title: Bicycle helmet use after the introduction of all ages helmet legislation in an urban community in Alberta, Canada.
abstract: BACKGROUND
  Bicycle trauma is a common cause of recreational death and disability and helmets have been shown to reduce fatal and non-fatal head and face injuries. This study evaluated the effect of mandatory bicycle helmet legislation for all ages in St. Albert, Alberta.
  
  
  METHODS
  We observed bicyclists from June to September of 2006 in St. Albert, a community subject to both provincial (< 18 years old) and municipal (all ages) helmet legislation, and compared our results with observations taken in 2000 when no legislation existed. Helmet wearing and rider characteristics were recorded by trained observers. Poisson regression analysis was used to obtain helmet prevalence (HP) and prevalence ratio (PR) estimates.
  
  
  RESULTS
  HP increased from 45% to 92% (PR = 2.03; 95% CI: 1.72-2.39) post-legislation. Controlling for other covariates, children were 53% (PR = 1.53; 95% CI: 1.34-1.74) and adolescents greater than 6 times (PR =6.57; 95% CI: 1.39-31.0) more likely to wear helmets; however, adults (PR = 1.26; 95% CI: 0.96-1.66) did not show a statistically significant change post-legislation. Restricting the analysis to high socio-economic status areas, adult helmet prevalence increased in St. Albert from 58% to 73% post-legislation compared with a 52% to 57% change across the province; this effect was not statistically significant.
  
  
  CONCLUSIONS
  Helmet legislation in St. Albert was associated with a significant increase in helmet use among child and adolescent cyclists. A larger increase in HP was observed for adults in St. Albert than in other areas of the province; however, this difference was not statistically significant, which may reflect the small sample size or insufficient time passage after bylaw enactment.
authors: School of Public Health, University of Alberta, Edmonton, AB.
authors: Mohammad
authors: M
authors: Karkhaneh
authors: Brian H
authors: BH
authors: Rowe
authors: L Duncan
authors: LD
authors: Saunders
authors: Don
authors: D
authors: Voaklander
authors: Brent
authors: B
authors: Hagel
references: Accid Anal Prev. 2001 May;33(3):345-52
references: 11235796
references: Pediatrics. 2003 Sep;112(3 Pt 1):e192-6
references: 12949311
references: CMAJ. 1995 Jan 1;152(1):45-53
references: 7804921
references: Inj Prev. 2006 Aug;12(4):262-5
references: 16887950
references: CMAJ. 2002 Mar 5;166(5):592-5
references: 11898937
references: Ann R Coll Surg Engl. 1995 Jan;77(1):38-44
references: 7717644
references: Am J Epidemiol. 2004 Aug 15;160(4):301-5
references: 15286014
references: Accid Anal Prev. 2011 May;43(3):788-96
references: 21376867
references: CMAJ. 1990 Jul 15;143(2):108-12
references: 2364332
references: JAMA. 1996 Dec 25;276(24):1968-73
references: 8971066
references: Accid Anal Prev. 2007 Jan;39(1):86-93
references: 16919590
references: Accid Anal Prev. 2000 Jul;32(4):565-73
references: 10868759
references: Psychol Bull. 1995 Nov;118(3):392-404
references: 7501743
references: Pediatrics. 2008 Sep;122(3):605-10
references: 18762532
references: Inj Prev. 1997 Jun;3(2):110-4
references: 9213156
references: Inj Prev. 2006 Aug;12(4):231-5
references: 16887944
references: Chronic Dis Can. 1996 Spring;17(2):56-62
references: 9079352
references: Inj Prev. 2007 Jun;13(3):162-7
references: 17567970
references: Inj Prev. 2010 Aug;16(4):219-24
references: 20587815
references: Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005401
references: 18646128
references: Inj Prev. 1998 Jun;4(2):122-5
references: 9666366
references: Int J Adolesc Med Health. 2011 May 18;5(3-4):221-34
references: 22912127
references: Can J Public Health. 2003 Mar-Apr;94(2):144-8
references: 12675173
references: Nurs Times. 2001 Oct 25-31;97(43):41
references: 11966086
references: Inj Prev. 2006 Apr;12(2):76-82
references: 16595420