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Revisión del 15:48 22 ene 2013

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Cyclists wearing helmets on a street in Melbourne, during a climate protest event

Entre 1990 y 1992, algunos estados de Australia introdujeron leyes que exigían a los ciclistas el uso del casco. La ley que regula actualmente la obligatoriedad del casco es la AS/NZS 2063.[1]​

La ley se reglamenta en la Parte 15 de las Normas Australianas de la Carretera (Australian Road Rules), aprobadas por el Consejo de Transportes de Australia (Australian Transport Council). Se especifica:

The rider of a bicycle must wear an approved bicycle helmet securely fitted and fastened on the rider’s head, unless the rider is exempt from wearing a bicycle helmet under another law of this jurisdiction.

Quien monte en bicicleta debe llevar un casco de bicicleta aprobado, ajustado con seguridad y fijo a la cabeza del usuario, a no ser que esté exento de llevar un casco de bicicleta en virtud de otra ley de esta jurisdicción.

Algunos pasajeros también han de llevar casco.[2]​

Australia fue el primer país en imponer este uso, y gran parte de la evidencia de los efectos del uso masivo del casco en ciclistas proviene de Australia.[3]​ Continúa existiendo un debate, sin consenso, sobre los resultados de la obligatoriedad del uso del casco.

Historia

En curso... Modern varieties of bicycle helmet first became commercially successful from 1975.[4]​ Industry helmet standards were developed from the 1970s[5]​ and are still under development.[6]​[7]​ Empirical studies on the effects of helmets were published from the late 1980s.

The Royal Australasian College of Surgeons (RACS) played a leading role in gaining public awareness, acceptance, and demand for helmet compulsion after a commissioned study showed "bicyclist casualties sustained head injuries three times more frequently than motorcyclist casualties". The RACS had been influential in bringing compulsory seat belts and motorcycle helmets and was urging for a bicycle helmet law as the "third major step"[8]​ Its spokesman in 1978 said to the House of Representatives Standing Committee on Road Safety : "We could perhaps worry a little less about and take a little less time in proving what is precisely right according to all standards … As doctors we are impatient. We cannot wait for 2 or 3 years’ evaluation."[9]​ The Committee recommended that "cyclists be advised of the safety benefits of protective helmets and the possibility of requiring cyclists to wear helmets be kept under review".[10]​

The 1978 inquiry issued a final report in 1985. It recommended that cooperation of states and territories should be sought to "review the benefits of bicycle helmet wearing … and unless there are persuasive arguments to the contrary introduce compulsory wearing of helmets by cyclists on roads and other public places". A federal parliament committee was set up in 1985. Early in the course of its inquiry (before it had reviewed all the evidence), it said: "It is, of course, this Committee’s belief that all cyclists should wear a helmet to increase cycling safety." [11]​

A report from the Australian Department of Transport in 1987 examined cycling accident victims and found that "of the unhelmeted cases involving severe head injury, over 40 percent would definitely have had an improved outcome if a substantial bicycle helmet had been worn". Substantial bicycle helmet means a bicycle helmet with a hard shell, which was the requirement under the standard prepared by Standards Australia. The report also warned about deficiencies in bicycle helmets: "The substantial elastic deformation of the child head that can occur during impact can result in quite extensive diffuse brain damage … rotational accelerations were found to be 30% higher than those found in similar tests using a full face polymer motorcycle helmet." Bicycle helmets are not suitable for children more deformable heads, which can result in brain injury. Soft-shell helmets showed high rotational acceleration, the main cause of brain injury. The report recommended changes to the helmet standard to remedy those deficiencies [12]​ [13]​

The recommendations to improve the bicycle helmet standard were ignored. Instead, the standard was lowered to accommodate soft-shell helmets that were more comfortable to wear, paving the way for mandatory helmet legislation.[14]​

A former minister in the Hawke Government observed that after 1987: "increasingly, the Government, and most importantly (Prime Minister) Hawke, became hostage to narrow and unrepresentative pressure groups." By 1989, just before the government decided to introduce compulsory wearing of bicycle helmets, an officially commissioned survey showed that public support for it was 92% for children and 83% for all riders.[15]​

In 1988, the largest ever cycling casualty study was published, involving more than eight million cases of injury and death to cyclists over 15 years in the US. It concluded: "There is no evidence that hard shell helmets have reduced the head injury and fatality rates. The most surprising finding is that the bicycle-related fatality rate is positively and significantly correlated with increased helmet use." Though this study was published a year before the announcement of compulsory helmet wearing as Federal policy, the Federal Office of Road Safety gave no warning about it to the ministers who decided on the policy.[16]​

A controlled study of 1,710 cyclists undertaken throughout the 1980s "demonstrated that bicyclist casualties wearing Standards Australia Association approved helmets had a 45% reduction in the frequency of head injuries."[17]​ The RACS used this study to push for mandatory bicycle helmets in Vitoria. A position paper released in 2009 reaffirmed the Colleges position that mandatory helmet laws be retained.[18]​

There was a cycling boom in the late 1980s, associated with increased safety for cyclists. In Western Australia, the number of regular cyclists increased from 300,000 in 1986 to 400,000 in 1989, while deaths and serious injuries per 10,000 regular cyclists fell from 5.7 to 3.8. There was a similar phenomenon in the eastern states, for example cycling increased 250% in the 1980s in the Sydney metropolitan area.[19]​

