University of Idaho

HS 490 Health Promotion

Interventions
Assignment 2

Professor Helen Brown- Spring 2017

Name: Macy Simoneaux

Health Topic, Target (can be a primary and secondary target) and Location (must be
clearly defined):

NAME: League of American Bicyclists #1 Intervention

Website Review- 15 pts.
Review a website with intervention strategies related to your topic. Only 1 is
required, recommend you look at more than one for greater learning.
Website and Link:
League of American Bicyclists- http://bikeleague.org/

APA citation of website:

The League of American Bicyclists. (n.d.). Retrieved April 13, 2017, from
http://bikeleague.org/

GeneralDirections
Purpose of the Website
(e.g., what type of information presented, What populations are addressed?)
The
Goal is to following information
disseminate pages guide you
that willon each
help stepsafer
create of this assignment.
roads, You
stronger communities and
will look
a bike-friendly for intervention
American. resources
This is done through on web sites,
promotion and class readings,
advocacy class
to community
members across
notes andAmerica.
peer reviewed journals (Research Notes 1-3). You will pull it
all you
What did together
learnand create
about an evidence
effective based plan
interventions based
for your on your
topic? findings
Answer the
(Pulling
questions it All
below andTogether) and include
add additional references, APA format. You may
comments.
type directly on these pages but it is not required. I put the
What intervention tools and resources are available? What are the top recommended
assignment
interventions? inan
Is there boxes to make
evidence baseitfor
easier to follow butinterventions?
the recommended it may be easier forsure the
(Make
website you to create
is useful a topic).
to your word document with all the assignment components.
Many tools and
Total resources
Point Value-are
100 available
points-from
20%Bike Leaguegrade
of course to promote and advocate for bikes
and bike safety at the local, state, and federal levels. The league offers technical support,
policy and legislative
Website support,
Reviewand-15the latest research to those who are working to make
points
biking better in their communities.
Intervention Research Readings- 15 points
The league cites The 5 Es
Research as the key Reviewed
Articles-Peer intervention
30strategies
points to making a bike-friendly
America.
Pulling it All Together- 35 points
Engineering- The league states that a great number of surveys indicate physical environment
is a large determinant in whether people will get on a bike and ride. The most bike friendly
Unlike the other assignments you will submit in this in hard copy
communities have well-connected bike networks with policies on use and maintenance.
in class and also on Bblearn.
Education- According to the league, giving people of all ages the skills and confidence to ride
will ultimately help build a larger cycling community. The also mention making motorists and
cyclists aware of their rights and responsibilities on the road through campaigns that promote
the Share the Road campaign.

Encouragement- By providing opportunities and incentives to bike through communities,

businesses, and universities, hopefully people will be encouraged to get on their bikes. This
can also be accomplished through campaigns such as National Bike Month and Bike to Work
Day.

Enforcement- Enforcement is key to ensuring safe roads for all users. Once the proper laws
are in place to treat bicyclists as equal users of the road, it is important that everyone
understands them. This is especially important for law enforcement officers. They must
understand the laws, be able to enforce them, and apply them equally to ensure user safety.

Evaluation and Planning- A comprehensive plan in addition to funding and community support
to the foundation of a great bike community. The plan should focus on building a seamless
bike network alongside encouragement, education and enforcement programs.

Critical thinking and relation to your health promotion topic

What did you learn from the website that you can apply to your project? Organize by
answering # 1-3 below:

1) Intervention activities that are appropriate for your project, 2) Useful tools and resources,
including health education/promotion resources; 3) Other resources- give web links for at
least two other helpful resources the web page directed you to and write 1-2 sentences about
what you was helpful about each site.

I think the education and enforcement aspects are the most appropriate to my topic.

The league offers an interactive map that allows the web user to click on a state and the
corresponding bike laws will pop up. The comprehensive lists include state laws on helmets,
turns, shared roadways, and passing lanes. Videos are also available that go in depth into
Sharing the Road and motor vehicle and bike cooperation and safety. Quick guides on
various bike and bike safety topics are available at no cost for distribution. Another
interactive map is available that helps users find bike classes in their area.

