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Bicycle helmets can substantially reduce the risk of head and brain injury during accidents. Researchers analyzed the medical records of 3,390 injured bicyclists who were treated at 7 Seattle emergency departments. Half of those who suffered non-head injuries were wearing helmets compared to only 29% of those who sustained head injuries. Helmets reduced the risk of head and brain injury by approximately 65% to 70%. Hard-shell, thin-shell and no-shell helmets were equally protective. Both children and adults benefitted from the protection offered by a bicycle helmet., Objectives.--To examine the protective effectiveness of bicycle helmets in 4 different age groups of bicyclists, in crashes involving motor vehicles, and by helmet type and certification standards. Research Design.--Prospective case-control study Setting.--Emergency departments (EDs) in 7 Seattle, Wash, area hospitals between March 1, 1992, and August 31, 1994. Participants.--- Case subjects were all bicyclists treated in EDs for head injuries, all who were hospitalized, and all who died at the scene. Control subjects were bicyclists treated for nonhead injuries. Main Results.--There were 3390 injured bicyclists in the study; 29% of cases and 56% of controls were helmeted. Risk of head injury in helmeted vs unhelmeted cyclists adjusted for age and motor vehicle involvement indicate a protective effect of 69% to 74% for helmets for 3 different categories of head injury: any head injury (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.26-0.37), brain injury (OR, 0.35; 95% CI, 0.25-0.48), or severe brain injury (OR, 0.26; 95% CI, 0.14-0,48). Adjusted ORs for each of 4 age groups ( Conclusions.--Bicycle helmets, regardless of type, provide substantial protection against head injuries for cyclists of all ages involved in crashes, including crashes involving motor vehicles. JAMA. 1996;276:1968-1973

Analysis of head injuries and total injuries resulting from bicycle crashes among members of a health maintenance organization. Injuries per 100,000 population, per 100 miles ridden, and according to season and day of the week are reported. Individuals between 5 and 14 are at highest risk. The data can be used in community bicycle helmet campaigns and safety programs. (EVL)

Objectives. The purpose of this study was to identify circumstances in which biochemical assessments of smoking produce systematically higher or lower estimates of smoking than self-reports. A secondary aim was to evaluate different statistical approaches to analyzing variation in validity estimates. Methods. Literature searches and personal inquiries identified 26 published reports containing 51 comparisons between self-reported behavior and biochemical measures. The sensitivity and specificity of self-reports of smoking were calculated for each study as measures of accuracy. Results. Sensitivity ranged from 6% to 100% (mean = 87.5%), and specificity ranged from 33% to 100% (mean = 89.2%). Interviewer-administered questionnaires, observational studies, reports by adults, and biochemical validation with cotinine-plasma were associated with higher estimates of sensitivity and specificity. Conclusions. Self-reports of smoking are accurate in most studies. To improve accuracy, biochemical assessment, preferably with cotinine-plasma, should be considered in intervention studies and student populations. (Am J Public Health, 1994;84:1086-1093), It appears that self-reports of smoking are accurate in most studies and for most populations. A total of 26 studies of smokers that used participant self-reports and biochemical measures to confirm smoking status were analyzed. The studies included information on 36,830 participants. Almost 38% of the participants completed self-administered questionnaires about smoking habits. The remaining participants were interviewed about their smoking habits. Slightly less than 23% of the participants were students. Interviewer-administered questionnaires, biochemical validation of smoking status with blood plasma cotinine levels, reports by adults and observational studies were associated with higher reporting accuracy. Student participants were more likely to deny smoking even when there was biochemical evidence that they smoked. Biochemical measurements appear to be most appropriate for student populations and interventional studies.

