Background: This paper analyzes changes in the frequency of cycling to school and helmet wearing after the introduction of a mandatory helmet law, and attempts to identify factors associated with the acceptance of helmet use.
Methods: A mixed-method study was designed with a 7-month follow-up period (April 2014 to November 2014). The initial sample included 262 students (aged 12 to 16 years) from Valencia, Spain. The data were collected by questionnaire and 2 focus-group interviews were conducted.
Results: No significant changes in cycling-to- school behavior were found during the study period. Cycle helmet use improved, especially among boys, those who used their own bike, and among adolescents who lived within 2 km of school (P < .05 in all cases). The most common reasons given for not using a helmet were social factors. Peer-group pressure had a negative influence on helmet use among adolescents. Participants also indicated that helmet use is inconvenient, in particular among students who used the public bicycle-sharing program.
Conclusion: The implementation of the helmet-use law did not have a negative impact on the frequency of cycling to school. Our findings provide an empirical basis for designing educational interventions and programs to increase helmet use among adolescents.