The objectives of the study were to determine helmet use rates, incidence rates (IRs) of head and facial injuries for population attributable fraction (PAF) estimation, and to elucidate the magnitude of and changes in PAFs as the result of helmet use changes among preschool children. A study consisting of cross-sectional (survey) and longitudinal (follow-up) component was designed by including a randomly selected group of participants (n = 322) from 10 Head Start sites provided with free bicycle helmets along with a subgroup of prior helmet owners (n = 68) from the other random group (n = 285). All participants received bicycle helmet education. Helmet use surveys were conducted in May (1st Survey) and November 2008 (2nd Survey). The helmet owners were followed up to determine IRs, and incidence rate ratios (IRRs) for head and facial injuries. PAFs were computed using IRs as well as helmet use rates and IRRs. Helmet use rates increased significantly from the 1st to the 2nd Survey. The mean follow-up person-time was 5 months. The IRs for head, face (all portions), and face (upper/mid portions) injuries were higher in non-helmeted than helmeted riders. By using IRs, PAFs for the 3 injuries among the riders in both groups of helmet owners were 77%, 22%, and 32% respectively. The PAFs for each of the above injuries decreased by about 10% as helmet use rates increased. The magnitude of and changes in preventable head and facial injuries following free bicycle helmet distribution and education among helmeted riders was elucidated in this Head Start preschool children population.
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