title: Evaluation of a subsidy program to increase bicycle helmet use by children of low-income families.
abstract: OBJECTIVE
  We have previously shown that an educational program was not effective in increasing bicycle helmet use in children of low-income families. The objective of this study was to evaluate a combined educational and helmet subsidy program in the same population, while controlling for secular trends. The secondary objective was to complete a third year of surveying children's bicycle helmet use throughout the study community.
  
  
  METHODS
  A prospective, controlled, before-and-after study.
  
  
  METHODS
  Bicycling children 5 to 14 years of age from areas of low average family income.
  
  
  METHODS
  A defined geographic community within a large urban Canadian city.
  
  
  METHODS
  In April 1992, students in three schools located in the area of lowest average family income were offered $10 helmets and an educational program; three other low-income areas served as control areas.
  
  
  METHODS
  Helmet use was determined by direct observation of more than 1800 bicycling children.
  
  
  RESULTS
  Nine hundred ten helmets were sold to a school population of 1415 (64%). Reported helmet ownership increased from 10% to 47%. However, observed helmet use in the low-income intervention area was no different from the rate in the three low-income control areas (18% versus 19%). There was no difference in the trend in helmet use during the period of 1990 through 1992 in the intervention area (4% to 18%) compared with the control areas (3% to 19%). Helmet use rates from all income areas have increased from 3.4% in 1990, to 16% in 1991, to 28% in 1992. In 1992, helmet use in the high-income areas was 48% and in the low-income areas was 20%.
  
  
  CONCLUSIONS
  There has been a trend toward increasing helmet use in all income areas during the 3-year period. Despite encouraging helmet sales and increases in reported helmet ownership, the results of the observational study do not support the efficacy of a helmet subsidy program in increasing helmet use in children residing in areas of low average family income. Strategies to increase helmet use in children of low average family income remain a priority.
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: P C
authors.initials: PC
authors.lastname: Parkin
authors.forename: X
authors.initials: X
authors.lastname: Hu
authors.forename: L J
authors.initials: LJ
authors.lastname: Spence
authors.forename: K E
authors.initials: KE
authors.lastname: Kranz
authors.forename: L G
authors.initials: LG
authors.lastname: Shortt
authors.forename: D E
authors.initials: DE
authors.lastname: Wesson
mesh_terms: D000293:Adolescent; D001642:Bicycling / Q000191:economics* / Q000193:education; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D005381:Financing, Organized; D006260:Head Protective Devices / Q000191:economics* / Q000706:statistics & numerical data*; D006266:Health Education; D006292:Health Priorities; D006801:Humans; D007182:Income; D008297:Male; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011203:Poverty; D011446:Prospective Studies; D012923:Social Class; D014504:Urban Health