How effective are bicycle helmet campaigns?

Answer

Bicycle helmet campaigns generally lead to an increase of helmet use, but sometimes the effect is only temporary. Campaigns vary widely in terms of the extent of the effect. This depends among other things on the exact content and duration of the campaign and of course on the extent to which helmets are already worn at the start of the campaign. Moreover, most campaigns are combined with other activities, such as making bicycle helmets readily available or measures such as mandatory helmet use. As a result, the effect of stand-alone mass media awareness campaigns is unknown.

A 2002 review study reports results from 19 studies on campaigns to encourage helmet use [44]. Most of these were conducted in the United States and Canada and focused primarily on children. The studies showed different results, but the researchers conclude that:

  • promotional campaigns generally increase helmet use; 
  • the largest effect is reached among young children and particularly among girls;
  • helmet discounts have a positive effect on purchase and usage.

A more recent but smaller-scale meta-study [45] analysed eight studies on the effects of campaigns to encourage bicycle helmet use: three from North America and five from Europe. These showed an overall positive effect of campaigns, but there were large differences in the magnitude of the effect found. Further analyses showed that only the effect of campaigns combined with legislation was statistically significant and that of stand-alone campaigns was not.

One of the studies included in the aforementioned 2023 meta-analysis was the evaluation of the Dutch bicycle helmet campaign “Coole kop, helm op!” (“Wanna look cool, wear a helmet!'”). This campaign was aimed at children in the first four years of primary school in the province of Zeeland and consisted of a large number of different activities. The campaign was found to have a positive effect on helmet use among participating children, albeit only in the first campaign year [11]. In the first campaign year, almost five times as many children (aged 4-8) wore helmets compared to the pre-campaign period: an increase from an average of 3.3% to 15.7%.

Well-known and now often cited in the Netherlands, is the very successful and long-running approach taken by Denmark. In Denmark, as in the Netherlands, helmets are not mandatory. Yet, for many years Denmark has encouraged voluntary helmet use in all kinds of ways. Not only by mass media campaigns, but also by many local activities aimed at specific target groups. The so-called AAA approach in Denmark has three central elements [46]: inform people about the positive effect of helmets on the prevention of brain injury (Awareness), ensure that bicycle helmets are easy to get and cheap to buy (Availability), and improve helmet design and make adults role models for (grand)children (Attractiveness). Between 2004 and 2021, overall bicycle helmet use in Danish cities increased from 6% to 48% and helmet use by children on their way to school from 33% to 80% [46].

The Ministry of Infrastructure and Water Management is committed to encouraging the voluntary use of bicycle helmets, starting with parents of young children, commuters and seniors. In preparation of a possible campaign, both MARE [47] and SWOV [8] carried out exploratory studies of public support and experiences elsewhere on behalf of the ministry. Subsequently, D&B [48] developed a behavioural strategy, based on behavioural science principles. The strategy has three phases: 1) facilitation, 2) motivation and activation, and 3) internalisation.

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Bicycle helmets

A bicycle helmet is intended to protect cyclists against head and brain injuries when they are involved in crashes. Research shows that in case of a Meer

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