title: Parent-child concordance on reported barriers to helmet use by children.
abstract: BACKGROUND
  We determined the agreement between parents and their school-age children on reported barriers to bicycle helmet use.
  
  
  METHODS
  We conducted a cross-sectional survey in a 2-county Central Texas region with no helmet use legislation. Parent-child pairs, selected through a randomized, multi-stage sampling procedure and pre-matched by unique identifiers, were surveyed independently with self-administered questionnaires. Parent-child concordance was assessed using Kappa statistic.
  
  
  RESULTS
  Of 1,987 surveys distributed, children returned 1,203 (61%) while parents returned 636 (53% of child respondents). Parents included 31% college graduates and 33% reported annual income of >55,000 dollars. Children included 60% whites, 16% blacks, and 16% Hispanics. The most popular reasons cited by children as barriers to helmet use were not having one (34%), being a safe rider (31%), and helmets messing up hair (18%). Good concordance was found on reported child bicycle riding (parent=88.0% vs. child=88.0%; K=0.64) and child helmet use the last time child rode a bicycle (parent=25.1% vs. child=28.0%; K=0.54). While good concordance was also found for reported helmet ownership (parent=31.9% vs. child=29.9%; K= 0.50), poor concordance was found for other barriers to helmet use including helmets looking ugly (parent=6.5% vs. child=13.4%; K=0.38) and messing up hair (parent=5.6% vs. child=15.2%; K=0.36).
  
  
  CONCLUSIONS
  Although parents may be generally aware of their children's bicycle riding and helmet use habits, they may not be fully aware of the reasons why their children may not use a helmet. Public education and interventions on helmet promotion need to focus on parents.
authors.affiliation: Department of Family & Community Medicine, Scott & White Memorial Hospital and Scott, Sherwood and Brindley Foundation, Texas A&M University System Health Science Center, College of Medicine, Temple, TX 76504, USA. sforjuoh@swmail.sw.org
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Forjuoh
authors.forename: John A
authors.initials: JA
authors.lastname: Schuchmann
authors.forename: Troy
authors.initials: T
authors.lastname: Fiesinger
authors.forename: Saundra
authors.initials: S
authors.lastname: Mason
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000517:prevention & control*; D001294:Attitude to Health; D001642:Bicycling / Q000293:injuries*; D002648:Child; D002652:Child Behavior; D005260:Female; D006260:Head Protective Devices; D015438:Health Behavior; D006266:Health Education; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010290:Parents; D011795:Surveys and Questionnaires