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Increased bicycle helmet use in Sweden: needs and possibilities
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: From the perspective of what is called "vision zero" in Sweden, fatalities and injuries among bicyclists are unacceptable. Despite that, bicyclists constitutes approximately one third of all road user inpatients in Swedish hospitals, which is about the same proportion seen for drivers and passengers of motor vehicles. There are too many bicycle-related head injuries, but the risk of such traumas could be reduced considerably by the use of helmets. Bicycle helmet wearing can be increased by voluntary means, for instance by long-term community-based helmet promotion programs. However, the best effect has been achieved by combining promotion with a compulsory helmet law for all bicyclists, as has been done in Australia, New Zealand, and North America

Aim: The general aim of the research underlying this dissertation was to provide further information about the need for increased bicycle helmet use in Sweden, and to determine what measures can lead to more widespread helmet wearing. The four papers included addressed two main questions: (1) What is the need for increased helmet wearing among different categories of bicyclists in Sweden? (2) Is a non-compulsory local bicycle helmet law a realistic alternative to a mandatory helmet law for all bicyclists?

Materials and methods: Observational studies of helmet use by bicyclists in Sweden were conducted once a year (average n = 37,031/year) during the period 1988-2002 (paper I). The general trend in observed helmet wearing in different categories of bicyclists was analyzed by linear regression, and the results were used to predict future trends in helmet wearing. Three studies (papers II-IV) were also performed to evaluate a non-compulsory local bicycle helmet "law" in Motala municipality during the study period 1995 to 1998 (papers II-IV). This law was introduced in 1996 and applies specifically to school children (ages 6-12 years), although the intention is to increase helmet use among all bicyclists. Adoption of the law was accompanied by helmet promotion activities. In one of the studies in the evaluation, written material and in-depth interviews (n=8) were analyzed qualitatively to describe the process and structure of development of the Motala helmet law. The other two studies used a quasi-experimental design to assess the impact of the helmet law: one comprised annual observations of helmet wearing among bicyclists in Motala (average n=2,458/year) and control areas (average n=17,818/year); and the other included questionnaire data on attitudes, beliefs, and self-reported behavior of school children in Motala (n=1,277) and control areas (n=2,198). The average response rate was 72.8%.

Results and discussion: There was a significant upward trend in helmet use in all categories of bicyclists from 1988 to 2002. Helmet wearing increased from 20% to 35% among children(≤ 10 years) riding bikes in their leisure time, from 5% to 33% among school children, and from 2% to 14% in adults. Total average helmet use rose from 4% to 17%. However, during the last five years of the study period (1998-2002), there was no upward trend in helmet wearing for any of the categories of bicyclists. If the historic trend in helmet use continues, the average wearing rate will be about 30% by the year 2010. The Motala helmet law was dogged by several problems, mainly during the initiation phase, and some of them led to poor rooting of the law in the schools and indistinct roles and responsibilities of the municipal actors. Despite that, the law initially led to a significant increase in helmet wearing among the primary target group (school children), from a pre-law level of 65% to about 76% six months post-law, whereas thereafter the wearing rate gradually decreased and was at the pre-law level 2 ½ years after the law was adopted. Nonetheless, a weak but significant effect on adult bicyclists remained: the pre-law level of about 2% rose to about 8% at the end of the study period. Only about 10% of bicyclists on bike paths in Motala wore helmets 2 ½ years post-law. The questionnaire study showed one significant effect on school children in Motala two years post-law, namely, a stronger intention to ride bicycles if a national compulsory helmet law was introduced. There was, however, no significant long-term influence on children's attitudes or beliefs about helmet wearing, which agrees with the results of the observational study.

