Contracting with Children and Helmet Distribution in the Emergency Department to Improve Bicycle Helmet Use

David Bishai, Asma Qureshi, Noelia Cantu, Cheryl Parks

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Objectives: To determine whether injury prevention counseling and behavioral counseling delivered in the emergency department (ED) could result in increases in self-reported bicycle helmet use. Methods: The authors undertook a trial of counseling in 222 children recruited in an urban ED between August 2000 and October 2001. All consenting patients in the ED aged 5 to 15 years who did not have life-threatening conditions were eligible. One hundred nine children were assigned to the control group on the basis of attendance on an odd-numbered day, and they received a photocopied photograph of the hospital. One hundred thirteen children were assigned to the intervention group, and they received a personal counseling session and signed a contract promising to wear their bicycle helmets. In addition, 57 of the intervention children were assigned (based on having an even-numbered birthday) to be fitted with helmets if they did not already own them. Parents were telephoned four weeks after the ED encounter for follow-up. Results: Follow-up data were obtained for 148 children (67% follow-up rate), of whom only 69 reported riding a bicycle in the four weeks after their ED visit. Of the final sample of 69 children, 38 belonged to one of the intervention groups, and 25 of these (66%) reported always wearing a helmet while cycling during the four weeks after their ED visit, versus 13 of 31 (42%) in the control group (odds ratio, 2.66; p < 0.05). The effect of the intervention was independent of whether the children owned a helmet at baseline. Conclusions: Injury prevention counseling in the ED using "The Injury Prevention Program" (TIPP) sheet, behavioral contracting, and helmet distribution may have a significant effect on reports of subsequent bike helmet use.

Original languageEnglish (US)
Pages (from-to)1371-1377
Number of pages7
JournalAcademic Emergency Medicine
Issue number12
StatePublished - Dec 2003


  • Anticipatory guidance
  • Communications
  • Counseling
  • Helmet safety
  • Injury prevention
  • Knowledge
  • Patient education
  • Pediatrics
  • Quality of care
  • Risk behavior

ASJC Scopus subject areas

  • Emergency Medicine


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