peer pressure consumer reports enforcement skate summary recommendations safety presentation

Kids Helmets are COOL or UNCOOL?

How many times have your children told you they don't want to do something because it's "uncool" or because Jordan or Jessica don't have to do it? And how many times have you heard yourself say, "I don't care what Jordan or Jessica do. You'll do as I say!"? We all know that this approach does not usually work. Think of how you felt when your parents said the same thing to you.

When your children are 7 or older, everything that their peers think matters to them. Children become more concerned about their peer's opinions of such things as clothes and modes of transportation and less concerned about their parents as early as the second grade.

These days, wearing a helmet while riding a bicycle is an absolute necessity. With more drivers and increased traffic, the roads are much more dangerous than ever before."Every time you ride your bike you should wear a bicycle helmet certified to the ANSI, ASTM or Snell Standards."

Peer pressure can actually be a safety hazard for children who ride bicycles to and from school. A bike helmet - the most effective way to prevent bike-related injuries, disabilities and deaths - is often rejected by kids because it could "mess up their hair", or it "looks stupid", or because it "isn't worn by classmates". Unfortunately, kids still worry about what other kids think of them and, if friends think that wearing a bike helmet is not "cool", then most kids won't wear one.

Wearing a bike helmet is essential to you child's safety. In 1997, an estimated 350,000 children age 14 and younger were injured in bike-related incidents. One in seven of these children suffered head injuries. The wearing of bike helmets has been shown to reduce the risk of head injury by 85 percent and the risk of brain injury by almost 90 percent.

Bike helmets can prevent injury in a significant number of children. Unfortunately, some parents do not recognize how dangerous bicycle riding can be. They didn't wear bike helmets as kids, so neither do their children.

So how does a safety-conscious parent convince a son or daughter to wear a bike helmet on every ride in spite of peer pressure?

Encourage helmet use before "being cool" matters. Some bike helmet experts suggest putting helmets on children when they begin riding tricycles. If children get the habit of wearing a helmet before the age of 7, it may be more acceptable to them to wear a helmet later. In fact, helmet advocates have found that preschool-age children think bike helmets are cool and will happily wear them.

Be a role model. Younger children are strongly influenced by the example of their parents and other siblings. Establish a household rule that applies to everyone: "If you ride a bicycle, you wear a helmet."

Help organize a one-time helmet purchase at your child's school. The excitement of every child getting a helmet makes it uncool not to wear one. Call the Center for Injury Prevention at 800-344-7580, extension 15 to order discounted helmets.

Plan to attend a local bike helmet safety presentation throughout the school year or summer.

Take your children and several friends to pick out helmets together. Brightly colored helmets that come with decorative stickers are available. Allowing a child to choose his or her own style will help ensure the helmet is worn. Also, by having your child select a helmet with friends, you child will by more inclined to use it and to feel part of a cool group.

Promote bicycle helmet use among other parents and caregivers. Many parents and caregivers do not realize the risk of serious head injury from a collision, no the effectiveness of helmets in reducing that risk. By educating one another, parents ensure that rules are consistent from household to household, thereby relieving peer pressure.

Be prepared to take a stand when peer pressure is working against helmet use. Be firm with your children. do not back down or change your mind about helmets. Make it clear that if they do not wear a helmet, they cannot ride their bicycles.

BIKE HELMETS

More children are using protective helmets when cycling, and that's good news. But the bad news is that most children wear the helmets incorrectly.

Massachusetts researchers found that 73 percent of children age 4 to 18 are wearing helmets while biking. That's up from just 18 percent in 1991. But only 4 percent of children are fully protected by those helmets. The three main difficulties are that the helmet rests too high on the forehead, the strap does not fit in a "v" pattern around the ears, and the helmet slides too easily on the head forward or backward.

All these factors can expose a child's frontal region of the skull, the most common site of impact in bike head injuries.

Helmets cut the risk of head injury in bicycle accidents by over 80%. But children who wear bicycle helmets that do not fit properly are nearly twice as likely to suffer from a head injury in an accident as those with better fitting helmets, a new study suggests.

Younger children and boys are less likely to wear proper fitting helmets, according to the report in the journal Injury Prevention. And wearing a helmet that is too big appears to be particularly hazardous.

"Although bicycle helmets are effective in preventing head and brain injury, some helmeted individuals nevertheless sustain head injury," report Dr. Frederick Rivara of the Harborview Injury Prevention Research Center, Seattle Washington and colleagues. "One of the possible reasons may be poor fit of the helmet on the head."

