Georgia
Epidemiology
Report
The Georgia Epidemiology Report is a publication of the Epidemiology Section of the Epidemiology and Prevention Branch, Division of Public Health, Department of Human Resources
October 1996
Volume 12 Number 10
Effectiveness of the Georgia Bicycle Helmet Law
http://www.ph.dhr.state.ga.us
Division Of Public Health
Patrick J. Meehan, M.D. - Director Epidemiology and Prevention Branch State Epidemiologist
Kathleen E. Toomey, M.D., M.P.H.- Director Epidemiology Section Paul A. Blake, M.D., M.P.H.-Chief
Notifiable Diseases
Jeffrey D. Berschling, M.P.H.; Karen R. Horvat, M.P.H. ; Amri B. Johnson, M.P.H. ; Jane E. Koehler, D.V.M, M.P.H.; Preeti Pathela, M.P.H.; Sabrina Walton, M.S.P.H.
Chronic Disease
Nancy E. Stroup, Ph.D.-Program Manager Patricia M. Fox, M.P.H.; David M. Homa, Ph.D., M.P.H.; Thomas W. McKinley, M.P.H.; Edward E. Pledger, M.P.A.;
Tuberculosis
Naomi Bock, M.D., M.S.
HIV/AIDS/Sexually Transmitted Diseases
Kim Cook, M.D., M.S.P.H.-Program Manager Awal D. Khan, Ph.D., M.A.; Stephanie Bock, M.P.H.; Andrew Margolis, M.P.H.
Office of Perinatal Epidemiology
Roger W. Rochat, M.D. - Program Manager Mary D. Brantley, M.P.H.; Raymond E. Gangarosa, M.D., M.P.H.; Rebekah Hudgins, M.P.H.; Mary P. Mathis, Ph.D., M.P.H.; Florina Serbanescu, M.D.
Preventive Medicine Residents
Hussain R. Yusuf, M.B.B.S., M.P.H..; E. Anne Peterson, M.D.
EIS Officer
Michael S. Friedman, M.D.
Georgia Epidemiology Report Editorial Board
Editorial Executive Committee Paul A. Blake, M.D., M.P.H.- Editor Kathleen E. Toomey, M.D., M.P.H. Mary D. Brantley, M.P.H. Jeffrey D. Berschling, M.P.H.
Mailing List Edward E. Pledger, M.P.A.
Each year in the United States, bicycle-related injuries lead to roughly 800 deaths, 20,000 hospital admissions and 580,000 emergency room visits1. About two-thirds are younger than 16 years of age; among these--65% who die and 36% who are nonfatally injured--have sustained a head injury. Although a bicycle helmet reduces the risk of head injury in a crash by 74-85%2, only about 15% of the estimated 26.4 million bicyclists younger than 15 years in the US wear one all or most of the time3.
In response to this low usage and the more than one dozen bicycle-related deaths each year in Georgia, the state passed a law effective July 1, 1993 that all riders less than 16 years wear a helmet or be subject to a $25 fine. Georgia was the second state in the nation to do so. The Georgia Division of Public Health, in collaboration with the Centers for Disease Control and Prevention (CDC), studied the effectiveness of this law on helmet usage.
Methods The Georgia Behavioral Risk Factor Surveillance System
(BRFSS) Survey, a random-digit-dialed telephone survey, was used to collect data. Between June-November 1993, six questions about helmet ownership and use were added to this ongoing state survey. Within each household contacted, one adult respondent was randomly selected and asked to (proxy) report on each child living there who was 4 through 15 years old and rode a bicycle. Reported helmet use was ascertained in two ways: (1) "last-time" helmet use, defined as wearing a helmet the last time a child rode, and (2) "typical" helmet use during the periods before and after July 4. The final survey question asked whether the respondent knew of any law in Georgia requiring children to wear a bicycle helmet. It was assumed that if the adult respondent did not know that a law existed, effectively, no law existed for the children in that household. Thus, by comparing helmet use of children from families in which the law was known versus was not known, we could estimate the effectiveness of the law.
