School Bicycle Safety Project: A health promotion school approach to encourage children to wear helmets: Intervention trial
Bicycle related injury remains a major cause of death and injury hospitalisation among Australian children. A randomised intervention trial was conducted in 27 Western Australian primary schools. The study aimed to assess the effectiveness of a whole-school intervention to increase the correct wearing of bicycle helmets by primary school children. A major component of the intervention was a peer-led classroom curriculum for 10-12 year old children. Helmet use by cyclists was observed as children were leaving school at baseline (May, 2000) and after the first year and second year of the intervention. Additionally, a group of 10-11 year old children in study schools completed a self-administered questionnaire at the same three data collection points.
The health promoting school activities in the intervention included:
- Classroom learning activities and peer teaching;
- Communication with parents and the school community;
- Policy development and implementation; and
- Environmental assessment and supports.
The design of this project builds on research previously conducted by the Western Australian Centre for Health Promotion Research as part of the Child Pedestrian Injury Prevention Project and the Formative Evaluation of Helmet Use by Young People Project.
Over the two years of the study, observed helmet wearing rates declined by 13% in the control group (from 93% at baseline to 80% at post-test 2) and by 5% in the intervention group (from 89% to84%). When trends were tested for significance for the 27 schools, there was not a time by condition interaction (F=1.745, p=0.185) nor a difference between intervention and control schools (F=0.297, p=0.591).
The overall percentage of children wearing helmets did decline over time (F=6.465, p=0.003). By the end of the study only 24% of children in both the intervention and control groups wore their helmet in a manner to maximise effectiveness. Self-reported helmet use at any time in their neighbourhood or around school by the Grade 5/6 cohort students was significantly greater in the group receiving the peer teacher intervention. There were increased odds at post-test 1 (OR=1.8) and at post-test 2 (OR=1.3) of cohort students reporting always wearing a helmet for intervention group students (who did not always wear a helmet at baseline) compared with the same group of control group students. This difference was statistically significant at post-test 1 (z=2.33, p=0.020) but not at post-test 2 (z=1.28, p=0.200).
When the analyses were repeated for the ‘regular riders’ (ride on at least 1-3 days a month), the differences between the study condition schools were slightly larger. The likelihood of reporting always wearing a helmet was 1.9 times higher at post-test 1 (z=2.51, p=0.012) and 1.7 times higher at post-test 2 (z=2.13, p=0.033) for the intervention group than the control group students who did not always wear a helmet at baseline.
The data suggest that school-based activities can arrest the rate of decline in helmet use by children. Further effort is required to encourage children to correctly wear a helmet to maximise its effectiveness. Using peer teachers is a useful strategy to engage students in normative-based protective behaviours. The logistical challenges this strategy presents appear to be worth the outcomes.
The education materials and findings of this study have been made available to road safety and education agencies. The investigators continue to work with these agencies to provide evidence-based road safety education for young people. The whole-school strategies developed in this study form the foundation of a new research project that examines the effectiveness or strategies to maximise parent involvement in the pedestrian safety of 4 to 6 year old children.
National Health and Medical Research Council