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Parenting Influences on Bicycle Helmet Rules and Estimations of Children's Helmet Use a

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Lisa Thomson Ross , Margaret Kay Brinson & Thomas P. Ross

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College of Charleston Published online: 07 Dec 2013.

To cite this article: Lisa Thomson Ross , Margaret Kay Brinson & Thomas P. Ross (2014) Parenting Influences on Bicycle Helmet Rules and Estimations of Children's Helmet Use, The Journal of Psychology: Interdisciplinary and Applied, 148:2, 197-213, DOI: 10.1080/00223980.2013.771131 To link to this article: http://dx.doi.org/10.1080/00223980.2013.771131

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The Journal of Psychology, 2014, 148(2), 197–213 C 2014 Taylor & Francis Group, LLC Copyright  doi: 10.1080/00223980.2013.771131

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Parenting Influences on Bicycle Helmet Rules and Estimations of Children’s Helmet Use LISA THOMSON ROSS MARGARET KAY BRINSON THOMAS P. ROSS College of Charleston

ABSTRACT. The present study examined the potential relationship between parenting variables and estimations of children’s bicycle helmet use. Parents (N = 121) completed surveys asking about parental monitoring and questions about their bicycle habits and attitudes, as well as their expectations for their children to wear a helmet and their estimation of how often their children wear a helmet. Parents reported stronger helmet rules for their children who are beginning cyclists rather than experienced cyclists, and rules for experienced cyclists were more strongly endorsed among parents who reported more parental monitoring as well. Parents who wear helmets themselves endorsed stronger helmet rules for their experienced riders, compared to parents who do not wear helmets. Parents without helmet rules reported more peer pressure in that they were more likely to agree that their friends do not make their kids wear helmets and that their child’s friends do not wear helmets. In addition, believing other parents do not wear helmets and believing one’s child’s friends do not wear helmets were both associated with a lower likelihood that their children wear a helmet. This appears to be the first study linking perceptions of parental peer pressure with helmet rules and use. For public health reasons, it is imperative to examine parental factors that may establish children’s helmet wearing. Keywords: bicycle, helmet, monitoring, role modeling, peer pressure

BICYCLING CAN BE USED FOR TRANSPORTATION, a form of exercise, and as an enjoyable leisure activity. However, bicycling also poses a potential risk for physical injury for those who ride. It is important that parents introduce the habit of wearing a bicycle helmet to children, just as they help establish other safety behaviors. Following an overview of statistics concerning bicycle injuries, this article examines how parental monitoring, role modeling, and perceived pressure relate to children’s bicycling helmet use. Address correspondence to Lisa Thomson Ross, Ph.D., Department of Psychology, College of Charleston, 66 George Street, Charleston, SC 29424, USA; [email protected] (e-mail). 197

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The Center for Disease Control and Prevention estimates that among children aged 5 to 14 in the United States, approximately 200,000 are injured each year while bicycling (2008a). Children under the age of 15 accounted for over half (53%) of bicycle injuries in emergency rooms, with 75% of all head injuries due to bicycling occur among children younger than 14 years of age (Safe Kids USA, 2005). Ortega, Shields, and Smith (2004) estimated that at one hospital alone (Columbus Children’s Hospital), approximately two children are treated for bicycle injuries daily at the emergency department; 43% of these involve the head and neck area. Bicycle helmets dramatically decrease the risk of a head injury for children while riding a bike. Researchers analyzing trauma data from San Diego County found wearing a helmet decreases ones odds of having a serious head injury by over 40% (Ji, Gilchick, & Bender, 2006). In a meta-analysis of 16 studies assessing the efficacy of helmets, Attewell, Glase, and McFadden (2001) found risk reductions of at least 45% fewer head injuries, 33% fewer brain injuries, and 29% fewer fatal injuries among bicycle riders who wear helmets compared to those who do not. Other reduction estimates are even higher: Thompson, Rivara, and Thompson (1989) estimate helmets can reduce the risk of head injury up to 85% and brain injury up to 88%. Despite their effectiveness, the rates of helmet use are surprisingly low. Using a national telephone survey, 48% of children aged 5–14 were reported by parents to always wear their helmet, compared to 23% who reported sometimes and 29% never (Dellinger & Kresnow, 2010). These data were collected in 2001–2003. Other national estimates suggest 15–20% of children aged 15 and younger wear helmets most of the time (Klein, Thompson, Scheidt, Overpeck, & Gross, 2005; Rodgers, 1996), and 15% of high school students wear helmets sometimes, often, or always (CDC, 2012b). Children are dependent individuals and their caretakers, primarily parents, have a responsibility for their safety. Therefore, to understand how children develop the habit of wearing a bicycle helmet, it is important to examine parental expectations, beliefs, and behaviors. One reason many children may not wear a helmet is the lack of parental expectations. The converse relationship has strong support: children who are helmet wearers typically know their parents have such rules. In a study of Swedish teens, most students (84%) who wear helmets stated their parents tell them to wear a helmet when they ride (Berg & Westerling, 2001). Miller, Binns, and Christoffel (1996) found consistent helmet use was very common (88%) among children who reported their parents had strict rules, whereas children who reported either a partial rule or no rule at all were much less likely to consistently wear a helmet (19%). Similarly, college students who currently wear a helmet had stronger recollections of parental rules or norms for helmet use growing up, compared with peers who do not wear a helmet (Kakefuda, Henry, & Stallones, 2009; T. P. Ross, Ross, Rahman, & Cataldo, 2010). As with all rules, a related issue is whether they are enforced. Loubeau (2000) conducted focus groups with 12 and 13 year

