ABSTRACT The objectives of the study were to determine helmet use rates, incidence rates (IRs) of head and facial injuries for population attributable fraction (PAF) estimation, and to elucidate the magnitude of and changes in PAFs as the result of helmet use changes among preschool children. A study consisting of cross-sectional (survey) and longitudinal (follow-up) component was designed by including a randomly selected group of participants (n = 322) from 10 Head Start sites provided with free bicycle helmets along with a subgroup of prior helmet owners (n = 68) from the other random group (n = 285). All participants received bicycle helmet education. Helmet use surveys were conducted in May (1st Survey) and November 2008 (2nd Survey). The helmet owners were followed up to determine IRs, and incidence rate ratios (IRRs) for head and facial injuries. PAFs were computed using IRs as well as helmet use rates and IRRs. Helmet use rates increased significantly from the 1st to the 2nd Survey. The mean follow-up person-time was 5 months. The IRs for head, face (all portions), and face (upper/mid portions) injuries were higher in non-helmeted than helmeted riders. By using IRs, PAFs for the 3 injuries among the riders in both groups of helmet owners were 77%, 22%, and 32% respectively. The PAFs for each of the above injuries decreased by about 10% as helmet use rates increased. The magnitude of and changes in preventable head and facial injuries following free bicycle helmet distribution and education among helmeted riders was elucidated in this Head Start preschool children population.
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nullHlaing Zhu, T. , Aaland, M. , Kerrigan, C. , Schiebel, R. , Henry, H. and Hollister, L. (2011) Preventable head and facial injuries by providing free bicycle helmets and education to preschool children in a head start program. Health, 3, 689-697. doi: 10.4236/health.2011.311116.
 Administration for Children and Families (2008) Head Start program fact sheet. U.S. Department of Health and Human Services, Washington DC.
 Kopjar, B. (2000) Population preventable fraction of bicycle related head injuries. Injury Prevention, 6, 235- 238. doi:10.1136/ip.6.3.235
 Attewell, R.G. and Glase, K. (2001) McFadden M. Bicycle helmet efficacy: A meta-analysis. Accident Analysis and Prevention, 33, 345-352.
 Thompson, D.C., Rivara, F.P. and Thompson, R. (1999) Helmets for preventing head and Facial injuries in bicyclists (Review). Cochrane Database of Systematic Review. Issue 4. Article No.:CD001855. (This review is prepared and maintained by The Cochrane Collaboration, the commentary section was updated and published in The Cochrane Library 2007, Issue 3.)
 Thompson, D.C., Rivara, F.P. and Thompson, R.S. (1996) Effectiveness of bicycle helmets in preventing head injuries: A case-control study. Journal of American Medical Association, 276, 1968-1973.
 Powell, E.C. and Tanz, R.R. (2000) Cycling injuries in emergency departments: Need for bicycle helmets among preschoolers. Archive Pediatric Adolescent Medicine, 154, 1096-1100.
 Thompson, D.C., Thompson, R.S. and Rivara, F.P. (1990) Incidence of bicycle-related injuries in a defined population. American Journal of Public Health, 80, 1388-1389.
 Rivara, F.P., Thompson, D.C., Patterson, M.Q. and Thompson, R.S. (1998) Prevention of bicycle-related injuries: Helmets, education, and legislation. Annual Review of Public Health, 19, 293-318.
 Schieber, R.A. and Sacks, J.J. (2001) Measuring community bicycle helmet use among children. Public Health Reports, 116, 113-121.
 Thompson, D.C., Nunn, M.E., Thompson, R.S. and Rivara, F.P. (1996) Effectiveness of bicycle safety helmets in preventing serious facial injury. Journal of American Medical Association, 276, 1974-1975.
 Britt, J., Silver, I. and Rivara, F.P. (1998) Bicycle helmet promotion among low income preschool children. Injury Prevention, 4, 280-283. doi:10.1136/ip.4.4.280
 Armitage, P., Berry, G. and Matthews, J.N.S. (2002) Statistical methods in Medical Research. 4th Edition, Black- well Science Ltd, Malden, 121-133.
 Rothman, K.J., Greenland, S. and Lash, T.L. (2008) Modern Epidemiology. Third Edition. Lippincott Williams & Wilkins, Philadelphia.
 Hendrickson, S.G. and Becker, H. (1998) Impact of a theory based intervention to increase bicycle helmet use in low income children. Injury Prevention, 4, 126-131.
 Thompson, R.S., Rivara, F.P. and Thompson, D.C. (1989) A case-control study of the effectiveness of bicycle safety helmets. New England Journal of Medicine, 320, 1361- 1367. doi:10.1056/NEJM198905253202101
 Rivara, F.P., Thompson, D.C., Thompson. R.S., Rogers, L.W., Alexander, B., Felix. D. and Bergman AB. (1994) The Seattle Children’s Bicycle Helmet Campaign: Change in Helmet Use and Head Injury Admissions. Pediatrics, 93, 567-569.
 Thompson, N.J. and McClintock, HO. (2000) Demonstrating your program’s worth. National Center for Injury Prevention and Control, Atlanta, Georgia.
 Rockhill, B., Newman, B. and Weinberg, C. (1998) Use and misuse of population attributable fractions. American Journal of Public Health, 88, 15-19.