General conclusions: It is indeed necessary to increase bicycle helmet wearing in Sweden. Both the current average rate of helmet use and the rate predicted for the near future are far from the goal of 80% that was officially proposed by several years ago. Previous research has shown that, to achieve substantial and sustained bicycle helmet use, it is necessary to use helmet promotion in combination with a national helmet law that is compulsory and applies to all bicyclists. The present evaluation of the non-compulsory local helmet law in Motala indicated that this type of initiative is not a powerful alternative to a mandatory national helmet law. Nevertheless, much has been learned from the initiation and implementation of this local action.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2004. , 91 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 857
Keyword [en]
Bicycle helmet us
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-22196DOI: 10.3384/diss.diva-22196Local ID: 1348ISBN: 91-7373-832-8 (print)OAI: oai:DiVA.org:liu-22196DiVA: diva2:242509
Public defence
2004-10-01, Aulan, Hälsans hus, Hälsouniversitetet, Linköping, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-08-21Bibliographically approved
List of papers
1. Bicycle helmet use in Sweden during the 1990s and in the future
Open this publication in new window or tab >>Bicycle helmet use in Sweden during the 1990s and in the future
2005 (English)In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 20, no 1, 33-40 p.Article in journal (Refereed) Published
Abstract [en]

This paper describes how the use of bicycle helmets in Sweden has changed for different categories of cyclists from 1988 to 2002, and it also estimates future trends in voluntary wearing of bicycle helmets up to the year 2010. Observational studies of the use of bicycle helmets were conducted once a year from 1988 to 2002 at 157 sites in 21 cities. The subjects observed were children cycling to school (average n = 5471/year) and in their free time (average n = 2191/year), and adults cycling to workplaces and on public bike paths (average n = 29 368/year). The general trend in helmet use from 1988 to 2002 was determined by linear regression analysis, and the results were also employed to estimate future helmet wearing for the period 2003–2010. Differences in helmet use according to gender and size of city were analysed by chi-square tests. From 1988 to 2002, all categories of cyclists showed an upward trend in helmet use (p < 0.01, p < 0.001). Helmet wearing increased from about 20 to 35% among children (≤10 years) cycling during free time, from approximately 5 to 33% among school children, and from around 2 to 14% in adults. Total average helmet use rose from about 4 to 17%. However, during the last 5 years of the study period (1998–2002), none of the categories of cyclists studied showed an upward trend in helmet wearing. It is estimated that ∼30% of cyclists will wear helmets voluntarily by the year 2010, if helmet promotion activities are continued at the same level as previously. The results suggest that Sweden will probably not reach its official goal of 80% helmet use unless a national bicycle helmet law is passed.

Keyword
bicycle helmet, observational study, safety promotion
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-29696 (URN)10.1093/heapro/dah505 (DOI)15086 (Local ID)15086 (Archive number)15086 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
2. A local bicycle helmet ‘law’ in a Swedish municipality: the structure and process of initiation and implementation
Open this publication in new window or tab >>A local bicycle helmet ‘law’ in a Swedish municipality: the structure and process of initiation and implementation
2002 (English)In: Injury control and safety promotion, ISSN 1566-0974, E-ISSN 1744-4985, Vol. 9, no 2, 89-98 p.Article in journal (Refereed) Published
Abstract [en]

On May 1, 1996, the Municipality of Motala in Sweden introduced a local bicycle helmet ‘law.’ It is, however, not an official law in a legal sense, but a municipally endorsed recommendation supported by promotional activities. This ‘law’ applies to children (ages 6–12), although the objective is to increase helmet use among cyclists of all ages. The study is a qualitative evaluation of the structure and process during initiation and implementation of the Motala bicycle helmet law. The aim was to describe the activities that were carried out, which actors took part and the opinions of the most closely involved actors. The results are based on analysis of written material and on interviews with eight of the actors. The mass media focused much attention on the bicycle helmet law, especially during the first six months after its introduction. The name helmet law was presumably of significance in this context. It is essential that relevant target groups provide sufficient support and that committed individuals initiate and promote the work, which, however, must not become dependent on a single individual. All issues concerning bicycle helmets should be coordinated with the law. Also, continuous engagement of the municipal government and a strategy for the control and follow-up of the law are needed. Local bicycle helmet laws of this type have a potential to produce a long-lasting effect on helmet use, provided some of the problems encountered can be avoided and some of the promotional activities are intensified.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-26283 (URN)10.1076/icsp.9.2.89.8695 (DOI)10799 (Local ID)10799 (Archive number)10799 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
3. A local bicycle helmet ‘law’ in a Swedish municipality: the effects on helmet use
Open this publication in new window or tab >>A local bicycle helmet ‘law’ in a Swedish municipality: the effects on helmet use
2004 (English)In: Injury control and safety promotion, ISSN 1566-0974, E-ISSN 1744-4985, Vol. 11, no 1, 39-46 p.Article in journal (Refereed) Published
Abstract [en]

