B. Jacksonville/Duval County, Florida
Jurisdiction: State law, countywide activities.
Effective date: January 1, 1997.
Ages covered: Children under age 16.
Penalty: State law established a $15 fine; counties have the authority to levy an additional monetary penalty. Thus, in Duval County, which has an added $8 fine, the total penalty is $23.
Agency enforcing the law: In Duval County, the Jacksonville Sheriff's Office.
Legislative language is reprinted in Section VII B.
Duval County, FL, is an urbanized county that includes the city of Jacksonville, FL. The county population is approximately 773,000.
Duval County has embraced the state bicycle helmet use law (especially in comparison to some Florida counties, described below). This profile examines Duval County’s experience with the state law and the county’s approach to the law’s implementation. The city and county merged in 1968, so the government structure consists of a single entity covering Duval County, where the bulk of the population resides (several small beach communities continue to have local jurisdictions within the county).
Impetus For Legislation:
Elizabeth “Budd” Bell created a coalition on children, family, and health issues in 1970 “which grew quickly into a statewide clearinghouse (a group of agencies interested in learning advocacy for change).” The organization, the Clearinghouse on Human Services, to date has almost 300 participating agencies.
Bell remains its volunteer coordinator, active in advocating on a variety of children’s issues. In addition to her professional knowledge of state government and programs and her work as a social worker working with head-injured children, she has learned a lot about the benefits of bicycle helmets from colleagues who were pediatricians, and from her son, who was a safety specialist in Sweden.
“A number of pediatricians had talked to me, pediatric neurologists. They asked, ‘why don’t you do something about preventing head injury?’ And I was in Sweden almost every year” seeing the high rates of bicycle helmet use there. Then, a retail executive for Target Corp. who had moved to the area from California worked with her to help publicize bicycle helmets and bike safety in the parking lot of his store.
A bicycle helmet awareness project was launched, and from that, a coalition to work for passage of a bicycle helmet use law began in 1993. Its leaders included the state’s pedestrian/bicycle coordinator and Bell. “It was very natural for the Florida Department of Health and other agencies to look to the Clearinghouse for help with pressing injury prevention issues,” she said.
A variety of organizations were approached to participate in this effort, including the THINK FIRST Foundation and Florida SAFE KIDS. The coalition began meeting in late 1993 to discuss draft legislation and to prepare for the upcoming legislative session.
The Legislative Experience:
Bell, a skilled volunteer lobbyist, emphasizes the coalition effort in support of bill passage as the foundation of legislative success. In her words: “Our first coalition developed in 1993 and from that legislative session on, 1994, 1995, and 1996, we increased the understanding of the helmet issue with the help of the media that resulted in the statute we have today. The bicycle helmet bill became a yearly pilgrimage with widening circles of support throughout the state.”
The wide-ranging coalition included the Bicycle Safety Office of the Florida Department of Transportation, the Developmental Disabilities Council, Florida State Highway Patrol, the Junior League State Public Affairs Committee, the Academy of Florida Trial Lawyers, the Florida Junior Chamber of Commerce, SAFE KIDS coalitions, and every county Bicycle Safety Coordinator in the state. Bell noted that the American Academy of Pediatrics was “a great ally.” She wrote: “many medical societies including the pediatric groups came to the capital in Tallahassee frequently to testify and joined us in countless press conferences.”
However, Bell also noted one drawback in working with the many professional associations in the coalition. Given that the leadership of many of these associations changes annually, there can be a loss of institutional memory, expertise, and level of involvement.
The legislative sponsors also were important; in this case, both were physicians. “Both legislative sponsors stayed with us the entire four years. Dr. Don Sullivan, an orthopedic surgeon from St. Petersburg and Dr. Robert Casey, a family physician from Gainesville, carried the torch for us.”
Bell summarized the process, attributing part of the success to a change in the governor’s office: “We lost it three years in a row after a good deal of lobbying. Finally in the fourth year, it was a combination of the weariness (of the legislators), and we had a different governor. We had (the late Governor Lawton) Chiles who believed in children.”
