Transcript Bicycle Helmet Laws: What we know and where we are going.

Bicycle Helmet Laws:
What we know and where
we are going.
Presented by:
Tara Middaugh-Bonney &
Alison Macpherson
Overview
What we know:
Bicycle Helmet Use Rates
Social Factors
Behaviourial Factors
Helmet Fit
Helmet laws and head injuries
Current Helmet Laws and Their
Evaluation
Hospitalization and Mortality Data
Bicycle Helmet Use Rates
(Northern Ontario)
Irvine, Rowe and Sahai, 2002
41% of those who were bicycling regularly
as a form of exercise reported regular
helmet use.
71.7% age 12-14 wore helmets.
33.3% age 15-18 wore helmets.
39% over the age of 18 wore helmets.
Social Factors (Cryer, Cole Davidson et al., 1998)
Parental encouragement increased helmet
use by 6.77 times.
If the child’s closest friend (age 11) wore a
helmet there was a 2.8 times increase.
If the child’s closet friend (age 15) wore a
helmet there was a 17.17 times increase.
If the child “sometimes” rode their bike “off
roading” they were 5.69 times more likely
to wear their helmet.
Knowledge, Attitudes, Beliefs and
Behaviours
Liller, Morissette, Noland & McDermott, 1998
76% of children reported helmets
could save lives.
77% wearing a helmet is a good way
to protect your head.
71% of friends do not wear helmets.
58% of siblings do not wear helmets.
50% of the children did not know of or
believe in the mandatory law in
Florida.
Parental Perception
Ehrlich, Longhi, Vaughan, & Rockwell, 2001
Parents reported their children wearing their
helmets up to 90% of the time.
The same children reported wearing their helmet
39% of the time.
Parents reported wearing their helmets 60% of the
time and the children agreed to this rate.
This indicates that parents are unaware of their
children’s behaviours but their children are
watching all of their safety behaviours.
Bicycle Helmets and Fit
Parkinson & Hike, 2003
During bicycle helmet assessment by
a health unit only 88% of the children
own a helmet and of those only 4%
passed for condition and fit.
If the parents had fit the helmet for the
child the pass rate was 0%.
Helmets, Fit and Crashes
Rivara, Astley, Clarren, Thompson & Thompson, 1999
If the helmet did not fit at the time of a
bicycle crash it doubled the risk of a
head injury.
If the helmet was tipped towards the
posterior, there was a 52% greater
risk of head injuries.
Current Helmet Laws and Their
Evaluation
Provinces without laws
Provinces with laws
Provinces with laws and evaluation
Provinces With No Provincial Legislation
Newfoundland and Labrador
Quebec
Manitoba
Saskatchewan
Northwest Territory
Nunavut
Yukon
Provinces With Provincial Legislation
Prince Edward Island (effective 2003)
Pertains to all ages
Nova Scotia (effective 1997)
Pertains to all ages
New Brunswick (effective 1995)
Pertains to all ages
Ontario (effective 1995)
Pertains to individuals under 18
Alberta (effective 2002)
Pertains to individuals under 18
British Columbia (effective 1996)
Pertains to all ages
Provinces With Laws and Evaluation:
Nova Scotia (LeBlanc, Beattie & Culligan, 2002)
Following the helmet enactment the
following helmet use rates were
observed:
1995 – 36% (before legislation)
1996 – 38% (before legislation)
1997 – 75% (after legislation)
1998 – 86% (after legislation)
1999 – 84% (after legislation)
Provinces With Laws and Evaluation:
Nova Scotia (LeBlanc, Beattie & Culligan, 2002)
A significant decrease was seen in
head injuries:
1995/96 = 3.6%
1998/99 = 1.6%
There is enforcement by police and
regular education in this area.
Provinces With Laws and Evaluation:
Alberta (Hagel, Rizkallah, Lamy, Belton, Jhangri, Cherry & Rowe, 2006)
Prior to legislation helmet use was
43% in 2000.
Following legislation helmet use was
53% in 2004
Helmet use increased in those under
18 (OR 3.69, 95% CI 2.65-5.14)
Did not change in those over 18 (OR
1.17, 95% CI 0.95-1.43).
Provinces With Laws and Evaluation:
British Columbia (Foss & Beirness, 2000)
Helmet use pre- and post- legislation
Age
1995
1999
1-5
60%
78%
6-15
35%
61%
16-30
47%
69%
31-50
52%
75%
51+
41%
73%
Provinces With Laws and Evaluation:
British Columbia (Foss & Beirness, 2000)
Helmet use by Bicycle Type
Bicycle
Type
Mountain
Bike
Road Bike
1995
1999
46%
71%
54%
76%
Other Bike
39%
58%
Percent of helmets worn incorrectly,
British Columbia pre and post legislation
Category
1995
1999
Male
12%
10%
Female
24%
14%
Mountain bike
15%
11%
8%
5%
33%
21%
Road bike
Other
Legislation and head injuries across
Canada
One study examined helmet laws and
head injuries across Canada
(Macpherson et al 2002)
Helmet laws were associated with a
decrease in head injuries
Injury rate per 100,000
Bicycling related head injury rates in
provinces with and without legislation
20
18
16
14
12
10
8
6
4
2
0
p = 0.001
Legislation
No legislation
94-95
95-96
96-97
Year
97-98
Current Head Injury Rates
Due to Bicycle Crashes
(1994-2005)
…In Progress
Data challenges
Discharge abstract database (DAD)
Why we’re having problems
understanding it
Lack of a universally used injury coding
system (ICD-9 and 10, HMDB and DAD)
Lack of a universal format to allow for
data analysis without recoding within
subjects (i.e. gender)
Lack of diagnostic codes- therefore we
do not know how they are injured.
Next steps: indicator development
Literature review (mostly done by
Tara)
Defining best practice in helmet laws
-methodology for this?
-lit review
-expert opinion
-others?
Indicator development: policy rating
Scoring current helmet laws based on
best practice
-How do we measure the various
components of helmet laws?
Should they be weighted the same?
Enhancement and inhibiting factors?
Indicator development: linking
policy and risk factors
Observational studies to be discussed
tomorrow
Indicator development: linking
policy and outcomes
Is bicycle-related head injury our only
outcome?
Hospitalization and ED data
Systematic bias of using only hospital
data?
Other sources?
Do we want to try to examine
exposure?