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olds and noted “Many of the students reported that their parents had rules that required them to wear a helmet when bicycle riding, but the rules rarely seem to be enforced” (p. 113). Parental rules for helmet use appear to decline as children age. In Berg and Westerling’s (2001) study of Swedish youth, approximately one-third of 11–13 year olds and only 10% of 14–16 year olds stated their parents had rules for them to wear a helmet. These rates mirrored rates of actual use, as only 27% of the 12 year olds and only 1% of the 15 year olds reported helmet use. Others note that helmet use declines rapidly around middle school (Kakefuda et al., 2009). It is unclear whether parental helmet rules become weaker before or after children stop wearing one. Another parenting factor that may influence helmet use among children is monitoring. Parental monitoring has two components: parent-child communication and supervision (Stanton et al., 2000). Establishing and conveying expectations to wear a helmet is relevant to parent-child communication, whereas supervision relates to knowing whether such rules are being followed. Indeed, parents may be unaware of whether their children wear helmets. Ehrlich, Longhi, Vaughan, and Rockwell (2001) surveyed parents and children (aged 8–12) separately and found a significant discrepancy: parents stated children wore a helmet 90% of the time, whereas children estimated riding without one approximately 60% of the time. Similarly, Ehrlich, Helmkamp, Williams, Haque, and Furbee (2004) found 51% of children stated that they always wear helmets (compared to 70% of corresponding parents) and 20% of the children reported never wearing one (compared to 4% of corresponding parents). Thus, parents may believe they are good monitors of their children’s helmet use when in fact they are not. Although parental monitoring is associated with less risky behaviors in other domains such as later initiation of sexual activity (Huang, Murphy, & Hser, 2011) and having fewer antisocial/deviant peers (Fosco, Stormshak, Dishion, & Winter, 2012), it has not been linked to helmet use. Role modeling is another parenting factor that may relate to children’s helmet use. Social learning theory (Bandura, 1977) describes how people learn by observing and imitating others’ behavior (i.e., wearing a helmet), which helps explain why it is important for parents to role model wearing a helmet. According to a national survey, most parents (86%) believe that children who see their parents wearing a helmet are more likely to wear one themselves (Safe Kids USA, 2005). In a community samples, the rates of helmet usage increased among children when their parents wore helmets (Caplow & Runyan, 1995; Finnoff, Laskowski, Altman, & Diehl, 2001). This survey data is supplemented by observational research by Khambalia, MacArthur, and Parkin (2005), who found helmet use most common among children in metro Toronto who were riding with an adult who was also wearing a helmet. Although it is uncertain that these adults were all parents, in any case they were good role models. Unfortunately, parental helmet use rates are relatively low. In one study, only 2% of adolescents reported that their

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parents wear helmets (Berg & Westerling, 2001). According to a national survey by Safe Kids USA (2005), 25% of parents stated they always wear a helmet when riding. Parents who wear bicycle helmets are being strong role models and can help establish this healthy habit in their children. Interestingly, there is a dearth of research examining whether parents experience peer pressure in general. Sutton (2004) noted that parental concerns regarding whether peers would negatively judge their parenting decisions hindered their children leading an active lifestyle. In particular, because these parents were concerned about what other parents would think about them, they were less likely to allow their children to play outdoors, which interfered with an obesity prevention campaign focused on increasing children’s activity (Sutton, 2004). This shows that parents do perceive judgments and peer pressure from other parents. Parents may also consult with their child’s friends when making monitoring-relevant decisions (e.g., when to allow a child to drive a car, or what time a curfew should be) (Conger, 1977). To date, there are no parental peer pressure studies specifically related to bicycle helmets. There is strong support that children’s helmet decisions are influenced by pressure from their peers (see Rezendes, 2006, for a review). Indeed, Australian adolescents reported peer pressure was a major factor in their decision not to wear helmets (Stevenson & Lennie, 1992). Teenagers in the United States aged 12–13 stated one of the most common reasons for not wearing helmets was because they made them look “dumb” (Howland et al., 1989), and 33% of Swedish teens reported helmets looked silly (Berg & Westerling, 2001). It is interesting to note that in one focus group study, young adolescents feared being viewed negatively by peers if they wore a helmet, yet they themselves did not express negative attitudes toward other children for wearing a helmet (Loubeau, 2000). Peer pressure may be difficult to admit, as few (10%) adolescents explained their lack of helmet use relates to friends not wearing one, yet many (80%) claimed this was why their friends stopped wearing helmets (Berg & Westerling, 2001). Another point to consider is that positive peer pressure may increase helmet use. One successful study used college students as “peer agents” to give out helmets and request students to sign pledge cards; this social marketing strategy increased helmet wearing from 26% to 49% (Ludwig, Bucholz, & Clarke, 2005). The present study investigated predictors of whether parents have helmet rules for their children and whether their children wear helmets and the hypotheses are as follows: Hypothesis 1: Overall parental monitoring would positively correlate with helmet rules and helmet use. Hypothesis 2: Parents who wear helmets themselves would have stronger expectations for their children to do so and would have children who wear them more often.

