THE PHYSICIAN AND SPORTSMEDICINE - VOL 30 - NO. 4 - APRIL 2002
Bike Safety Future Takes Shape
Bike safety efforts are breaking new ground, thanks to an unprecedented thrust from biking, transportation, and government groups. Though participation has decreased the past few years as scooters, skateboards, and in-line skates have become popular, many experts believe that cycling will rebound because of antiobesity efforts, traffic congestion, and the arthritic knees of aging baby boomers.
Mapping National Priorities
In July 2000, a diverse panel—including groups that had previously been adversaries—met in Washington, DC, to establish safety priorities. In 2001, the group published an action plan1 that consists of five main goals with several suggested action steps. Richard A. Schieber, MD, MPH, who heads up childhood injury prevention efforts for the Centers for Disease Control and Prevention, notes that the safety discussions went well beyond helmet use. The five main goals are that motorists will share the road, bicyclists will ride safely, bicyclists will wear helmets, the legal system will support safe bicycling, and roads and paths will safely accommodate bicyclists.
"We're taking a broader look at injury prevention, not walking away from traumatic brain injury," Schieber says. He adds that nearly 90% of bike-related emergency department visits are for injuries other than the brain. The report points out that society has not placed the same value on cyclist education as on driver education. Observers hope to see a shift toward school- and community-sponsored safe riding courses (covering road rules and bike maintenance) for all age-groups.
Randy Swart, a panel participant and director of the Bicycle Helmet Safety Institute based in Arlington, Virginia, says the group addressed all factors, such as driving habits and traffic congestion, that make biking more dangerous than it should be. "We're doing more with bike safety than I've ever seen before," he says, "but efforts aren't yet as intensive as I'd like to see."
Despite a focus on helmet use over the past several years, many riders still aren't using them. Tracking helmet-use patterns, though, has been controversial. The US Consumer Product Safety Commission (CPSC) phone survey2 found that 50% of riders wear helmets when they bike; but observational studies have found usage levels to be as low as 17%.3 Swart says that observational studies are the gold standard, and he notes that if helmet use had really approached 50%, retailers would have noted a boom in helmet sales, "and we haven't seen that."
Some experts wonder if helmets may give some riders a false sense of security. Yet no one disputes the protective effect of helmets, Schieber says. Bike helmets are thought to prevent between 74% and 85% of brain injuries. "You don't get these kind of favorable odds from most other types of safety gear," he says.
Some states and municipalities are so swayed by the ability of helmets to protect against brain injuries that 20 states and 84 localities have enacted mandatory bike helmet laws. "About half of children age 14 and under in the US are now covered by a helmet use law," says Schieber, who notes that such laws have a powerful effect, particularly when accompanied by intensive public information campaigns.
Another facet of recent helmet safety discussions is a federal safety standard set by the CPSC that went into effect in 1999. A CPSC safety sticker can be found on the inside liner of new helmets; older helmets certified by the American Society for Testing and Materials (ASTM) and/or the Snell Memorial Foundation may continue to be used. If a multisport helmet is used for biking, it must meet the CPSC bike helmet standard.
Important Roles for Physicians
Schieber, also a pediatric intensive care specialist, says physicians have a vital role in promoting helmet use and bike safety. They can be spokespeople who advocate mandatory helmet laws; he notes that sample legislation is available on the American Academy of Pediatrics Web site. Such laws are potent because parents and teachers seem willing to enforce bike helmet use among children, and children want to be law abiding. "The laws also seem to overcome some excuses for not wearing bike helmets," he says. Physicians can also become knowledgeable about and support local bike safety educational efforts.
A physician's most powerful efforts can occur during routine office visits, Scheiber says. It's particularly useful to ask grade school children and preteens if they wear helmets and if they conduct regular safety checks of their bicycles. A recent study4 of the effects of physician counseling that targeted six health risk and safety behaviors among fifth and sixth graders found a positive outcome only for bicycle helmet use. The intervention consisted of clinician encouragement of family communication and rule setting about the health and safety issues, along with quarterly newsletters that reinforced the clinician's message. Another key intervention, says Frederick Rivara, MD, MPH, a panel participant and professor of pediatrics at Harborview Injury Prevention and Research Center in Seattle, is to encourage parents to wear helmets. "There is good data to show that if parents are helmeted, then kids are helmeted," he says. Parents should also be advised about proper helmet fit.
AHA Urges AEDs for Fitness Clubs
The recommendation applies to larger facilities and those that have programs targeted to seniors. The statement supports a 1998 AHA recommendation that health clubs screen clients for cardiovascular disease and train for emergencies. The AHA notes that as the number and age of health club users grow, so will the number of members with undiagnosed cardiovascular disease.
New Doping Agent Made Olympic Debut
Though darbepoetin is not specifically listed in the Olympic Movement Anti-Doping Code, the code states that substances related to EPO are prohibited. In a press release issued by the International Olympic Committee (IOC), Donald Catlin, MD, who headed the IOC-accredited drug testing lab during the Salt Lake City games, said that the urine test for EPO also detects darbepoietin, which can easily be differentiated from EPO because the new drug is an artificial substance.