Section VII. Profiles

B. Jacksonville/Duval County, Florida

Jurisdiction: State law, countywide activities.

Effective date: January 1, 1997.

Ages covered: Children under age 16.

Penalty: State law established a $15 fine; counties have the authority to levy an additional monetary penalty. Thus, in Duval County, which has an added $8 fine, the total penalty is $23.

Agency enforcing the law: In Duval County, the Jacksonville Sheriff's Office.

Legislative language is reprinted in Section VII B.

Duval County, FL, is an urbanized county that includes the city of Jacksonville, FL. The county population is approximately 773,000.

Duval County has embraced the state bicycle helmet use law (especially in comparison to some Florida counties, described below). This profile examines Duval County’s experience with the state law and the county’s approach to the law’s implementation. The city and county merged in 1968, so the government structure consists of a single entity covering Duval County, where the bulk of the population resides (several small beach communities continue to have local jurisdictions within the county).

Impetus For Legislation:

Elizabeth “Budd” Bell created a coalition on children, family, and health issues in 1970 “which grew quickly into a statewide clearinghouse (a group of agencies interested in learning advocacy for change).” The organization, the Clearinghouse on Human Services, to date has almost 300 participating agencies.

Bell remains its volunteer coordinator, active in advocating on a variety of children’s issues. In addition to her professional knowledge of state government and programs and her work as a social worker working with head-injured children, she has learned a lot about the benefits of bicycle helmets from colleagues who were pediatricians, and from her son, who was a safety specialist in Sweden.

“A number of pediatricians had talked to me, pediatric neurologists. They asked, ‘why don’t you do something about preventing head injury?’ And I was in Sweden almost every year” seeing the high rates of bicycle helmet use there. Then, a retail executive for Target Corp. who had moved to the area from California worked with her to help publicize bicycle helmets and bike safety in the parking lot of his store.

A bicycle helmet awareness project was launched, and from that, a coalition to work for passage of a bicycle helmet use law began in 1993. Its leaders included the state’s pedestrian/bicycle coordinator and Bell. “It was very natural for the Florida Department of Health and other agencies to look to the Clearinghouse for help with pressing injury prevention issues,” she said.

A variety of organizations were approached to participate in this effort, including the THINK FIRST Foundation and Florida SAFE KIDS. The coalition began meeting in late 1993 to discuss draft legislation and to prepare for the upcoming legislative session.

The Legislative Experience:

Bell, a skilled volunteer lobbyist, emphasizes the coalition effort in support of bill passage as the foundation of legislative success. In her words: “Our first coalition developed in 1993 and from that legislative session on, 1994, 1995, and 1996, we increased the understanding of the helmet issue with the help of the media that resulted in the statute we have today. The bicycle helmet bill became a yearly pilgrimage with widening circles of support throughout the state.”

The wide-ranging coalition included the Bicycle Safety Office of the Florida Department of Transportation, the Developmental Disabilities Council, Florida State Highway Patrol, the Junior League State Public Affairs Committee, the Academy of Florida Trial Lawyers, the Florida Junior Chamber of Commerce, SAFE KIDS coalitions, and every county Bicycle Safety Coordinator in the state. Bell noted that the American Academy of Pediatrics was “a great ally.” She wrote: “many medical societies including the pediatric groups came to the capital in Tallahassee frequently to testify and joined us in countless press conferences.”

However, Bell also noted one drawback in working with the many professional associations in the coalition. Given that the leadership of many of these associations changes annually, there can be a loss of institutional memory, expertise, and level of involvement.

The legislative sponsors also were important; in this case, both were physicians. “Both legislative sponsors stayed with us the entire four years. Dr. Don Sullivan, an orthopedic surgeon from St. Petersburg and Dr. Robert Casey, a family physician from Gainesville, carried the torch for us.”

Bell summarized the process, attributing part of the success to a change in the governor’s office: “We lost it three years in a row after a good deal of lobbying. Finally in the fourth year, it was a combination of the weariness (of the legislators), and we had a different governor. We had (the late Governor Lawton) Chiles who believed in children.”

