Bicycle Helmet Legislation Helmet Use Legislation: Nine Years Later The effect of police enforcement on helmet use in an urban and a rural community in Nova Scotia Sherry Huybers
Introduction Bicycling-related injuries in Canada per year = mean of 4,476 hospital admissions 36 in-hospital deaths In 2001-02, 02, cycling injuries were estimated to result in direct and indirect costs of almost $175 million. Canadian Institute for Health Information (2004)
Introduction Among helmet users A case-control control study showed 85% reduction in head injuries Thompson et al. (1989) Two systematic reviews showed 73% reduction in cyclists deaths 63% to 88% decrease in the risk of head and brain injury Attewell,, et al. (2001); Thompson, et al. (2000)
Introduction Helmet-use legislation has led to increased rates of helmet wearers 90 80 70 60 50 40 30 20 10 0 NS BC AB ON LeBlanc et al. (2002) Foss & Beirness (2000) Hagel et al. (2006) Parkin et al. (2003) Pre legislation Post legislation
Introduction Decreases in bicycle-related injuries and deaths have been attributed, in part, to helmet legislation The proportion of head injuries in Halifax, Nova Scotia were reduced in half from 3.6% to 1.6% after legislation was enacted LeBlanc et al. (2002) Head injuries decreased significantly more in Canadian provinces with legislation than provinces without legislation (45% reduction compared to 27% reduction) Macpherson et al. (2002) Bicycle-related deaths among Ontario cyclists in which legislation applied decreased significantly following legislation (55% reduction) Wesson et al. (2008)
Introduction Legislation = Helmet Use Legislation + Enforcement = quicker and more effective Helmet Use Gilchrist et al.. (2000) Legislation + Enforcement in Halifax + Regular education = Helmet use for up to 2 years post legislation LeBlanc et al. (2002)
Introduction Helmet Use Rates for Halifax Year 1995 1996 1997 1998 1999 Rate (%) 35.9 37.7 75.3 85.5 83.8 LeBlanc et al. (2002)
Purpose Phase 1 To examine helmet use rates in metropolitan Halifax (pop. 373,000) and in the Town of Pictou (pop. 3800) and determine the amount of education and enforcement taking place Compare helmet use rates, education, and enforcement between Halifax and Pictou Phase 2 Implement any recommendations determined in Phase 1 and replicate the study
Methods Phase 1 This study replicated the methods used to conduct an earlier (1995 to 1999) longitudinal observational survey that took place in Halifax (LeBlanc et al., 2002) July through September, 2006 Observational data were collected from the north, south, east and west quadrants of the Halifax Peninsula Included a variety of neighborhoods with different property values Throughout the entire Town of Pictou Included a variety of neighborhoods with different property values
Methods Direct observation by 2 trained observers Cyclists were observed on arterial roads, residential roads, and recreational areas Information recorded: sex age group (coded as child, adolescent or adult) helmet use accompaniment companion age group companion helmet use road type day of the week
Methods Enforcement and Education assessed by: Information obtained from the Halifax Regional Police Department and the Pictou detachment of the RCMP Interviews of bicyclists convenience sampling Surveying the largest daily newspapers in Halifax and Pictou - The Chronicle Herald, The Daily News, The News January 2000 through October 2006 discussing bicycle helmet use in general and helmet legislation
Results (Helmet Use) Inter-observer agreement Pictou Halifax helmet use 100% age group - 94% (range of 92% and 100%) sex - 96% (range of 94% and 100%) 251 cyclists observed 571 cyclists observed
Results (Helmet Use) Proportion of helmeted cyclists for 2006 Halifax = 82% Pictou = 69%
Results (Helmet Use) Halifax Pictou Male = 80% Female = 89% Male = 64% Female = 80% p value =.009 p value =.008 There were lower rates of helmet use among males in Pictou than among males in Halifax (p value = 0.0001)
Results (Helmet Use) Halifax Adolescent = 59% Child = 75% Adult = 88% Pictou Adolescent = 32% Child = 70% Adult = 79% Both adolescent and adult helmet use rates in Pictou were statistically significantly lower than helmet use rates among adolescents and adults in Halifax (p value = 0.012 and 0.059 respectively)
Results (Enforcement) Halifax Enforcement began on Sept.1, 1997 and has continued through to 2006 From 2000 to 2006 total of 1001 summary offence tickets issued (average of 143 and a range of 41 and 287 summary offences/year) Pictou No enforcement from the passing of the law in December, 1997 through to June, 2006 From June, 2006 through September, 2006, minimal enforcement - 5 bicycles impounded