I was directed to the Pedestrian and Bicycle Information Center

(http://www.pedbikeinfo.org/programs/enforcement_worklawenforce.cfm). This site was useful
to me because it explained potential barriers to gaining law enforcement support for cycling
and gave tips to getting officers to join the movement. Specifically, I learned that officers are
more likely to offer their support when presented numbers showing the frequency and
severity of crashes as well as high risk locations.

Another site I was redirected to was the International Police Mountain Bike Association
(http://ipmba.org/blog/comments/the-case-for-bicycle-enforcement). I found this site helpful
because it gave ideas to possible enforcement methods that dont involve ticketing. The
IPMBA suggests methods such as community service and mandatory participation in local
education classes, or in terms of positive reinforcement, free food coupons for those aiding by
the laws.
 #2 Intervention Research Readings- 15 pts.
General Intervention Considerations- Answer the following using lectures and
readings. 1 paragraph for each.

1. Health Behavior Theory- Identify the theory (or theories) that is most important to
guide your intervention and discuss how that theory will guide interventions. (See
Theories at a Glance).

I think the Precaution Adoption Process model is most fitting for my topic due to this
model addressing issues that people are unaware of. The main strategies that should
be taken for this topic start with informing people that there is an issue. Even many
people who are avid cyclists are not aware of their community bike laws. After
informing people of this issue, the challenge will be convincing people that the issue is
relevant to them. Regardless of if they cycle or not, odds are they know a cyclist. A
person who decides to act will inform themselves of the laws in their area and
throughout their lifetime remain up to date on these laws and promote safe cycling and
share the road strategies.

2. Spectrum of Prevention- Based on the reading from the Prevention Institute-what levels
of prevention are most important for your topic/target and location? The type/level of
change desired will direct you to types of interventions that will have the most impact.

I think the levels of prevention that are most important are influencing policy and
legislation and strengthening individual knowledge and skills. Policy and legislative
changes would include the creation of new and safer road laws as well as the
enforcement of these laws. Strengthening knowledge will allow for drivers and cyclists
to learn laws and behaviors that they maybe were unaware of before. Strengthening
skills will help them to put their new knowledge into action.

3. Discuss what you learned about the predisposing, enabling and reinforcing factors that
are most related to the health behaviors you are trying to change.

Predisposing factors: Lack of knowledge, belief that it is not relevant to them. I think a
large part of this project will be making people understand that cyclists are parents,
children, siblings, and friends. In one form or another, everyone knows and loves a
cyclist.

Enabling factors: Lack of educational materials presented to people. While there is

plenty of material available if one is searching, not much is made known otherwise. It
will be important to ensure that this material is readily available and searching is not
necessary

Reinforcing factors: People continue their behavior because they know they will not be
reprimanded for it. Even in the case that people are unaware of the laws, they are
never told they are breaking them, therefore they never change their actions. Stricter
 enforcement will ultimately lead to less factors reinforcing poor driving behaviors.

#3 RESEARCH ARTICLES PEER REVEIWED- 1 of 3

3 peer reviewed research articles needed- 1 can be a review article. You do not
need to use this box format, you can use a word doc and include the headings
below. 10 pt. each -30 pt. total
APA Citation of article

Love, D. C., Breaud, A., Burns, S., Margulies, J., Romano, M., & Lawrence, R. (2012). Is the
three-foot bicycle passing law working in Baltimore, Maryland? Accident Analysis &
Prevention, 48, 451-456.

Participants or population reached

Motorists

Describe the intervention and its effectiveness

Briefly describe the intervention what did they do? What was unique or most
interesting to you?

This study looked at examining the effectiveness of a 3-foot passing law implemented
in Baltimore, MD. The study measured the distance between cyclist and overtaking
vehicles (Vehicle passing distance, VPD) to track the implementation of the 3-foot law
and assess risk factors for dangerous passes. For the purpose of the study, 5 cyclists
recorded their daily commutes over the course of two months.

What did you learn about the effectiveness of the intervention?

