Racial/Ethnic Disparities in Bicycle Helmet Use among Children with and Without Special Health Care Needs: Effects of Neighborhood Characteristics and State Helmet Laws

Introduction: Bicycle related head injuries are a major cause of morbidity and mortality among children, but little is known about racial and ethnic disparities in bicycle helmet use (BHU) among children with (CSHCN) and without special health care needs (CWSHCN).

Objective: To examine racial/ethnic disparities in BHU among CSHCN and CWSHCN, and the effects of neighborhood characteristics (perceived support and home safety) and state bike helmet laws on BHU.

Methods: Analysis of data on 55106 children, 6-17 year old in the 2003 National Survey of Children¢s Health. Multivariate analyses adjusted for child s age, gender, health status, residence, maternal education, income, and availability of personal doctor/nurse.

Results: 55% of CSHCN (n=7109) and 52% of CWSHCN (n=24976) always or usually used bicycle helmets. Among CSHCN, blacks (OR=0.5 [0.4-0.7]), Hispanics (OR=0.6 [0.4-0.8]), and American Indians (OR=0.3 [0.1-0.8]) had significantly lower unadjusted odds of BHU than white children. After adjustments, disparities in BHU persisted for black (OR=0.5 [0.4-0.7]) and Hispanic (OR=0.5 [0.4-0.8]) CSHCN. Among CWSHCN, blacks (OR=0.4 [0.4-0.5]), Hispanics (OR=0.7 [0.6-0.8]), and American Indians (OR=0.6 [0.4-0.9]) had significantly lower unadjusted odds of BHU, and Asians had twice the BHU odds of white children (OR=2.5 [1.3-4.5]). Racial/ethnic disparities in BHU persisted for blacks (OR=0.5 [0.4-0.5]) and Hispanics (OR=0.8 [0.7-0.9]) after adjustment. For both CSHCN (OR=2.7 [2.2-3.3]) and CWSHCN (OR=2.8 [2.6-3.2]), BHU was 3 times greater in states with statewide bicycle helmet laws and 20% greater in states with some bicycle helmet laws compared to those without any bicycle helmet laws. Home safety was associated with increased BHU among CWSHCN (OR=1.3 [1.1-1.4]) but not CSHCN. CWSHCN in least supportive neighborhoods had lower BHU (OR=0.8 [0.7-0.9]) than those in the most supportive neighborhoods. Overall, BHU was lower among older children, non-MSA residents, children without a personal doctor/nurse or with mothers with less than college graduate education, and those in household with income <300% federal poverty threshold.

Conclusions: Racial/ethnic disparities in BHU exist for black and Hispanic CSHCN and CWSHCN and persist after adjustments. For both CSHCN and CWSHCN, state bicycle helmet laws are significantly associated with greater BHU. Policies that increase statewide bicycle helmet laws and interventions that promote BHU among all children, and particularly black and Hispanic children, are likely to substantially increase BHU and reduce racial/ethnic disparities in BHU.