Results (Education) Regular education has been carried out by police and community members in both Halifax and Pictou since the passing of the law in 1996 Halifax Routine visits to schools Education during patrol Bike rodeos Pictou Routine visits to schools Education during patrol Bike rodeos
Results (Education) Halifax 54 articles in The Chronicle Herald (range of 3 and 18 articles/year) Pictou 54 articles in The Chronicle Herald (range of 3 and 18 articles/year) 44 articles in The Daily News (range of 2 and 13 articles/year) 43 articles in The News (range of 3 and 10 articles/year)
Results (Education) The proportion of bicyclists aware of the helmet use legislation was 89% for both Halifax and Pictou Halifax Male = 89% Female = 90% Pictou Male = 97% Female = 75% Child = 67% Adolescent = 96% Adult = 90% Child = 84% Adolescent = 91% Adult = 94%
Conclusions Halifax Regular, ongoing education and enforcement = continued high compliance rates Pictou Regular, ongoing education and little enforcement = significantly lower compliance rates than those in Halifax Indicates that enforcement contributes to higher rates of helmet use
Conclusions Helmet use rates of urban and rural adolescents are lower than rates found among children and adults Consistent with findings from other studies
Limitations Difficult to determine if enforcement alone was responsible for the higher rates of helmet use in the urban location Many legislative and non-legislative factors influence helmet use and the magnitude of these factors is difficult to estimate This study did examine the extent of education about helmet use and helmet-use legislation and the extent of awareness of the legislation
Recommendations Ongoing enforcement should be made part of multifaceted approaches encouraging helmet use Future studies needed to compare helmet use rates between urban and rural communities where regular enforcement takes place in both communities To determine if the rural rate can increase to the rate reached in the urban community
Phase 2 Ongoing enforcement should be made part of multifaceted approaches encouraging helmet use The RCMP in Pictou as well as the policing forces in surrounding towns apprehensive about giving out summary offense tickets (SOTs( SOTs) Future studies needed to compare helmet use rates between urban and rural communities where regular enforcement takes place in both communities If we can t t get police to enforce the law, we can t t do a study Need a way to convince the police in Pictou and the surrounding towns to give out SOTs
Operation Headway/Noggin Noggin Knowledge Partnering for Injury Prevention Key players Lynne Fenerty Neuro-Trauma/Injury Prevention Program Helmet Safety Action Committee Partners Nova Scotia Department of Health Promotion and Protection QEII/IWK Division of Neurosurgery Think First/Aviva Insurance Company of Canada IWK Child Safety Link Brain Injury Association of Nova Scotia Emergency Health Services Nova Scotia Canadian Paraplegic Association Dr. Nicole Boutilier Head of ER and Acting Chief of staff at PCHA Eileen MacIsaac - Director of Public Relations at PCHA Representatives from the 5 police departments Sherry Huybers Dalhousie University
Phase 2 Results (Enforcement) Halifax Enforcement began on Sept.1, 1997 and has continued through to 2006 2000 to 2006 Total of 1001 SOTs issued (average of 143 summary offences/year) 2006-301 SOTs issued 2007-355 SOTs issued 2008-177 SOTs issued up to the end of September 2008 Pictou No enforcement from the passing of the law in December, 1997 through to June, 2006 2006 minimal enforcement 2007 minimal enforcement 2008 7 SOTs issued plus a substantial number of warnings
Results (Helmet Use) Halifax Pictou 2006 = 82% 2006 = 69% 2008 = 92% 2008 = 77%
Results (Helmet Use) Halifax (n = 720) Pictou (n = 261) Male Female Male Female 2006 80% 89% * 2006 64% 80% * 2008 91% 97% * 2008 73% 91% * * * * + * Significantly different + P = 0.07
Results (Helmet Use) Halifax (n = 720) Pictou (n = 261) Child Teen Adult Child Teen Adult 2006 75% 59% 88% 2006 70% 32% 79% 2008 100% 81% 96% 2008 85% 38% 83% * * * * * Significantly different
Conclusions The significant increase in helmet use in Pictou (from 69% to 77%) indicates that enforcement may contribute to higher rates of helmet use The continued increase in helmet use in Halifax (currently 92%) indicates that ongoing enforcement is effective
Conclusions Halifax Pictou Teen Teen 2006 59% 2006 32% 2008 81% 2008 38% The much higher helmet use rates for teens in Halifax suggests that targeted enforcement is effective
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