Advancing the bill was a step-by-step process. Supporters would work to win the bill’s support in one committee and then move to the next battle in the next committee. Though bicycle helmet use legislation made some progress in every session in which it was introduced, it took “four long years” before the enactment of the law. Both houses of the legislature enacted the law near the end of the 1996 legislative session. Bell wrote in a letter to supporters following passage of the bill: “After the failure we experienced in the 1994 and 1995 sessions, this is a sweet victory for all of us.”
The coalition was active in educating legislators about the need for the legislation. Fact sheets, posters, and handouts were developed and distributed. One 1995 hand-out urged legislators to “Use Your Head - Vote Yes” on the bicycle helmet bills, listing the coalition members. A poster from the Florida Agency for Health Care Administration was illustrated with a photo of a child on a bicycle, wearing a bicycle helmet, with the legend:
A Bicycle Helmet Fact Sheet, referencing information from the Florida Department of Transportation Safety Office and the State Bicycle Coordinator, listed a variety of statistics and arguments in support of the bill. Many of these arguments showed up in other venues, such as in columns and editorials printed in state newspapers.
One frequently used argument was that Florida was the most dangerous place to ride a bicycle in the nation. According to data from the state Division of Highway Safety and Motor Vehicles, Floridians were almost three times as likely to be killed in a bicycle crash as the national average.
Another frequently raised argument was: “The world has changed since many of today’s adults were children. There is more traffic, more concrete, and more complexity in even a simple bicycle trip.”
A May 1995 open letter from Richard E. Weibley, the Director of the Tampa General Hospital Pediatric Intensive Care Unit (PICU), was widely distributed, including to the capital’s press corps. Some excerpts from the letter:
News conferences and bike safety fairs also were held. A November 1995 news conference to kick off the 1996 session included the bill’s sponsors as well as representatives of the medical, insurance and legal communities. Speakers included representatives of the Florida Medical Association, Neuroscience Center of the Tallahassee Memorial Hospital, Florida Brain & Spinal Cord Injury Advisory Council, Florida Association of Professional Emergency Medical Technicians (EMT’s) and Paramedics, Florida Developmental Disabilities Council, and the Academy of Florida Trial Lawyers.
Events would respond to concerns raised by legislators. For example, an April 1995 news conference sought to answer legislators’ concerns about access to bicycle helmets by children in low-income families. The news release announced:
A number of editorials and columns in major newspapers around the state clamored for the bill, especially as the 1996 legislative session looked like it might end without bill passage. A March 10, 1996 editorial in the Tallahassee Democrat in support of the bill raised many of the arguments and statistics developed by the bicycle helmet coalition and called the legislature’s lack of action on the legislation “shameful.” A March 31, 1996 editorial in the Miami Herald, titled “Protecting Little Noggins,” began with “the docs know best,” referring to the bill’s sponsors.
Bell emphasized the benefits of getting out your message through the media. “The press will always do something decent if you give them materials,” by assuring that a copy of whatever is distributed to legislators is also put into each reporter’s box in the capital’s press room. Social work students at the Clearinghouse aided Bell in these and other efforts.
Statistical evidence was very helpful throughout the process of moving the bill through the legislature, including the information that Florida’s bicycle fatality rate was much higher than the national average.
After the bill had not advanced in several legislative sessions, Stephen McCloskey of the Duval County Injury Prevention Program Office undertook a focused effort to make state legislators aware of the statistical evidence supporting bicycle helmet use early in the legislative session. He described it as “deciding to walk on the wild side.” Working with Ted Miller of Pacific Institute for Research and Evaluation (PIRE), McCloskey developed statistics about the cost of injuries and a cost/benefit analysis for the state and Duval County. McCloskey compiled a list of all of the legislators who hadn’t supported the legislation in the earlier sessions. He then spent several days in the state capital in Tallahassee to meet with those legislators, presenting them with the materials he had compiled and answered their questions about government intrusion, transfer of payments, and other issues raised during the debates on the legislation. “We went to the legislators and educated them on the injury epidemic, leaving the statistics and documents with them in each office,” McCloskey said.