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Hypothesis 3: Parents’ perceived pressure from other parents (as well as from their children’s peers) would be correlated with less strict helmet rules and with decrease reports of helmet use.

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Method Participants Parents were recruited from two locations, both in the Southeast: a community preschool (N = 22) and a private Christian elementary school (N = 99). Most participants were mothers (87%) and Caucasian (97%). Parents’ age ranged from 30 to 57, with the average age 39. Most families had one child (13%), two children (52%), or three children (25%), with fewer reporting four children (9%) or five children (2%). The ages of the children, according to parental report, ranged from under one to 25 years of age; most were in the 4 to 7 age range (33%) or the eight to 11 age range (39%), whereas fewer were under age 4 (11%), ages 12 to 15 (15%) or over 15 (4%). Parents were fairly well educated: most families had a father (72%) or a mother (83%) with at least a bachelor’s degree. Materials Parents read brief instructions from the researchers that stressed that participation was anonymous and voluntary. This cover letter also indicated that the study had met the institutional guidelines for ethical treatment of participants and that the school’s head administrator approved of the project. Parents were instructed what to do with completed surveys. The ten-page survey included a total of 170 questions. There were demographic questions, including number of children and their ages. Next, the survey contained questions regarding riding a bicycle. Parents were asked to classify themselves as either a helmet wearer or not a helmet wearer. Parents were asked to indicate each child by age, and what their specific bicycle habits were, including what percentage of the time each child wore a helmet while riding a bike. Because the majority of the families had two children, child’s helmet use analyses were based on responses to the first two children listed. The next section, with 33 questions, dealt with rules, opinions, and perceived peer pressure related to bicycles and helmets. Relevant helmet rules questions were: “I require my child who is a beginner cyclist to wear a helmet” and “I require my child who is an experienced cyclist to wear a helmet.” Parents responded on a scale from 1 (never or almost never) to 6 (always or almost always). Parents read a variety of statements about helmets that pertained to concerns or pressures for one’s child and for one’s self. The peer pressure items are as follows: “My child’s friends do not wear helmets,” “I fear that my child may be teased by other children who don’t wear a helmet,” “People will think I’m cooler if I don’t wear a helmet,” “Most of my friends do not require their children to wear a helmet,” “Most of the other parents I know do not wear helmets,” and “I believe other parents may view

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me as overprotective if I require my child/ren to wear a helmet.” The response scale for these items was from 1 (strongly disagree) to 6 (strongly agree). The next section contained a modified version of the Parental Monitoring Scale and the Television Monitoring Scale by L. T. Ross and Veal (2009). The original scale was based on young adults’ retrospective reports of parental monitoring during childhood; therefore, all questions from the original scale were re-worded to capture current reports by parents. Original monitoring items were not included if they pertained to dating. The eight questions taken and modified from the original scale are as follows “I know where my children are during their free time (i.e., not in school or at work),” “I know how my children spent the money they have saved,” “I know who my children are with during free time (i.e., not at school or work),” “I let my children watch whatever television shows they want,” “I set either daily or weekly limits on the amount of television my children can watch,” “My children are allowed to watch as much television as they please,” “My children are not allowed to watch certain shows because I believe they have inappropriate content (e.g., violence, sex, swearing, or drug use),” and “I pre-approved the television shows I let my children watch.” Three additional items were generated for the present study: “I am in the room with my children whenever they watch television,” “I have restrictions about where my children can go (e.g., what streets they can cross or how far away from home they can go),” and “I have restrictions about who my children can play with or hang out with.” Parents responded to these 11 statements on a scale from 1 (strongly disagree) to 6 (strongly agree). In the present sample, the PMS demonstrated adequate reliability (α = .73). In addition, parents completed a 10-item form of the Marlow-Crowne Social Desirability Scale (Strahan & Gerbasi, 1972) to assess proneness to social desirability (i.e., responding to questions in a way that is socially accepted as the right thing). Parents were to answer questions such as “I have never intensely disliked someone” on a scale from one indicating “strongly disagree” to six indicating “strongly agree.” Higher scores reflect more susceptibility to social desirability. In the present sample, items had adequate reliability (α = .72). Comments were welcomed at the very end. Procedure Surveys, along with a cover letter from the Principal Investigators, were distributed at the local preschool by placing them inside the children’s cubbies for parents to pick up. If parents decided to complete the survey, they returned it to the school and anonymously submitted it in a box titled “Completed Helmet Use Survey” located near the main office and took with them a debriefing form. At the elementary school, surveys were distributed with a cover letter from an Assistant Investigator to teachers in each class room. Teachers handed the surveys to students at the end of the day to take home. Parents who completed the survey were instructed to deposit their survey in a box located in the front office and take

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a debriefing form. The debriefing form included some facts about bicycle-related injuries, including the estimated effectiveness of helmets and the fact a majority of bicycling deaths are caused by head injury.

