1.
This webinar has been made possible with support from the
Canadian Institutes of Health Research
Welcome!
Bicycle Helmet
Promotion in
Children:
What’s the evidence?
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2.
What’s the evidence?
 Owen, R., Kendrick, D., Mulvaney, C., Coleman,
T., & Royal, S. (2011). Non-legislative interventions
for the promotion of cycle helmet wearing by
children. Cochrane Database of Systematic Reviews.
(11) Art. No.: CD003985.
 http://health-evidence.ca/articles/show/16356

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4.
This webinar has been made possible with support from the
Canadian Institutes of Health Research
Welcome!
Bicycle Helmet
Promotion in
Children:
What’s the evidence?

5.
The Health Evidence Team
Kara DeCorby Heather Husson Jennifer Yost
Managing Director Project Manager Guest Presenter
Maureen Dobbins
Scientific Director
Tel: 905 525-9140 ext 22481
E-mail: dobbinsm@mcmaster.ca
Lori Greco Robyn Traynor Lyndsey McRae
Knowledge Broker Research Coordinator Research Assistant

6.
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7.
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8.
Knowledge Translation
Supplement Project
CIHR-funded KTB-112487

9.
Review
 Owen, R., Kendrick, D., Mulvaney, C., Coleman, T., &
Royal, S. (2011). Non-legislative interventions for the
promotion of cycle helmet wearing by children. Cochrane
Database of Systematic Reviews. (11) Art. No.: CD003985.

10.
Questions?

11.
Summary Statement:
Owens (2011)
 P children & adolescents 0-18 years
 I interventions to promote bicycle helmet use that
did not require the enactment of legislation
 C usual care/no intervention
 O primary outcomes: Observed bicycle helmet
wearing and self reported bicycle helmet ownership and
bicycle helmet wearing
Quality Rating 9 (strong)

12.
Overall Considerations
 non-legislative interventions (community-based,
school-based and the provision of free helmets) led to
increased odds, of observed helmet wearing and self-
reported helmet wearing
 findings must be interpreted cautiously given the
significant differences across study findings, moderate
to high risk of bias of the included studies, and the bias
associated with self-reported outcomes

13.
General Implications
Public health should promote/support/implement:
 Community- or school-based interventions to improve
observed and self-reported helmet wearing
 Interventions focused on those <12 years of age to
improve observed helmet wearing
 Provision of free helmets (with inclusion of education)
to improve odds of observed OR self-reported helmet
wearing
 Provision of interventions delivered in a healthcare
setting to increase observed helmet wearing
For some outcomes a small number of studies was available (i.e. n=2), and studies were at
moderate to high risk of bias, meaning reported positive effect was likely overestimated

14.
General Implications
Public health should consider that:
 long-term effectiveness remains unknown, and most
sub-analyses (e.g. community-based interventions vs.
control) were based on studies at high risk of bias.
 this review did not evaluate whether non-legislative
interventions promoting the wearing of helmets
resulted in fewer head injuries sustained by children.

15.
What’s the evidence -
Outcomes reported in the review *
 Observed helmet wearing
 Self-reported helmet ownership
 Self-reported helmet wearing
*summary includes outcomes for which data are reported in the review

16.
What’s the evidence?
Observed Helmet Wearing
 Overall, interventions increased the odds of
observed helmet wearing (OR 2.08, 95%CI 1.29
to 3.34).
 Specifically, community-based (OR 4.30, 95%CI 2.24 to 8.25,
four studies); school-based (OR 1.73, 95%CI 1.03 to 2.91, eight
studies); provision of free helmets (OR 4.35, 95%CI 2.13 to 8.89,
two studies); population 12 years of age and under (OR 2.50,
95%CI 1.17 to 5.37, five studies)
 No impact with interventions providing subsidized
helmets (with education).

17.
What’s the evidence?
Self-reported Helmet Ownership
 No impact (OR 2.67, 95%CI 0.89 to 8.03), overall,
with interventions on self-reported helmet ownership
compared to no intervention, except in studies
providing free helmets (OR 11.63, 95%CI 2.14 to
63.16, 3 studies).

18.
What’s the evidence?
Self-reported Helmet Wearing
 Overall, the odds of self-reported helmet
wearing were greater among those receiving
interventions (OR 3.27, 95%CI 1.56 to 6.87).
 Specifically, school-based (OR 4.21, 95%CI 1.06 to 16.74, six
studies); healthcare setting (OR 2.78, 95%CI 1.38 to 5.61, two
studies); provision of free helmets (OR 7.27, 95%CI 1.28 to
41.44, three studies); provision of education-only (OR 1.93,
95%CI 1.03 to 3.63, seven studies); and, age >11 years (OR
4.99, 95%CI 1.68 to 14.83, three studies)
 No impact on those < 12 years of age

19.
Excluded Studies
 Studies not included in the meta-analysis (8 studies)
found mixed effects on both self-reported helmet
ownership, and observed helmet wearing, across a
variety of intervention settings

20.
General Implications
Public health should promote/support/implement:
 Community- or school-based interventions to improve
observed and self-reported helmet wearing
 Interventions focused on those <12 years of age to
improve observed helmet wearing
 Provision of free helmets (with inclusion of education)
to improve odds of observed OR self-reported helmet
wearing
 Provision of interventions delivered in a healthcare
setting to increase observed helmet wearing
For some outcomes a small number of studies was available (i.e. n=2), and studies were at
moderate to high risk of bias, meaning reported positive effect was likely overestimated

21.
General Implications
Based on limited evidence of effectiveness, public
health should not promote/support/implement:
 Provision of subsidized helmets (with education)
 Non-legislative interventions if the goal is to increase
odds of self-reported helmet ownership

22.
Questions?

23.
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24.
Canadian Institutes of Health Research
Institute of Population and Public Health
Funding Opportunities
• Population Health Intervention Research to
Promote Health and Health Equity
• Knowledge Translation Awards
• Institute Community Support Grants and
Awards
• CIHR’s Open Operating Grants Program
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25.
Population Health Intervention Research
Example
Evaluation of traffic safety interventions in B.C.
Jeffrey Brubacher, et. al (UBC)
Looking at whether number of vehicle crashes changed after
changes to the province’s Motor Vehicle Act.
Findings will influence B.C.’s road safety strategy and will be of
interest to traffic safety lawmakers from other Canadian
provinces and territories.
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26.
• Visit ResearchNet for current CIHR
funding opportunities:
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recherchenet.ca/
• For further information please contact us
ipph-ispp@uottawa.ca
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