PERSONAL VIEW Cycle helmet wearing ian teenagers ~ do health beliefs influence behaviour ?

The issue of cycle helmets continues to excite considerable debate among cycle enthusiasts, road safety officers, and medical practitioners. Some assert that the helmet constitutes an unambiguous safety gain, whereas others question this and focus on the broader social and political context of cycling, helmet use, and legislation. As the BMA report Cycling Towards Health and Safety demonstrates,1 cycling offers young people a cheap, convenient, independent, and environmentally sound form of transport. It is also an excellent form of exercise that should be encouraged in light of The Health of the Nation targets,2 and particularly in view of recent research that points to low levels of fitness among contemporary teenagers.3 4 However, cycling on Britain's congested roads also involves risks to health through accident and injury.' Cyclists aged 15-24 appear to be particularly at risk and indeed in Oxfordshire in 1993 accounted for 41% of reported accidents to cyclists aged 15 years and over.5 Males are disproportionately represented in these figures. In Oxfordshire, more than half of young people's serious or fatal cycle accidents involve injuries to the head.6 Current debate about cycle helmets centres on the efficacy ofhelmets and the broader implications of their use. Some authors note that most cycle accidents are minor, and argue that enforced helmet use may deter people from using a bicycle and detract governments from providing safe provision for cyclists.7 In addition, considerable press coverage has been given to risk compensation theorists, who argue that cycle helmets decrease cyclists' safety by giving them a false sense of security which leads them to take more risks than they otherwise would.7-11 On the other hand, medical specialists are in little doubt that higher rates of cycle helmet wearing would radically reduce rates of serious injury and indeed save some lives.12 13 In a case-controlled study of children in Australia, Thomas et al conclude that wearing a helmet reduced the risk ofhead injury by 63% and loss of consciousness by 86%. 14 In the UK, on the basis of their study in Cambridge, Maimaris et al conclude that 'the odds of head injury were significantly reduced, by a factor of three, by wearing a cycle helmet and the protective effect of wearing a helmet was present in all ages and all types of accidents, including motor vehicle accidents'. 15 In 1993 Oxford City Council recorded a low helmet wearing rate of 13% among cyclists, including teenagers. Our study therefore aimed to discover what teenagers think about cycle helmets, the influences on wearing, and their attitudes towards prevailing counter arguments.