Dannenberg et al (1993) – Legislation

Dannenberg et al., (1993) ‘Bicycle helmet laws and educational campaigns: an evaluation of strategies to increase children’s helmet use’, American Journal of Public Health 83 (5), 667–74)



This is the second study we will be looking at from the Methods of Health Promotion section of ‘Healthy Living’, as part of your OCR A2 Health and Clinical Psychology course. It is further categorised into ‘Legislation


Legislation is varies from country to country and this can have an effect upon the health of it’s citizens.

Dannenburg et al (1993) – studied legislation in Maryland in the United States to see how the legislation to compel young cyclists to wear helmets affected health behaviour.


To review the impact of the passing of a law requiring cycle helmet wearing in children.

Method and Design

A Quasi-experiment. As the experimenter could not have controlled the law, the experiment had to be quasi, the independent variable was naturally occurring.

The experiment was conducted when laws were passed in Howard County, Maryland, USA requiring children under 16 to wear approved safety helmets when riding bicycles.

The design of the study was an independent design.


Children from 47 schools in Howard County, and two control groups from Montgomery County and Baltimore County (all of which were in Maryland, USA). They were in the 4th, 7th and 9th grades and were aged between 10-15 years old.

In the control group of Montgomery County there was already a campaign to promote bicycle safety.

In all 7322 children were sent questionnaires, around 3000 questionnaires were returned.


Questionnaires containing four-point likert scales were sent and completed by the children, but parents were asked to help the child complete the questionnaires, so consent was gained.

Topics covered in the questionnaires included:

  • bicycle use
  • helmet ownership and use
  • awareness of law
  • sources of information about helmets
  • peer pressure.

Participants were asked about use one year previously and on their most recent bike ride. Howard county reported usage had increased from 11.4 to 37.5%, compared with 8.4 to 12.6% in Montgomery County and 6.7 to 11.1% in Baltimore County.

The younger the children, the more their bicycle helmet usage increased.

After the law was introduced Howard County had the highest rates of helmet adherence in the entire USA.


Passing legislation has more of an effect than educational campaigns alone, and educational campaigns are not necessarily at all in increasing health behaviours.

The self report method used here correlated with an observational study by Cote et al (1992), which found similar rates of cycle helmet usage.

Dannenburg et al  (1993) Evaluation

– The use of likert scales can be lacking in validity if they are not properly operationalised.

+ Useful the study is useful for increasing health behaviours in individuals, it may be better to combine passing laws with media campaigns.

– Quasi-experiments – lack control as the experimenter cannot manipulate the variables. However, this does lead to higher ethics.

– Reductionism – the experiment has not considered the wider causes for the adoption of health behaviours.

– Generalisability – as the sample considered of school children, we could argue that this sample is more suggestible than older populations.

– Replicability is low because to repeat this study one would have to wait for another similar law to be passed.

+ Concurrent validity – is shown due to Cote et al’s observational study, which also suggests that issues with self-reports may not have a risen with this study.


Dannenberg et al., (1993) ‘Bicycle helmet laws and educational campaigns: an evaluation of strategies to increase children’s helmet use’, American Journal of Public Health 83 (5), 667–74) 


Further Reading

OCR A2 Psychology Student Unit Guide New Edition: Unit G543 Health and Clinical Psychology (Student Unit Guides)

Psych Yogi’s Top Ten Psychology Revision Tips for the A* Student

Article Name
Dannenberg et al (1993) - Legislation
'Theories of Health Belief' section of 'Methods of Health Promotion' Revise OCR A2 Health & Clinical Psychology course. Further categorised into 'Legislation'