One legislator representing a low-income area was worried about her constituents’ ability to afford bicycle helmets. McCloskey described for her the sources for free and low-cost bicycle helmets, such as funding that his program had recently been awarded to provide 50,000 bicycle helmets.
In every office except for one, McCloskey’s education effort resulted in a commitment from the legislator to support the bill.
Anecdotal evidence, such as the letter from Dr. Weibley excerpted earlier, also was used.
After the law passed, in a letter to coalition members, Bell discussed effective components of their strategy. In this paragraph, she described the impact of bringing forward crash victims:
One recommended strategy as to “bring children up over and over” as a way of reminding and educating legislators. In addition to the active involvement of children in the process, witnesses also included parents who had lost children in bicycle crashes. “We brought parents of children who didn’t survive, parents who wanted to do something, even though it was painful for them and for us.”
Once the legislation started to move, a fatal bicycle crash got the attention of legislators and appeared to help the bill’s chances. Margaret Raynal, an avid bicyclist who was instrumental in developing the curriculum for Duval County’s highly successful Traffic, Bicycle and Pedestrian Safety Education Program (see next section for more information on this program), was killed in a crash. Interestingly, it was the death of Raynal, an adult, that helped focus the legislature’s interest in requiring children (but not adults) to wear bicycle helmets.
The strongest arguments against the bill appeared to be concerns about government intrusion into private family choices and the idea that it was an individual’s choice whether or not to wear a helmet.
An undated Associated Press story about the House bill included some of these arguments:
The story also quoted the response of the bill’s sponsor, Rep. Robert Casey (R-Gainesville):
Bill supporters believed they disproved the “government intrusion” arguments by transfer cost analysis of long-term traumatic brain injury victims; that is, by illustrating how this “individual choice” frequently resulted in substantial, and preventable, costs to society at large, especially taxpayers.
The issue of the cost of bicycle helmets was a strong and recurring concern. One newspaper columnist criticized the argument raised by one legislator “who worried about ‘selective enforcement in poor neighborhoods where children can’t afford to get to the Wal-Marts to get the low-priced helmets.’ So where does he think they get their bicycles? Last I heard, helmets cost a good deal less.”
As mentioned above, a news conference to respond to these concerns was held. Bell had tremendous resistance from some legislators because bicycle helmets were so costly at the time. They told me “the only children who will die are low income children because they can’t afford the helmet.”
Bell looked for a solution. Through contacts with Bell Sports, Inc. (no relation), she was able to locate bicycle helmets at a substantial discount.
“Bell Sports was very available to us when there were problems like legislators protesting that impoverished parents in their counties could not afford helmets. Bell, as well as other manufacturers, responded with very reduced prices for helmets.”
And, in her post-passage letter to coalition members congratulating them on the victory, the issue remained on her mind: “Now we have to start fundraising in your local areas to provide free or low cost helmets to all children identified as needing them . . .”
A variety of bicycle helmet programs, described elsewhere, also responded to these concerns.
Some bill supporters believe that the most persuasive arguments for the bill were the cost-benefit analysis developed by McCloskey and Miller (mentioned earlier) and the availability of low-cost (and no-cost) bicycle helmets.
Some provisions in the legislation were changed over time in response to concerns raised. According to Bell, the bill “didn’t change radically” over the years, in part due to the fact that “we had the same sponsors” throughout the process. “We used the base of it, lopped off two or three things.”
The bill was always a minors-only law according to Bell.
In the last session, the bill “was amended slightly to meet some of the 1995 objections about private driveways,” as Bell wrote to her coalition members in 1996. Law enforcement officers can not issue citations “to persons on private property, except any part thereof which is open to the use of the public for purposes of vehicular traffic,” according to the statute.
