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Bicycling is a popular recreational activity and a principal mode of transportation for children. However, bicycle related injuries, especially head injuries, are a major public health problem in Québec, 1 in Canada, 2- 5 and elsewhere. 6- 9 The use of helmets has been cited and promoted as a strategy for reducing the frequency and severity of bicycle related head injuries. 10- 12 Educational interventions are popular approaches that attempt to increase voluntary bicycle helmet use, and have been found to be effective in that particular sense. 13- 17
Few studies, however, have examined the impact of educational programmes on injury rates. 18- 20 In the particular case of the wearing of bicycle helmets in childhood, two studies, one conducted in Seattle, Washington, 18 the other in Victoria, Australia 19 point to significant reductions in bicycle related head injuries. By contrast, a study from New Zealand suggests that an increase in helmet wearing has little association with the occurrence of serious head injuries among bicyclists. 20
In summary, despite their widespread use, there is a paucity of studies assessing the impact of population based, bicycle helmet wearing educational programmes on head injury occurrence. In addition, little is known about their differential impact on people from different living circumstances and environments. This study was embarked upon so as to assess the differential impact of a four year bicycle helmet promotion programme on the occurrence of bicycle related head injuries among children from areas of different socioeconomic status.
BICYCLE HELMET PROMOTION PROGRAMME IN THE MONTéRéGIE, 1990 TO 1993
The programme, in place during the period 1990 to 1993, had a population based approach, forming part of a five year plan that aimed at reducing road injury mortality and morbidity in the entire Montérégie region. The programme targeted elementary school children, 5 to 12 years of age, attending both French and English publicly provided schools in the Montérégie (about 380 schools and 140 000 children). The objective of the programme was to increase the helmet wearing rate from 1.3% to 20%.
A preliminary study identified the factors that were most likely to influence children's intentions to use a helmet, and inspired the advocacy messages adopted during the programme. describes the different activities undertaken during the programme and how...