Out of a sample of 1,718 helmeted bicycle riders who were involved in an accident, Rivara and colleagues took a closer look at 28 children aged 2 to 14 who sustained a head injury and 98 children who did not.

When the researchers measured the helmet and the child's head, as well as made a plaster cast of the youngster's skull, they found those with a poor fitting helmet were nearly twice as likely to end up with a head injury as those with a properly fitting helmet. Most often, the helmet was too wide. Almost half of the children with head injuries had a helmet that was two centimeters (almost an inch) or more wider than their heads.

A helmet that tilted backwards on the head increased the risk of head injury by 50% compared with a helmet centered on the head. Overall, 6% of children had a helmet fit that was fair or poor, 13% had a helmet that tilted backwards, and in 4% of cases, the helmet had come off the head on impact, tripling the risk of injury.

"Helmets may need to be redesigned, particularly for the younger age group, to fit better, in particular by decreasing its width," concludes Rivara's team. They also recommend the development of a measuring system, such as the use of head calipers, to be used in stores to ensure that the correct size of helmet is being purchased.

Consumer Reports Publishes Helmet Article The July issue of Consumer Reports has their promised helmet article. This is their first article on helmets since 1999, so it is particularly welcome.

The ratings cover impact performance as measured in the Consumers Union test labs, the only independent test data available to the public. The only model rated excellent for impact is a youth helmet, the Specialized Air Wave, a $35 model rated as a Best Buy. All of the others tested were rated very good or good, meaning that they all meet the same CPSC standard, but do not go far beyond it. CU apparently did not test for the "softest landing" helmet as they did in 1994, instead testing for the models that could take the hardest impact.

The top adult models were all rated very good for impact protection, and included the Giro Gila, Trek Vapor (at $40 rated as a Best Buy), Giro Torrent and Specialized Enduro Comp. Others were rated good, including the Specialized M1, Bell Aquila, Giro Pneumo and Bell X-Ray. Price was not an indicator of impact protection, since the top models were mostly much cheaper than the lower rated ones. In CU's opinion the lower rated adult models were all still good helmets.

For ventilation, most of the adult models rated were very good or good, with the Specialized M1 the only helmet offering excellent vents. It wasrecommended as the choice for those needing maximum ventilation despite
being in the third rank for impact protection. The three skate-style models tested were all rated fair for ventilation, as were all three of the toddler models tested.

CU tested visors to make sure they would detach easily in a crash. They said three did not: Bell Aquila, Bell Cognito and the Giro Semi MX skate-style helmet.

skate helmets

A sidebar on skate helmets notes that although bike helmets must meet the CPSC standard, skate-style helmets are not required by law to meet ASTM 1492 for skateboarding. It says the Pro-tec Ace Freestyle was the only skate model they tested that meets both standards, so we assume that means that the Specialized P3, Bell Trailrider and Giro Semi MX should be considered bike helmets only, despite their "skate" shape. All three rated only good in impact protection.

We are impressed with this well-researched and well-written article, but would have welcomed test results on more helmets. The very narrow helmet selection may represent what affluent Consumer Reports readers are likely to see when they go to a bike shop to buy, but covers mostly Bell/Giro and Specialized. It should really be titled Bike Shop Helmets, since it does not cover the discount retail market where other people buy millions of helmets. CU considers a $40 helmet cheap, but most people are paying $25 or less. The article ignores the cheaper lines, but in fact we believe that some of the most protective helmets are out there in the discount stores at prices from ten to twenty dollars. At least the message was clear that higher prices do not mean more protection.

Cycle helmets are now compulsory in Australia [5], New Zealand [6], Spain, Iceland (aged under 16), the Czech Republic (aged under 16), Canada (aged under 18) [7] and twenty states in the USA. Studies in a number of these
countries have shown that high usage rates of helmets as a result of legislation is associated with a reduction in cycle related deaths and head injuries. Evidence supporting the wearing of cycle helmets continues to mount:

It is estimated that 90,000 road-related and 100,000 off-road related cycling accidents occur every year in the UK, of which 53% (100,000) involve children under sixteen [8]. In 2002, 594 children and 1,801 adults were killed or seriously injured as a result of road-related cycling accidents [10].

