Bicycle helmet campaigns increase helmet use but there is uncertainty about their effect on head injuries. During and after a campaign in Quebec, Canada (

) head injuries were reduced in children in both poor and more affluent communities.

The campaign took place in spring and summer during the years 1990 to 1993 and involved schools, police, community organisations, and retailers. It targeted 140 000 children aged 5–12 years. A different community with 83 500 children of that age but without a bicycle helmet campaign served as control. In the target community 24 of 210 municipalities were classified as poor (20% or more of households of low income) and in the control community 27 of 98. Previous reports from the study showed that the campaign increased helmet ownership and use but was three times more effective in these respects in more affluent municipalities than in poor municipalities. This paper reports that, despite this lesser response in poor communities, the effect on head injuries in cyclists was similar in both poor and non-poor municipalities. Before the campaign the incidence of head injuries in poor municipalities was three times greater in the target community than in the control community and in non-poor municipalities it was 50% greater in the target community. After the campaign the incidence fell in both poor and non-poor municipalities in the target community but did not change in the control community. In the target community the incidence of head injuries due to cycling accidents fell by 55% in poor communities and by 45% in non-poor communities when the 3 years before the campaign (1988–90) were compared with the 3 years after the campaign (1994–96).

The campaign was followed by a reduction in head injuries in both poor and non-poor municipalities despite a lesser uptake of helmets in the poor municipalities. The reasons for this apparent discrepancy are unclear.