Promoting helmet usage in undergraduates with electric and non-electric bicycles and scooters: a single-site survey and intervention

College students report alarmingly low helmet usage while riding bikes and other open-wheeled forms of transportation (OWTs), increasing risk of brain injury and skull fracture. Despite prior interventions, this problem persists, necessitating an updated examination of the current barriers to helmet usage, and how to effectively mitigate them. This study aimed to determine the effect of class year on helmet usage in American college students, and explore emerging trends with electric bikes, skateboards, and scooters. We created and distributed an online survey to undergraduate students at Stanford University in California (N = 400) who regularly used electric or non-electric bikes, skateboards, or scooters. This survey collected information on helmet usage, attitudes on bike safety, and demographics, and the findings were used to design a pilot intervention. Students who regularly wore helmets were recruited as peer agents (N=3) and were trained to ask friends and classmates to pledge to wear a helmet. We observed bike, scooter, and skateboard rides (N = 4885), and followed up with students who pledged to analyze their behavior change. We confirmed prior trends that most college students never or rarely wear a helmet, and the most common reasons for not wearing a helmet were "Helmets mess up my hair" (44%), "I dont see others wearing helmets" (43%), and "Its unlikely I will fall/crash" (34%). We also found that helmet usage was similarly low (48% of participants reported never wearing a helmet) across class years, but class years reported different reasons for not wearing a helmet. Lastly, there was no difference in helmet usage between electric and non-electric OWT users for any of the frequency categories (p=0.43 for daily, p=0.44 for a few times a week, p=0.77 for a few times a month, p=0.23 for rarely, p=0.15 for never), revealing that previous trends in helmet behavior also apply to American college students with electric OWTs. The pilot intervention resulted in a non-significant yet positive trend, and students who pledged demonstrated a behavior change (as measured by follow-up surveys about helmet usage) that persisted 3 weeks after the conclusion of the intervention. In addition to finding that past trends about helmet behavior in college students are still present, we discovered new trends on electric OWTs and class years in American college students. We also found that our peer agent program shows promise in modifying the behavior of college students.