Objective. To examine whether the helmet status of riding companions (child or adult) influences helmet use by children (5–14 years).

Methods. This study is part of a larger prospective observational survey that was conducted in a defined urban region of Toronto, Canada (1990–1997, 1999, and 2001). Trained observers collected data on children who were riding bicycles in April through October each year. Observation sites included school yards, parks, major intersections, and residential streets.

Results. Of the 2094 children who were observed riding a bicycle, 50% were riding alone, 36% were riding with at least 1 child companion, and 14% were riding with at least 1 adult companion. Compared with riding alone, children were less likely to wear a helmet when riding with nonhelmeted child companions (relative risk [RR]: 0.29; 95% confidence interval [CI]: 0.22–0.38) and were more than twice as likely to wear a helmet when riding with either helmeted child (RR: 2.18; 95% CI: 1.97–2.42) or adult companions (RR: 2.67; 95% CI: 2.44–2.93). Compared with children who were riding with nonhelmeted child companions, children were more likely to wear a helmet when riding with nonhelmeted adults (RR: 3.93; 95% CI: 2.86–5.40), helmeted adults (RR: 9.18; 95% CI: 7.04–11.98), or helmeted children (RR: 7.49; 95% CI: 5.72–9.82). Adjusted analyses showed no difference between companion helmet status and helmet use by children before and after legislation.

Conclusions. Helmeted and nonhelmeted adult riding companions were positively associated with child helmet use. The association between child riding companions and child helmet use was positive for helmeted child riding companions and negative for nonhelmeted child riding companions. Efforts need to be made toward improving adult helmet use and children's perceptions and attitudes toward helmet use.

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