Advancing the bill was a step-by-step process. Supporters would work to win the bill’s support in one committee and then move to the next battle in the next committee. Though bicycle helmet use legislation made some progress in every session in which it was introduced, it took “four long years” before the enactment of the law. Both houses of the legislature enacted the law near the end of the 1996 legislative session. Bell wrote in a letter to supporters following passage of the bill: “After the failure we experienced in the 1994 and 1995 sessions, this is a sweet victory for all of us.”

The coalition was active in educating legislators about the need for the legislation. Fact sheets, posters, and handouts were developed and distributed. One 1995 hand-out urged legislators to “Use Your Head - Vote Yes” on the bicycle helmet bills, listing the coalition members. A poster from the Florida Agency for Health Care Administration was illustrated with a photo of a child on a bicycle, wearing a bicycle helmet, with the legend:

Do the Math
Safety Helmet = $11.95
Child’s Health = Priceless

A Bicycle Helmet Fact Sheet, referencing information from the Florida Department of Transportation Safety Office and the State Bicycle Coordinator, listed a variety of statistics and arguments in support of the bill. Many of these arguments showed up in other venues, such as in columns and editorials printed in state newspapers.

One frequently used argument was that Florida was the most dangerous place to ride a bicycle in the nation. According to data from the state Division of Highway Safety and Motor Vehicles, Floridians were almost three times as likely to be killed in a bicycle crash as the national average.

Another frequently raised argument was: “The world has changed since many of today’s adults were children. There is more traffic, more concrete, and more complexity in even a simple bicycle trip.”

A May 1995 open letter from Richard E. Weibley, the Director of the Tampa General Hospital Pediatric Intensive Care Unit (PICU), was widely distributed, including to the capital’s press corps. Some excerpts from the letter:

“As an example of the cost of treatment for injuries rather than prevention, I want you to know about the 12 (year old) child we have had in the PICU since February 7, 1995. He was hit by a car while riding his bicycle without wearing a helmet. He suffered multiple injuries, including a head injury. All of his injuries EXCEPT the head injury have essentially resolved. As of today, his movements are not purposeful; he does not ‘fix and follow,’ but stares blankly. His accumulated hospital charges (without physician fees) are $130,000.00 to date [May 1995]. He will be discharged to a skilled nursing facility until (and if) he reaches rehabilitation potential. The State of Florida is paying the bill through Medicaid. I am certain there are others like him around the State.

“The use of a helmet in this case may or may not have prevented a closed head injury. Almost without question, it would have lessened the severity of the injury. More importantly, at $10.00/helmet, this same State expenditure could have purchased 13,000 helmets and distributed them to Medicaid clients as a health prevention benefit!”

News conferences and bike safety fairs also were held. A November 1995 news conference to kick off the 1996 session included the bill’s sponsors as well as representatives of the medical, insurance and legal communities. Speakers included representatives of the Florida Medical Association, Neuroscience Center of the Tallahassee Memorial Hospital, Florida Brain & Spinal Cord Injury Advisory Council, Florida Association of Professional Emergency Medical Technicians (EMT’s) and Paramedics, Florida Developmental Disabilities Council, and the Academy of Florida Trial Lawyers.

Events would respond to concerns raised by legislators. For example, an April 1995 news conference sought to answer legislators’ concerns about access to bicycle helmets by children in low-income families. The news release announced:

“Representatives from such diverse groups as the Academy of Florida Trial Lawyers, the Florida Insurance Council, and private insurers like Blue Cross-Blue Shield and AETNA, said today they will purchase bicycle helmets to give to low income children who might not otherwise be able to afford them . . .

“During discussion of the bill last year some opponents raised the issue of affordability. Supporters arranged with helmet manufacturers to purchase helmets at a discounted price and so far more than $25,000 has been pledged. The helmets will be distributed statewide to those children whose family incomes make them eligible for the school lunch programs.”