The bill included provisions on other aspects of bicycling, such as not allowing a passenger to remain in a child seat or carrier on a bicycle when the rider is not in immediate control of the bicycle, but permitting an adult rider to “carry a child securely attached to his or her person in a backpack or sling.”
One unique aspect of the law allowed counties to “opt-out” of the bicycle helmet use requirement. To do so, the county government had to hold a hearing, provide notice of the proposal, take testimony, and then enact an ordinance to that effect, before January 1, 1998.
The law took effect January 1, 1997, requiring children under 16 to wear bicycle helmets when riding bicycles anywhere traffic passes. For the first year, verbal warnings and information pamphlets were given. Beginning January 1, 1998, the state fine for violating the law was $15. Counties have the authority to levy an additional amount for county-specific revenue generation.
When the state law passed, three counties -- Brevard, Citrus, and St. Lucie -- used the “opt-out” provision and chose to exempt their residents from the law. Brevard County later reversed that decision.
The Bicycle Helmet Environment And Existing Efforts:
A wide variety of bicycle helmet promotion activities were in place in Duval County in advance of the state law.
The Duval County Health Department’s Injury Prevention Program has had a Traffic, Bicycle and Pedestrian Safety Education Program (TBPSEP) in place since 1995.
This five-year program is recognized as one of the premier bicycle safety projects in the nation. It has received funding from the state of Florida, the National Highway Traffic Safety Administration, and the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control. The program has resulted in a steady decrease in bicycle-related injury mortality and morbidity, demonstrated through rigorous evaluation. This has been accomplished through policy changes (in addition to the state bicycle helmet legislation, the program also cites school district policies), education, behavior modification techniques, and distribution of 20,000 bicycle helmets.
TBPSEP includes training physical education teachers in elementary schools to carry out the bicycle safety curriculum developed by the University of Florida. The training is coordinated through the school district, using a full-time employee supplied by the district who assists the schools in holding bicycle safety classes. One school administrative official believes the program would not be a success without having a staff person dedicated to its operation, providing support to the teachers. Each school that implements the TBPSEP includes a bicycle helmet activity in its lesson plan. Students learn how to determine proper bicycle helmet fit and the importance of proper fit.
TBPSEP has created a framework for distributing subsidized bike helmets. Aided by TBPSEP, schools and Parent-Teacher Associations (PTAs) conduct bicycle helmet sales at their school site. The cost of bicycle helmets is 50 to70 percent below retail prices. When a PTA representative or a physical education teacher conducts a bicycle helmet sale, they can check out a “helmet kit” from the county’s Injury Prevention Program. These kits provide step-by-step help for the bicycle helmet sales.
The kit includes samples of the four bicycle helmets that are offered, a manila envelope with an order form, a flyer to send to parents announcing the upcoming bicycle helmet sale, and guidelines on how to conduct a sale (see Section IX G for the guidelines, page 187). The guidelines illustrate a simple way to measure a child’s head properly, using lengths of string, to make sure the bicycle helmet will be the right size.
After the sale, the organizer provides the order form and money to the Injury Prevention Program office, which arranges the bicycle helmet shipment directly to the school. (The bicycle helmet sale order form is reprinted in Section IX F, page 186). The bicycle helmets are sold for $4 to $5, slightly less than the $6 to $8 price paid by the Injury Prevention program. The difference is made up by funds from the program’s state grant.
The program also provides ideas to schools for raising money for free bicycle helmet scholarships. The “scholarships” started when parents asked how they could donate money for bicycle helmets for those who might not be able to afford them. These funds are set up and run by the parents and schools independent of the county program but are used to purchase bicycle helmets through the program.
Several bike rodeos were conducted at local libraries to help promote bike and helmet safety.
Phase-In To Implementation:
The state legislature established a one-year interval between the law’s effective date (January 1997) and the date that penalties took effect (January 1998), to allow for education and awareness efforts. During that year, law enforcement officers only issued verbal warnings and passed out information packets.