The intervention had only been enforced twice after 2 years of being implemented,
both times after vehicle-bike collisions. VPDs of less than three feet were common in
standard lanes (17%) and lanes with a shared lane marking (sharrows) (23%). No
passes of less than three feet occurred in the bicycle lanes. However, other studies
were cited stating that high speed roads (>40 mph) VPD is greater on streets without
bicycle lanes. Motorist Lane size also effected VPD as passing distance increased with
lane width.

Overall, cyclists in Baltimore were often passed during their daily commutes at a
distance of less than three feet. These results indicate that the 3-foot law is not being
 followed which ultimately leads to decreased safety for cyclists.

For what were the main conclusions about the interventions reached by the author(s)
including limitations?

The three-foot law is a positive step towards making cycling safer, as risk factors for
dangerous passes include lack of bike lanes and decreased lane width. However, in
Baltimore specifically, there are significant gaps in the monitoring and enforcing of the
3-foot law, besides when there is a vehicle-bicycle crash.

Love, et al. (2012) concluded that interventions and education campaigns are needed
to influence driving behavior, create norms for passing cyclists, and enhance
enforcement and compliance of the 3-foot law. They also support the use of bicycle
lanes, stating it is an infrastructure solution that would help to remove deficiencies in
motorist behavior towards cyclists.

Critical thinking and relation to your project

What did you learn from this research/intervention that can be applied to you project?

I think this research really solidified the knowledge that interventions have to be
maintained. While the implementation of such things are positive, without proper
enforcement or public knowledge the benefits will not be seen.

What would you need to do to adapt the intervention to fit your population and why?

If the intervention was adopted, a much stricter enforcement policy would be

necessary. Baton Rouge is a very different city than Baltimore. Street infrastructure is
not the same nor is the number of cyclists and motor vehicle operators on the road. I
think adherence to the policy comes down to how well it is enforced.
 #3 RESEARCH ARTICLES PEER REVEIWED- 2 of 3

APA Citation

Carlin, J., Taylor, P., & Nolan, T. (1998). School based bicycle safety education and bicycle
injuries in children: A case-control study. Injury Prevention, 4(1), 22-27.

Participants or population reached

School aged children

Describe the intervention and its effectiveness

Briefly describe the intervention what did they do? What was unique or most
interesting to you?

This study looked at the effectiveness of a school based bicycle safety education
program (Bike Ed). The program was begun mainly to increase the use of bicycle
helmets. The course covers materials such as safe riding skills, traffic knowledge and
skills, and basic bike mechanics. A previous study found the program to be successful
in improving riding knowledge and performance when compared to a control group,
however, I found it interesting that no research was done to determine the
effectiveness of decreasing risk of injury in the students who participated.

Case subjects were selected from a population of kids between the ages of 5 and 14
who presented to one of two major hospitals for injuries related to biking. Control
subjects were chosen using a sample of randomly selected telephone numbers. The
study used an interview technique to determine the childs knowledge and practice of
bike safety and determine their exposure to the Bike Ed program. Parents were
questioned on the limits they set for bike riding and if other family members rode
bikes.

What did you learn about the effectiveness of the intervention?

Surprisingly, there was a positive association between Bike Ed exposure and injury risk.
No evidence could be found to support participation in the Bike Ed program. Especially
in boys and younger children, Bike Ed showed a potentially harmful effect. There was
no difference in helmet wearing between groups that had participated in Bike Ed and
 those who had not.

For what were the main conclusions about the interventions reached by the author(s)
including limitations?

Because the research found that Bike Ed had a negative effect only for boys and for
families of lower educational backgrounds, it was hypothesized that the program may
inadvertently lead susceptible children to undertake risky behavior on a bike. Overall, it
was determined that more care needs to be taken in monitoring the implementation of
the course and a greater emphasis needs to be placed on safety. This includes
promoting reinforcement in the home, rather than behavioral skills, which could lead to
removal of restrictions, over-confidence and risk taking.

Critical thinking and relation to your project

What did you learn from this research/intervention that can be applied to you project?