A number of editorials and columns in major newspapers around the state clamored for the bill, especially as the 1996 legislative session looked like it might end without bill passage. A March 10, 1996 editorial in the Tallahassee Democrat in support of the bill raised many of the arguments and statistics developed by the bicycle helmet coalition and called the legislature’s lack of action on the legislation “shameful.” A March 31, 1996 editorial in the Miami Herald, titled “Protecting Little Noggins,” began with “the docs know best,” referring to the bill’s sponsors.

Bell emphasized the benefits of getting out your message through the media. “The press will always do something decent if you give them materials,” by assuring that a copy of whatever is distributed to legislators is also put into each reporter’s box in the capital’s press room. Social work students at the Clearinghouse aided Bell in these and other efforts.

Statistical evidence was very helpful throughout the process of moving the bill through the legislature, including the information that Florida’s bicycle fatality rate was much higher than the national average.

After the bill had not advanced in several legislative sessions, Stephen McCloskey of the Duval County Injury Prevention Program Office undertook a focused effort to make state legislators aware of the statistical evidence supporting bicycle helmet use early in the legislative session. He described it as “deciding to walk on the wild side.” Working with Ted Miller of Pacific Institute for Research and Evaluation (PIRE), McCloskey developed statistics about the cost of injuries and a cost/benefit analysis for the state and Duval County. McCloskey compiled a list of all of the legislators who hadn’t supported the legislation in the earlier sessions. He then spent several days in the state capital in Tallahassee to meet with those legislators, presenting them with the materials he had compiled and answered their questions about government intrusion, transfer of payments, and other issues raised during the debates on the legislation. “We went to the legislators and educated them on the injury epidemic, leaving the statistics and documents with them in each office,” McCloskey said.

One legislator representing a low-income area was worried about her constituents’ ability to afford bicycle helmets. McCloskey described for her the sources for free and low-cost bicycle helmets, such as funding that his program had recently been awarded to provide 50,000 bicycle helmets.

In every office except for one, McCloskey’s education effort resulted in a commitment from the legislator to support the bill.

Anecdotal evidence, such as the letter from Dr. Weibley excerpted earlier, also was used.

After the law passed, in a letter to coalition members, Bell discussed effective components of their strategy. In this paragraph, she described the impact of bringing forward crash victims:

“It may be dangerous to identify any one strategy in the passage of the law without minimizing all the other contributions that were made, but I want to especially thank the two boys, age ten and fourteen, who are survivors of bad bicycle accidents and their mothers. They were able to describe, like none of us, the fright, the very long recovery periods and the many hospital bills still being paid. Three SAFE KIDS coordinators accompanied these families and went with them to every one of the 160 offices.”

One recommended strategy as to “bring children up over and over” as a way of reminding and educating legislators. In addition to the active involvement of children in the process, witnesses also included parents who had lost children in bicycle crashes. “We brought parents of children who didn’t survive, parents who wanted to do something, even though it was painful for them and for us.”

Once the legislation started to move, a fatal bicycle crash got the attention of legislators and appeared to help the bill’s chances. Margaret Raynal, an avid bicyclist who was instrumental in developing the curriculum for Duval County’s highly successful Traffic, Bicycle and Pedestrian Safety Education Program (see next section for more information on this program), was killed in a crash. Interestingly, it was the death of Raynal, an adult, that helped focus the legislature’s interest in requiring children (but not adults) to wear bicycle helmets.

The strongest arguments against the bill appeared to be concerns about government intrusion into private family choices and the idea that it was an individual’s choice whether or not to wear a helmet.

An undated Associated Press story about the House bill included some of these arguments:

“Some lawmakers questioned the legislation, saying it was an example of government trying to mandate changes in the public’s behavior. ‘The problem is the government is trying to save lives but what they’re going to do is create more regulations,’ said Rep. Luis Rojas (R-Hialeah), who voted for the bill despite his concerns.”

