Abstract
Objective—To evaluate the effectiveness of a skills training program in improving safe cycling behavior, knowledge, and attitudes in young children.
Methods—Grade 4 children from six elementary schools in East York (a borough of Metropolitan Toronto) participated. The intervention—playground based instruction on bicycle handling skills by certified instructors—was randomly allocated to three schools. Altogether 141 children participated: 73 in the intervention group and 68 in the control group, with follow up evaluations available on 117 (83%). The primary outcome was safe cycling behavior (straight line riding, coming to a complete stop, and shoulder checking before a left turn). A self report questionnaire collected data on knowledge and attitudes. Baseline assessments were made in June, with follow up evaluations in September, 1995.
Results—The prevalence of safe cycling behaviors at follow up in the intervention and control groups respectively, were: straight line riding (90% v 88%; p=0.782), coming to a complete stop (90% v 76%; p=0.225), and shoulder checking (0% v 2%; p=1.000). Over time (from baseline to follow up) children in both groups were more likely to maintain straight line riding, less likely to ride on the sidewalk, and less likely to consider that a car had more right to the road.
Conclusions—This brief skills training program was not effective in improving safe cycling behavior, knowledge, or attitudes among grade 4 children.
Full Text
The Full Text of this article is available as a PDF (114.6 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Agran P. F., Winn D. G. The bicycle: a developmental toy versus a vehicle. Pediatrics. 1993 Apr;91(4):752–755. [PubMed] [Google Scholar]
- Cameron M. H., Vulcan A. P., Finch C. F., Newstead S. V. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia--an evaluation. Accid Anal Prev. 1994 Jun;26(3):325–337. doi: 10.1016/0001-4575(94)90006-x. [DOI] [PubMed] [Google Scholar]
- Cornfield J. Randomization by group: a formal analysis. Am J Epidemiol. 1978 Aug;108(2):100–102. doi: 10.1093/oxfordjournals.aje.a112592. [DOI] [PubMed] [Google Scholar]
- Donner A., Birkett N., Buck C. Randomization by cluster. Sample size requirements and analysis. Am J Epidemiol. 1981 Dec;114(6):906–914. doi: 10.1093/oxfordjournals.aje.a113261. [DOI] [PubMed] [Google Scholar]
- Donner A., Klar N. Methods for comparing event rates in intervention studies when the unit of allocation is a cluster. Am J Epidemiol. 1994 Aug 1;140(3):279–301. doi: 10.1093/oxfordjournals.aje.a117247. [DOI] [PubMed] [Google Scholar]
- Donner A., Klar N. Statistical considerations in the design and analysis of community intervention trials. J Clin Epidemiol. 1996 Apr;49(4):435–439. doi: 10.1016/0895-4356(95)00511-0. [DOI] [PubMed] [Google Scholar]
- Dorsch M. M., Woodward A. J., Somers R. L. Do bicycle safety helmets reduce severity of head injury in real crashes? Accid Anal Prev. 1987 Jun;19(3):183–190. doi: 10.1016/0001-4575(87)90002-9. [DOI] [PubMed] [Google Scholar]
- Dowswell T., Towner E. M., Simpson G., Jarvis S. N. Preventing childhood unintentional injuries--what works? A literature review. Inj Prev. 1996 Jun;2(2):140–149. doi: 10.1136/ip.2.2.140. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kimmel S. R., Nagel R. W. Bicycle safety knowledge and behavior in school age children. J Fam Pract. 1990 Jun;30(6):677–680. [PubMed] [Google Scholar]
- Langley J., Silva P. A., Williams S. M. Cycling experiences and knowledge of the road code of nine-year-olds. Accid Anal Prev. 1987 Apr;19(2):141–145. doi: 10.1016/0001-4575(87)90033-9. [DOI] [PubMed] [Google Scholar]
- Li G., Baker S. P. Injuries to bicyclists in Wuhan, People's Republic of China. Am J Public Health. 1997 Jun;87(6):1049–1052. doi: 10.2105/ajph.87.6.1049. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Maimaris C., Summers C. L., Browning C., Palmer C. R. Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers. BMJ. 1994 Jun 11;308(6943):1537–1540. doi: 10.1136/bmj.308.6943.1537. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Maring W., van Schagen I. Age dependence of attitudes and knowledge in cyclists. Accid Anal Prev. 1990 Apr;22(2):127–136. doi: 10.1016/0001-4575(90)90064-r. [DOI] [PubMed] [Google Scholar]