Changes in knowledge and attitudes that may be achieved through educational

interventions do not necessarily translate to behavioral changes that may influence
safety. When teaching kills, it may lead to over-confidence and risk taking. Emphasis
should be placed on safety in my project, while still

What would you need to do to adapt the intervention to fit your population and why?

Im focusing on drivers rather than cyclists. Because of this, the education classes will
not be taught in school. Instead, they should be combined with drivers education
classes or held separately.
 #3 RESEARCH ARTICLES PEER REVEIWED 3 of 3

APA Citation

Kirsch, S. E. D., & Pullen, N. (2003). Evaluation of a school-based

education program to promote bicycle safety. Health Promotion
Practice, 4(2), 138-145.

Participants or population reached

School aged children (5th and 6th grade)

Describe the intervention and its effectiveness

Briefly describe the intervention what did they do? What was unique or most
interesting to you?

Safety Central was begun with the intentions to increase elementary students
awareness of safe behavior on a bicycle. It consisted of five parts. The first part was a
teachers guide containing an overview, background of the safety messages, lesson
plans, and an evaluation form. Parts 2-4 were a student activity sheet teaching skills, a
letter to parents explaining the program, and a 24- minute video teaching the
importance of staying in control, keeping your head up, and gearing up. Part 5
consisted of fitting each student with a custom bicycle helmet.

What did you learn about the effectiveness of the intervention?

Participation in the Safety Central Program was strongly associated to reported helmet
use during the last bicycle ride. 50% of students reported their main reason for using a
helmet to was protect the brain or head. In contrast, the most common response for
lack of helmet use was related to helmets not being cool to wear, with 45% of
students citing that reason. Ultimately, the findings suggest that students can retain
the safety messages for a 1- to 2- year period.
 If a health behavior theory was identified, briefly discuss which one was used and how
it shaped the intervention?

The theoretical foundation was based on developmental theory, social cognitive

theory, and the health belief model. Developmental theory focused on the transfer of
regulatory responsibilities from adult to child. School age children are believed to be
more responsive in situations where they can make their own decisions. Therefore, this
program was designed for fourth graders. Social cognitive theory focuses on behavioral
capabilities and self-confidence. In this program, self confidence levels are increased
through video tape and skill drills (performance accomplishments), skill building, and
persuasion by valued others such as parents and teachers. The health belief model
looks at perceived threats, benefits, and barriers to participating in physical activity.
The particular video used in this program was intended to increase students
perception of those susceptible to injury. Fact sheets sent home to parents were used
to increase the parents perceptions on the possible seriousness of a bike crash. Finally,
the custom helmets that were provided to each child helped reduce barriers to healthy
behavior.

For what were the main conclusions about the interventions reached by the author(s)
including limitations?

The study should be cautiously interpreted as there was self-reported data and a small
sample size. Regardless, the findings of retention of safety measures provide important
addition to the research into the effectiveness of certain program components.,
specifically school related programs. The importance of returning to the school to ask
students about their opinions and knowledge was stressed as critical information would
not have been discovered by relying on injury data alone.

Critical thinking and relation to your project

What did you learn from this research/intervention that can be applied to you project?

Checking retention after education is very important. The ability to retain information
indicates a successful program. However, information is typically only retained for a 1-
to 2-year period. This could indicate the need for occasional refresher courses.

What would you need to do to adapt the intervention to fit your population and why?

Again, I aim to target driving age population. Schools make educational programs like
this very attainable. While drivers education classes can offer the initial training, it will
be a bit harder to offer booster classes that would gather a large number of attendees.
Pulling it All Together- 35 pts.

1. Select a performance measure target based on the Healthy People 2020

objectives or Healthy Campus 2020 as appropriate.

Pedalcyclist deaths will decrease from .24 deaths per 100,000 to .22 deaths per
100,000 by 2020. (10% improvement)

2. Deciding on strategies for interventions (must be appropriate for target(s). 8 pt.

each- 24 pts.

