Mock et al (1995),10 USA | 5–15 years Community-wide | Mass media campaign discount schemes. School based educational activities and bicycle events | Prospective observational study (A) 8860 observations (B) 466 admissions | (A) Observed helmet use at 150 sites (B) Hospital admissions | (A) Helmet wearing when riding: 5% (1987) to 57% (1993) (B) Severe head injuries (all ages) 29% of all admissions to 11% Partly effective Reasonable evidence |
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Parkin et al (1995),11 Canada | 5–14 years Low income areas School based | “Be Bike Smart” Week Educational and promotional activities. Helmets available at discounted price | Controlled trial without randomisation I=3 low income schools C1 not clear C2 (educated in previous year) 2 schools | (A) Observed helmet use (B) Self report helmet ownership use in I (C) Helmets sold | (A) Observed helmet use in I: 4% to 18% C1: 3% to 19% C2: 1% to 26% (B) Reported helmet ownership in I :10% to 47% (C) 910 helmets sold in I schools Inconclusive Reasonable evidence |
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Farley et al (1996),12 Canada | 5–12 years Elementary school Community-wide | Promotional activities over 4 years. Helmet discounts and free helmets | Controlled trial without randomisation I=6087 observations C=2025 observations | Observed helmet use in variety of locations | Observed helmet use in I: 9.6% (1st year) to 32.5% (3rd year) In C: 3.9% to 14.3% Partially effective— less effective in poor municipalities Reasonable evidence |
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Ekman et al (1997),13 Sweden | 0–14 years Community-wide | Series of local, regional, nation-wide campaigns | Time series: I1, I2, I3, 3 communities; C1, C2, 2 communities; C4=Sweden overall | Hospital discharge data for cycling injuries | Over 15 year period. In I1: 48% decrease in bicycle injuries and 59% in head injuries Sweden (C4): 32% decrease in bicycle injuries and 43% in head injuries Effective Reasonable evidence |
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Kim et al (1997),14 USA | 6–12 years. Primary health care | Free helmet distribution (I) or helmet discounts (C) along with educational intervention at public health clinics (I and C) | Randomised controlled trial I=3 clinics (n=243 ) C=3 clinics (n=180 ) | (A) Reported use of helmets | (A) Reported helmet use: 76% in I and 82% in C Partially effective for some groups Reasonable evidence |
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Britt et al (1998),15 USA | 3–4 years. Low income | Multifaceted promotion programme | Controlled trial without randomisation I=14 sites, 680 children C=4 sites, 200 children | (A) Observed helmet use (B) Reported behaviour | (A) I: 43% to 89% C: 42% to 60% (B) Reported helmet use I: 26% to 58% C: 36% to 37% Effective Reasonable evidence |
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Henrickson and Becker (1998),16 USA | 10–12 year old children attending schools. Low income families | I1 school intervention + telephone parental counselling I2 school only intervention | Randomised controlled trial I1=142 children 3 schools I2=163 children 3 schools C=102 children 3 schools | Self report of helmet use | Reported helmet use I 25% to 39% C: 17% to 20% Partially effective Reasonable evidence |
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Logan et al (1998),17 USA | 5–13 year old children. Rural town School based | Education, helmet provided, and incentive scheme | Before and after study. No controls I=2 schools 403 children | Observed helmet use. Self report surveys | Observed use 3% baseline, 25% one day after giveaway, and 5% at 9 months Inconclusive Reasonable/weak evidence |