Epidemiology Section, Epidemiology & Prevention Branch, Two Peachtree St., N.W., Atlanta, GA 30303-3186
Phone: (404) 657-2588
FAX: (404) 657-2586
Results Data were available for 1,106 (99.2%) of the
1,115 households interviewed. Three hundred ninety (76%) of the 522 children (234 households) in that sample were between 4 and 15 years old and rode a bicycle. Complete data were available for 79 riders from 47 households from interviews before the law took effect, and for 290 riders from 182 households from interviews afterwards.
The month before the law took effect, 33% of riders used a helmet (Figure 1). After the law took effect, helmet use ranged from 39% to 60% (mean 52%). Compared with baseline, average use increased by 58% from the pre-law to the post-law period (p<0.05).
Figure 1. Reported Helmet Use, Georgia June through November 1993
spondent knew of the law (Figure 2).
Black and white riders were analyzed separately because race significantly interacted with knowledge of the law. Sixty-nine percent of black riders from households in which the law was known used a helmet, compared with none of the riders from households in which the law was not known. Thus, in black riders, a very strong association existed between knowledge of the law and helmet use. In white riders, the association also existed, but was not statistically significant. Instead, household income and rider age appeared to be more important than knowledge of the law in predicting whether a helmet would be used.
Figure 2. Reported Helmet Use by Race, Age and Annual Household Income
Typical helmet use increased after the law took effect in 18% and decreased in 2% of children. Seven percent switched from "never-wearing" to "always-wearing" reported behavior; all lived in households in which the respondent knew the law. Reported typical use was consistent with reported last-time use.
Because helmet use did not change significantly during the five months following the law, data from the post-law period were aggregated. Overall, 71% of respondents were aware of the law; this value did not fluctuate significantly during the study period. Helmet use was significantly associated with knowledge of the law: 64% of riders from households in which the law was known used a helmet, compared with only 25% of those from households in which the law was not known. In each race, income, and age strata, helmet use was consistently higher in households in which the re-
Conclusions The Georgia law appears to have increased
helmet use and achieved part of its purpose. These findings are consistent with those of other studies. In Howard County, Maryland, helmet use increased in children from 4% before the law to 47% afterwards4. In Victoria, Australia, helmet use increased from 36% to 73% after a mandatory helmet law took effect, and the number of bicyclists killed or hospitalized for a head injury decreased substantially5.
For a variety of reasons, many children resist wearing a bicycle helmet. A law could help overcome short-term resistance to use, giving promotional programs more time to change the prevailing attitudes and social norms. Examples of such promotions are bicycle helmet giveaway or discount programs, and including a helmet with each new
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bicycle sold. This study suggests that such programs may likely succeed, because, by report, most children who owned a helmet used it, regardless of income (data not shown). Because sibling helmetwearing behavior was largely concordant, we postulate that convincing one child to wear a helmet could possibly result in other children in that household wearing theirs as well. Also, more publicity about the law to enhance public awareness may increase helmet use further, since our results show that reported helmet ownership and use were greater among those aware of the law, particularly in blacks. This study supports the value of the Healthy People 2000 objective urging all 50 states to enact a statewide bicycle helmet law in the next four years. According to these findings, Georgia's children have already surpassed the national goal of 50% helmet use by the Year 2000. A full report was recently published6.
References 1. Baker SP, Li G, Fowler C, Dannenberg AL: Injuries to bicyclists: a national perspective. The Johns Hopkins University Injury Prevention Center, Baltimore, Maryland, 1993.
2. Thompson RS, Rivara FP, Thompson DC. A case-control study of the effectiveness of bi-
cycle safety helmets. N Engl J Med. 1989;320:1361-1367.
3. Rogers GB, Tinsworth DK, Polen C et al. Bicycle use and hazard patterns in the United States. Washington, DC: US Consumer Product Safety Commission; June 1994. Publication 1994-376-299/10414.
