More than 70 percent of children ages 5 to 14 (27.7 million) ride bicycles. This age group rides about 50 percent more than the average bicyclist and accounts for approximately one-third of all bicycle-related deaths and more than two-thirds of all bicycle-related injuries. Bicycles are associated with more childhood injuries than any other consumer product except the automobile.

Head injury is the leading cause of death in bicycle crashes and is the most important determinant of bicycle-related death and permanent disability. Head injuries account for more than 60 percent of bicycle-related deaths, more than two-thirds of bicycle-related hospital admissions, and about one-third of hospital emergency room visits for bicycling injuries. The single most effective safety device available to reduce head injury and death from bicycle crashes is a bicycle helmet. Helmet use is associated with a reduction in the risk of bicycle-related death and injury and a reduction in the severity of head injury when a crash occurs. Unfortunately, national estimates report that bicycle helmet use among child bicyclists ranges from 15 to 25 percent. Helmet usage is lowest (for all ages) among children ages 11 to 14 (11 percent). Bicycle education programs and mandatory bicycle helmet legislation are effective at increasing helmet use and, therefore, reducing bicycle-related death and injury.

DEATHS AND INJURIES

• In 1995, more than 250 children ages 14 and under died in bicycle-related crashes. Motor vehicles were involved in 230 of these deaths.

• In 1996, more than 350,000 children ages 14 and under were treated in hospital emergency rooms for bicycle-related injuries.

• It is estimated that collisions with motor vehicles account for 90 percent of all bicycle-related deaths and 10 percent of all nonfatal bicycle-related injuries. Collision with a motor vehicle increases the risk of death, severity of injury, and the probability of sustaining a head injury.

• More than 40 percent of all head injury-related deaths and approximately three-fourths of head injuries occur among children ages 14 and under. Younger children suffer a higher proportion of head injuries than older children.

WHEN AND WHERE BICYCLE DEATHS AND INJURIES OCCUR

• Children are more likely to die from bicycle crashes at non-intersection locations (66 percent), during the months of May to August (55 percent), and between 3 p.m. and 6 p.m. (39 percent).

• Nearly 60 percent of all childhood bicycle-related deaths occur on minor roads. The typical bicycle/motor vehicle crash occurs within one mile of the bicyclist's home.

• Children ages 14 and under are more likely to be injured riding in non-daylight hours (e.g., at dawn, dusk or night). The risk of sustaining an injury during non-daylight conditions is nearly four times greater than during the daytime.

• Among children ages 14 and under, more than 80 percent of bicycle-related fatalities are associated with the bicyclist's behavior. The most common crashes include riding into a street without stopping; turning left or swerving into traffic that is coming from behind; running a stop sign; and riding against the flow of traffic.

WHO IS AT RISK

• Riding without a bicycle helmet increases the risk of sustaining a head injury in the event of a crash. Nonhelmeted riders are 14 times more likely to be involved in a fatal crash than bicyclists wearing a helmet.

• Collision with a motor vehicle and crashes occurring at speeds greater than 15 miles per hour increase the risk of severe bicycle-related injury and death.

• Children ages 14 and under are five times more likely to be injured in a bicycle-related crash than older riders.

• Males account for approximately 85 percent of bicycle-related deaths and 70 percent of nonfatal injuries and have higher bicycle-related death and injury rates than females. Children ages 10 to 14, especially males, have the highest death rate from bicycle-related head injury of all ages.

• Children under age 10 are at greater risk for serious injury and are more likely to suffer head injuries than older riders. Approximately half of all bicycle-related injuries among children under age 10 occur to the head/face, compared to one-fifth among older children.

• Bicyclists admitted to hospitals with head injuries are 20 times more likely to die as those without head injuries.

BICYCLE HELMET EFFECTIVENESS

• Bicycle helmets have been shown to reduce the risk of head injury by as much as 85 percent and the risk of brain injury by as much as 88 percent. Bicycle helmets have also been shown to offer substantial protection to the forehead and mid face.

• It is estimated that 75 percent of bicycle-related fatalities among children could be prevented with a bicycle helmet.

• Universal use of bicycle helmets by children ages 4 to 15 could prevent between 135 and 155 deaths, between 39,000 and 45,000 head injuries, and between 18,000 and 55,000 scalp and face injuries annually.

• Child helmet ownership and use increases with income and educational level, yet decreases with age. Children are more likely to wear a bicycle helmet if riding with others (peers or adults) who are also wearing one and less likely to wear one if their companions are not.

BICYCLE HELMET LAWS AND REGULATIONS

• Currently, 15 states and more than 30 localities have enacted some form of bicycle helmet legislation, most of which cover only young riders.

• Various studies have shown bicycle helmet legislation to be effective at increasing bicycle helmet use and reducing bicycle-related death and injury among children covered under the law. Helmet use among children is greater in those regions of the United States with the highest proportion of mandatory helmet laws.

• One example shows that five years following the passage of a state mandatory bicycle helmet law for children ages 13 and under, bicycle-related fatalities decreased by 60 percent.

• Pursuant to the Child Safety Protection Act of 1994, the Consumer Product Safety Commission is currently developing a mandatory federal safety standard for bicycle helmets.

HEALTH CARE COSTS AND SAVINGS

• Every bicycle helmet saves this country $395 in direct medical costs and other costs to society.

• If 85 percent of all child cyclists wore bicycle helmets in one year, the lifetime medical cost savings could total between $109 million and $142 million.

• A review of hospital discharge data in Washington state found that treatment for nonfatal bicycle injuries among children ages 14 and under cost more than $113 million each year, an average of $218,000 per child.

PREVENTION TIPS FROM THE NATIONAL SAFE KIDS CAMPAIGN

• A bicycle helmet is a necessity, not an accessory. Always wear a bicycle helmet every time and everywhere you ride.

• Wear a bicycle helmet correctly. A bicycle helmet should fit comfortably and snugly, but not too tightly. It should sit on top of your head in a level position and should not rock forward and back or from side to side. The helmet straps must always be buckled.

• Buy a bicycle helmet that meets or exceeds the safety standards developed by the American National Standards Institute (ANSI), the Snell Memorial Foundation and/or the American Society for Testing and Materials (ASTM).

• Learn the rules of the road and obey all traffic laws. Ride on the right side of the road, with traffic, not against; use appropriate hand signals; respect traffic signals; stop at all stop signs and stop lights; and stop and look both ways before entering a street.

• Cycling should be restricted to sidewalks and paths until a child is age 10 and able to show how well he or she rides and observes the basic rules of the road. Parental and adult supervision is essential until the traffic skills and judgment thresholds are reached by each child.

9/97