The story also quoted the response of the bill’s sponsor, Rep. Robert Casey (R-Gainesville):

“This is an immunization shot against childhood injury.”

Bill supporters believed they disproved the “government intrusion” arguments by transfer cost analysis of long-term traumatic brain injury victims; that is, by illustrating how this “individual choice” frequently resulted in substantial, and preventable, costs to society at large, especially taxpayers.

The issue of the cost of bicycle helmets was a strong and recurring concern. One newspaper columnist criticized the argument raised by one legislator “who worried about ‘selective enforcement in poor neighborhoods where children can’t afford to get to the Wal-Marts to get the low-priced helmets.’ So where does he think they get their bicycles? Last I heard, helmets cost a good deal less.”

As mentioned above, a news conference to respond to these concerns was held. Bell had tremendous resistance from some legislators because bicycle helmets were so costly at the time. They told me “the only children who will die are low income children because they can’t afford the helmet.”

Bell looked for a solution. Through contacts with Bell Sports, Inc. (no relation), she was able to locate bicycle helmets at a substantial discount.

“Bell Sports was very available to us when there were problems like legislators protesting that impoverished parents in their counties could not afford helmets. Bell, as well as other manufacturers, responded with very reduced prices for helmets.”

And, in her post-passage letter to coalition members congratulating them on the victory, the issue remained on her mind: “Now we have to start fundraising in your local areas to provide free or low cost helmets to all children identified as needing them . . .”

A variety of bicycle helmet programs, described elsewhere, also responded to these concerns.

Some bill supporters believe that the most persuasive arguments for the bill were the cost-benefit analysis developed by McCloskey and Miller (mentioned earlier) and the availability of low-cost (and no-cost) bicycle helmets.

Some provisions in the legislation were changed over time in response to concerns raised. According to Bell, the bill “didn’t change radically” over the years, in part due to the fact that “we had the same sponsors” throughout the process. “We used the base of it, lopped off two or three things.”

The bill was always a minors-only law according to Bell.

In the last session, the bill “was amended slightly to meet some of the 1995 objections about private driveways,” as Bell wrote to her coalition members in 1996. Law enforcement officers can not issue citations “to persons on private property, except any part thereof which is open to the use of the public for purposes of vehicular traffic,” according to the statute.

The bill included provisions on other aspects of bicycling, such as not allowing a passenger to remain in a child seat or carrier on a bicycle when the rider is not in immediate control of the bicycle, but permitting an adult rider to “carry a child securely attached to his or her person in a backpack or sling.”

One unique aspect of the law allowed counties to “opt-out” of the bicycle helmet use requirement. To do so, the county government had to hold a hearing, provide notice of the proposal, take testimony, and then enact an ordinance to that effect, before January 1, 1998.

The law took effect January 1, 1997, requiring children under 16 to wear bicycle helmets when riding bicycles anywhere traffic passes. For the first year, verbal warnings and information pamphlets were given. Beginning January 1, 1998, the state fine for violating the law was $15. Counties have the authority to levy an additional amount for county-specific revenue generation.

When the state law passed, three counties -- Brevard, Citrus, and St. Lucie -- used the “opt-out” provision and chose to exempt their residents from the law. Brevard County later reversed that decision.

The Bicycle Helmet Environment And Existing Efforts:

A wide variety of bicycle helmet promotion activities were in place in Duval County in advance of the state law.

The Duval County Health Department’s Injury Prevention Program has had a Traffic, Bicycle and Pedestrian Safety Education Program (TBPSEP) in place since 1995.

This five-year program is recognized as one of the premier bicycle safety projects in the nation. It has received funding from the state of Florida, the National Highway Traffic Safety Administration, and the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control. The program has resulted in a steady decrease in bicycle-related injury mortality and morbidity, demonstrated through rigorous evaluation. This has been accomplished through policy changes (in addition to the state bicycle helmet legislation, the program also cites school district policies), education, behavior modification techniques, and distribution of 20,000 bicycle helmets.

