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Bicycle helmet use and bicyclists head injuries before and after helmet legislation in Alberta Canada Open Access


Other title
Injury prevention
Head injury
Bicycle helmet
Type of item
Degree grantor
University of Alberta
Author or creator
Karkhaneh, Mohammad
Supervisor and department
Hagel, Brent (Departments of Pediatrics and Community Health Sciences, University of Calgary)
Rowe, Brian (Department of Emergency Medicine & Public Health Sciences)
Examining committee member and department
Carroll, Linda (Department of Public Health Sciences)
Saunders, Duncan (Department of Public Health Sciences)
Pickett William (Department of Community Health and Epidemiology, Queen's University)
Voaklander, Don (Department of Public Health Sciences)
Public Health Sciences

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Bicycle activity in Canada is common and unfortunately, can result in injuries, hospitalization and even death. Bicycle helmets reduce severe head injuries. Both promotional activities and helmet legislation have been used in several countries to increase helmet wearing among bicyclists. The results of different studies have demonstrated that although promotional activities increase helmet use to some extent, sustainable effects occur following the implementation of helmet legislation. Bicycle helmet use was studied in this thesis prior to (2000-2001) and after (2003-2006) helmet legislation in Alberta. A significant increase in helmet use was observed post-legislation in Alberta by youth <18 (target age group for provincial legislation). St. Albert, an urban community in Alberta, implemented a by-law requiring cyclists of all ages to wear a helmet in 2006 and helmet wearing rose among youth <18; an encouraging but not statistically significant increase occurred among adults (18+). We examined the rate of bicycling per unit of observation time pre- and post-legislation and demonstrated that bicycling activities among youth <18 decreased only in schools and commuter routes, with no change at other locations. Since preventing head- and brain-related injuries is the main purposes of helmet wearing, the trend of bicyclist head injuries (HI) in Alberta was examined. Before doing so, in a reliability/validity study we demonstrated that bicycle injuries are coded in a reliable and valid manner in both ICD-9-CM and ICD-10-CA by emergency department (ED) coders. Examining the HI rates per 100,000 population and proportion of HI among bicyclists who presented to EDs or who were hospitalized, we demonstrated a significant decline among the legislated target age groups (<18) which was not obvious in adults. This decline was larger than expected, based on analysis of pedestrians with head injuries as a control group. We conclude that helmet legislation increased bicycle helmet use and deceased bicycle-related head injuries among the target age groups in Alberta.
License granted by Mohammad Karkhaneh ( on 2011-08-23T17:09:46Z (GMT): Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of the above terms. The author reserves all other publication and other rights in association with the copyright in the thesis, and except as herein provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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