Rural adolescent attitudes and use of bicycle helmets in Iowa.

Background: Helmet use significantly decreases head injuries, the most common cause of bicycle-related fatalities in youth. Our objective was to determine bicycle helmet use by rural adolescents, their attitudes regarding helmets, and associated demographic factors.

Methods: A convenience sample of 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees completed an anonymous electronic or paper survey. After compilation in Qualtrics, descriptive, bivariate and multivariable logistic regression analyses were performed using statistical program, R.

Results: 1,331 adolescents 13-18 years participated. Almost three-fifths (58%) were female; 56% were 16-18 years. One-half lived on a farm, 21% lived in the country/not on a farm and 28% lived in town. 90% of subject households had at least one bicycle. Overall, 78% had ridden a bicycle in the past year. Those from farms had lower proportions that had ridden a bicycle in the past year (73%) than those living elsewhere (83%), p < 0.001, and also rode them less frequently. The mean importance (rated 1-10) of wearing a bike helmet was 4.7 (median 4). Males, older teens, non-Hispanic White individuals, and those from farms all ascribed lower bicycle helmet importance than their corresponding peers. Only 15% supported laws requiring bicycle helmet use. Three-quarters (74%) rarely or never wore a helmet; only 13% said they always or mostly wore a helmet. A direct relationship was noted between helmet use and those who rode more frequently, and to those ascribing higher importance to helmet use. Only 12% stated their parents had a strict "no helmet, no riding" rule. However, those with a rule had 18 times greater odds of supporting bicycle helmet laws and had a higher median ascribed bicycle helmet importance as compared to those without a rule (9 vs. 4). Moreover, participants with a strict rule had 32 times higher odds of wearing a bicycle helmet always/most of the time versus those without a rule.

Conclusions: Bicycle helmet use is infrequent among rural adolescents. Youth whose parents had a strict "no helmet, no riding" rule placed greater importance on using helmets, were more supportive of bicycle helmet laws, and had significantly greater helmet use.