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Results Prior to beginning data analysis, we verified that social desirability would not bias parents’ responses. There was no relationship between social desirability scores and helmet rules, parental monitoring, helmet use, peer pressure responses, or estimations of their child’s helmet use. When presented with the statement “I require my child who is a beginner cyclist to wear a helmet,” few parents stated never/almost never (6%), rarely (4%), on occasion (4%), or fairly often (1%); in contrast, more parents said frequently (10%) and most parents said always/almost always (74%). Parents responded to a similar statement for whether they require their child who is an experienced cyclist to wear a helmet. As with the prior statement, it was less common for parents to reply never/almost never (9%), rarely (5%), on occasion (10%), or fairly often (2%), and more common for them to state they frequently (8%) or always/almost always (66%) require their experienced cyclist to wear a helmet. A paired sample t-test revealed that the mean score for helmet rules for their children who are beginning cyclists was higher (M = 5.3, SD = 1.44) than that for their children who are experienced cyclists (M = 4.9, SD = 1.69), t [106] = 3.960, p < .001. When describing a child who rides a bicycle (whether it was the first or the second child described), half of the sample stated their children always wear a helmet (100% of the time), 18% stated a majority of the time (greater than 50% but less than 100%), 11% state occasionally (between 2% and 50% of the time), and 11% stated they never wear a helmet. It should be noted that although we did not specify which child they describe first, a paired t-test revealed that the children described first were on average significantly older (M = 9.29, SD = 4.22) than the children described second (M = 8.10, SD = 3.84), t [103] = 3.397, p < .001. Among families with two or more children who ride bicycles, there was a strong correlation between the percentage of time each of these children wear a helmet (r = .87, n = 88, p < .001). The age of the child was negatively correlated with the estimate of the percentage of time the child wears a helmet while riding; this was repeated for the first and second child the parents described (r = –.34, n = 111, p < .001 and r = –.25, n = 91, p < .017, respectively). As a final preliminary analysis, we verified that estimates of actual helmet use (i.e., the percentage of time the child wears a helmet when riding based on parent report) correlated with parental rules. This was true for the first child parents described (which is by definition all children, including those who have no siblings), as correlations between parents’ estimates of their helmet use and parents’ rules for their beginning cyclist and for their experienced cyclist were significant (r = .67, n = 99, p < .001 and r = .82, n = 99, p < .001, respectively).

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TABLE 1. Descriptive Statistics for Role Modeling Hypothesis

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Variable I require my child who is a beginning cyclist to wear a helmet I require my child who is an experienced cyclist to wear a helmet

Helmet Wearing Parents (N = 37) M (SD)

Non-helmet Wearing Parents (N = 35) M (SD)

5.89 (31)

5.17 (1.67)

5.56 (1.04)

4.91 (1.75)

Similarly, the relationship between estimates of helmet use and having rules for the second child described were significant for both beginning cyclist helmet rules (r = .71, n = 85, p < .001) and experienced cyclist helmet rules (r = .87, n = 85, p < .001). To test Hypothesis 1 that parental monitoring would positively correlate with helmet rules and helmet use for children, correlations were computed. Overall parental monitoring correlated with stronger expectations for children who are experienced cyclists to wear a helmet (r = .26, p = .007), but not with expectations for beginner cyclists to wear a helmet. Overall monitoring correlated with estimated frequency of helmet use as well, both for the first child and the second child that parents described (r = .25, n = 103, p < .012 and r = .33, n = 87, p < .002, respectively). Taken as a whole, Hypothesis 1 was supported. Hypothesis 2 proposed that parents who wear helmets would have stronger expectations for their children to do so and would report that their children wear helmets more often. For these analysis, only the parents who answered that they own a bicycle (n = 78) were included. A MANOVA revealed overall group differences for helmet wearing parents (n = 37) versus nonwearing parents (n = 35), Pillais F[2, 69] = 3.401, p = .039, eta2 = .090. Follow-up ANOVAS revealed a significant effect on helmet rules for beginning cyclists F[1, 72] = 6.632, p = .012, eta2 = .087, and a trend for experienced cyclists, F[2, 69] = 3.736, p = .057, eta2 = .051. See Table 1 for details. As predicted, parents who wear helmets themselves have stronger rules for children (especially beginning cyclists) to wear helmets. Furthermore, an additional analysis revealed that parents who wear helmets themselves more strongly agreed with the statement “People who wear bicycle helmets when they ride are being good role models” (M = 5.9, SD = .31) compared to parents who don’t wear a helmet (M = 5.3, SD = .80), t[56.079] = –4.236, p = .001. The second analysis for testing Hypothesis 2 revealed no parent helmet group differences for their child’s actual use. Thus, Hypothesis 2 was supported for rules but not for use.

