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Canadian doctors call for mandatory cycle helmets for all 'to reduce head injury'

Paper claims those discouraged from cycling by helmet laws may move to alternative sports to keep fit

Paediatricians in Canada are putting pressure on the government to legislate for mandatory cycle helmets, saying that forcing adults to wear them could protect children who copy their behaviour.

Currently only currently only four of thirteen Canadian provinces and territories have full helmet legislation, but the Canadian Paediatric Society is calling for them to be made mandatory for all ages.

In a paper entitled Bicycle helmet use in Canada: The need for legislation to reduce the risk of head injury, the CPS argues:

Bicycling is a popular activity and a healthy, environmentally friendly form of transportation. However, it is also a leading cause of sport and recreational injury in children and adolescents. Head injuries are among the most severe injuries sustained while bicycling, justifying the implementation of bicycle helmet legislation by many provinces. There is evidence that bicycle helmet legislation increases helmet use and reduces head injury risk. Evidence for unintended consequences of helmet legislation, such as reduced bicycling and greater risk-taking, is weak and conflicting. Both research evidence to date and recognition of the substantial impact of traumatic brain injuries support the recommendation for all-ages bicycle helmet legislation.

"Bicycle helmets reduce the risk of head and brain injuries significantly and studies show that legislation increases the use of helmets," said Dr. Brent Hagel, statement co-author and member of the CPS Injury Prevention Committee.

"Everyone is at risk for head injury, regardless of age group.
"Children see adults and often adopt similar behaviours, so if we can get helmets on adults then children and adolescents will be more likely to wear them too."

Six provinces and territories currently have no legislation at all on bike helmets:

  • Saskatchewan
  • Quebec
  • Newfoundland and Labrador
  • Yukon
  • Northwest Territories
  • Nunavut
  • Three provinces have bike helmet legislation that only applies to children:

  • Alberta
  • Ontario
  • Manitoba

Four provinces meet CPS recommendations for all ages bike helmet legislation:

  • British Columbia
  • New Brunswick
  • Nova Scotia
  • Prince Edward Island

The report found that in those places that had legislated, helmet use had gone up.
“Systematic reviews have... demonstrated that legislation increases the use of helmets in children and youth.

“One review showed that bicycle helmet use increased postlegislation, with more than one-half of the included studies demonstrating an increase of at least 30%.

“One Ontario study noted a 20% increase in helmet use among children five to 14 years of age two years after passage of helmet legislation covering riders younger than 18 years of age, demonstrating larger increases in low- and middle-income areas.”

Despite evidence from countries including Australia, showing that helmet legislation reduces the number of people riding bikes, Dr Hagel insists that this is not necessarily proven.

“We definitely don’t want to stop people from cycling, we want to increase cycling,” he said.
“If there’s more education that needs to be done and perhaps more environmental changes to increase cycling, I think that’s where we need to look next rather than target legislation for mixed evidence.”

The report added: “While some individuals may avoid bicycling due to helmet legislation, it would need to be shown that they do not replace it with other physical activities for helmet legislation to be considered to have a negative effect on overall health.”

The report said: “There is... ample research indicating that legislation reduces risk of bicycle-related head injury. Evidence of the potential negative effects of bicycle helmet legislation, such as reduced bicycling, is mixed, and a direct cause-and-effect relationship has not been demonstrated.

“Head injuries rank among the most severe injuries in bicyclists, representing 20% to 40% of all bicycling injuries.

“Overall death rates in Canada are estimated to be 0.27 per 100,000 population.”

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