title: Safe cycling: how do risk perceptions compare with observed risk?
abstract: OBJECTIVE
  Safety concerns deter cycling. The Bicyclists' Injuries and the Cycling Environment (BICE) study quantified the injury risk associated with 14 route types, from off-road paths to major streets. However, when it comes to injury risk, there may be discordance between empirical evidence and perceptions. If so, even if protective infrastructure is built people may not feel safe enough to cycle. This paper reports on the relationship between perceived and observed injury risk.
  
  
  METHODS
  The BICE study is a case-crossover study that recruited 690 injured adult cyclists who visited emergency departments in Toronto and Vancouver. Observed risk was calculated by comparing route types at the injury sites with those at randomly selected control sites along the same route. The perceived risk was the mean response of study participants to the question "How safe do you think this site was for cyclists on that trip?", with responses scored from +1 (very safe) to -1 (very dangerous). Perceived risk scores were only calculated for non-injury control sites, to reduce bias by the injury event.
  
  
  RESULTS
  The route type with the greatest perceived risk was major streets with shared lanes and no parked cars (mean score = -0.21, 95% confidence interval [CI]: -0.54-0.11), followed by major streets without bicycle infrastructure (-0.07, CI -0.14-0.00). The safest perceived routes were paved multi-use paths (0.66, CI 0.43-0.89), residential streets (0.44, CI 0.37-0.51), bike paths (0.42, CI 0.25-0.60) and residential streets marked as bike routes with traffic calming (0.41, CI 0.32-0.51). Most route types that were perceived as higher risk were found to be so in our injury study; similarly, most route types perceived as safer were also found to be so. Discrepancies were observed for cycle tracks (perceived as less safe than observed) and for multiuse paths (perceived as safer than observed).
  
  
  CONCLUSIONS
  Route choices and decisions to cycle are affected by perceptions of safety, and we found that perceptions usually corresponded with observed safety. However, perceptions about certain separated route types did not align well. Education programs and social media may be ways to ensure that public perceptions of route safety reflect the evidence.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Vancouver, BC. mwinters@sfu.ca
authors.forename: Meghan
authors.initials: M
authors.lastname: Winters
authors.forename: Shelina
authors.initials: S
authors.lastname: Babul
authors.forename: H J E H Jack
authors.initials: HJ
authors.lastname: Becker
authors.forename: Jeffery R
authors.initials: JR
authors.lastname: Brubacher
authors.forename: Mary
authors.initials: M
authors.lastname: Chipman
authors.forename: Peter
authors.initials: P
authors.lastname: Cripton
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cusimano
authors.forename: Steven M
authors.initials: SM
authors.lastname: Friedman
authors.forename: M Anne
authors.initials: MA
authors.lastname: Harris
authors.forename: Garth
authors.initials: G
authors.lastname: Hunte
authors.forename: Melody
authors.initials: M
authors.lastname: Monro
authors.forename: Conor C O
authors.initials: CC
authors.lastname: Reynolds
authors.forename: Hui
authors.initials: H
authors.lastname: Shen
authors.forename: Kay
authors.initials: K
authors.lastname: Teschke
mesh_terms: D000328:Adult; D001642:Bicycling / Q000293:injuries*; D018592:Cross-Over Studies; D004779:Environment Design / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012306:Risk; D018570:Risk Assessment; D012449:Safety
keywords: environmental design; injury; safety; transportation