Article Text

Download PDFPDF
Factors associated with bicycle helmet use among young adolescents in a multinational sample
  1. K S Klein1,
  2. D Thompson2,
  3. P C Scheidt1,
  4. M D Overpeck1,4,
  5. L A Gross3,
  6. the HBSC International Investigators*
  1. 1National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
  2. 2Maryland Medical Research Institute, Baltimore, MD, USA
  3. 3Macro International Inc, Calverton, MD, USA
  4. 4Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD, USA
  1. Correspondence to:
 Dr P C Scheidt
 Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, 6100 Executive Boulevard, MSC 7510, Bethesda, MD 20892–7510, USA;


Objective: To determine factors associated with variation in bicycle helmet use by youth of different industrialized countries.

Design: A multinational cross sectional nationally representative survey of health behaviors including symptoms, risk taking, school setting, and family context.

Setting: School based survey of 26 countries.

Subjects: School students, ages 11, 13, and 15 years totaling 112 843.

Outcome measures: Reported frequency of bicycle helmet use among bicycle riders.

Results: Reported 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.

Conclusions: Bicycle 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.

  • GDP, gross domestic product
  • HBSC, Health Behaviour in School Children
  • bicycle helmet
  • bicycle safety
  • health behavior

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • * Of the 29 HBSC participating countries, three were excluded from the analysis. The Swiss and Belgian (French) surveys did not include the question about bicycle use. Finland was excluded because an error in wording of the question caused an invalid interpretation.

  • * HBSC International Injury Group: Saoirse Nic Gabhainn, PhD, National University of Ireland, Galway, Republic of Ireland; Lothar Schelp, MD, Swedish Rescue Services Agency, Stockholm, Sweden; Yossi Harel, PhD, Bar-Ilan University, Ramat Gan, Israel; J Michael Pedersen, MD Frederikssund, Denmark; Will Boyce, PhD, Queens University, Kingston Ontario; Emmanuelle Godeau, MD, Service medical du Rectorat de Toulouse, Toulouse, France; Anna Aszmann, PhD, National Centre of Health Promotion and Development, Budapest, Hungary.

  • None of the authors has competing interests with this research or this report.