A wide variety of state agencies and organizations undertook efforts to educate the public about the new law. Groups included the Florida Brain Injury Association and the Florida Department of Transportation as well as bicycle helmet manufacturers, bicycle shops, and others.
In Duval County, the TBPSEP efforts described earlier were already underway and continued during the year phase-in period and beyond. To date (May 2001), approximately 20,000 bicycle helmets have been distributed in Duval County/Jacksonville. Other activities in the county included:
One unique approach to encourage proper bicycle helmet use was to train elementary school crossing guards to recognize correct and incorrect bicycle helmet fit. Under this 1998 program, after their training, on designated days at their respective schools, the crossing guards would distribute two types of bookmarks. One bookmark congratulated a bike-riding student for wearing a bicycle helmet and the bookmark was a ticket for a prize drawing. The other bookmark encouraged a bike-riding student who was not wearing a bicycle helmet to go to the physical education teacher to get a session on bike helmet safety. The bookmarks given to these students were a different color. After a student had participated in the bike helmet safety session, s/he could then submit the bookmark for a prize drawing. This program was through a Florida Department of Health program, funded by a CDC grant.
In 1999, the county also created a unique Bike and Dental Program. This effort uses the opportunity of a dental visit, from waiting to examination time, to conduct educational sessions for children five to 14 years old. Patients were encouraged to arrive 15 minutes early for their appointment using a free bicycle helmet as an incentive; a pre-test was administered to these children. After the child's dental examination, the dentist gave a five-minute talk on bicycle helmet safety using a poster-board presentation especially developed for this program.
After the presentation, a health educator was brought in to fit a bicycle helmet properly onto the child's head. At the end of the session, a post-test was administered. The effort appeared to be successful in increasing the knowledge of proper bicycle helmet usage within the 5-14 age group (See Section IX J., Dental visit/bicycle helmet use program evaluation (page 203), and ”My Bike Safety Contract,” Duval County, FL, page 203).
After the state law was adopted, Duval County public schools added a bicycle and pedestrian safety component to their standards. The standard stated: “by the year 2001, each student in every ethnic group will participate by the end of fifth grade . . . in a pedestrian and/or bicycle safety education program.” (See Section IX L, “High Expectations,” performance standards for Duval County schools, page 213).
However, this specific standard was later dropped, in part due to changes in school district leadership. Although the district does not track whether or not every fifth grader has participated in a pedestrian or bicycle safety program, it is continuing its strong support for the bicycle program described in the section “The Bicycle Helmet Environment And Existing Efforts,” page 52. School district employees report strong support for the program and frequent demand for the bicycle trailers and the training program. Every time a school conducts a training session, it submits a report to the county Injury Prevention program.
Law Enforcement Involvement During Phase-In:
As described earlier, law enforcement activity included some awareness and education efforts by the C.O.P.S. program in certain zones of the city. Some law enforcement officers were trained to recognize correct and incorrect bicycle helmet fit as part of the School Crossing Guard program described earlier. The Duval County Sheriff’s department coordinates the school-crossing program so the officers who supervised the program also received the training, although the crossing guards did the fieldwork.
Duval County officials involved in implementing the law did not observe consistent involvement by law enforcement in educating or enforcing the law. According to one official, “there is sporadic involvement but no sustained executive or strategic plan to apply enforcement/education on a consistent basis over time.” This official would support this approach, believing it to be “the only way to penetrate the psyche of the masses that there is no tolerance for breaking the helmet law,” thus resulting in behavior change.
Bicycle Helmet Use Law Enforcement:
A March 10, 1996 editorial in the Tallahassee Democrat, in urging legislators to pass the bicycle helmet use law, promised: “enforcement will be gentle.” That prediction appears to be accurate.
