title: Does sharing the cost of a bicycle helmet help promote helmet use?
abstract: OBJECTIVE
  To determine whether asking for a $5.00 donation for bicycle helmets, compared with distribution free of charge, would affect helmet use among children receiving helmets and an educational intervention from public health clinics.
  
  
  METHODS
  Six public health clinic sites in King County, Washington.
  
  
  METHODS
  Six participating clinic sites were randomly assigned to either free helmet distribution or to a $5.00 suggested donation for the helmets, stratified by whether a helmet law was in place. Three sites were assigned to each arm. Children who were between 6 and 12 years of age and who reported riding bicycles, but having no bicycle helmets, were eligible. Clinicians distributed helmets and delivered an educational intervention to 506 eligible children, or siblings of children seen at the clinic between March and July 1993. Parents were contacted after helmet distribution to ascertain helmet use.
  
  
  RESULTS
  82% of children whose parents were asked for a copayment and 77% of children who received free helmets were reported to wear their helmets every time they rode their bicycles (p=0.20). The adjusted odds ratio for the association between copayment compared with free helmets and helmet use was 1.66 (95% confidence interval 0.94 to 2.92).
  
  
  CONCLUSIONS
  Helmet use was not significantly different among children whose parents were asked for a small copayment, compared with those who received helmets free. Use of copayments can increase helmet use by increasing the number of helmets given to low income children.
authors.affiliation: Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Kim
authors.forename: F P
authors.initials: FP
authors.lastname: Rivara
authors.forename: T D
authors.initials: TD
authors.lastname: Koepsell
mesh_terms: D001642:Bicycling / Q000293:injuries*; D002648:Child; D017047:Cost Sharing; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D006260:Head Protective Devices / Q000191:economics*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000517:prevention & control*