title: Contracting with children and helmet distribution in the emergency department to improve bicycle helmet use.
abstract: OBJECTIVE
  To determine whether injury prevention counseling and behavioral counseling delivered in the emergency department (ED) could result in increases in self-reported bicycle helmet use.
  
  
  METHODS
  The authors undertook a trial of counseling in 222 children recruited in an urban ED between August 2000 and October 2001. All consenting patients in the ED aged 5 to 15 years who did not have life-threatening conditions were eligible. One hundred nine children were assigned to the control group on the basis of attendance on an odd-numbered day, and they received a photocopied photograph of the hospital. One hundred thirteen children were assigned to the intervention group, and they received a personal counseling session and signed a contract promising to wear their bicycle helmets. In addition, 57 of the intervention children were assigned (based on having an even-numbered birthday) to be fitted with helmets if they did not already own them. Parents were telephoned four weeks after the ED encounter for follow-up.
  
  
  RESULTS
  Follow-up data were obtained for 148 children (67% follow-up rate), of whom only 69 reported riding a bicycle in the four weeks after their ED visit. Of the final sample of 69 children, 38 belonged to one of the intervention groups, and 25 of these (66%) reported always wearing a helmet while cycling during the four weeks after their ED visit, versus 13 of 31 (42%) in the control group (odds ratio, 2.66; p < 0.05). The effect of the intervention was independent of whether the children owned a helmet at baseline.
  
  
  CONCLUSIONS
  Injury prevention counseling in the ED using "The Injury Prevention Program" (TIPP) sheet, behavioral contracting, and helmet distribution may have a significant effect on reports of subsequent bike helmet use.
authors.affiliation: Department of Population and Family Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21030, USA. dbishai@jhu.edu
authors.forename: David
authors.initials: D
authors.lastname: Bishai
authors.forename: Asma
authors.initials: A
authors.lastname: Qureshi
authors.forename: Noelia
authors.initials: N
authors.lastname: Cantu
authors.forename: Cheryl
authors.initials: C
authors.lastname: Parks
mesh_terms: D000293:Adolescent; D001642:Bicycling / Q000293:injuries*; D002648:Child; D003376:Counseling / Q000379:methods; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000517:prevention & control*