Contracting with children and helmet distribution in the emergency department to improve bicycle helmet use.
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.
Bishai
David
D
Department of Population and Family Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21030, USA. dbishai@jhu.edu
Qureshi
Asma
A
Cantu
Noelia
N
Parks
Cheryl
C
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*