Q&A: Hard Hats for Little Heads Advocates Alan Howell, MD, and Martha Howell.

Promoting public health initiatives in local communities can help physicians build relationships with the people they care for every day. Martha Howell and her husband, infectious disease specialist Alan Howell, MD, have taken that idea a few steps further with Hard Hats for Little Heads.

Wheels For All: Addressing Social Determinants of Health One Bicycle at a Time.

BACKGROUND: Wheels For All provides bicycles to individuals in La Crosse, Wisconsin to address the transportation barrier that often inhibits low-income individuals' ability to access community resources. METHODS: Recipients are referred by social service, health care, or other community agencies based on their need for transportation or exercise. Donated bicycles are matched to a recipient, repaired, and delivered personally by volunteers. RESULTS: Through collaboration with social service agencies, health care systems, and the community at-large, Wheels For All received referrals from 21 different sources and provided 101 recipients with bicycles from April 2015 to July 2017. CONCLUSION: Using a cost-effective, community-engagement model, Wheels For All provides a means of transportation for recipients, resulting in an enhanced ability to access community resources.

Achieving all-age helmet use compliance for snow sports: strategic use of education, legislation and enforcement.

BACKGROUND: Nova Scotia is the first jurisdiction in the world to mandate ski and snowboard helmet use for all ages at ski hills in the province. This study represents a longitudinal examination of the effects of social marketing, educational campaigns and the introduction of helmet legislation on all-age snow sport helmet use in Nova Scotia. METHODS: A baseline observational study was conducted to establish the threshold of ski and snowboarding helmet use. Based on focus groups and interviews, a social marketing campaign was designed and implemented to address factors influencing helmet use. A prelegislation observational study assessed the effects of social marketing and educational promotion on helmet use. After all-age snow sport helmet legislation was enacted and enforced, a postlegislation observational study was conducted to determine helmet use prevalence. RESULTS: Baseline data revealed that 74% of skiers and snowboarders were using helmets, of which 80% were females and 70% were males. Helmet use was high in children (96%), but decreased with increasing age. Following educational and social marketing campaigns, overall helmet use increased to 90%. After helmet legislation was enacted, 100% compliance was observed at ski hills in Nova Scotia. CONCLUSIONS: Results from this study demonstrate that a multifaceted approach, including education, legislation and enforcement, was effective in achieving full helmet compliance among all ages of skiers and snowboarders.

Non-legislative interventions for the promotion of cycle helmet wearing by children.

BACKGROUND: Helmets reduce bicycle-related head injuries, particularly in single vehicle crashes and those where the head strikes the ground. We aimed to identify non-legislative interventions for promoting helmet use among children, so future interventions can be designed on a firm evidence base. OBJECTIVES: To assess the effectiveness of non-legislative interventions in increasing helmet use among children; to identify possible reasons for differences in effectiveness of interventions; to evaluate effectiveness with respect to social group; to identify adverse consequences of interventions. SEARCH METHODS: We searched the following databases: Cochrane Injuries Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; PsycINFO (Ovid); PsycEXTRA (Ovid); CINAHL (EBSCO); ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED); Social Sciences Citation Index (SSCI); Conference Proceedings Citation Index-Science (CPCI-S); and PubMed from inception to April 2009; TRANSPORT to 2007; and manually searched other sources of data. SELECTION CRITERIA: We included RCTs and CBAs. Studies included participants aged 0 to 18 years, described interventions promoting helmet use not requiring enactment of legislation and reported observed helmet wearing, self reported helmet ownership or self reported helmet wearing. DATA COLLECTION AND ANALYSIS: Two independent review authors selected studies for inclusion and extracted data. We used random-effects models to estimate pooled odds ratios (ORs) (with 95% confidence interval (CI)). We explored heterogeneity with subgroup analyses. MAIN RESULTS: We included 29 studies in the review, 21 of which were included in at least one meta-analysis. Non-legislative interventions increased observed helmet wearing (11 studies: OR 2.08, 95% CI 1.29 to 3.34). The effect was most marked amongst community-based interventions (four studies: OR 4.30, 95% 2.24 to 8.25) and those providing free helmets (two studies: OR 4.35, 95% CI 2.13 to 8.89). Significant effects were also found amongst school-based interventions (eight studies: OR 1.73, CI 95% 1.03 to 2.91), with a smaller effect found for interventions providing education only (three studies: OR 1.43, 95% CI 1.09 to 1.88). No significant effect was found for providing subsidised helmets (seven studies: OR 2.02, 95% CI 0.98 to 4.17). Interventions provided to younger children (aged under 12) may be more effective (five studies: OR 2.50, 95% CI 1.17 to 5.37) than those provided to children of all ages (five studies: OR 1.83, 95% CI 0.98 to 3.42).Interventions were only effective in increasing self reported helmet ownership where they provided free helmets (three studies: OR 11.63, 95% CI 2.14 to 63.16).Interventions were effective in increasing self reported helmet wearing (nine studies: OR 3.27, 95% CI 1.56 to 6.87), including those undertaken in schools (six studies: OR 4.21, 95% CI 1.06 to 16.74), providing free helmets (three studies: OR 7.27, 95% CI 1.28 to 41.44), providing education only (seven studies: OR 1.93, 95% CI 1.03 to 3.63) and in healthcare settings (two studies: OR 2.78, 95% CI 1.38 to 5.61). AUTHORS' CONCLUSIONS: Non-legislative interventions appear to be effective in increasing observed helmet use, particularly community-based interventions and those providing free helmets. Those set in schools appear to be effective but possibly less so than community-based interventions. Interventions providing education only are less effective than those providing free helmets. There is insufficient evidence to recommend providing subsidised helmets at present. Interventions may be more effective if provided to younger rather than older children. There is evidence that interventions offered in healthcare settings can increase self reported helmet wearing.Further high-quality studies are needed to explore whether non-legislative interventions increase helmet wearing, and particularly the effect of providing subsided as opposed to free helmets, and of providing interventions in healthcare settings as opposed to in schools or communities. Alternative interventions (e.g. those including peer educators, those aimed at developing safety skills including skills in decision making and resisting peer pressure or those aimed at improving self esteem or self efficacy) need developing and testing, particularly for 11 to 18 year olds. The effect of interventions in countries with existing cycle helmet legislation and in low and middle-income countries also requires investigation.

