Bicycle Helmet Use After the Introduction of All Ages Helmet Legislation in an Urban Community in Alberta, Canada

Background: Bicycle trauma is a common cause of recreational death and disability and helmets have been shown to reduce fatal and non-fatal head and face injuries. This study evaluated the effect of mandatory bicycle helmet legislation for all ages in St. Albert, Alberta. Methods: We observed bicyclists from June to September of 2006 in St. Albert, a community subject to both provincial (<18 years old) and municipal (all ages) helmet legislation, and compared our results with observations taken in 2000 when no legislation existed. Helmet wearing and rider characteristics were recorded by trained observers. Poisson regression analysis was used to obtain helmet prevalence (HP) and prevalence ratio (PR) estimates. Results: HP increased from 45% to 92% (PR=2.03; 95% Cl: 1.72-2.39) post-legislation. Controlling for other covariates, children were 53% (PR=1.53; 95% Cl: 1.34-1.74) and adolescents greater than 6 times (PR=6.57; 95% Cl: 1.39-31.0) more likely to wear helmets; however, adults (PR=1.26; 95% Cl: 0.96-1.66) did not show a statistically significant change post-legislation. Restricting the analysis to high socio-economic status areas, adult helmet prevalence increased in St. Albert from 58% to 73% post-legislation compared with a 52% to 57% change across the province; this effect was not statistically significant. Conclusions: Helmet legislation in St. Albert was associated with a significant increase in helmet use among child and adolescent cyclists. A larger increase in HP was observed for adults in St. Albert than in other areas of the province; however, this difference was not statistically significant, which may reflect the small sample size or insufficient time passage after bylaw enactment.