TBPSEP includes training physical education teachers in elementary schools to carry out the bicycle safety curriculum developed by the University of Florida. The training is coordinated through the school district, using a full-time employee supplied by the district who assists the schools in holding bicycle safety classes. One school administrative official believes the program would not be a success without having a staff person dedicated to its operation, providing support to the teachers. Each school that implements the TBPSEP includes a bicycle helmet activity in its lesson plan. Students learn how to determine proper bicycle helmet fit and the importance of proper fit.

TBPSEP has created a framework for distributing subsidized bike helmets. Aided by TBPSEP, schools and Parent-Teacher Associations (PTAs) conduct bicycle helmet sales at their school site. The cost of bicycle helmets is 50 to70 percent below retail prices. When a PTA representative or a physical education teacher conducts a bicycle helmet sale, they can check out a “helmet kit” from the county’s Injury Prevention Program. These kits provide step-by-step help for the bicycle helmet sales.

The kit includes samples of the four bicycle helmets that are offered, a manila envelope with an order form, a flyer to send to parents announcing the upcoming bicycle helmet sale, and guidelines on how to conduct a sale (see Section IX G for the guidelines, page 187). The guidelines illustrate a simple way to measure a child’s head properly, using lengths of string, to make sure the bicycle helmet will be the right size.

After the sale, the organizer provides the order form and money to the Injury Prevention Program office, which arranges the bicycle helmet shipment directly to the school. (The bicycle helmet sale order form is reprinted in Section IX F, page 186). The bicycle helmets are sold for $4 to $5, slightly less than the $6 to $8 price paid by the Injury Prevention program. The difference is made up by funds from the program’s state grant.

The program also provides ideas to schools for raising money for free bicycle helmet scholarships. The “scholarships” started when parents asked how they could donate money for bicycle helmets for those who might not be able to afford them. These funds are set up and run by the parents and schools independent of the county program but are used to purchase bicycle helmets through the program.

Several bike rodeos were conducted at local libraries to help promote bike and helmet safety.

Phase-In To Implementation:

The state legislature established a one-year interval between the law’s effective date (January 1997) and the date that penalties took effect (January 1998), to allow for education and awareness efforts. During that year, law enforcement officers only issued verbal warnings and passed out information packets.

A wide variety of state agencies and organizations undertook efforts to educate the public about the new law. Groups included the Florida Brain Injury Association and the Florida Department of Transportation as well as bicycle helmet manufacturers, bicycle shops, and others.

In Duval County, the TBPSEP efforts described earlier were already underway and continued during the year phase-in period and beyond. To date (May 2001), approximately 20,000 bicycle helmets have been distributed in Duval County/Jacksonville. Other activities in the county included:

• Representatives of the Florida Brain Injury Association educated the public about brain injury, its permanence and its human and emotional costs, such as the impact on families and marriages. Soon after the law’s adoption, the group issued a brochure explaining the law, the importance of wearing a bicycle helmet and proper fit, and how to get a low-cost bicycle helmet.
  
  
• The Brooks Rehabilitation Hospital provided $100,000 to augment the Duval County Injury Prevention program’s TBPSEP to allow the program to increase the number of subsidized bicycle helmets available for the 75,000 children at risk.
  
  
• The Community Oriented Police Strategies program (C.O.P.S.) in the county also undertook bicycle helmet and bicycle safety efforts. In some cases, officers made visits to schools to educate about the bicycle helmet use law and to increase bicycle helmet use. In other cases, their programs included both bicycle helmet information as well as bicycle skills training. The Duval County Injury Prevention program trained the officers in the University of Florida curriculum to maintain standardization throughout the county schools and throughout the state. The county program would also loan the bicycle trailers to the C.O.P.S. program. Shortly after this C.O.P.S. unit completed the community-training course, it received grant money to get its own bicycle trailer. However, this group of officers has since been relocated to other units and their bicycle safety education efforts have ceased.
  
