title: Helmet-Wearing Practices and Barriers in Toronto Bike-Share Users: a Case-Control Study.
abstract: BACKGROUND
  Helmet use among bike-share users is low. We sought to characterize helmet-use patterns, barriers to helmet use, and cycling safety practices among bike-share users in Toronto.
  
  
  METHODS
  A standardized survey of public bike-share program (PBSP) users at semi-random distribution of PBSP stations was undertaken. By maintaining a ratio of one helmet-wearer (HW): two non-helmet-wearers (NHW) per survey period, we controlled for location, day, time, and weather.
  
  
  RESULTS
  Surveys were completed on 545 (180 HW, 365 NHW) unique users at 48/80 PBSP locations, from November 2012 to August 2013. More females wore helmets (F: 41.1%, M: 30.9%, p=0.0423). NHWs were slightly younger than HWs (NHW mean age 34.4 years vs HW 37.3, p=0.0018). The groups did not differ by employment status, education, or income. Helmet ownership was lower among NHWs (NHW: 62.4% vs HW: 99.4%, p<0.0001), as was personal bike ownership (NHW: 65.8%, vs HW: 78.3%, p=0.0026). NHWs were less likely to always wear a helmet on personal bikes (NHW: 22.2% vs HW: 66.7%, p<0.0001), and less likely to wear a helmet always or most of the time on PBSP (NHW: 5.8% vs HW: 92.3%, p<0.0001). Both groups, but more HWs, had planned to use PBSP when leaving their houses (HW: 97.2% vs NHW: 85.2%, p<0.0001), primarily to get to work (HW: 88.3% vs NHW: 84.1%, p=0.19). NHWs were more likely to report that they would wear a helmet more (NHW: 61.4% vs HW: 13.9%, p<0.0001), and/or cycle less (NHW: 22.5% vs HW: 4.4%) if helmet use was mandatory.
  
  
  CONCLUSIONS
  PBSP users surveyed appear to make deliberate decisions regarding helmet use. NHWs tended to be male, slightly younger, and less likely to use helmets on their personal bikes. As Toronto cyclists who do not wear helmets on PBSP generally do not wear helmets on their personal bikes, interventions to increase helmet use should target both personal and bike-share users. Legislating helmet use and provision of rental helmets could improve helmet use among bike-share users, but our results suggest some risk of reduced cycling with legislation.
authors.affiliation: *Department of Emergency Medicine,University Health Network,Toronto, ON.
authors.forename: Steven Marc
authors.initials: SM
authors.lastname: Friedman
authors.affiliation: †Faculty of Medicine,University Health Network,Toronto, ON.
authors.forename: Matthew
authors.initials: M
authors.lastname: Adamson
authors.affiliation: *Department of Emergency Medicine,University Health Network,Toronto, ON.
authors.forename: Paula
authors.initials: P
authors.lastname: Cleiman
authors.affiliation: †Faculty of Medicine,University Health Network,Toronto, ON.
authors.forename: Tamara
authors.initials: T
authors.lastname: Arenovich
authors.affiliation: ‡Faculty of Science,University of Toronto,Toronto, ON.
authors.forename: Karolina
authors.initials: K
authors.lastname: Oleksak
authors.affiliation: ‡Faculty of Science,University of Toronto,Toronto, ON.
authors.forename: Ishmael Michael
authors.initials: IM
authors.lastname: Mohabir
authors.affiliation: §School of Medicine,Trinity College Dublin,Dublin,Ireland.
authors.forename: Robert
authors.initials: R
authors.lastname: Ta
authors.affiliation: ¶Faculty of Medicine,University of Ottawa,ON.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Reiter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001642:Bicycling / Q000293:injuries*; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010865:Pilot Projects; D011379:Prognosis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult
keywords: bicycle helmets; bicycling Injuries; bike lanes; bike share