Helmets for skiers and snowboarders: an injury prevention program.

The authors' Level I trauma center has advocated the use of ski helmets for several years and in 1998, undertook a social-marketing campaign and a helmet loaner program to increase helmet use among skiers and snowboarders. The loaner program's effect on helmet acceptance was measured by comparing helmet acceptance in participating rental stores with acceptance in nonparticipating stores during 3 years. For the 1998-1999 season, 13.8% of renters in the participating stores accepted a helmet compared to 1.38% in the nonparticipating stores (p < .01); for 2000-2001, 33.5% to 3.93% (p < .01); and for 2001-2002, 30.3% to 4.48% (p < .01). The authors believe that efforts to increase helmet use--by increasing education and public awareness and decreasing barriers, such as through helmet loaner programs or routinely including helmets in rental packages--have significant potential to decrease the incidence and severity of brain injuries from skiing and/or snowboarding accidents in Colorado.

Seizure-related injuries in a group of young people with epilepsy wearing protective helmets: incidence, types and circumstances.

PURPOSE: To provide information on the incidence, types and circumstances of injuries sustained in a group of young people with epilepsy using protective helmets. METHODS: Thirty-three residential students (21 M, 12 F, age range 5-21, mean 14.5 years) attending a special epilepsy centre over 1 year were provided with helmets. The types of protective measures, seizure frequency, types of injuries, circumstances and outcome were recorded. RESULTS: Fourteen thousand seven hundred and fifty-one seizures were recorded in the 33 patients, which resulted in 59 injuries. The seizure-related injury risk was 4/1000 seizures. Scalp and facial bruises were the commonest injury (51%). Additional protective measures, such as bed guards and padding of dinner tables and sinks, were used for 57% of these students. Helmets were in use in 46% of the accidents; 68% of these accidents resulted in facial or scalp injuries, which required medical attention in 48%. Helmets were not in use in 41% of accidents; 57% of these accidents resulted in facial or scalp injuries, which required medical attention in 36%. Data on wearing of helmets in the accidents were unavailable in 13%. CONCLUSIONS: Injuries continue to occur despite the use of helmets. Changes to the helmet design and modifications to suit the seizure type may improve the protection offered by helmets.

Child and family safety device affordability by country income level: an 18 country comparison.

OBJECTIVE: To compare availability, urban price, and affordability of child/family safety devices between 18 economically diverse countries. DESIGN: Descriptive: urban price surveys by local safety organisations or shoppers. SETTING: Retail stores and internet vendors. MAIN OUTCOME MEASURES: Prices expressed in US dollars, and affordability measured by hours of factory work needed to buy a child safety seat, a belt-positioning booster seat, a child bicycle helmet, and a smoke alarm. RESULTS: Prices of child and family safety devices varied widely between countries but the variation for child safety seats and bicycle helmets did not relate strongly to country income. Safety devices were expensive, often prohibitively so, in lower income countries. Far more hours of factory work were required to earn a child safety device in lower income than middle income, and middle income than higher income, countries. A bicycle helmet, for example, cost 10 hours of factory work in lower income countries but less than an hour in higher income countries. Smoke alarms and booster seats were not available in many lower income countries. CONCLUSIONS: Bicycles and two-axle motor vehicles were numerous in lower and middle income countries, but corresponding child safety devices were often unaffordable and sometimes not readily available. The apparent market distortions and their causes merit investigation. Advocacy, social marketing, local device production, lowering of tariffs, and mandatory use legislation might stimulate market growth. Arguably, a moral obligation exists to offer subsidies that give all children a fair chance of surviving to adulthood.

