Evaluation of a subsidy program to increase bicycle helmet use by children of low-income families.
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.
Parkin
P C
PC
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Hu
X
X
Spence
L J
LJ
Kranz
K E
KE
Shortt
L G
LG
Wesson
D E
DE
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