A Cochrane review [Abstract] 1 included 6 studies where bicycle helmet legislation had been enacted for children only. Adults were used as controls in five of the studies, whilst jurisdictions with no helmet legislation were used as controls in the sixth. One study reported on bicycle related mortality while three of the studies reported on changes in head injury rates and three reported on changes in helmet use. There were no included studies reporting change in bicycle use or other adverse consequences of legislation. In three studies, statistically significant decreases in mortality or head injuries were reported following the implementation of helmet legislation compared with controls, whilst one reported a non-statistically significant decline in head injuries. Bicycle helmet use increased statistically significantly post-legislation in all three of the studies reporting on helmet use.
Comment: The quality of evidence is downgraded by study quality (only before-after, non-randomized case-control studies; insufficient reporting on e.g. actual helmet use) and indirectness (only child cyclists; adults used as controls for children).
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