4. Cote T, Sacks JJ, Lambert-Huber DA, et al. Bicycle helmet use among Maryland children: effect of legislation and education. Pediatrics. 1992; 89:1216-1220.
5. Cameron MH, Vulcan AP, Finch CF, Newstead SV. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia--an evaluation. Acc Anal Prev. 1994;26:325-337.
6. Schieber RA, Kresnow MJ, Sacks JJ, Pledger EE, O'Neil JM, Toomey KE. Effect of a state law on reported bicycle helmet ownership and use. Arch Pediatr Adolesc Med 1996;150:707-712.
This report was contributed by Richard A. Schieber, MD, MPH, Marcie-jo Kresnow, MS, Jeffrey J. Sacks, MD, MPH, and Joann M. O'Neil, BS of the National Center for Injury Prevention and Control, CDC, and by Edwin E. Pledger, MPA and Kathleen Toomey, MD, MPH of the Epidemiology and Prevention Branch, Division of Public Health, GA Department of Human Resources.
Nurses, Social Workers, Respiratory Therapists
Second Annual Georgia Nurses' Tuberculosis Conference
A Multidisciplinary Approach to Building Partnerships in the Community
Tuesday, December 3, 1996 Atlanta Marriott North Central, Atlanta, GA
Keynote Speaker:
Lee B. Reichman, MD, MPH
Executive Director, National Tuberculosis Center New Jersey Medical School
Sponsors Atlanta Tuberculosis Coalition, American Lung Association of GA, Division of Infectious Diseases Emory University School of Medicine, Georgia Department of Human Resources Epidemiology and Prevention Branch, Georgia Infection Control Network, and Southeast AIDS Training and Education Center (SEATEC)
Contact hours will be offered Call for a brochure/application/information
TB Conference Hotline (404) 727-1758
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The Georgia Epidemiology Report Epidemiology and Prevention Branch Two Peachtree St., NW Atlanta, GA 30303-3186
October 1996
Volume 12 Number 10
Reported Cases of Selected Notifiable Diseases in Georgia
Profile for July 1996
Selected Notifiable Diseases Campylobacteriosis Giardiasis
Total Reported forJuly 1996 86 83
Previous 3 Months Total
Ending inJuly
1996 1995 1994
241
343
379
173
144
124
Previous 12 Months Total
Ending inJuly
1996 1995 1994
864
1102
811
642
480
461
Meningococcal Disease Rubella Salmonellosis Shigellosis Viral Meningitis Tuberculosis Congenital Syphilis Early Syphilis Other Syphilis Cryptosporidiosis E. coli O157:H7 Legionnaires' Disease Lyme Disease Mumps Pertussis
5
35
13
23
153
80
93
0
0
0
7
0
0
7
156
375
403
460
1654
1499 1357
90
183
427
622
761
1907 1091
8
16
22
29
95
68
108
33
149
189
186
766
745
800
0
15
15
16
61
51
67
170
453
633
594
2262
2636 3001
76
211
329
220
993
1014
891
10
24
14
2
128
38
8
7
15
13
6
36
34
18
0
1
6
25
5
44
101
0
1
7
44
2
52
103
0
0
2
3
7
13
15
0
7
6
12
31
28
49
The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state
office; and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.
AIDS Profile Update
Report Period
Total Cases Reported *
Percent Female
MSM
Risk Group Distribution (%)
Race Distribution (%)
IDU MSM&IDU HS Blood Unknown White Black Other
Last 12 Mos 10/95 to 09/96 5 Yrs Ago 10/90 to 09/91 Cumulative 01/80 to 09/96
2397 1434 16389
18.3 12.0 14.1
44.9 16.6
4.3
58.5 20.3
5.6
52.6 19.0
6.0
16.1
1.4
16.7
34.6 62.6 2.8
9.0
1.9
4.7
46.2 52.4 1.4
10.6
2.1
9.7
41.3 56.7 1.9
MSM - Men having sex with men
IDU - Injection drug users
* Case totals are accumulated by date of report to the Epidemiology Section
HS - Heterosexual
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