Predicting bicycle helmet stage-of-change among middle school, high school, and college cyclists from demographic, cognitive, and motivational variables

Objectives To apply Prochaska's Transtheoretical model of behavior change to bicycle helmet use among middle school, high school, and college students. Study design A battery of questionnaires was administered to cyclists in the seventh and ninth grades and to college students in Phoenix, Arizona (N=797). The battery included: (1) a question to determine respondent's stage of behavior change in Prochaska's Transtheoretical model; (2) items assessing the perceived pros and cons of helmet use; (3) a bicycle safety knowledge test; and (4) demographic information. Results Forty-three percent of the students were in "Precontemplation," 17% were in either "Contemplation" or "Preparation," 16% were in either "Action" or "Maintenance," and 24% were in the "Relapse" stage of change. Grade, Sex, Knowledge, Pros, and Cons, and the Grade by sex and the Grade by knowledge interactions were significant predictors of helmet use stages. Compared with students in Precontemplation, students in the Contemplation stage were disproportionately younger and had higher Pro scores, lower Con scores, and more knowledge (except in the ninth grade). Conclusions The Transtheoretical model of behavior change is a viable theoretical framework for designing interventions aimed at increasing bicycle helmet use in children and adolescents.