Background:We determined the agreement between parents and their school-age children on reported barriers to bicycle helmet use.Material/Methods:We conducted a cross-sectional survey in a 2-county Central Texas region with no helmet use legislation. Parent-child pairs, selected through a randomized, multi-stage sampling procedure and pre-matched by unique identifiers, were surveyed independently with self-administered questionnaires. Parent-child concordance was assessed using Kappa statistic.Results:Of 1,987 surveys distributed, children returned 1,203 (61%) while parents returned 636 (53% of child respondents). Parents included 31% college graduates and 33% reported annual income of >$55,000. Children included 60% whites, 16% blacks, and 16% Hispanics. The most popular reasons cited by children as barriers to helmet use were not having one (34%), being a safe rider (31%), and helmets messing up hair (18%). Good concordance was found on reported child bicycle riding (parent=88.0% vs. child=88.0%; K=0.64) and child helmet use the last time child rode a bicycle (parent=25.1% vs. child=28.0%; K=0.54). While good concordance was also found for reported helmet ownership (parent=31.9% vs. child=29.9%; K= 0.50), poor concordance was found for other barriers to helmet use including helmets looking ugly (parent=6.5% vs. child=13.4%; K=0.38) and messing up hair (parent=5.6% vs. child=15.2%; K=0.36).Conclusions:Although parents may be generally aware of their children’s bicycle riding and helmet use habits, they may not be fully aware of the reasons why their children may not use a helmet. Public education and interventions on helmet promotion need to focus on parents.

Keywords: Adolescent, Athletic Injuries - prevention & control, Attitude to Health, Bicycling - injuries, Child, Child Behavior, Head Protective Devices, Health Behavior, Health Education, Parent-Child Relations, Parents, Questionnaires