Predicting Bicycle Helmet Wearing Intentions and Behavior among Adolescents

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Abstract

Introduction: Cycling accidents in Australia, especially those resulting in head injuries, are a substantive cause of death and disability; but despite legislation and evidence that helmets reduce the risk of head injury, few adolescents wear them. Method: This study employed a revised version of the Theory of Planned Behavior (TPB; [Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211]) to investigate the determinants of helmet use among a sample of adolescents. Participants in the initial data collection were 294 high school students in Year 8 and Year 11, with 266 completing a follow-up questionnaire measuring behavior over the previous two weeks. Results: Social norms, perceptions of control, and past behavior significantly predicted intentions to use helmets and perceptions of control and past behavior predicted actual helmet use. Conclusions: Strengthening the routine of helmet use and building young people's confidence that they can overcome any perceived barriers to helmet use will improve adherence to helmet wearing behavior.

Introduction

Approximately 7,550 cyclists were seriously injured or killed on Australian roads from 1999 to 2002 (Australian Transport Safety Bureau [ATSB], 2004a), and of those killed, 40% to 50% were under the age of 16 years (ATSB, 2004b). Several studies confirm that young cyclists are over represented in accident statistics (Dolinis et al., 1995, Queensland Transport and Land Transport, 2002, Rodgers, 2000). Such a high frequency of injury and fatality among adolescent cyclists and in particular, young males, suggests that this is an at risk population that requires further investigation.

Studies show that resistance to helmet use is common among adolescents (Berg & Westerling, 2001). Previous research has identified numerous factors related to helmet use among adolescents, including past helmet use behavior (Quine et al., 1998, Seijts et al., 1995), role modeling, parental encouragement, (Cryer et al., 1998, Lajunen and Rasanen, 2001), attitudes (Berg and Westerling, 2001, Cryer et al., 1998, Rodgers, 2000), and having friends who use helmets (Cryer et al., 1998, Lajunen and Rasanen, 2001). Furthermore, safety considerations (Berg and Westerling, 2001, Finch, 1996), compulsory helmet wearing by law (Sutton, 1994), and educational campaigns (Ashby et al., 1998, Brewer et al., 1995) have been associated with increased use of helmets.

The sheer number and diverse nature of such risk factors has prompted recent research based on more general models under which such varied predictors can be incorporated. This has been achieved with social psychological theories that recognize health behaviors as being determined by multiple influences. The Theory of Planned Behavior (TPB) has been successfully applied to the prediction of bicycle helmet use (Lajunen and Rasanen, 2001, Lajunen and Rasanen, 2004, Quine et al., 1998, Quine et al., 2001), in addition to a range of road user behaviors such as driving safely (Parker et al., 1995, Parker et al., 1996) and the wearing of seatbelts (Stasson & Fishbein, 1990). The TPB (Ajzen, 1991) proposes that attitude, subjective norm, and perceived behavioral control (PBC) predict intention and that both intention and PBC predict actual behavior.

Attitude is based on a set of behavioral beliefs about the perceived likelihood that performance of the behavior will lead to a particular outcome. Subjective norm is underpinned by normative beliefs concerning the likelihood that important others will approve or disapprove of the behavior (i.e., injunctive norms), however more recent conceptualizations of this variable have incorporated the measurement of moral norms and descriptive norms (i.e., how others behave in relation to the behavior). PBC has also been reconceptualized in recent years, incorporating measures of control (based on beliefs about the presence of factors likely to facilitate or inhibit performance of the behavior) and self efficacy. Meta analytic reviews provide evidence for the significant relations between the theory's three major predictors and belief based measures (Ajzen, 1991, Armitage and Conner, 2001).

In previous research employing the TPB to predict adolescent helmet wearing intentions and behavior, Quine et al. (1998) found that intention and PBC explained helmet use, while behavioral intention was predicted by subjective norm and PBC. Lajunen and Rasanen (2004) found that all components of the TPB were significantly related to intention to use a helmet (actual behavior was not measured). Previous research suggests that habit or past behavior is one of the most important predictors of future behavior (Conner and Armitage, 1998, Conner and McMillan, 1999), and considering that experience with wearing a helmet is strongly related to continued use (Quine et al., 1998, Seijts et al., 1995), past behavior was also included in the current study. A further variable that warrants investigation since it is proposed to be a major barrier toward helmet use is the perception of peer attitudes (Howland et al., 1989). It has been suggested that the perception of the normativeness of a behavior in a peer group may be a more important influence than the actual prevalence of the behavior (Page & Scanlan, 1999). Page and Scanlan examined perceptions of the prevalence of marijuana use among a university sample and showed that those who held the perception that use was the norm were significantly more likely to use marijuana than those holding the perception that use was less prevalent.

The aim of the current study was to investigate predictors of bicycle helmet use, within the framework of the TPB. The current study extends previous research by examining beliefs underlying the different types of norms, as well as beliefs underlying the two components of perceived behavioral control (PBC). It also examined past behavior and perceptions of the prevalence of helmet use (PPHU) among adolescents in the sample, assessing the relationship between perception and actual use.

Section snippets

Participants

Participants were Year 8 (N = 153) and Year 11 (N = 141) students enrolled at a state high school in a middle socioeconomic area. The first questionnaire included 294 participants (140 males and 154 females) and 266 (122 males and 144 females) of these students completed the follow-up questionnaire, representing a return rate of 90%. Participants' ages ranged from 11 to 17 years, with a mean age of 12.5 years in Year 8 and 15.5 years in Year 11.

Materials

The constructs of the TPB were assessed in accordance

Bicycle riding characteristics

Of the final sample (n = 293), 166 participants (57%) indicated that they rode a bicycle at least 1 to 4 days per week. The sample consisted predominantly of helmet owners (78.2%), with frequencies indicating that more males and Year 8 students than females and Year 11 students owned bicycle helmets. Almost 60% (n = 169) had used a bicycle helmet in the two weeks prior to the study (past behavior), while 67% (n = 177) used a bicycle helmet during the two week period that the study was conducted

Discussion

In general, the sample reported positive attitudes toward helmet use, relatively high perceived social pressure to use helmets (subjective norm), and moderate levels of moral obligation and perceptions of control regarding helmet use. The majority of the sample owned bicycle helmets (78.2%). More than half had used helmets in the two weeks prior to the study (59%), intended to use helmets (78%), and subsequently used helmets during the two week study period (67%). Overall, males and Year 8

Ethics statement

The research was reviewed and approved by the University's Human Research Ethics Committee.

Frances O'Callaghan, PhD is a Senior Lecturer at Griffith University where she has been employed since 1994. She is a registered psychologist and a member of the Griffith Psychological Health Research Centre, the Australian Psychological Society and the Australian College of Health Psychologists. Her research primarily focuses on adolescent and young adult health related behaviors, in particular, risky behaviors.

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