  
• After the state law was passed, Duval County public schools passed a bicycle safety helmet proclamation (to be posted at all elementary schools), signed by the superintendent and the school board chair, stating that it is their goal to encourage all bicycle riders to comply with the bicycle helmet use law and that bicycle helmets should be worn for the protection of bicycle riders as they ride to and from school (reprinted in Section IX K, page 212).
  
  
• As part of a Back to School Program, the Injury Prevention Program and the Jacksonville Housing Authority participated in a number of bike rodeos at several low-income apartment sites to educate children about bike and helmet safety.
  
  
• The Jacksonville Jaguars National Football League (NFL) Foundation provided bicycle helmets at Christmas time to accompany bikes that were given to children in foster homes.

One unique approach to encourage proper bicycle helmet use was to train elementary school crossing guards to recognize correct and incorrect bicycle helmet fit. Under this 1998 program, after their training, on designated days at their respective schools, the crossing guards would distribute two types of bookmarks. One bookmark congratulated a bike-riding student for wearing a bicycle helmet and the bookmark was a ticket for a prize drawing. The other bookmark encouraged a bike-riding student who was not wearing a bicycle helmet to go to the physical education teacher to get a session on bike helmet safety. The bookmarks given to these students were a different color. After a student had participated in the bike helmet safety session, s/he could then submit the bookmark for a prize drawing. This program was through a Florida Department of Health program, funded by a CDC grant.

In 1999, the county also created a unique Bike and Dental Program. This effort uses the opportunity of a dental visit, from waiting to examination time, to conduct educational sessions for children five to 14 years old. Patients were encouraged to arrive 15 minutes early for their appointment using a free bicycle helmet as an incentive; a pre-test was administered to these children. After the child's dental examination, the dentist gave a five-minute talk on bicycle helmet safety using a poster-board presentation especially developed for this program.

After the presentation, a health educator was brought in to fit a bicycle helmet properly onto the child's head. At the end of the session, a post-test was administered. The effort appeared to be successful in increasing the knowledge of proper bicycle helmet usage within the 5-14 age group (See Section IX J., Dental visit/bicycle helmet use program evaluation (page 203), and ”My Bike Safety Contract,” Duval County, FL, page 203).

After the state law was adopted, Duval County public schools added a bicycle and pedestrian safety component to their standards. The standard stated: “by the year 2001, each student in every ethnic group will participate by the end of fifth grade . . . in a pedestrian and/or bicycle safety education program.” (See Section IX L, “High Expectations,” performance standards for Duval County schools, page 213).

However, this specific standard was later dropped, in part due to changes in school district leadership. Although the district does not track whether or not every fifth grader has participated in a pedestrian or bicycle safety program, it is continuing its strong support for the bicycle program described in the section “The Bicycle Helmet Environment And Existing Efforts,” page 52. School district employees report strong support for the program and frequent demand for the bicycle trailers and the training program. Every time a school conducts a training session, it submits a report to the county Injury Prevention program.

Law Enforcement Involvement During Phase-In:

As described earlier, law enforcement activity included some awareness and education efforts by the C.O.P.S. program in certain zones of the city. Some law enforcement officers were trained to recognize correct and incorrect bicycle helmet fit as part of the School Crossing Guard program described earlier. The Duval County Sheriff’s department coordinates the school-crossing program so the officers who supervised the program also received the training, although the crossing guards did the fieldwork.

Duval County officials involved in implementing the law did not observe consistent involvement by law enforcement in educating or enforcing the law. According to one official, “there is sporadic involvement but no sustained executive or strategic plan to apply enforcement/education on a consistent basis over time.” This official would support this approach, believing it to be “the only way to penetrate the psyche of the masses that there is no tolerance for breaking the helmet law,” thus resulting in behavior change.

Bicycle Helmet Use Law Enforcement:

A March 10, 1996 editorial in the Tallahassee Democrat, in urging legislators to pass the bicycle helmet use law, promised: “enforcement will be gentle.” That prediction appears to be accurate.

