title: Racial/ethnic and socioeconomic disparities in the use of helmets in children involved in bicycle accidents.
abstract: OBJECTIVE
  While bicycle helmet use reduces bicycle-related head injury, few children wear them regularly. We aimed to describe racial/ethnic and socioeconomic differences in pediatric helmet use in Los Angeles County (LAC) to help target groups for injury prevention programs.
  
  
  METHODS
  A retrospective review of all pediatric patients involved in bicycle-related accidents in LAC between 2006 and 2011 was performed. Our primary analysis examined the association between helmet use and age, gender, insurance status, and race/ethnicity. We also evaluated the association between helmet use and the need for emergency surgery, mortality, and length of hospital stay (LOH), after adjusting for injury severity score (ISS), age, insurance status, and race/ethnicity.
  
  
  RESULTS
  Of 1248 patients, 11.3% wore helmets, with decreased use among children 12years and older, minorities, and those without private insurance. Overall, 5.9% required an emergency operation, 34.1% returned to their pre-injury capacity, and mortality was 0.7%. On multivariable analysis, higher ISS increased LOH, the risk for emergency surgery, and mortality.
  
  
  CONCLUSIONS
  Nearly 90% of children involved in bicycle-related accidents were not wearing helmets. Helmet use was lower among older children, minorities, and those from a low socioeconomic status. Injury prevention programs targeting low-income middle and high schools and minority communities may help increase helmet use in children in LAC.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, CA 90509, USA.
authors.forename: Veronica F
authors.initials: VF
authors.lastname: Sullins
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA 90095, USA.
authors.forename: Arezou
authors.initials: A
authors.lastname: Yaghoubian
authors.affiliation: University of California, Los Angeles, Los Angeles, CA 90095, USA.
authors.forename: Julien
authors.initials: J
authors.lastname: Nguyen
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA 90509, USA.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, CA 90509, USA. Electronic address: slleemd@yahoo.com.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001642:Bicycling / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000191:economics / Q000208:ethnology* / Q000517:prevention & control; D005006:Ethnicity; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007348:Insurance, Health; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012959:Socioeconomic Factors
keywords: Bicycle accidents; Bicycle helmet; Ethnic disparities; Helmet use; Racial disparities