PHE 505 Module 2 Milestone One Example

Helmets, Heads and Shared Scooters: A Research Topic Proposal for a Midwestern University City

[Student Name]

Southern New Hampshire University

PHE 505: Research Methods in Public Health

Final Project Milestone One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Helmets, Heads and Shared Scooters: A Research Topic Proposal for a Midwestern University City

Shared electric scooters spread across American cities with little warning and less data. Riders unlock them with a phone, travel at up to about 15 miles per hour and rarely wear helmets. This milestone proposes a study of whether helmet nonuse is associated with head injury among adults treated after scooter crashes in a composite Midwestern university city of about 210,000 people, and explains why the question matters, what is already known and how it could be answered.

The Public Health Problem

Head injuries are the most serious common harm from scooter crashes. They range from scalp cuts to concussion and bleeding in the brain, and they account for most of the lasting disability and death. Because scooters are small, have small wheels and leave the rider's head high above hard pavement, a fall at modest speed can still cause a significant head impact. If most riders go without helmets, the population-level burden may be large even though each ride is short.

What Published Studies Show

The first systematic look came from Los Angeles. Trivedi et al. (2019) reviewed records of 249 patients treated after scooter injuries at two emergency departments over a year. About 40% had head injuries, nearly a third had fractures and only 4.4% of riders were documented as wearing a helmet; on the street, 94% of 193 observed riders went without one. Bloom et al. (2021) reviewed 248 patients across a hospital network and found that only 3% wore helmets and that every traumatic brain injury occurred in an unhelmeted rider. Nationally, Namiri et al. (2020) used emergency department surveillance to show scooter injuries and hospital admissions rising sharply from 2014 to 2018. In Washington, DC, Cicchino et al. (2021) found that injured scooter riders wore helmets far less often than injured cyclists and more often had concussions with loss of consciousness.

For cyclists, the protective effect of helmets is well established. Pooling data on more than 64,000 hurt cyclists, one meta-analysis showed that wearing a helmet roughly halved the odds of head injury and cut the odds of serious head injury by about two thirds (Olivier & Creighton, 2017). Whether the same protection holds for scooter riders, who fall differently and at different speeds, has not been measured directly.

The Local Situation

Two companies have operated about 1,800 shared scooters in the city for four years, concentrated around the university and downtown. The county health department's review of emergency visits coded as scooter-related shows a steady rise, summarized in Table 1. The city council is considering a rule requiring helmets for riders under 21 and asking the companies to offer helmets, but it has no local data on whether helmets would reduce injuries.

Table 1. Emergency visits for injuries while riding shared scooters

Note. Counts are composite figures from a preliminary record search.

The Gap

Published studies describe how often riders are hurt and how few wear helmets, but most were not designed to estimate how much helmets reduce head injury after accounting for other factors, such as alcohol, nighttime riding and age, which may differ between helmeted and unhelmeted riders. Most also come from large coastal cities. The proposed study would estimate the association in a university city and adjust for these factors, giving local decision makers evidence that fits their setting.

Preliminary Research Question

Among adults aged 18 and older treated in the city's two emergency departments for injuries sustained while riding a shared electric scooter, is not wearing a helmet associated with greater odds of head injury, after adjusting for age, sex, alcohol involvement and time of day?

Table 2. Main variables

Note. Definitions will be refined in Milestone Three.

Why Adjustment Matters

A simple comparison of head injuries between helmeted and unhelmeted riders could mislead. Riders who choose helmets may also ride more slowly, avoid alcohol and ride in daylight, all of which lower injury risk on their own. If so, helmets would appear more protective than they are. The reverse is possible too: riders who wear helmets may be commuters who ride longer distances in traffic. Measuring these factors and adjusting for them is what would separate this study from a description of injured riders. Records may not capture speed or distance, which will remain a limitation.

Ethical Considerations in Brief

The study would use existing medical records without contacting patients. It would need approval from an institutional review board and a waiver of individual consent, justified because the study poses minimal risk and could not practicably be done otherwise. Records would be stripped of names and addresses before analysis. These steps will be developed in the ethics journal and methods milestone.

Likely Design and Feasibility

The most feasible design is a retrospective review of emergency department records for the three years since scooters arrived. Both hospitals use the same electronic record system, triage nurses routinely ask about helmets for wheeled vehicle injuries and the health department already has a data-sharing agreement with both for injury surveillance. The main risk is missing helmet information, which will be checked in a pilot of 50 records before the full study.

Significance

The findings would inform the council's helmet decision, the companies' safety measures and the health department's prevention messages. They would also add a mid-sized university city to a literature dominated by large coastal ones.

If helmets prove strongly protective, the evidence would support offering helmets with every rental and focusing outreach on late-night riders. If the association is weak once other factors are considered, prevention might better target alcohol, lighting or street design.

Conclusion

The question is narrow, the data appear to exist and a decision is waiting for the answer. The next milestone will review the literature in depth and test whether the gap is as clear as it appears.

Either way, the city will know more than it does now.

References

Bloom, M. B., Noorzad, A., Lin, C., Little, M., Lee, E. Y., Margulies, D. R., & Torbati, S. S. (2021). Standing electric scooter injuries: Impact on a community. American Journal of Surgery, 221(1), 227-232. https://doi.org/10.1016/j.amjsurg.2020.07.020

Cicchino, J. B., Kulie, P. E., & McCarthy, M. L. (2021). Injuries related to electric scooter and bicycle use in a Washington, DC, emergency department. Traffic Injury Prevention, 22(5), 401-406. https://doi.org/10.1080/15389588.2021.1913280

Namiri, N. K., Lui, H., Tangney, T., Allen, I. E., Cohen, A. J., & Breyer, B. N. (2020). Electric scooter injuries and hospital admissions in the United States, 2014-2018. JAMA Surgery, 155(4), 357-359. https://doi.org/10.1001/jamasurg.2019.5423

Olivier, J., & Creighton, P. (2017). Bicycle injuries and helmet use: A systematic review and meta-analysis. International Journal of Epidemiology, 46(1), 278-292. https://doi.org/10.1093/ije/dyw153

Trivedi, T. K., Liu, C., Antonio, A. L. M., Wheaton, N., Kreger, V., Yap, A., Schriger, D., & Elmore, J. G. (2019). Injuries associated with standing electric scooter use. JAMA Network Open, 2(1), Article e187381. https://doi.org/10.1001/jamanetworkopen.2018.7381