• M L Macknin and S V Medendorp.
• Department of Pediatrics and Adolescent Medicine, Cleveland Clinic Foundation, OH.
• Arch Pediat Adol Med. 1994 Mar 1; 148 (3): 255-9.

ObjectiveTo determine the association between bicycle helmet legislation and bicycle safety education and the use of bicycle helmets by children under age 16 years.DesignAnonymous questionnaire and direct observations of bicycle helmet use.SettingFour predominantly white, upper-middle class suburbs of Cleveland, Ohio.ParticipantsAll students in grades 1 through 7 attending public school on the day of the survey and children riding bicycles in a direct observational study.InterventionsBeachwood had bicycle helmet legislation and safety education. Orange had only bicycle helmet legislation. Pepper Pike and Moreland Hills did not have bicycle helmet legislation or safety education.ResultsIn Beachwood, 416 (67.6%) of 615 children who owned a bicycle reported always wearing their helmets, and 72 (85%) of 85 children directly observed were wearing bicycle helmets. In Orange, 103 (37.2%) of 277 children who owned bicycles reported always wearing helmets, whereas 41 (17.9%) of 229 children in Moreland Hills and 78 (21.5%) of 362 children in Pepper Pike reported always wearing helmets. Helmet use was significantly (P < .001) higher in Beachwood, with legislation and education, than in the other communities; helmet use was significantly (P < .001) higher in Orange, with legislation alone, than in Moreland Hills and Pepper Pike, with no programs.ConclusionsThere was a dramatic association between reports of increased helmet use and bicycle helmet legislation plus education; the association was stronger than that found with legislation only.

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