A bicycle safety helmet subsidy program may increase helmet usage and reduce the number of head injuries among children. This type of program would provide between $5 and $15 towards the cost of a bicycle helmet for children between five and nine years old. Researchers used a mathematical model to examine the effect of a $5, $10 or $15 subsidy on helmet use by 100,000 children who were members of a health maintenance organization (HMO). A helmet subsidy between $5 and $10 that increases helmet use to 40% to 50% would prevent 564 to 840 head injuries among this group of children over a five-year period. It would also reduce the cost associated with the treatment of head injuries by 189,271 to $427,808, at which point the program would be cost-effective., Objective. To examine the potential effects of bicycle safety helmet cost subsidy on bicycle head injury rates and costs. Design. Using empiric data on the incidence and costs of bicycle injuries to children, we examined the hypothetical effects of various bicycle helmet subsidies in a cost-effectiveness analysis. A hypothetical cohort of 100 000 5- through 9-year-olds was followed for 5 years after helmet cost subsidization. Sensitivity analyses were done of three different levels of safety helmet subsidy ($5, $10, $15), three discount rates (2%, 4%, 6%), 10 levels of safety helmet use ranging from 10% to 100%, and the occurrence or nonoccurrence of catastrophic head injuries. Patients. Forty-three children 5 through 9 years of age and 27 children 10 through 14 years of age with head injuries due to bicycling were identified through emergency department surveillance of a population of 29 533. Setting. Group Health Cooperative of Puget Sound, a large health maintenance organization. Outcome measures. Bicycle head injuries prevented and the savings or costs associated with various subsidy, safety helmet use, and discount rates. Results. Hypothetically, an increase in bicycle helmet use rates to 40% to 50% due to subsidies of $5 or $10 prevents 564 to 840 head injuries in a cohort of 100 000 5-through 9-year-olds over 5 years. Under these conditions and a 2% discount rate, cost savings ranging from $189 207 to $427 808 will result when catastrophic head injuries are included in the analysis. Conclusion. Subsidization of bicycle safety helmets to achieve a cost of $14 to $20 per helmet and use rates of 40% to 50% will likely prove cost-effective. Empirical evidence from a Seattle campaign suggests that such helmet use rates are achievable. Pediatrics 1993;91:902-907; bicycle helmets, cost-effectiveness analysis, head injuries, prevention.

Although studies of injury-related disability among children tend to focus on injuries requiring hospitalization or on brain injuries, most injuries suffered by children are treated in the doctor's office and do not require admission to the hospital. There is limited information about the degree of disability caused by injury among children who do not require hospitalization. The effects of injuries on long-term physical health of children not requiring hospitalization were assessed. In addition, the types of injuries that result in impairment of function were identified in an effort to develop methods to prevent those types of injuries. The study involved children and adolescents from newborn to 19 years old. The subjects were seen in either an emergency department or outpatient clinic. Their physical health was assessed using a test developed by the Rand Health Insurance Study. Injury restricted normal weekly activities for 55.1 percent of subjects. Complete resumption of ordinary activities had not been achieved one week after injury for 16.4 percent of subjects and one month after injury for 3.8 percent. Impairment of function was more severe for children aged 10 years or older as compared with younger children. The most severe disability resulted from injuries related to fractures and dislocations, sprains, activities involving sports, recreation, and falls. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bicycle helmets have been reported to produce an 85 percent reduction in the risk of head injury. Facial injuries, as well as head injuries, are common in bicycle accidents. Previous studies have reported that helmets, usually with face pieces, have contributed to a reduction in facial trauma among riders of motorcycles and mopeds. The effectiveness of bicycle helmets in reducing facial injury was evaluated among 531 bicyclists who sought medical care at Seattle area hospitals. During the one-year study period, 212 bicyclists suffered 256 facial injuries; 319 cyclists sustained injuries to other parts of the body. Head injuries occurred in combination with upper facial injuries in 61 percent of the cases, and with lower facial injuries in 31 percent of the cases. There was a tendency toward a greater protective effect of helmets on the upper face than on the lower face. It is likely that bicycle helmets would provide more facial protection if they contained a protective bar across the front of the helmet. The findings indicate that bicycle helmets, as they are currently designed, provide some protection against serious injuries to the upper part of the face, but do not reduce the risk of facial injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Safety helmets are highly effective in preventing head injuries in bicycle riders. Approximately 1,300 deaths per year result from bicycle accidents and the majority of the deaths result from head injuries. A case-control study of bicycle accidents was conducted over a period of one year. Head injuries and injuries not involving the head were studied. Only four percent of the 99 cyclists with serious brain injury wore helmets. Helmets reduced head injury by 85 percent and brain injury by 88 percent.