Significantly, with child cyclists, 85 per cent of accidents occur off road where primary prevention measures such as cycle lanes, vehicle speed reduction and driver education are ineffective [9].

Several recent studies and discussions [14] have provided scientific evidence that bicycle helmets protect against head, brain, severe brain and facial injuries, as well as death, as a result of cycling accidents:

In the USA, a 30-month study of 3,854 cyclists showed that helmet usage decreased the overall risk of brain injury by 65 per cent and severe brain injury by 74 per cent in all age groups [9]. An Australian study showed that wearing cycle helmets reduces both the incidence of facial injuries by 28 per cent and their severity [11]. A Cochrane review considering five case-control studies from the UK, Australia and the USA illustrates a large and consistent protective effect from cycle helmets, reducing the risk of head and brain injury by 65 to 88 per cent and injury to the upper and mid face by 65 per cent [12].

A study of primary school, secondary school and adult cyclists in New Zealand demonstrated a 19 per cent reduction in head injuries to cyclists in the three years after the introduction of legislation [13].

In Victoria, Australia, an increase in helmet use from 31 per cent prior to legislation to 75 per cent one year after was accompanied by a decrease in head injuries by 40 per cent in the following four years [12].

Enforcement

As with any other legislation enforcement is as important as the law itself. Without compliance the law is at best ineffective. To achieve maximum compliance, the legislation should be complemented by mass educational and promotional campaigns. Evidence from Australia and New Zealand showed that educational campaigns prior to the introduction of legislation resulted in an increase in helmet wearing from two per cent to up to 95 per cent [8].

An education programme in Reading that promoted cycle helmet use among children and teenagers resulted in a local increase in usage from 18 per cent to 60 per cent and a concurrent decrease in cycle-related injuries [9].
The most difficult group in which to increase helmet use was teenagers, who are often the category most at risk. One approach is to target educational programmes at adults, as evidence from a Seattle-based study suggests that helmet usage is greatest in children riding with helmeted adults [12].

At a practical level, enforcing the legislation can be achieved through on-the-spot fines or tickets issued by police and traffic wardens, while schools can ensure all children wear helmets on journeys to and from school. Cycle helmet legislation and other safe cycling promotions are not mutually exclusive, and there is a clear role for the simultaneous introduction of more primary prevention measures including cycle lanes, driver education and vehicle speed reduction initiatives.

Further measures to improve cyclists' safety The BMA believes that cycling has many advantages to the individual in terms of improved health and mobility, as well as to society via, for example, reduced air pollution and traffic congestion. Even in the current hostile traffic environment, the benefits gained from regular cycling are likely to outweigh the loss of life through accidents for regular cyclists.

We need to reinforce the points made in our 1999 report, that action to reduce the high rate of fatal and serious accidents suffered by cyclists must include:

-the creation of a safer cycling environment

-reductions in vehicle speeds and traffic volume in urban areas

-the provision of cycling training for all children recognising road safety, including cycling proficiency education, as part of the curriculum for
all school children.

This should include basic cycle maintenance, and safety precautions (eg lights, reflective clothing), information on the health benefits of cycling, as well as encouraging cycle helmet use.

Information on current cycle helmet standards and the level of protection they provide should be more easily accessible to consumers.

Advertising Standards officials should ensure that the public are protected against misleading safety claims from manufacturers.

Cycle manufacturers and retailers should consider supplying a free cycle helmet (or helmet voucher) with every bike sold.

Helmet costs should be reduced substantially, eg through Government subsidy schemes and the reassessment of VAT on safety products on a European wide basis.

Summary of evidence.

The evidence from those countries where compulsory cycle helmet use has already been introduced is that such legislation has a beneficial effect on cycle-related deaths and head injuries. This strongly supports the case for introducing legislation in the UK. Such legislation should result in a reduction in the morbidity and mortality associated with cycling accidents. Recent evidence has indicated that the introduction of compulsory legislation does not have a significant negative effect on cycling levels. Such legislation in the UK should not discourage cyclists and lead to a more sedentary lifestyle with consequent health risks.

Recommendations

In light of this evidence we support the introduction of legislation making the wearing of cycle helmets compulsory for both children and adults.

Further, as stated in the 1999 report we strongly recommend that all cyclists wear proper fitting helmets which as a minimum should be certified to the EN 1078 standard, but preferably certified to the Snell B95 standard. It is also important that helmets are replaced after an accident.

UPTOP