The municipality of Motala in Sweden introduced a local bicycle helmet ‘law’ on May 1, 1996. This is not a legally enacted ordinance, but instead a legislated recommendation backed up by information and education. Formally, the law applies to children (aged 6–12 years), although the intention is to increase helmet use by all cyclists. The objective of the present study was to quantitatively evaluate the impact of the Motala helmet law on observed use of helmets by children and adults. Bicycle helmet use was monitored in Motala (n = 2,458/year) and in control towns (n = 17,818/year) both before and after adoption of the helmet law (1995–1998). Chi-square tests showed that helmet wearing 1995–1998 increased in Motala among all bicyclists (from 6.1% to 10.5%) and adults biking on cycle paths (from 1.8% to 7.6%). Helmet use by school children aged 6–12 increased during the first 6 months after introduction of the law (from 65.0% to 75.7%) but then progressively decreased to the pre-law level. Considering children cycling on cycle paths and for recreation in housing areas, there was a tendency towards increased helmet use during the first post-law year, but this was followed by a reduction to a lower level in 1998 than in 1995. Logistic regression analysis taking into account data from the control towns indicated that the helmet law had a positive effect on children cycling to schools during the first 6 months, and a weak delayed but more long-term positive effect on adult cyclists on cycle paths. There were no positive effects on children in housing areas and on cycle paths. The Motala helmet law probably would have had greater and more lasting effects on helmet use by bicyclists, if certain problems had been avoided during the initiation phase. Moreover, although it did have a positive influence on both school children and adults, it is not legally binding, and hence no penalties can be imposed. Presumably, compulsory legislation would have a more substantial impact on helmet wearing than a non-mandatory helmet ‘law’ such as that introduced in Motala.

Keyword
Bicycle helmet;injury prevention
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-22266 (URN)10.1076/icsp.11.1.39.26314 (DOI)1440 (Local ID)1440 (Archive number)1440 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
4. A local bicycle helmet ‘law’ in a Swedish municipality: effects on children's attitudes, beliefs and self-reported behavior
Open this publication in new window or tab >>A local bicycle helmet ‘law’ in a Swedish municipality: effects on children's attitudes, beliefs and self-reported behavior
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The municipality of Motala, Sweden, has a non-compulsary bicycle helmet "law" that is supported by promotional activities. The applies to children aged 6-12 but is intended to increase helmet use by all cyclists.

This study evaluate the effects of the law on children's attitudes, beliefs, and self-reported behavior. Questionnaires were sent to a random sample of 6-12-year-old children in the intervention area (n = 1,277) and the control area (n = 2,198), one to two months before and two years after the intervention. The avarage response rates were 76.5% in the intervention area and 79.3% in the control area. Data were analyzed by t-tests and ANOVA.

The study showed only one positive long-term effect on children's self-reported behavior or on factors supposed to precede their behavior. Children in the intervention area indicated a stronger intention to ride a bicycle if a national compulsory helmet law in introduced. There were no other changes in Motala that differed from changes in the control area. However, the overall responses, irrespective of test occasions, were often more positive or "better" among children in the intervention area that in the control area. This is probably due to helmet promotion programs conducted before the pre-test, which makes it more difficult to find effects of the intervention. Nonetheless, the findings suggest that the non-compulsory local helmet "law" in Motala is not a realistic alternative to a mandatory national helmet law for Sweden.

Keyword
bicycle helmets, legislation, safety promotion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-85041 (URN)
Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2012-10-31

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