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                  Canadian Institutes of Health Research




       Welcome!
       Bicycle Helmet
        Promotion in
          Children:
What’s the evidence?
  You will be placed on hold until the webinar begins.
The webinar will begin shortly, please remain on the line.
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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   Welcome!
   Bicycle Helmet
    Promotion in
      Children:
What’s the evidence?
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
What is www.health-evidence.ca?


                     Evidence
                          inform



              Decision Making
Why use www.health-evidence.ca?
 1. Saves you time
 2. Relevant & current evidence
 3. Transparent process
 4. Supports for EIDM available
 5. Easy to use
Knowledge Translation
 Supplement Project
    CIHR-funded KTB-112487
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.
Questions?
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)
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
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
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.
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
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).
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).
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
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
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
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
Questions?
Posting Board
For a copy of the presentation please visit our
                  posting board:
       http://forum.health-evidence.ca/
Login with your health-evidence username and password or
             register if you aren’t a member yet.
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




                      27
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.




                                  28
• Visit ResearchNet for current CIHR
  funding opportunities:
  http://www.researchnet-
  recherchenet.ca/

• For further information please contact us
  ipph-ispp@uottawa.ca




                    29

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Bicycle Helmet Promotion in Children: What's the Evidence?

  • 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? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  • 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
  • 3. Participant Side Panel Housekeeping in WebEx  Use Q&A to post comments/questions during the webinar  ‘Send’ questions to All (not privately to ‘Host’)  Connection issues  Recommend using a wired Internet connection (vs. wireless), to help Q&A prevent connection challenges  WebEx 24/7 help line: 1-866-229-3239
  • 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. What is www.health-evidence.ca? Evidence inform Decision Making
  • 7. Why use www.health-evidence.ca? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  • 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.
  • 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.
  • 18. 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).
  • 19.
  • 20. 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
  • 21.
  • 22. 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
  • 23. 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
  • 24. 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
  • 26. Posting Board For a copy of the presentation please visit our posting board: http://forum.health-evidence.ca/ Login with your health-evidence username and password or register if you aren’t a member yet.
  • 27. 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 27
  • 28. 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. 28
  • 29. • Visit ResearchNet for current CIHR funding opportunities: http://www.researchnet- recherchenet.ca/ • For further information please contact us ipph-ispp@uottawa.ca 29