Children's bicycle helmet attitudes and use. Association with parental rules. The Pediatric Practice Research Group

Previous studies have assessed the attitudes of parents and children toward bicycle helmet ownership and use in various settings, but they have not addressed the role of parental rules in promoting bicycle helmet use by children.

To further explore the attitudes of parents and children at pediatric practices toward bicycle helmet ownership and use by children and to assess the role of parental rules in promoting bicycle helmet use by children.

One hundred sixty-nine 5- to 14-year-old children who owned bicycles and their parents were surveyed during well-child visits at 5 general pediatric practices in the Chicago, Ill, area. One hundred twenty-nine families were represented. Of the children, 60% were aged 5 to 9 years, and 50% were girls.

Forty-eight children (28%) reported helmet ownership. Of the helmet owners, 21 (45%) reported helmet use; thus, the overall percentage of helmet use was 12%. Helmet ownership by children was significantly (P < .05) related to parental characteristics: educational level, race, perceived effectiveness of bicycle helmets, seat belt use, and parental helmet ownership. The most common reasons parents gave for lack of helmet ownership by children were "never thought about purchasing" a helmet (35%), "never got around to purchasing" a helmet (29%), "child wouldn't wear it anyway" (26%), and the bicycle helmet was "too expensive" (16%). Only 33% of the parents reported hearing about helmets from their children's pediatrician, but 40% of these parents regarded pediatricians as their most important information source. Of the children who did not own helmets, 64% said they would wear a bicycle helmet if they had one, a more frequent comment for 5- to 9-year-old children than 10- to 14-year-old children (76% vs 49%, P < .01). The most common reasons for not wearing a helmet among owners were as follows: forgot or lost it and not needed. The most common reasons for not wearing a helmet among nonowners were as follows: uncomfortable and appearance or perception of others. Children who owned helmets and whose parents had a strict rule about wearing helmets were more likely to always wear their helmets than helmet owners whose parents had a partial rule or no rule (88% vs 19%, P < .001).

Parental rules are associated with bicycle helmet use by children. Pediatricians may increase helmet use rates by promoting strict parental helmet rules as part of their anticipatory guidance regarding bicycle safety. More research about the effectiveness of this strategy is needed.