- Nixon J., Clacher R., Pearn J., Corcoran A. Bicycle accidents in childhood. Br Med J (Clin Res Ed) 1987 May 16;294(6582):1267–1269. doi: 10.1136/bmj.294.6582.1267. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Otis J., Lesage D., Godin G., Brown B., Farley C., Lambert J. Predicting and reinforcing children's intentions to wear protective helmets while bicycling. Public Health Rep. 1992 May-Jun;107(3):283–289. [PMC free article] [PubMed] [Google Scholar]
- Parkin P. C., Hu X., Spence L. J., Kranz K. E., Shortt L. G., Wesson D. E. Evaluation of a subsidy program to increase bicycle helmet use by children of low-income families. Pediatrics. 1995 Aug;96(2 Pt 1):283–287. [PubMed] [Google Scholar]
- Parkin P. C., Spence L. J., Hu X., Kranz K. E., Shortt L. G., Wesson D. E. Evaluation of a promotional strategy to increase bicycle helmet use by children. Pediatrics. 1993 Apr;91(4):772–777. [PubMed] [Google Scholar]
- Pendergrast R. A., Ashworth C. S., DuRant R. H., Litaker M. Correlates of children's bicycle helmet use and short-term failure of school-level interventions. Pediatrics. 1992 Sep;90(3):354–358. [PubMed] [Google Scholar]
- Rivara F. P., Booth C. L., Bergman A. B., Rogers L. W., Weiss J. Prevention of pedestrian injuries to children: effectiveness of a school training program. Pediatrics. 1991 Oct;88(4):770–775. [PubMed] [Google Scholar]
- Rivara F. P. Injury prevention and the pediatrician. J Pediatr. 1996 Oct;129(4):487–488. doi: 10.1016/s0022-3476(96)70108-7. [DOI] [PubMed] [Google Scholar]
- Rivara F. P., Thompson D. C., Thompson R. S., Rogers L. W., Alexander B., Felix D., Bergman A. B. The Seattle children's bicycle helmet campaign: changes in helmet use and head injury admissions. Pediatrics. 1994 Apr;93(4):567–569. [PubMed] [Google Scholar]
- Runyan C. W., Runyan D. K. How can physicians get kids to wear bicycle helmets? A prototypic challenge in injury prevention. Am J Public Health. 1991 Aug;81(8):972–973. doi: 10.2105/ajph.81.8.972. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sacks J. J., Holmgreen P., Smith S. M., Sosin D. M. Bicycle-associated head injuries and deaths in the United States from 1984 through 1988. How many are preventable? JAMA. 1991 Dec 4;266(21):3016–3018. [PubMed] [Google Scholar]
- Schwartz H. J., Brison R. J. Bicycle-related injuries in children: a study in two Ontario emergency departments, 1994. Chronic Dis Can. 1996 Spring;17(2):56–62. [PubMed] [Google Scholar]
- Selbst S. M., Alexander D., Ruddy R. Bicycle-related injuries. Am J Dis Child. 1987 Feb;141(2):140–144. doi: 10.1001/archpedi.1987.04460020030021. [DOI] [PubMed] [Google Scholar]
- Sidky M. SAFE KIDS Canada. Inj Prev. 1996 Mar;2(1):70–72. doi: 10.1136/ip.2.1.70. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spence L. J., Dykes E. H., Bohn D. J., Wesson D. E. Fatal bicycle accidents in children: a plea for prevention. J Pediatr Surg. 1993 Feb;28(2):214–216. doi: 10.1016/s0022-3468(05)80278-7. [DOI] [PubMed] [Google Scholar]
- Thomas S., Acton C., Nixon J., Battistutta D., Pitt W. R., Clark R. Effectiveness of bicycle helmets in preventing head injury in children: case-control study. BMJ. 1994 Jan 15;308(6922):173–176. doi: 10.1136/bmj.308.6922.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thompson R. S., Rivara F. P., Thompson D. C. A case-control study of the effectiveness of bicycle safety helmets. N Engl J Med. 1989 May 25;320(21):1361–1367. doi: 10.1056/NEJM198905253202101. [DOI] [PubMed] [Google Scholar]
- Vulcan A. P., Cameron M. H., Watson W. L. Mandatory bicycle helmet use: experience in Victoria, Australia. World J Surg. 1992 May-Jun;16(3):389–397. doi: 10.1007/BF02104437. [DOI] [PubMed] [Google Scholar]
- Wasserman R. C., Waller J. A., Monty M. J., Emery A. B., Robinson D. R. Bicyclists, helmets and head injuries: a rider-based study of helmet use and effectiveness. Am J Public Health. 1988 Sep;78(9):1220–1221. doi: 10.2105/ajph.78.9.1220. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wood T., Milne P. Head injuries to pedal cyclists and the promotion of helmet use in Victoria, Australia. Accid Anal Prev. 1988 Jun;20(3):177–185. doi: 10.1016/0001-4575(88)90002-4. [DOI] [PubMed] [Google Scholar]
- Young D. S., Lee D. N. Training children in road crossing skills using a roadside simulation. Accid Anal Prev. 1987 Oct;19(5):327–341. doi: 10.1016/0001-4575(87)90020-0. [DOI] [PubMed] [Google Scholar]
- van Schagen I. N., Brookhuis K. A. Training young cyclists to cope with dynamic traffic situations. Accid Anal Prev. 1994 Apr;26(2):223–230. doi: 10.1016/0001-4575(94)90092-2. [DOI] [PubMed] [Google Scholar]