore a helmet increased from 11% in January 1992, at the start of the project, to 21% in January 1993 to 32% in January 1994. However, the greatest reduction in head injuries was during the 12 months up to May 1992. The fact that at least part of the decrease in head injuries occurred before the increase in helmet wearing suggests that other factors were also involved that need to be considered fully before any reasonable and balanced conclusions can be drawn.

Cycle use not measured

It is stated that "the survey data did not demonstrate a reduction in cycle usage" (implying there was no reduction), but nor was there any attempt to measure usage. From 1991/2 to 1992/3, as the campaign started, there was a 28% fall in 'all bicycle injuries' treated by Reading hospital, which is highly indicative of less cycling. If the cycling population was changing on this scale, it is impossible to make sensible judgements about changes in head injury.

Helmet wearing data inadequate

 Helmet use was judged solely through self-administered reporting by children, with no independent verification of wearing rates when cycling. Nor was the type and extent of cycling by the children taken into account.

There was no information on helmet wearing rates by head-injured cyclists, nor whether their injuries took place on-road or off-road, while making purposeful journeys by bicycle or just playing. There was no A&E data at all for the control area. This makes it impossible to isolate the outcomes of the helmet promotion campaign from other influences or to judge the significance of any reduction in head injury that might have taken place.

Control town too dissimilar

The intervention town, Reading, and the control town, Basingstoke, have considerably different cycling environments. Reading is an old town with largely traditional street patterns, while Basingstoke has been redeveloped and expanded as a 'new town' with greater separation between through and local traffic and different types of conflict. There are also different socio-economic factors. It is therefore quite possible that the characteristics of cyclists and the type of cycling they undertake is also different. If this is the case, then the two groups of cyclists are unlikely to be sufficiently well-matched for comparison by the study.

Results conflict with road casualty data for Reading

Road casualty statistics for children in Reading (Reading, 2000) prior to and during the survey period are as below:

 
1990
1991
1992
1993
1994
1995
1996
1997
1998
serious
3
1
2
3
1
1
0
2
0
total
23
15
24
16
18
19
17
25
18

The number of serious injuries for road cycling is very small, and there were no fatalities during the period. For children, the total number of reported road injuries is typically only 4% of the number of all bicycle injuries treated in hospital A&E departments, but they include the great majority of the most serious injuries.

It is likely that most head injuries dealt with during the survey period were not serious. However, there was a peak (of just 3) in serious road injuries at the same time as the survey reported a sharp decline in both head injuries and all injuries. Serious road injuries rose again (to just 2) towards the end of the survey period when it was claimed that head injuries were little more than half of those pre-survey. These characteristics do not indicate that increased helmet wearing had any benefit for children cycling on the road network.

Other deficiencies

The paper expounds the benefits of cycle helmets by noting that a Transport Research Laboratory hospital study (Mills, 1989) estimated that if cyclists had been wearing bicycle helmets 30% of the slightly injured would not have been injured, 18% of the serious casualties would have only had slight injuries, and 11% of the serious casualties would have been uninjured. However, it fails to explain that these reductions were based on the uncritical application of predictions of the ability of helmets to prevent head injury in a controversial paper by Thompson, Rivara & Thompson (BHRF, 1068) and not through original research. No comment is made that the predicted reductions in head injuries have not been fulfilled anywhere that helmet use has become significant.

No attempt is made to put accidents or head injury through cycling into perspective relative either to other.causes of serious injury to children or to the health benefits from cycling.

References

BHRF, 1068

A case study of the effectiveness of bicycle helmets. .

Lee and Smyth 1996

Lee A, Smyth J, 1996. A bicycle helmet promotion campaign for the under 16 year olds in West Berkshire, England 1992-1995. Proc Velo Australis International Bicycle Conference, Freemantle .

Mills, 1989

Mills P, 1989. Pedal cycle accidents - a hospital based study. Transport Research Laboratory RR220.

Reading, 2000

Reading Borough Council. . Figures prior to 1990 were the responsibility of the former Berkshire County Council and are not currently available..

See also