Long-Term Effects of Education and Legislation Enforcement on All-Age Bicycle Helmet Use: A Longitudinal Study.

Bicycle-related injuries are a leading cause of child and youth hospitalizations in Canada. The use of helmets while bicycling reduces the risk of brain injuries. This study investigated the long-term effect of legislation coupled with enforcement to improve helmet use rates. We conducted a longitudinal observational study of helmet use at 9, 11, and 14 years after bicycle helmet legislation was enacted. Data were compared to baseline observations collected after legislation was passed in 1997. A comprehensive enforcement and educational diversion program, Operation Headway-Noggin Knowledge (OP-NK), was developed and implemented in partnership with regional police during the study period. Helmet use was sustained throughout the post-legislation period, from 75.3 % in the year legislation was enacted to 94.2 % 14 years post-legislation. The increase in helmet use was seen among all age groups and genders. Helmet legislation was not associated with changes in bicycle ridership over the study years. OP-NK was associated with improved enforcement efforts as evidenced by the number of tickets issued to noncompliant bicycle riders. This observational study spans a 16-year study period extending from pre-legislation to 14 years post all-age bicycle helmet legislation. Our study results demonstrate that a comprehensive approach that couples education and awareness with ongoing enforcement of helmet legislation is associated with long-term sustained helmet use rates. The diversion program described herein is listed among best practices by the Public Health Agency of Canada.

Reducing conflicts between motor vehicles and pedestrians: the separate and combined effects of pavement markings and a sign prompt.

The effects of a symbolic "yield here to pedestrians" sign and advance yield pavement markings on pedestrian/motor vehicle conflicts, motorists' yielding behavior, and the distance motorists' yield in advance of crosswalks were evaluated at multilane crosswalks at uncontrolled T intersections. In Experiment 1, the sign, when used alone, reduced pedestrian/motor vehicle conflicts and increased motorist yielding distance. The use of fluorescent yellow-green sheeting as the background of the sign did not increase the effectiveness of the sign. Further reductions in pedestrian/motor vehicle conflicts and further increases in yielding distance were associated with the addition of advance yield pavement markings. In Experiment 2, advance yield pavement markings, when used alone, were as effective in reducing pedestrian/motor vehicle conflicts and increasing yielding distance as the sign combined with pavement markings. These data suggest that the pavement markings were the essential component for reducing conflicts and increasing yielding distance.

Improving bicycle safety: The role of paediatricians and family physicians.

Cycling is a complex activity requiring motor, sensory and cognitive skills that develop at different rates from childhood to adolescence. While children can successfully ride a two-wheeled bicycle at age five or six, judgment of road hazards are poor at that age and matures slowly until adult-like judgment is reached in early adolescence. Safe cycling depends on the care, skills and judgment of cyclists and motorists; roadway design that promotes safe coexistence of bicycles and motor vehicles; and the use of safety devices, including bicycle helmets, lights and reflective tape. Whereas, research into optimal roadway design and educational programs for drivers to improve road safety has yielded contradictory results, the benefits of bicycle helmet use and programs to enhance their use have been clearly shown. This paper has the following objectives for paediatricians and family physicians: To understand the relationship between bicycle safety and children's motor and cognitive skills.To understand the effectiveness and limitations of strategies to improve bicycle safety.To describe activities to promote bicycle safety that physicians can undertake in clinical settings and in the community.