Based on the intervention activities discussed in class (see ppt) and the findings of the
literature, select the 3 most important types of interventions for your project and list 4-
5 strategies for each strategy. These strategies need to be related to evidence based
practices. Add enough information about the intervention strategies selected that it is
clear what the intervention will accomplish.

Example: Tobacco and Youth (Targeting the Community)

Educational activities
o Create educational safety videos which can be shared across social media
platforms
o Teach bicycle Ed in primary schools using proven methods
o Have cyclists in popular community locations (downtown) advocating for
themselves and helping educate the general public
o Have local schools promote a bike to school day several times a year. This
day would also include educational sessions, skills training, and helmet fitting.
o Formation of cycling groups focused on advocacy and education of the public.
These groups should consist of members of all age in order to reach all
members of the community.
Regulatory
o Meet with local officials to determine creating new laws and revising old laws
that would benefit both drivers and cyclists.
 o Increase enforcement of 3-foot law. Vehicles who pass a cyclist closer than
3-feet will be cited.
o Consider increasing passing distance from 3-feet to 5-feet or more
o Make bicycle safety a part of drivers education courses. Questions regarding
state specific laws related to cycling should be included in the tests for
drivers education classes and license renewal.
Incentive and discentive activities
o Reward drivers and cyclists who follow the law with things such as coupons to
local food establishments
o Discuss with insurance providers the possibility of offering discounts to those
who participate in educational courses on safe roadways
o Offer ticket/fine reductions to those who choose to participate in an
educational course
o Increase the punishment for violations of road laws (higher fines/community
service)
o Have companies promote cycling to work/provide incentives and the
participation in educational activities

3. Potential for Success- 10 pts (critical thinking questions)

a.) Discuss why your intended approaches would work (e.g., how do they impact
predisposing, enabling or reinforcing factors?) Write no more than 2 paragraphs and
cite the literature you used to come up with your ideas/strategies.

I think education will help change drivers attitudes and behaviors towards cyclists.
Negative attitudes towards cycling are directly related to aggressive driving
techniques (Fruhen & Flin, 2015).
By forming groups of all ages and skill levels, hopefully people will realize someone
they love is a cyclist and they should take precaution when driving.
Increased enforcement will be beneficial because people are less inclined to perform
risky behaviors when they know they could be reprimanded. Stanojevic, Jovanovic &
Lajunen (2013) found that lack of traffic enforcement led to people committing
aggressive and ordinary violations more often and engaging in more risky behaviors.
They stated that traffic rule enforcement should not increase performance, rather
behavior and driving style because the key to safe driving is the respect for rules.
Therefore, by increasing the knowledge of rules and then enforcing them, safer
driving behavior should result.

b.) Discuss sustainability of the intervention plan- what will help this work continue?

As discussed by Kirsch & Pullen (2003), retention of educational classes only lasts
around 1-2 years in children. Research on retention in adults would need to be
performed and refresher courses or programs would have to be implemented as
indicated. Because laws can change frequently and without much warning, it will be
important to stay abreast of any changes in laws regarding roadways, motor vehicle
operators and cyclists.
 Include a Reference page (APA citation) - 5 pts.

Gatersleben, B., & Uzzell, D. (2007). Affective appraisals of the daily commute. Comparing
perceptions of drivers, cyclists, walkers, and users of public transport. Environment &
Behavior, 39(3), 416-431.

Kirsch, S. E. D., & Pullen, N. (2003). Evaluation of a school-based education program to

promote bicycle safety. Health Promotion Practice, 4(2), 138-145.

Love, D. C., Breaud, A., Burns, S., Margulies, J., Romano, M., & Lawrence, R. (2012). Is the
three-foot bicycle passing law working in Baltimore, Maryland? Accident Analysis &
Prevention, 48, 451-456.

Parkin, J., & Meyers, C. (2010). The effect of cycle lanes on the proximity between motor traffic
and cycle traffic. Accident Analysis & Prevention, 42(1), 159-165.

Stanojevi, Jovanovi, & Lajunen. (2013). Influence of traffic enforcement on the attitudes and
behavior of drivers. Accident Analysis & Prevention, 52(1), 29-38