• K S Klein, D Thompson, P C Scheidt, M D Overpeck, L A Gross, and HBSC International Investigators.
• Division of Epimediology, National Institute of Child Health and Human Development, NIH, Bethesda, MD 20892-7510, USA.
• Inj. Prev. 2005 Oct 1; 11 (5): 288-93.

ObjectiveTo determine factors associated with variation in bicycle helmet use by youth of different industrialized countries.DesignA multinational cross sectional nationally representative survey of health behaviors including symptoms, risk taking, school setting, and family context.SettingSchool based survey of 26 countries.SubjectsSchool students, ages 11, 13, and 15 years totaling 112,843.Outcome MeasuresReported frequency of bicycle helmet use among bicycle riders.ResultsReported helmet use varied greatly by country from 39.2% to 1.9%, with 12 countries reporting less than 10% of the bicycle riders as frequent helmet users and 14 countries more than 10%. Reported helmet use was highest at 11 years and decreased as children's age increased. Use was positively associated with other healthy behaviors, with parental involvement, and with per capita gross domestic product of the country. It is negatively associated with risk taking behaviors. Countries reported to have interventions promoting helmet use, exemplified by helmet giveaway programmes, had greater frequency of reported helmet use than those without programmes.ConclusionsBicycle helmet use among young adolescents varies greatly between countries; however, helmet use does not reach 50% in any country. Age is the most significant individual factor associated with helmet for helmet using countries. The observation that some helmet promotion programmes are reported for countries with relatively higher student helmet use and no programmes reported for the lowest helmet use countries, suggests the possibility of a relation and the need for objective evaluation of programme effectiveness.

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