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TABLE 2. Descriptive Statistics for Peer Pressure Hypothesis

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Variable Beginning cyclist rules group differences Most of my friends do not require their children to wear a helmet My child’s friends do not wear helmets Experienced cyclist rules group differences Most of my friends do not require their children to wear a helmet My child’s friends do not wear helmets

No/weak Helmet Rules Parents M (SD)

Helmet Rules Parents M (SD)

4.13 (1.12)

2.48 (1.29)

4.13 (1.35)

3.06 (1.57)

4.17 (1.15)

2.38 (1.62)

4.30 (1.36)

2.97 (1.57)

Finally, in Hypothesis 3, this study tested whether perceived peer pressure negatively influenced helmet rules for their children and helmet use by their children. The peer pressure questions pertain to parents’ perceptions of peer pressure that their children might face, as well as pressure they themselves perceive from other parents. In order to run these MANOVAs, two new variables were created. These collapsed parents who strongly, moderately and slightly disagreed with the helmet rules statement into the “weak/no rules” group, and those who strongly, moderately, and slightly agreed with this statement into a “helmet rule” group. This was done twice, once for the beginning cyclist question and one for the experienced cyclist question. The first analysis comparing parents with weak/no rules for beginner riders (n = 15) with their peers who have helmet rules for beginners (n = 88) detected a significant group difference, Pillais F [6, 96] = 5.224, p = .001, eta2 = .246. Follow-up ANOVAs detected significant differences for two statements: “Most of my friends don’t make their children wear a helmet” (F [1, 102] = 21.687, p = .001, eta2 = .177) and “My child’s friends do not wear a helmet” (F [1, 102] = 6.187, p = .015, eta2 = .058). According the means displayed in Table 2, parents with no/weak rules for their beginning cyclists are more likely to agree that parent friends do not make their kids wear helmets and that their child’s friends do not wear helmets. These findings support Hypothesis 3 with regard to helmet rules for beginning riders. The next analysis compared parents with weak/no rules for their children who are more experienced riders (n = 23) with their peers who have helmet rules for experienced riders (n = 77). Again, this revealed a significant group difference, Pillais F [6, 93] = 10.176, p = .001, eta2 = .396 and follow-up ANOVAs detected difference on the same pair of variables. These means are shown in the lower half

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of Table 2. Parents with no/weak rules for experienced riders are more likely to agree that their friends do not make their kids wear helmets (F [1, 99] = 37.947, p = .001, eta2 = .279) and that their child’s friends do not wear helmets (F [1, 99] = 14.298, p = .001, eta2 = .127). These findings support Hypothesis 3 with regard to helmet rules for experienced riders. Table 3 summarizes correlations regarding peer pressure responses related to bicycle helmets and estimates for children’s helmet use. The variables pertaining to parents’ friends not wearing helmets and their own children’s friends not wearing helmets correlated with less frequent helmet use among children. Thus, the portion of Hypothesis 3 pertaining to helmet rules was partially supported. Discussion Overall, helmet rules were fairly common among these parents, although this was more consistently expressed for children who are newer at riding rather than experienced riders. There was no definition of beginning or experienced riders; therefore, these results are based on parents’ subjective opinions of their children’s abilities to ride a bicycle. Our finding that expectations were higher for beginning riders than experienced riders mirrors prior research demonstrating helmet rules decline as children age (Berg & Westerling, 2001). Actual use declining with age is supported by prior studies as well (Berg & Westerling, 2001; Kakefuda et al., 2009). Parents appear to be consistent across children, as those with two or more children had very similar responses to questions about what percentage of the time each child wears a helmet. Approximately half of parents in the sample who ride bicycles wear helmets, which exceeds the national average (Safe Kids, USA). However, we did not ask parents what percentage of the time they wear their helmets. Parents who reported more overall parental monitoring, which in this study included items pertaining to homework, friends, whereabouts, and television, have stronger rules for experienced riders, and they have children who wear their helmets more often. Because we did not survey the children as well, there is the possibility parents are overestimating whether the rules translate into actual helmet use (Ehrlich et al., 2001; Ehrlich et al., 2004). While these findings support earlier work on the importance of monitoring for children’s health and safety behaviors, this appears to be the first study demonstrating parental monitoring is associated with helmet rules and helmet use in particular. The fact monitoring and rules for beginning riders were unrelated is likely influenced by less variation in the rules for beginning riders. Rules and expectations for helmet use may reflect one specific aspect of parental monitoring that influences whether a child will establish the lifelong habit of wearing a bicycle helmet. However, these rules are not only important while learning to ride a bicycle. Helmet wearing parents perceive this safety habit demonstrates good role modeling; this is consistent with the fact most parents are aware that parents

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TABLE 3. Correlations Between Child Bicycle Helmet Wearing and Peer Pressure Variables

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1 1 % time first child wears helmet 2 % time second child wears helmet 3 My child’s friends do not wear helmets 4 I fear that my child may be teased by other children who don’t wear a helmet 5 People will think I’m cooler if I don’t wear a helmet 6 Most of my friends do not require their children to wear a helmet 7 Most of the other parents I know do not wear helmets 8 I believe other parents may view me as overprotective if I require my child/ren to wear a helmet

2

3

4

5

6

7

\ .86∗∗

\

–.37∗∗

–.44∗∗

\





.35∗∗

\





.18t

.37∗∗

\





.26∗∗

.58∗∗

.19∗

\

–.53∗∗

–.50∗∗

.60∗∗

.37∗∗



.33∗∗

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.24∗









t = < .10. ∗ = < .05. ∗∗ < .01.

wearing a helmet increases the chances kids will do so as well (Safe Kids USA, 2005). Parents who wear helmets themselves have stronger rules for experienced riders to wear helmets, and there is a tendency for them to have stronger rules for beginning cyclists as well. One helmet-wearing parent commented on the

