Bicycle safety knowledge and behavior in school age children

Journal of Family Practice, June, 1990 by Sanford R. Kimmel, Rollin W. Nagel

Bicycle Safety Knowledge and Behavior in School Age Children

Over 550,000 persons are treated for bicycle-related injuries in US emergency departments each year. [1-3] The highest incidence of bicycle injury and death occurs in children aged 10 to 14 years. [3,4] In 1981 approximately 1000 bicyclists were killed, with two thirds of these deaths occurring in children 5 to 14 years of age. [5] Serious injury to the head or neck occurs in over 75% of fatal injuries, [5,6] which are usually the result of collision with a motor vehicle. [7,8]

Various studies have suggested that wearing protective headgear is one way to reduce bicycle injuries. [2,6,9] Weiss, [10] however, observed less than 2% of elementary, junior, or senior high school students to be wearing helmets as they bicycled to school. Selbst et al [6] reported that few children seen in a children's hospital emergency department for bicycle-related injuries had been wearing protective equipment such as helmets, gloves, kneepads or reflective clothing. In addition, most children had not received previous instructions on bicycle safety.

Violations of traffic law by child bicyclists, such as riding on the wrong side of the street, or riding into traffic from driveways, side streets, or alleys without stopping, are frequent causes of bicycle-motor vehicle collisions. [3,4] It is unclear whther children are ignorant of the rules of the road or are disregarding the rules.

The number and potential severity of bicycle-related injuries in children are serious concerns for parents, physicians, teachers, and law enforcement officials. The role of bicycle safety instruction in the reduction of bicycling accidents, however, is unclear. The present study surveyed school-age children about their knowledge of basic bicycle rules of the road and their use of helmets. The students were also asked about accidents or injuries that occurred while they were riding a bicycle.

METHODS

A one-page bicycle safety questionnaire was designed by the authors and confirmed as appropriate for the 4th and 5th grade reading leveled by the Fry Readability Graph. [11] All children present in grades 4 through 8 of an upper middle class suburban school district in Lucas County, Ohio, were given this questionnaire to complete during school in May 1988. The teachers for each grade distributed and collected the questionnaires. Each child could decline to compete the questionnaire, and all responses were anonymous. Differences in responses between groups were analyzed by the chi-square test of independence or Fisher's exact test.

RESULTS

The questionnaire was completed and returned by 276 of the 300 students (92%) in grades 4 through 8. Students were 9 to 15 years of age with 96% of the respondents being 10 to 14 years old. There were 146 boys (53%) completing the questionnaire. Distribution by grade level was also relatively equal.

Only 15 of 267 respondents (6%) indicated ownership of a bicycle helmet. (Nine students did not answer this question.) At least one half (8 of 15) of those owning a helmet either did not wear it or wore it less than one half the time. Thus, only 7 of 267 students (2.6%) reported frequent use of a bicycle helmet.

Almost one quarter (24%) of the students did not know that they should always ride on the right side of the street, with traffic (rule 1). One eighth (13%) did not know that a bicyclist should always stop at a stop sign or red light (rule 2). Twenty-nine percent of students did not know that a bicyclist should always stop to watch for cars and trucks when approaching a street from a driveway or alley (rule 3). There were no sex or age differences in knowledge of these rules.

Over one sixth (17%) of the students surveyed indicated that they had not received any instruction about bicycling safety and rules of the road (BSRR) from either their parents or a class. Students who had received any instruction (class or parental) in BSRR were no more likely to know rule 1 than students lacking such instruction (Table 1). Ninety percent of students receiving instruction in BSRR, however, knew rule 2 compared with 74% of those receiving no instruction (P = .008). Seventy-four percent of students receiving instruction knew rule 3 compared with 60% who did not receive instruction (P = .074). Children who had received instruction from both a formal class and their parents indicated a better knowledge of rule 2 (P < .02) and rule 3 (P < .05) than students receiving no instruction. Children receiving instruction from only their parents also indicated a better knowledge of rule 2 (P = .033) than students having no instruction. Bicycle safety instruction appears to have improved children's knowledge of two basic bicycling rules essential for safe travel with motor vehicles.

Over one third (36%) of the students indicated that they had had a bicycling accident during the preceding year. Fifty-two of these 99 students also reported that they had been hurt in the accident, while 31 indicated that their bicycle had been damaged. One eighth (32/273) of the students indicated that during their lifetime they had seen a physician or gone to a hospital as the result of a bicycling accident. Students who knew rule 1, rule 2, or rule 3 and those who responded incorrectly to questions concerning these rules did not differ in the incidence of recent bicycling accidents or whether they had been hurt in the accident. As shown in Table 2, however, students who were knowledgeable about rule 3 were less likely to have had a recent significant accident in which their bicycle was damaged than were students lacking this knowledge (8% compared with 21%, P = .005). Those students who knew rule 3 were also less likely to have ever gone to a hospital or to have seen a physician because of an injury sustained in a bicycling accident than students who did not know this rule (9% compared with 19%, P = .028) (Table 3). In a similar manner, children who did not know rule 2 were approximately twice as likely as correct responders to have their bicycle damaged in an accident (21% compared with 10%, P = .112) and to have ever gone to a physician or hospital as the result of a bicycling injury (21% compared with 11%, P = .073). Therefore, children who knew rule 2 and especially rule 3 were less likely to have had a significant bicycling accident than children who did not know these rules.