EVALUATION OF A SUBSIDY PROGRAM TO INCREASE BICYCLE HELMET USE BY CHILDREN OF LOW-INCOME FAMILIES

Objective. We have previously shown that an educational program was no t effective in increasing bicycle helmet use in children of low-income families. The objective of this study was to evaluate a combined educ ational and helmet subsidy program in the same population, while contr olling for secular trends. The secondary objective was to complete a t hird year of surveying children's bicycle helmet use throughout the st udy community. Design. A prospective, controlled, before-and-after stu dy. Subjects. Bicycling children 5 to 14 years of age from areas of lo w average family income. Setting. A defined geographic community withi n a large urban Canadian city by direct observation of more than 1800 bicycling children. Intervention. In April 1992, students in three sch ools located in the area of lowest average family income were offered $10 helmets and an educational program; three other low-income areas s erved as control areas. Main Outcome Measure. Helmet use was determine d by direct observation of more than 1800 bicycling children. Results. Nine hundred ten helmets were sold to a school population of 1415 (64 %). Reported helmet ownership increased from 10% to 47%. However, obse rved helmet use in the low-income intervention area was no different f rom the rate in the three low-income control areas (18% versus 19%). T here was no difference in the trend in helmet use during the period of 1990 through 1992 in the intervention area (4% to 18%) compared with the control areas (3% to 19%). Helmet use rates from all income areas have increased from 3.4% in 1990, to 16% in 1991, to 28% in 1992. In 1 992, helmet use in the high-income areas was 48% and in the low-income areas was 20%. Conclusions. There has been a trend toward increasing helmet use in all income areas during the 3-year period. Despite encou raging helmet sales and increases in reported helmet ownership, the re sults of the observational study do not support the efficacy of a helm et subsidy program in increasing helmet use in children residing in ar eas of low average family income. Strategies to increase helmet use in children of low average family income remain a priority.