The promotion of bicycle helmet use in children and youth: an overview of reviews

Background Bicycle-related head injuries are a common reason for paediatric emergency department visits. Helmets have been designed to reduce head injuries, and helmet use has been encouraged through mandatory helmet legislation and nonlegislation helmet promotion activities. Objectives To synthesize the evidence published in the Cochrane Database of Systematic Reviews regarding bicycle helmet use among children, including helmet effectiveness and methods to promote helmet use. Methods The Cochrane Database of Systematic Reviews was searched for all systematic reviews where ‘bicycle*’ or ‘helmet’ appeared in title, abstract or keywords. Reviews were included if they examined paediatric data concerning head injuries among helmeted and nonhelmeted cyclists, helmet use or adverse consequences of helmets. Data pertaining to adults were excluded. Relevant data were extracted, entered into tables and synthesized using qualitative and quantitative methods. Main results Three systematic reviews were identified and included 21 observational studies and 14 experimental studies. The methodological quality was assessed in only two of the reviews: the quality was similar in studies examining legislative interventions and several weaknesses were identified in the nonlegislative interventions. Among children, helmet use resulted in a 63% reduction in medically reported head injuries [adjusted odds ratio (OR): 0.37; 95% confidence interval (CI): 0.20, 0.66] and an 86% reduction in the odds of brain injuries (OR: 0.14; 95% CI: 0.05, 0.38). Enactment of mandatory helmet legislation for child cyclists reduced the odds of head injury hospitalizations by 45%, while the odds of head injury hospitalizations reduced by 27% among children in jurisdictions without legislation. There was a significant reduction in traumatic brain injury among children cycling after the passage of helmet legislation (OR: 0.82; 95% CI: 0.76, 0.89); however, there was no significant decrease in other head and facial injuries post-legislation (OR: 1.08; 95% CI: 0.90, 1.23). Legislation also resulted in a significant increase in the number of children observed wearing a helmet (prevalence ratio: 3.69; 95% CI: 2.65, 5.14). Compared with children who received no intervention, those who received nonlegislative helmet promotion activities had a significant increase in observed helmet wearing (OR: 2.08; 95% CI: 1.29, 3.34), self-reported helmet wearing (OR: 3.27; 95% CI: 1.56, 6.87) and self-reported helmet ownership (OR: 2.67; 95% CI: 0.89, 8.03). No adverse events were associated with helmet use among cyclists. Authors' conclusions Bicycle helmets appear to be an effective way to reduce head injuries among children. Interventions to increase helmet use may be effective, particularly community-based, school-based, and those that provide free helmets; however, no effect of the interventions on helmet use were reported in randomized controlled trials. Finally, helmet legislation appears to be effective in increasing helmet use and reducing head injuries. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration