Beyond helmet use: enhancing fit and safety in a youth bicycling program

Bicycling is a popular form of transportation and recreation among youth, yet head injuries remain one of the most common and serious outcomes in bicycle-related crashes. While helmet use can substantially reduce head injury risk, the protective benefit is compromised when helmets are worn improperly. Educational interventions aimed at both helmet use and correct fit remain limited, particularly those using objective, naturalistic methods for evaluation. This study aimed to evaluate the effectiveness of a school-based bicycle safety program, with and without a parental component, in improving helmet use and proper helmet fit among adolescents.

This randomized controlled trial evaluated a bicycle safety program among adolescents aged 9-12 years. Participants were assigned to one of two intervention groups, Bike Club and Bike Club Plus, or a control group. Both intervention groups received a 12-h program combining safety education and practical bicycling skills; Bike Club Plus included an additional parent session. Participants' bicycle rides were video recorded for one week before and one week after the intervention. For each ride, helmet use fit (position, side/chin straps, buckle) was coded. Generalized linear models fit using weighted generalized estimating equations were used to evaluate changes in helmet fit and use across the three study groups.

Helmet use was high at baseline across all groups (≥90%) and remained stable post-intervention. Proper helmet positioning improved in both intervention groups relative to their baseline (Bike Club: odds ratio [OR] = 1.52, 95% confidence interval [CI] 1.02-2.26; Plus: OR = 1.60, 95% CI: 1.04-2.44), although differences between study arms were not statistically significant. Side/chin strap fit remained low overall, though improvements were greatest in the Plus group. Stratified analyses revealed that boys in the Plus group benefited most, suggesting sex-specific responses to different components.

This study provides evidence that a school-based intervention, particularly when enhanced with a parental component, may improve aspects of helmet fit among youth cyclists. Future interventions should consider tailoring strategies by sex and target specific aspects of helmet fit, not just usage.