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Am Fam Physician. 2002;65(2):326-329

AAP Policy Statement on Use of Bicycle Helmets

The Committee on Injury and Poison Prevention of the American Academy of Pediatrics (AAP) has issued a policy statement on the use of bicycle helmets. The statement appears in the October 2001 issue of Pediatrics.

Bicycling accounts for more emergency department visits by children and adolescents (younger than 21 years) than any other recreational sport. Two thirds of all bicycle-associated fatalities are a result of brain injury. According to the committee, a helmet that is undamaged and properly fitted should provide head protection in most cases if the trauma is not extreme. The helmet should fit snugly, sit low on the forehead and parallel to the ground, with the chin strap secured so that no more than two fingers can be inserted between the chin and strap. The helmet should not move or obscure vision with head movement.

Results of studies indicate that the use of bicycle helmets increased when local or state laws were in effect requiring helmet use and/or adults in the family also wore helmets while cycling.

The AAP recommendations include the following:

  • All bicyclists should wear helmets that meet the March 1999 safety standards of the U.S. Consumer Product Safety Commission (CPSC) and should bear a CPSC label inside the helmet. Helmets manufactured before this date should meet the safety standards of the Snell Memorial Foundation or the American Society for Testing and Materials. Helmets that have been damaged or outgrown should be discarded and replaced.

  • As passengers on bicycles, children should wear properly fitted and secured helmets, preferably ride in a bicycle-towed child trailer, and should be at least one year of age.

  • Physicians should encourage replacement of damaged helmets, with routine replacement every five years (or sooner depending on manufacturer's recommendations). Because hairline cracks or other subtle damage to a helmet may not be visible, purchase of used helmets should be discouraged.

  • Because bicycle helmets represent only one aspect of bicycle safety, adults responsible for children or adolescents who bicycle are encouraged to learn and teach their children all rules and regulations associated with bicycle safety.

As advocates for bicycle safety, the AAP recommends that physicians encourage parents and caretakers to educate their children about bicycle safety and to require that they wear helmets while bicycling, to serve as models to children by wearing helmets themselves, and to promote community-and school-based initiatives on the use of bicycle helmets in the community.

FDA Approves Weekly Birth Control Patch

The U.S. Food and Drug Administration (FDA) has approved the first contraceptive patch for use on a weekly basis.

The three-layer, combination, transdermal patch, Ortho Evra, contains 6.00 mg of norelgestromin and 0.75 mg of ethinyl estradiol, releasing 150 mcg and 20 mcg, respectively, into the blood stream every 24 hours. The patch is applied on the same day each week for three consecutive weeks to the buttocks, abdomen, upper torso (front or back, but not breasts), or upper outer arm. The fourth week is patch-free. Results of clinical studies demonstrate a low rate of premature detachment of the patches, and the patches were found to be durable while bathing, swimming, or exercising.

Pregnancy rates from three large, worldwide trials involving 3,300 women who completed 22,155 cycles of the patch were approximately one per 100-women years of use. Of the 15 pregnancies reported, five occurred in women who weighed 198 lb (90 kg) or more (less than 3 percent of the study population), indicating the patch may be less effective in this group of women. The most common adverse events reported included breast symptoms, headache, patch-site irritation, and nausea. It is strongly recommended that women who use the patch quit smoking. As with other combination hormonal contraceptives, the patch is not recommended for use by women who have blood clots, certain cancers, a history of heart attack or stroke, or those who may be pregnant. The patch does not provide protection against sexually transmitted diseases or human immunodeficiency virus, and is not indicated for use as an emergency contraceptive.

Ortho Evra is scheduled to be released to consumers by prescription during the first half of 2002. Additional information is available at

Scientific Exhibit Deadline for AAFP Assembly

A call for scientific exhibits has been issued by the American Academy of Family Physicians (AAFP) for possible presentation at the 2002 Scientific Assembly October 16–20, 2002, in San Diego. Applications must be submitted by April 12, 2002. Membership in the AAFP is not a prerequisite for submission. Scientific exhibits provide a forum for the presentation of research that is of interest and educational value to family physicians. The exhibits include those presented by residents and medical students.

Travel grants of $1,000 may be awarded to a maximum of 15 resident/student scientific exhibitors whose applications are accepted for presentation at the assembly. In addition, cash awards for first, second, third, and fourth places may be presented to resident/student exhibitors. Application forms may be obtained from Vicky Binder, Scientific Program Department, AAFP, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211; telephone: 800-274-2237, ext. 6564; or by visiting the AAFP Web site at

Alcohol, Tobacco, and Drug Use Statistics

The latest federal statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services are now available in a new report format analyzing substance abuse in the United States.

The new short reports, in fact-sheet format, cover a variety of topics, analyzing the most current data on substance abuse. Club Drugs, Youth Who Carry Handguns, and Pregnancy and Illicit Drug Use are some of the 18 topics currently available. Sources contributing to the reports include the National Household Survey on Drug Abuse, Drug Abuse Warning Network, and the Drug and Alcohol Information System. SAMHSA will publish an additional two to three reports on a monthly basis, all derived from a more comprehensive report issued by SAMHSA's Office of Applied Studies.

The reports are available online at or by contacting the Publications and Data Dissemination Team, OAS/SAMHSA, 16–105 Parklawn Bldg., 5600 Fishers Lane, Rockville, MD 20857.

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Copyright © 2002 by the American Academy of Family Physicians.

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