Barriers to bicycle helmet use

Objective. To determine why people do or do not wear helmets while bicyclin g. Methods. A survey was conducted from August through October 1999. Two surve y areas were chosen for this study: local public schools and paved bicycle trails. For the school arm of the study, 3 public elementary, middle, and h igh schools were selected from 3 different regions of Rochester, Minnesota, for participation in the study. For the bicycle arm of the study, 3 paved trails located in southeastern Minnesota were selected. A total of 2970 sur veys were distributed to the public school system, and 463 surveys were col lected from bicyclists on the paved bicycle trails. The survey population w as split into 3 age categories for analysis: child (7-10), adolescent (11-1 9), and adult (older than 19). Results. Of the 2970 surveys distributed to Rochester public schools, 2039 (69%) were returned for analysis. Seventy-eight of the surveys that were co mpleted in the public school system were discarded for the following reason s: age <10 years (35), insufficient completion (24), and selection of every reason for not wearing a bicycle helmet (19). A total of 463 surveys were completed on the 3 paved bicycle trails. One survey from the paved bicycle trail arm of the study was discarded because of insufficient completion. Th e total number of surveys used for statistical analysis was 2424. The distr ibution of male (52.7%) and female (47.3%) participants was similar. No sig nificant difference in bicycle helmet use was found between genders. The age groups with the highest rate of bicycle helmet use were 50 to 59 ye ars (62%) and older than 59 years (70%). The age groups with the lowest rat e of bicycle helmet use were 11 to 19 years (31%) and 30 to 39 years (30%). The most common reasons given for not wearing a bicycle helmet were "uncom fortable," "annoying," "it's hot," "don't need it," and "don't own one." Bi cycle helmet use was significantly influenced by peer helmet use in all 3 a ge groups. Children also were more likely to wear a bicycle helmet when the ir parents wore bicycle helmets. A majority of respondents in all 3 age groups indicated that bicycle helmet s provided either "moderate" or "great" protection from head injury, althou gh significantly more adults (65.9%) than adolescents (43.9%) believed that the protection afforded by bicycle helmets was "great." Despite this belie f, a majority of adolescents and adults indicated that there was only a "sl ight risk" of head injury when bicycling without a helmet. Participants in all 3 categories were more likely to wear a bicycle helmet when they indica ted either that there was a "great risk" of head injury when bicycling with out a helmet or that helmets provided "great protection" from head injury. Adolescents and adults who believed that bicycling without a helmet put one at "great risk" for head injury also were more likely to indicate that hel mets provided "great protection" from head injury. Conclusions. The prevalence of bicycle helmet use remains low despite resea rch indicating the high level of head injury risk when bicycling without a helmet and the significant protection afforded by bicycle helmets. With the information provided by this survey, a well-designed intervention to incre ase the use of bicycle helmets can be implemented. Suggestions for a campai gn to promote an increase in bicycle helmet use include focusing efforts on males and females between 11 and 19 years and 30 and 39 years of age; educ ating the public on new bicycle helmet designs that address comfort, ventil ation, and fashion; educating adolescents on the significant protection fro m head injury afforded by bicycle helmets; and educating the public on the risk and severity of head injury associated with bicycling without a helmet . The influence of parents and peers on bicycle helmet use may be targeted through education and statements such as, "If you wear a bicycle helmet, yo u are not only protecting yourself, you are also helping to protect your fr iends and/or children".