Beginning in January 1997, the law allowed officers to issue verbal warnings to offenders; beginning in January 1998, officers began issuing citations for violations of the statute. A county fine is added to the $15 state fine for a total of $23. According to the Duval County Sheriff’s Department, a portion of these fines go toward spinal cord and head injury prevention programs. The fine for a first-time offense could be waived if the offender brought evidence of purchase of a bicycle helmet to the judge. The judge also has alternative penalties at his/her disposal.

The Injury Prevention program held a focus group with schoolchildren and found that the children believed that the police are not going to enforce the bicycle helmet use law so some children choose not to comply. The schoolchildren’s perceptions appear to be realistic. Few citations are issued for violation of this law.

In 2000, the Duval Sheriff’s Department issued 24 citations for violating the bicycle helmet use law. One officer stated, “We’ve got some logistical problems with that law. It is hard to enforce; you have to write the citation for violator; most are 6, 7, 8, 10 years old. Writing a ticket for someone that age is hard for the police officer.” As a result, officers “do more education” about bicycle helmet use and the law than citation writing. “Our enforcement effort is very minimal.”

Effectiveness Of The Law:

Duval County has measured improvements in a variety of bicycle safety measures beginning before the passage of the bicycle helmet use law. The Injury Prevention program staff believes that the law has contributed to these improvements. “If you look at the data from 1996 through 1999, you can see dramatic changes, showing that something is working,” said one official.

It would be inaccurate, however, to give full credit to the bicycle helmet use law. And it would be difficult, if not impossible, to separate changes due to the law from the changes resulting from TBPSEP efforts, which began several years before the adoption of the law. Pre-law TBSPEP efforts were already generating bike safety benefits in the county. Post-law TBSPEP efforts are closely entwined with activities related to implementation of the new law.

The Injury Prevention program conducts an annual evaluation of the effectiveness of the TBSPEP, involving annual bike helmet observations at 48 sites, including elementary/middle schools and parks. They compare their findings annually with the incidence of bicycle-related morbidity and mortality and have found consistent reductions in injury and death. The Observation guidelines for the Duval County Bicycle Helmet Use and Behavioral Survey are reprinted in Section IX H, page 189. The coding instructions and form for the county’s bicycle helmet use observational study are reprinted in Section IX I., page 191.

From 1996 to 1999, the bicycle helmet usage rate increased 393 percent among children ages 12 and under. The county’s bicycle injury rate (per 100,000 population) over the same time period decreased from 51.07 to 33.62, or 34 percent. (See Charts 1 and 2, this page; also see Table 1 for breakdown of bicycle helmet usage rates by year and by age group, (page 59).

Chart 1 & 2
Duval County Comparison and Correlation of Bicycle Helmet Usage Rates and Bicycle Injuries Involving a Motor Vehicle, Fatal and Nonfatal for the 0-12 Age Group (1996-1999)

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	[d]
Source: Duval County Health Department TIPPO Annual Observational Survey Studies, U.S. Census Bureau and FL Department of Highway Safety and Motor Vehicle (DHSMV) Crash Data Reporting Agency: DCHD/TIPPO

FL Table 1
Duval County, FL, Bicycle Helmet Usage Rate Comparison by Age, 1996-1999

Year	0-12 Years	13-18 Years	>19 Years
1996	13.8	4.7	32.6
1997	58.7	13.2	29.5
1998	72.9	21.5	33.1
1999	68.0	7.9	29.9
Source: Duval County Injury Prevention Program Office

Overall, the 0-12 age group experienced the most significant increase in bicycle helmet usage, followed by the13-18 age group. The over-19 age group experienced the smallest increase in bicycle helmet use.

The Injury Prevention program staff also identified increases in observed “positive safety behavior techniques,” such as signaling intent to turn, obeying traffic rules, and wearing highly visible clothing. These findings are from observational studies that the program has conducted since 1996.