Helmet rental practices at United States ski areas: a national survey.

OBJECTIVES: Studies have shown that head injuries are the leading cause of death on ski slopes. Statistics on helmet rental practices at ski areas across the United States have never been reported. This study sought to determine the prevalence of United States ski areas offering helmet rental during the 2002-03 ski season. Secondarily it sought to analyze the relationships of geographic region and size of ski area with helmet rental availability and to gather information on ski helmet rental cost to the consumer. METHODS: and setting: A stratified cross sectional telephone survey of a sample of 331 United States ski area onsite rental shops during February 2003. RESULTS: Altogether 50% of ski areas offered helmet rental with significant variation in the prevalence of helmet rental among ski areas of differing regions and sizes (p<0.01). A majority of Northeastern (57%), Western (63%), and Rocky Mountain (71%) ski areas rented helmets, whereas a minority of Southern (37%) and Midwestern (23%) ski areas rented helmets. Twenty five percent of the smallest ski areas (< or =50 acres) rented helmets compared with 74% of the largest ski areas (> or =501 acres). CONCLUSIONS: United States ski area helmet rental practices vary by region of the country and ski area size. Winter sports participants interested in wearing protective headgear should be aware of the helmet rental practices at the ski area in which they plan to visit and consider helmet purchase if they visit mainly smaller ski areas or areas within the South or Midwest.

Helmet availability at skiing and snowboarding rental shops. a survey of Colorado ski resort rental practices.

BACKGROUND: Many studies have determined that head injuries are serious and potentially life threatening in skiers and snowboarders. Helmets have proven to be effective in reducing the risk of head and brain injury in blunt trauma from bicycling, climbing, skiing, and snowboarding. The objective of this study was to evaluate the availability, cost, and prevelance of helmet rental to skiers and snowboarders at Colorado ski resorts. METHODS: A survey of rental shops based at Colorado ski areas was conducted during the 1998-1999 ski season. Surveys were mailed to 27 Colorado ski areas. The establishments surveyed were skiing/snowboarding rental shops owned, operated, or both by the resorts based at respective mountains. RESULTS: Nineteen of 26 responding Colorado ski resorts rented helmets, and helmet rental has been increasing in popularity. However, helmets were not considered as part of the standard rental package by any of the resorts, and only one resort offered a discount on helmet rental with a package. While 2% to 38% of skiers/snowboarders rented equipment, less than 1% to 8.6% of renters rented helmets. Subjectively, helmet rental was encouraged mostly for children. CONCLUSIONS: The data acquired should represent a reasonable picture of current helmet rental practices at Colorado ski areas. While helmet use is increasing, it has not yet become generally accepted.

The protective performance of bicyclists' helmets in accidents.

A study of the injuries sustained by 1,892 bicycle riders during accidents indicated that 432 of the bicyclists had been wearing a helmet and 64 of the latter group had sustained an impact to the helmet. The 64 helmets were evaluated in this project to relate the nature and severity of the impact they had sustained to the head injury experienced by the wearer. The protective performance of the helmet shells, impact absorbing liners, and retention systems were evaluated, and the severity of the impacts sustained by the helmets was simulated in the test laboratory. The simulation was performed by dropping sample helmets from progressively greater heights in a test apparatus until the damage observed on a sample helmet matched that observed on an accident damaged helmet. The severity observed in the simulated impacts was compared with the severity of test impacts prescribed in established helmet performance standards (ANSI 1984; Snell 1984; AS 1986). It was found that all of the impacts occurred against flat objects; a high proportion of helmets sustained more than one impact; most impacts occurred on areas of a helmet which were not tested during certification to a standard; and many impacts were more severe than those stipulated in performance standards. The predominant form of head injury recorded was low severity concussion--AIS-1, AIS-2, AIS-3. All serious head injuries occurred when the helmet came off the rider's head and collapsed due to a material defect or was struck predominantly below the rim. A high proportion of helmets worn by young riders had been misused, and many helmets displayed defects in the impact-absorbing liners. Recommendations have been made for improving helmet construction and altering current standards to reflect the conditions encountered in the field.