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importance of role modeling by writing “safety requires diligence.” However, it was surprising that parent use was not associated with child’s helmet use. This contradicts other studies that have confirmed role modeling helmet use translates into higher rates of helmet wearing among children (Caplow & Runyan, 1995; Finnoff et al., 2001). In our study, wearing a helmet was not enough to get children to wear a helmet; yet, parental use was associated with stricter rules, and the rules are what predicted children’s helmet use. It is unlikely that these parents were made to wear helmets when they were children, as industry safety standards in the United States (i.e., the Snell Memorial Foundation) were not published until 1972 (Becker, 1998), and helmets for recreational cycling were not marketed until the late 1970s (Swart, 2012). Furthermore, an exploratory analysis of three items in our survey revealed that a very small proportion of parents stated that when they were a child their parents required them to wear a helmet when they were in elementary school (2.5%), in middle school (2.5%), or in high school (1.7%). Perhaps as more children get accustomed to wearing helmets, they will develop this habit, and then if they become parents, they will role model this safety behavior. Parents who reported stronger helmet rules and more frequent helmet wearing among their children also reported less concerns about peer pressure for themselves (i.e., their friends do not make their kids wear helmets, other parents do not wear helmets) and their child (i.e., their child’s friends do not wear helmets). These two concerns were related to each other, as well as to concerns about being viewed by other parents as being overprotective, and being concerned that one’s child may be teased by other children. Although a previous study showed parental fears of not wanting to be viewed as a bad parent (i.e., over protective) can potentially harm a child’s health (Sutton, 2004), there is very little research on parental peer pressure. Not only is this one of the first studies addressing peer pressure among parents, it is the first investigation demonstrating these perceptions are relevant to helmet rules. The concept of parenting peer pressure may be a specific component of more general parenting anxiety, as parents struggle with being effective at this demanding role. It is important to acknowledge limitations in the present study. Having a larger sample size would allow for testing the ideas generated by this project. For example, what were the ages of the children and at what point did parent decide to weaken their helmet rules? Were parents of only children more protective and did they convey stronger helmet rules? In addition, having a more ethnically and economically diverse sample of parents would likely allow for greater variance in attitudes and rules about helmets and would allow for the ability to generalize these findings to all parents. Waylen and McKenna (2009) found more monitoring, overall, among higher SES groups and that is likely reflected in the current sample as well. Similarly, national statistics suggest that Caucasians are more likely than African Americans to wear helmets (Ji et al., 2006; L. T. Ross et al., 2011), and Caucasian college students recalled stronger helmet rules growing up

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compared to non-Caucasian peers (L. T. Ross, Ross, Cataldo, & Rahman, 2008) . Furthermore, children who grow up with more parental income and more parental education in the home are more likely to wear helmets (Dellinger & Kresnow, 2010) and observational research suggests more helmet usage in higher socioeconomic neighborhoods (Parkin, Khamalia, & Macarthur, 2003). Therefore, it is possible there are ethnic differences and socioeconomic status differences for parenting expectations as well. Similarly, the majority of parents (82%) were recruited from a private Christian school, and it is not clear whether that may pose additional limitations on whether our findings generalize to the population of families as a whole. One strength of the present study is the fact we verified all our constructs were unrelated to social desirability. This increases our confidence that parents are giving honest responses on this anonymous survey, even though it might appear that there is a “best answer” for questions such as do you have rules for your children to wear a helmet. Had there been a significant association between social desirability and any of the constructs, we could have used social desirability as a covariate in those analyses to strengthen our confidence in the findings. Future research needs to include not only social desirability as a potential covariate, but also children’s self-reports of their helmet usage. The ideal study would include parents and children’s reports of helmet use, and perceptions of rules, and perceptions of peer pressure experienced by both parents and children. This would allow for interesting comparisons of whether children are wearing helmets as often as their parents’ think they are, and it would allow for the comparison of parents’ establishing and communicating helmet rules as opposed to what the children think those rules are. These findings have implications for prevention and outreach efforts. Programs need to target parents to become role models and wear a helmet (if and when they ride) and to communicate and enforce helmet rules; Safe Kids USA’s “Follow the Leader” program (2005) and the National Highway Traffic Safety Administration’s “Be a Roll Model” program are steps in the right direction. Such programs need to acknowledge parents’ perceptions of peer pressure regarding what other parents and children do, or in this case do not do. In addition, because peer pressure appears relevant to helmet expectations and use, stronger helmet rules and higher helmet use rates may result if parents (and children) are “inoculated” against peer pressure to not wear helmets, just as adolescents can be inoculated (i.e., taught refusal skills and coping skills) to resist pressure to smoke (see Killen, 1985, for a review). No doubt encouraging parents to be role models and wear a helmet, to have clear and consistent expectations, and to monitor their children more stringently are all great ideas. However, if the ultimate goal is higher helmet use rates, these activities should be accompanied by helmet legislation. Implementing state, provincial, or local laws is associated with increased helmet use, according to research based on both survey data (Dannenberg, Gielen, Beilenson, Wilson, &

