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Am J Public Health. 2014 Aug;104(8):e106-11. doi: 10.2105/AJPH.2014.302012. Epub 2014 Jun 12.

Public bicycle share programs and head injuries.

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At the time of this study, Janessa M. Graves was with Harborview Injury Prevention and Research Center, Department of Pediatrics, University of Washington School of Medicine, Seattle, and the College of Nursing at Washington State University, Spokane. Barry Pless is with Epidemiology and Biostatistics, McGill University, and the Injury Prevention Program at the Montreal Children's Hospital, Montreal, QC. Lynne Moore is with the Centre de Recherche du Centre Hospitalier Affilié Universitaire de Québec-Hôpital de l'Enfant-Jésus, Traumatologie-Urgence-Soins Intensifs, Axe Sante des Populations-Pratiques Optimales en Sante, Québec. Avery B. Nathens is with Sunnybrook Health Sciences Centre, the University of Toronto, and Systems of Trauma Care, Toronto, ON. Garth Hunte is with the Department of Emergency Medicine, University of British Columbia, Vancouver. Frederick P. Rivara is with Seattle Children's Hospital and Department of Pediatrics, University of Washington, and Harborview Injury and Research Center, Seattle.



We evaluated the effect of North American public bicycle share programs (PBSPs), which typically do not offer helmets with rentals, on the occurrence of bicycle-related head injuries.


We analyzed trauma center data for bicycle-related injuries from 5 cities with PBSPs and 5 comparison cities. We used logistic regression models to compare the odds that admission for a bicycle-related injury would involve a head injury 24 months before PBSP implementation and 12 months afterward.


In PBSP cities, the proportion of head injuries among bicycle-related injuries increased from 42.3% before PBSP implementation to 50.1% after (P < .01). This proportion in comparison cities remained similar before (38.2%) and after (35.9%) implementation (P = .23). Odds ratios for head injury were 1.30 (95% confidence interval = 1.13, 1.67) in PBSP cities and 0.94 (95% confidence interval = 0.79, 1.11) in control cities (adjusted for age and city) when we compared the period after implementation to the period before.


Results suggest that steps should be taken to make helmets available with PBSPs. Helmet availability should be incorporated into PBSP planning and funding, not considered an afterthought following implementation.

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