These observations were derived from a large sample of 103 elementary schools, nearly half of the county total. For example, in 1997, the children observed scanning while bicycle riding was only 6.9 percent; in 2000 this behavior more than doubled to 15.8 percent. Riders observed wearing bright clothing increased from 10.6 percent in 1997 to 55.9 percent in 2000.

According to the county data collected from the annual bicycle helmet observations, the number of students riding bicycles to school decreased from 1996 to 1999. This was determined by comparing the total number of bicycle riders observed for each year. However, county officials did not research reasons for a decrease, so it is not known if any portion of that ridership decrease may be attributed to the law.

Little information is available regarding the community’s attitudes toward the law. As mentioned earlier, the TBSPEP conducted both an attitude survey and a focus group with middle school students, chosen because those are ages identified as the hardest to affect. The students believed that the police were not going to enforce the bicycle helmet use law and simply didn’t like the law. Information characterizing the reaction to the law or its related education or enforcement efforts by other age groups was not available.

Evaluation:

To evaluate the effectiveness of their bicycle safety efforts, including the implementation of the bicycle helmet use law, Duval County uses observational surveys to determine bicycle helmet usage rates over time compared to bike injuries over time. As outlined above, the TBPSEP program has been able to track its impact over time, beginning with efforts before the adoption of the law.

Program managers would like to add data reflecting the citations issued for bike helmet violations to their evaluations. The official statistics for bicycle helmet citations are combined with the number of citations issued for a wide range of bicycle violations, so it is difficult to measure how many citations were issued to children who were not wearing bicycle helmets.

Those interviewed provided several reasons for the program’s strong evaluation component.

One factor is the source of funds: the federal dollars that support some of the TBPSEP’s activities come with the requirement that evaluations be built into the activity, so that the project’s success in reaching its goals and objectives can be measured.

Also, the Florida Department of Health and the Duval County Health Department (DCHD) both have traditionally supported evaluations of their programs. However, the strongest reason, according to those interviewed, is the staff’s commitment to the public health model. Individuals working on the project were described (both by themselves and by others) as having a strong personal commitment to conducting evaluations of their programs.

One official said he had seen too many injury prevention programs with poor or missing data. In his words: “We did a neat intervention but did it make a difference? I wanted to make sure that we had the data to do a valid evaluation of my programs . . . I tried to apply the academic model as rigorously as possible.”

These officials also acknowledged the challenges of conducting sound evaluations. Doing so at times required obtaining additional training or bringing in others with the appropriate expertise to assure the findings would be valid. Doing evaluations, as one official put it, “is not fun; it’s rigorous, tedious, a necessary evil to get the money. But it should be required. Funders should be more demanding of the outcomes and the evaluations conducted,” to assure that funds are being spent effectively. “Why throw money at a lemon?”

The motivation of the program managers was also identified as an important determinant. If the work is “just a job,” one might be less dedicated to finding the resources and undertaking the work needed to measure the outcome. Someone with that attitude may approach the program with the philosophy: “Let’s get the money for the program (and do the minimum amount of work required) and say we did it.”

The officials interviewed believed that senior management buy-in from the law enforcement community would be a primary condition for a jurisdiction to undertake an evaluation of its bicycle helmet use law. A secondary condition would be support from other members of the bicycle safety community.

Retrospective Analysis:

Duval County officials engaged in bicycle safety efforts had several comments for jurisdictions interested in the effectiveness of their bicycle helmet use law:

• Law enforcement agencies, at the highest levels, should establish zero tolerance for noncompliance. This senior-level commitment should be widely disseminated in the media, balanced with information about all of the support systems in place to help families support the injury prevention intent of the law (such as bicycle helmet subsidies and giveaways).
  
  
• The law would be more effective if it were inclusive of all ages.
  
  
• “Most laws will be effective in the first or second year. However, if a law is not enforced it may lose its potential due to the public’s awareness of the lack of penalties.”