Objective School environment has been often identified as a prosperous venue for injury prevention and safety promotion. This study sought to investigate the impact of a school-based helmet promotion program on knowledge, attitudes and practices of eligible adolescent drivers.

Methods A cluster randomised controlled trial was implemented, with schools as the unit of randomisation. Four public, four private and four vocational high-schools situated in Attica, Greece, were sorted by type and randomly assigned to receive a one-month intervention, based on the key concepts of the Health Belief Model, or serve as controls. Self-report data were collected at baseline from 741 second grade students (∼16 years) and immediately after program completion.

Results After program completion, helmet-related knowledge was significantly improved for all intervention students. The adjusted mean changes from baseline to post-test were: 1.71 for students attending public schools (p=0.0001); 2.31 for students attending private schools (p=0.0001); and 1.31 for students attending vocational schools (p=0.0001). Notwithstanding the greatest increase observed in private high-school students, the intervention had no impact on their attitudes and practices. Of note, individuals enrolled in private education had the lowest frequency of two-wheel motorised vehicle use, with 18.2% reporting frequent use, as contrasted to 38.6% in public schools and 61.1% in vocational.

Conclusions The intervention was successful in increasing students knowledge about helmet use. Nevertheless, its impact on helmet-related attitudes and practices of participants appeared to vary across different school types.