Neighborhood-based Social Determinants of Health are Associated With Decreased Helmet Use in Young Children

We sought to determine the association between neighborhood-level social determinants of health (SDoH) and protective helmet use for young children involved in bicycle, scooter, and skateboard crashes. We hypothesized that children from disadvantaged communities would be less likely to be wearing helmets at the time of their crash.

A retrospective cohort study was performed of all children ≤10 years old who presented after bicycle, scooter, and skateboard crashes to a single Level 1 Pediatric Trauma Center (7/1/2017-6/30/2021). Geocoding linked patient addresses to state-Area Deprivation Index (ADI) and Social Vulnerability Index (SVI). Multivariable logistic regression modeling investigated associations between neighborhood-level SDoH and helmet use, controlling for age, sex, and racialization. ADI and SVI were scaled to present decile change (0 = least disadvantaged, 10 = most disadvantaged).

220 children were in bicycle, scooter, and skateboard crashes, 56 % of whom were not wearing helmets. The median age was 7.6 years, 71 % were male, 52 % were on public insurance, and 63 % had minoritized racialization. Neighborhood-level SDoH indices were significantly associated with helmet use, with a 27 % (95 % CI 1.10-1.39, p < 0.001) increase in the odds of no helmet use for every decile increase in overall SVI, and a 23 % (95 % CI 1.12-1.44, p < 0.001) increase in the odds of no helmet use every decile increase in ADI.

Helmet use in young children was found to be closely associated with community structural factors. Neighborhood-level SDoH indices may be an effective tool for identifying at-risk communities for the development of injury prevention interventions.

Prognosis Study, Level II.