Parent-child concordance on reported barriers to helmet use by children.

BACKGROUND: We determined the agreement between parents and their school-age children on reported barriers to bicycle helmet use. MATERIAL/METHODS: We conducted a cross-sectional survey in a 2-county Central Texas region with no helmet use legislation. Parent-child pairs, selected through a randomized, multi-stage sampling procedure and pre-matched by unique identifiers, were surveyed independently with self-administered questionnaires. Parent-child concordance was assessed using Kappa statistic. RESULTS: Of 1,987 surveys distributed, children returned 1,203 (61%) while parents returned 636 (53% of child respondents). Parents included 31% college graduates and 33% reported annual income of >55,000 dollars. Children included 60% whites, 16% blacks, and 16% Hispanics. The most popular reasons cited by children as barriers to helmet use were not having one (34%), being a safe rider (31%), and helmets messing up hair (18%). Good concordance was found on reported child bicycle riding (parent=88.0% vs. child=88.0%; K=0.64) and child helmet use the last time child rode a bicycle (parent=25.1% vs. child=28.0%; K=0.54). While good concordance was also found for reported helmet ownership (parent=31.9% vs. child=29.9%; K= 0.50), poor concordance was found for other barriers to helmet use including helmets looking ugly (parent=6.5% vs. child=13.4%; K=0.38) and messing up hair (parent=5.6% vs. child=15.2%; K=0.36). CONCLUSIONS: Although parents may be generally aware of their children's bicycle riding and helmet use habits, they may not be fully aware of the reasons why their children may not use a helmet. Public education and interventions on helmet promotion need to focus on parents.

Helmet use: a survey of 4 common childhood leisure activities.

OBJECTIVE: To compare the distribution and observation of helmet use patterns among 4 common childhood leisure activities-bicycle riding, in-line skating, skateboarding, and scooter riding-in a setting with no helmet use legislation. DESIGN: A cross-sectional, unobtrusive, direct observation of children engaged in 1 of the 4 activities was conducted during an 8-week period. SETTING: Eight communities of at least 1000 persons each in a 2-county Central Texas area. MAIN OUTCOME MEASURES: Prevalence of activity, helmet use, and correct helmet use. RESULTS: Of 841 children observed, most rode bicycles (74.8%); only 4.2% rode skateboards. They included 127 children estimated to be younger than 6 years (15.1%) and 495 estimated to be aged between 6 and 12 years (58.9%). Most were male (67.3%) and observed in urban communities (61.7%). The locations of highest concentration of the 4 activities were minor streets for bicycle riding, playgrounds for in-line skating, and sidewalks for skateboarding and scooter riding. The rate of overall helmet use was 13.6% and did not vary significantly by activity: in-line skating, 18.2%; skateboarding, 14.3%; bicycle riding, 13.5%; and scooter riding, 11.5%. However, the observed correct helmet use prevalence of 72.6% differed significantly by activity. Most children riding scooters wore their helmets incorrectly. Helmet use was positively associated with helmet use by accompanying children and/or adults. CONCLUSIONS: While bicycle riding was the most popular activity observed, helmet use was most prevalent among in-line skaters and least prevalent among scooter riders, many of whom also wore them incorrectly. Observed helmet use was influenced mostly by adult and peer helmet use, indicating that public education and interventions should target children and their parents as well as scooter riders.