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The purpose of this research was to explore the changes in children's bicycle helmet use and motor vehicle bicycle related injuries in Hillsborough County, Florida before and after passage of the Florida's bicycle helmet law for children under the age of 16. The results show a significant increase in bicycle helmet use among children, ages 5-13, in the post-law years compared with the pre-law years. Also, there has been a significant decline in the rates of bicycle related motor vehicle injuries among children in the post-law years compared with the pre-law years. Although there have been complementary educational and outreach activities in the county to support helmet use, it appears that the greatest increase in use occurred after the passage of the helmet law. It is recommended that educational efforts continue to sustain helmet use rates and decreases in injuries. R esearch has shown that bicycle helmets effectively prevent head and brain injuries and related deaths. A recent meta-analytic report on helmets showed a summary odds ratio efficacy of 0.40, 0.42, 0.53, and 0.27 for head, brain, facial, and fatal injuries, respectively. 1 Legislation may be important in increasing bicycle helmet use.2 3 The increase in average probability of helmet wearing in mandated helmet states was 18.4%, 4 and in 2002, 20 states had such laws, all applying to individuals under age 18. 5In 1997 a Florida law adopted in 65 of 67 counties required that riders under 16 wear a helmet. A 1999 Florida study showed that children riding bicycles where the law was in effect were twice as likely to wear helmets as those in non-participating counties. 6 The relationship between the Florida legislation and bicycle related injuries is unknown. METHODSSince 1993, observations of helmet use in children 5-13 have been conducted in Hillsborough County, Florida (population 998 948). This age group includes those most likely to experience bicycle related injuries. 7Observation protocols followed guidelines established by the Harborview Injury Prevention and Research Center.8 Key issues were 9 :(1) Observers always obtained study approval through the county sheriff's office.(2) Youth showing obvious signs of puberty were excluded from the study.(3) Children's bicycles could not be equipped with training wheels and the helmet must have been observed on the head or being removed from the head.(4) Observation times (non-school settings) were limited to <20 minutes at any one site to avoid duplicate counts. At schools, observers were positioned at bike racks during the observation period.(5) All observers were trained for one or more days. Inter-rater reliability consistently exceeded 90%.County census tracts (n=167) were divided into two ordinal lists stratified by income and the population of children, ages 0-14. 9 Each of these lists was divided into deciles of approximately 17 tracts each. Three tracts were selected randomly from each decile-a total of 60 tracts with at least two observations sites chosen from each. Approximately 120 observation ...

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Injuries continue to be the leading cause of death for the first four decades of life. These injuries result from a confluence of behavioral, physical, structural, environmental, and social factors. Taken together, these illustrate the importance of taking a broad and multileveled approach to injury prevention. Using examples from fall, fire, scald, and poisoning-related injuries, this article illustrates the utility of an approach that incorporates a social–environmental perspective in identifying and selecting interventions to improve the health and safety of individuals. Injury prevention efforts to prevent home injuries benefit from multilevel modifications of behavior, public policy, laws and enforcement, the environment, consumer products and engineering standards, as demonstrated with Frieden’s Health Impact Pyramid. A greater understanding, however, is needed to explain the associations between tiers. While interventions that include modifications of the social environment are being field-tested, much more work needs to be done in measuring social–environmental change and in evaluating these programs to disentangle what works best.