Effectiveness Of The Law:
Duval County has measured improvements in a variety of bicycle safety measures beginning before the passage of the bicycle helmet use law. The Injury Prevention program staff believes that the law has contributed to these improvements. “If you look at the data from 1996 through 1999, you can see dramatic changes, showing that something is working,” said one official.
Overall, the 0-12 age group experienced the most significant increase in bicycle helmet usage, followed by the13-18 age group. The over-19 age group experienced the smallest increase in bicycle helmet use.
The Injury Prevention program staff also identified increases in observed “positive safety behavior techniques,” such as signaling intent to turn, obeying traffic rules, and wearing highly visible clothing. These findings are from observational studies that the program has conducted since 1996.
These observations were derived from a large sample of 103 elementary schools, nearly half of the county total. For example, in 1997, the children observed scanning while bicycle riding was only 6.9 percent; in 2000 this behavior more than doubled to 15.8 percent. Riders observed wearing bright clothing increased from 10.6 percent in 1997 to 55.9 percent in 2000.
According to the county data collected from the annual bicycle helmet observations, the number of students riding bicycles to school decreased from 1996 to 1999. This was determined by comparing the total number of bicycle riders observed for each year. However, county officials did not research reasons for a decrease, so it is not known if any portion of that ridership decrease may be attributed to the law.
Little information is available regarding the community’s attitudes toward the law. As mentioned earlier, the TBSPEP conducted both an attitude survey and a focus group with middle school students, chosen because those are ages identified as the hardest to affect. The students believed that the police were not going to enforce the bicycle helmet use law and simply didn’t like the law. Information characterizing the reaction to the law or its related education or enforcement efforts by other age groups was not available.
To evaluate the effectiveness of their bicycle safety efforts, including the implementation of the bicycle helmet use law, Duval County uses observational surveys to determine bicycle helmet usage rates over time compared to bike injuries over time. As outlined above, the TBPSEP program has been able to track its impact over time, beginning with efforts before the adoption of the law.
Program managers would like to add data reflecting the citations issued for bike helmet violations to their evaluations. The official statistics for bicycle helmet citations are combined with the number of citations issued for a wide range of bicycle violations, so it is difficult to measure how many citations were issued to children who were not wearing bicycle helmets.
Those interviewed provided several reasons for the program’s strong evaluation component.
One factor is the source of funds: the federal dollars that support some of the TBPSEP’s activities come with the requirement that evaluations be built into the activity, so that the project’s success in reaching its goals and objectives can be measured.
Also, the Florida Department of Health and the Duval County Health Department (DCHD) both have traditionally supported evaluations of their programs. However, the strongest reason, according to those interviewed, is the staff’s commitment to the public health model. Individuals working on the project were described (both by themselves and by others) as having a strong personal commitment to conducting evaluations of their programs.
One official said he had seen too many injury prevention programs with poor or missing data. In his words: “We did a neat intervention but did it make a difference? I wanted to make sure that we had the data to do a valid evaluation of my programs . . . I tried to apply the academic model as rigorously as possible.”
These officials also acknowledged the challenges of conducting sound evaluations. Doing so at times required obtaining additional training or bringing in others with the appropriate expertise to assure the findings would be valid. Doing evaluations, as one official put it, “is not fun; it’s rigorous, tedious, a necessary evil to get the money. But it should be required. Funders should be more demanding of the outcomes and the evaluations conducted,” to assure that funds are being spent effectively. “Why throw money at a lemon?”
The motivation of the program managers was also identified as an important determinant. If the work is “just a job,” one might be less dedicated to finding the resources and undertaking the work needed to measure the outcome. Someone with that attitude may approach the program with the philosophy: “Let’s get the money for the program (and do the minimum amount of work required) and say we did it.”
The officials interviewed believed that senior management buy-in from the law enforcement community would be a primary condition for a jurisdiction to undertake an evaluation of its bicycle helmet use law. A secondary condition would be support from other members of the bicycle safety community.
Duval County officials engaged in bicycle safety efforts had several comments for jurisdictions interested in the effectiveness of their bicycle helmet use law: