A quasi-experimental, longitudinal evaluation of a school-based bicycle helmet campaign for children age 4–8 years in the Netherlands

Head injury severity may be reduced by a helmet, however, helmets are not mandatory in the Netherlands. Yet public support for voluntary use of helmets for children is high. This study evaluated the effect of a five-year school-based campaign (4- to 8-year-olds) on helmet-wearing rates and identified its success and failure factors. We compared observed helmet-wearing rates before the campaign, with yearly rates during programme, and related those to wearing rates in a control area. Parents, together with their children, completed questionnaires on self-reported helmet wearing, attitudes, beliefs, and barriers. Results showed that observed helmet wearing increased in the first campaign year but varied in later years. This variation in rates coincided with variations in campaign intensity over the years. Factors associated with self-reported helmet wearing were age, with higher wearing rates for younger children than older children, and parental rules for helmet use. Children and parents are positive toward helmet use when children are perceived to be less competent cyclists. The most important reason for not wearing helmets is that peers do not wear helmets. Overall, parents and children seem to be influenced by the norm in the Netherlands that children above a certain age cycle without a helmet.