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Joffe, 1993; Dellinger & Kresnow, 2010; Caplow & Runyan, 1995) and observational data (Dannenber et al., 1993; Karkhaneh, Rowe, Saunders, Voaklander, & Hagel, 2011). Despite the effectiveness of helmet use legislation, and despite strong parental support for legislating bicycle helmets for children (Caplow & Runyan, 1995; Lohse, 2003; Ortega et al., 2004), currently only 22 states (including the District of Columbia) have statewide laws (Bicycle Helmet Safety Institute, 2012). Examining parental influences is important because parents provide crucial influence for establishing safety habits that may last a lifetime. We encourage setting and enforcing rules for helmet use, and we encourage parents to be role models and wear helmets themselves, as that strengthens the message about the importance of wearing a helmet. Head injuries while riding a bike are often preventable. Just as our society has had to get in the habit of wearing seat belts, it is imperative that we get in the habit of wearing bicycle helmets. It is imperative to examine parental helmet attitudes and behaviors as a means to establish helmet wearing habits of the next generation of riders and of parents. AUTHOR NOTES Lisa Thomson Ross is a Professor of Psychology and Women’s and Gender Studies at the College of Charleston. Her degree is in Social Psychology. Her current research interests include risk taking among college students and the correlates of family unpredictability and unpredictability beliefs, as well as understanding bicycle helmet use and nonuse. Margaret Kay Brinson earned her Master’s Degree as a Child Life Specialist at Bank Street College in New York City. She is now working as the Inpatient Cardiology Child Life Specialist at the Children’s Hospital at Vanderbilt in Nashville, TN. Her research interests focus on the effects of clinical supervision and professional well-being in the field of Child Life and on parents’ expectations for their children to wear helmets.This research was conducted while Ms. Brinson was a student at the College of Charleston. Thomas P. Ross is a Professor and Chair of Psychology at the College of Charleston and his degree is in Clinical Psychology with specialization in neuropsychology. His current research interests include theories of frontal-lobe mediated cognition and the measurement of executive functioning, as well as college student helmet use. REFERENCES Attewell, R. G., Glase, K., & McFadden, M. (2001). Bicycle helmet efficacy: A meta analysis. Accident Analysis & Prevention, 33, 345–352. Becker, E. B. (1998). Helmet development an standards. In N. Yoganandan, F. A. Pintar, S. J. Larson, & A. Sances (Eds.), Frontiers in Head and Neck Trauma: Clinical and Biomechanical. Amsterdam: IOS Press. Berg, P., & Westerling, R. (2001). Bicycle helmet use among school children: The influence of parental involvement and children’s attitudes. Injury Prevention, 7, 218–22.

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Bandura, A. (1977). Social learning theory. New York, NY: General Learning Press. Bicycle Helmet Safety Institute. (2012). Bicycle helmet laws. Retrieved November 18, 2013 from http://www.helmets.org/mandator.htm Caplow, M. P., & Runyan, C. W. (1995). Parental responses to a child bicycle helmet ordinance. American Journal of Preventive Medicine, 11, 371–374. Center for Disease Control and Prevention (CDC). (2012a). Web-based Injury Statistics Query and Reporting System (WISQARSTM). Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/injury/wisqars/index.html Center for Disease Control and Prevention (CDC). (2012b). Youth Risk Behavior Surveillance System, 2009 Data. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, National Center for Injury Prevention and Control. Retrieved from http://www.cdc.gov/HealthyYouth/yrbs/index.htm Conger, J. J. (1977). Adolescence and youth. New York, NY: Harper & Row. Dannenberg, A., Gielen, A., Beilenson, P., & Wilson, M., & Joffe, A. (1993). Bicycle helmet laws and educational campaigns: An evaluation of strategies to increase children’s helmet use. American Journal of Public Health, 83, 667–674. Dellinger, A. M., & Kresnow, M. (2010). Bicycle helmet use among children in the United States: The effects of legislation, personal and household factors. Journal of Safety Research, 41, 375–380. Ehrlich, P., Helmkamp, J., Williams, J., Haque, A., & Furbee, P. (2004). Matched analysis of parent’s and children’s attitudes and practices towards motor vehicles and bicycle safety: An important information gap. International Journal of Injury Control and Safety Promotion, 11, 23–28. Ehrlich, P., Longhi, J., Vaughan, R., & Rockwell, S. (2001). Correlation between parental perception and actual childhood patterns of bicycle helmet use and riding practices: Implications for designing injury prevention strategies. Journal of Pediatric Surgery, 36, 763–766. Finnoff, J., Laskowski, E., Altman, K., & Diehl, N. (2001). Barriers to bicycle helmet use. Pediatrics, 108, E4. Fosco, G. M., Stormshak, E. A., Dishion, T. J., & Winter, C. E. (2012). Family relationships and parental monitoring during middle school as predictors of early adolescent problem behavior. Journal of Clinical Child and Adolescent Psychology, 41, 202–213. Howland, J., Sargent, J., Weitzman, M., Mangione, T., Ebert, R., Mauceri, M., & Bond, M. (1989). Barriers to bicycle helmet use among children. American Journal of Diseases of Children, 143, 741–744. Huang, D. Y., Murphy, D. A., & Hser, Y. I. (2011). Parental monitoring during early adolescence deters adolescent sexual initiation: Discrete-time survival mixture analysis. Journal of Child and Family Studies, 20, 511–520. Ji, M., Gilchick, R. A., & Bender, S. J. (2006). Trends in helmet use and head injuries in San Diego County: The effect of bicycle helmet legislation. Accident Analysis And Prevention, 38, 128–134. Kakefuda, I., Henry, K., & Stallones, L. (2009). Associations between childhood bicycle helmet use, current use, and family and community factors among college students. Family and Community Health, 32, 159–166. Karkhaneh, M. M., Rowe, B. H., Saunders, L. D., Voaklander, D. C., & Hagel, B. E. (2011). Bicycle helmet use four years after the introduction of helmet legislation in Alberta, Canada. Accident Analysis and Prevention, 43, 788–796 Khambalia, A., MacArthur, C., & Parkin, P. C. (2005). Peer and adult companion helmet use is associated with bicycle helmet use by children. Pediatrics, 116, 939–942.

