The effects of a 4-year program promoting bicycle helmet use among children in Quebec.

OBJECTIVES: This study assessed the effectiveness of a 4-year program of bicycle helmet promotion that targeted elementary school children in one region of Quebec. The program revolved primarily around persuasive communication and community organization, combining standard educational activities and activities to facilitate helmet acquisition and use. METHODS: Helmet use was compared between more than 8000 young cyclists in municipalities exposed or not exposed to the program. Factors influencing helmet use were controlled through the use of multivariate analyses. RESULTS: Helmet use increased from 1.3% before program implementation to 33% in 1993. The program was clearly effective in most cycling circumstances and for various groups of children. However, the benefits of the program were unequally distributed; the program was one third as effective in poorer municipalities as in "average-rich" ones. CONCLUSIONS: This community-based program that combined various types of activities appeared to be effective. New intervention models are needed to ensure an equitable distribution of benefits.