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Killen, J. D. (1985). Prevention of adolescent tobacco smoking: The social pressure resistance training approach. Journal of Child Psychology and Psychiatry, 26, 7–15. Klein, K. S., Thompson, D. Scheidt, P. C., Overpeck, M. D., & Gross, L. A. (2005). Factors associated with bicycle helmet use among young adolescents in a multinational sample. Injury Prevention, 11, 288–293. Lohse, J. L. (2003). A bicycle safety education program for parents of young children. The Journal of School Nursing, 19, 100–110. Loubeau, P. (2000). Exploration of the barriers to bicycle helmet use among 12 and 13 year old children. Accident Analysis and Prevention, 32, 111–115 Ludwig, T., Bucholz, C., & Clarke, S. (2005). Using social marketing to increase the use of helmets among bicyclists. Journal of American College Health, 54, 51–58. Miller, P. A., Binns, H. J., & Christoffel, K. K. (1996). Children’s bicycle helmet attitudes and use: Association with parental rules. Archives of Pediatric and Adolescent Medicine, 50, 1259–1264. National Highway Traffic Safety Administration. Be a Roll Model. Retrieved from http: //www.nhtsa.dot.gov/people/injury/TSFLaws/PDFs/810886.pdf Ortega, H. W., Shields, B. J., & Smith, G. A. (2004). Bicycle-related injuries to children and parental attitudes regarding bicycle safety. Clinical Pediatrics, 43, 251–259. Parkin, P. C., Khamalia, A., & Macarthur, C. (2003). Influence of socioeconomic status on the effectiveness of bicycle helmet legislation for children: A prospective observational study. Pediatrics, 112, 192–196. Rezendes, J. (2006). Bicycle helmets: Overcoming barriers to use and increasing effectiveness. Journal of Pediatric Nursing, 21, 35–44. Rodgers, G. B. (1996). Bicycle helmet use patterns among children. Pediatrics, 97, 166–173. Ross, T. P., Ross, L. T., Rahman, A., & Cataldo, S. (2010). The Helmet Attitudes Scale: Using the Health Belief Model to predict undergraduates’ helmet use. Journal of American College Health, 59, 29–36. Ross, L. T., Ross, T. P., Cataldo, S., & Rahman, A. (2008, March). The psychometric properties of a helmet use scale. Paper presented at the Southeastern Psychological Association conference, Charlotte, NC. Ross, L. T., Ross, T. P., Farber, S., Davidson, C., Trevino, M., & Hawkins, A. (2011). The Theory of Planned Behavior and helmet use among college students. American Journal of Health Behavior, 35, 581–590. Ross, L. T., & Veal, M. L. (2009). Parental monitoring: Overview and the development of two retrospective scales. In P. H. Krause & T. M. Dailey (Eds.), Handbook of parenting: Styles, stresses, and strategies (pp. 19–35). Hauppauge, NY: Nova Science Publishers. Thompson, R. S., Rivara, F. P., & Thompson, D. C. (1989). A case control study of the effectiveness of bicycle safety helmets. New England Journal of Medicine, 320, 1361–1367. Safe Kids USA. (2005). Follow the leader: A national study of safety role modeling among parents and children. Retrieved from http//:www.safekids.org/assets/docs/ ourwork/research/research-report-safe-kids-week-2005.pdf Stanton, B. F., Li, X., Galbraith, J., Cornick, G., Fiegelman, S., Kalkee, L., & Zhou, Y. (2000). Parental underestimates of adolescent risk behavior: A randomized controlled trial of a parental monitoring intervention. Journal of Adolescent Health, 26, 18–26. Stevenson, T., & Lennie, J. (1992). Empowering school students in developing strategies to increase bicycle helmet wearing. Health Education Research, 7, 555–566. Strahan, R., & Gerbasi, K. C. (1972). Short, homogeneous versions of the Marlow-Crowne Social Desirability Scale. Journal of Clinical Psychology, 28, 191–193.

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Sutton, A. (2004). Childhood obesity and consumption of fizzy drinks: Play outside to reduce childhood obesity. BMJ: British Medical Journal, 329, 54. Swart, R. (2012). The History of Bicycle Helmets. Retrieved from Bicycle Helmet Safety Institute at http://www.bhsi.org/history.htm Waylen, A., & McKenna, F. (2009). The role of parental attitudes and monitoring in the risk exposure of young children. Journal of Applied Social Psychology, 39, 791–803.

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Original manuscript received June 22, 2012 Final version accepted January 18, 2013

Parenting influences on bicycle helmet rules and estimations of children's helmet use.

The present study examined the potential relationship between parenting variables and estimations of children's bicycle helmet use. Parents (N = 121) ...
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