Mandatory helmet laws were[cita requerida] first introduced in Victoria in July 1990, followed in January 1991 by laws for adult cyclists in New South Wales and all cyclists in Tasmania, then in July 1991 for child cyclists in New South Wales and all cyclists in South Australia as well as Queensland (not enforced the first 18 months). In January 1992 helmet laws were introduced in the Northern Territory and Western Australia (not enforced first 6 months) and in July 1992 in the ACT. In Tasmania the law only applies on public streets, while in the NT since March 1994 there is an exemption for adults cycling along footpaths or on cycle paths.[20]​

Injury rates

A 1994 study of cycling in Victoria found "The number of insurance claims from bicyclists killed or admitted to hospital after sustaining a head injury decreased by 48% and 70% in the first and second years after the law, respectively. Analysis of the injury data also showed a 23% and 28% reduction in the number of bicyclists killed or admitted to hospital who did not sustain head injuries in the first and second post-law years, respectively. For Melbourne, where regular annual surveys of helmet wearing have been conducted, it was possible to fit a logistic regression model that related the reduction in head injuries to increased helmet wearing."[21]​ This study was criticized because it ignored the similar trends for pedestrians, in particular that numbers of pedestrians with concussion fell by 29% and 75% in the first and second years of the bicycle helmet law.[19]​

In 1996 it was reported the decline in cycle use after the helmet law was greater than the decline in injuries.[22]​ From 1988 to 1994, for all road users, deaths from head injury fell by 42%, and by 38% for pedestrians, with no evidence of reduced driving or walking over this time period. For cyclists, the reduction in deaths from head injury (30%) was less than estimates noted above of the reduction in cycling.[23]​

King and Fraine studied data from the southern part of Brisbane, concluding that helmet wearing legislation and enforcement was associated with a reduction in head injuries, 26% more than expected if they had followed the trend for other injury types. The addition of the penalty for non-compliance had a larger effect, reducing severe head injuries by a further 55% and less severe injuries by a further 8% compared with the expected values.[24]​

Neither King's study, nor the 1994 study of cycling in Victoria, made allowance for declining trends in the proportion of head injuries to all road users. In 1996, a more comprehensive analysis was published of data for Victoria and New South Wales, noting almost identical declining trends in the percentage of injuries that involved head injuries for both cyclists and pedestrians.[19]​ Information on head injuries, recorded for hospital admissions in Western Australia (WA) since 1971, shows the remarkably similar trends for all road users.[25]​ The WA data were used in cost-benefit analysis in 1999 that concluded: "In monetary terms, it is unlikely that the helmet wearing legislation would have achieved net savings of any sizeable magnitude."[26]​

A review of head injuries and cycle use in four Australian states (Victoria, New South Wales, South Australia, Western Australia) and New Zealand concluded that there was no evidence that the laws had reduced head injuries.[27]​ In 2010, a district court judge in NSW agreed that there is no conclusive evidence to the benefits of wearing bicycle helmets.[28]​

A 2010 study from the University of New South Wales concluded that helmet laws led to a 29% reduction in cycling related head injuries over and above the effects of reduced cycling.[29]​ A subsequent paper argues that its conclusions were invalid.[30]​

Cyclists hospitalized with different types of injury; comparing reported rates of helmet use

Artículo principal: Bicycle_helmet#Case-control_studies

Case-control studies supporting the effectiveness of helmets, including some from Australia, have been used in the Australian debate.[31]​ All are disputed.[32]​ The Australian Transport Safety Bureau (ATSB) analyzed sixteen such studies, four from Australia.[33]​

Bicycle usage

Bicycle usage: studies with control groups

Some states made bicycle helmets compulsory before the 1991 census, which asked about mode of transport to work on census day. This allowed comparison of states with and without helmet laws. Cycling to work fell from 1.47% in 1986 to 1.22% in 1991 for states (NSW, Vic, SA and Tas) with enforced helmet laws in 1991, and from 2.28% in 1991 to 1.66% for Qld, WA and the ACT.[34]​[35]​

Bicycle usage: interviews, surveys and questionnaires

In a telephone survey shortly after the helmet law was introduced, the equivalent of 64% of adult cyclists in Western Australia, said they would ride more except for the helmet law.[27]​ Two years after the helmet law in New South Wales, 51% of schoolchildren owning bikes, who hadn’t cycled in the past week, cited helmet restrictions as the reason for not cycling.[27]​ A street survey in the Northern Territory found 20% of cyclists had given up because of the law and 42% said they had reduced their cycling.[19]​ When 325 cyclists in ACT in May 1992 were asked "Would you cycle less if helmets became compulsory?" (by members of group lobbying to against the proposed helmet law) 28% said they would.[36]​

Bicycle usage: changes without concurrent control groups around the time of helmet compulsion

The most recent census data (2006) shows much lower percentages cycling to work than before helmet laws were introduced.[37]​

For children, the decrease in numbers of cyclists counted (2215 in New South Wales, 649 in Victoria) was much greater than the increase in numbers wearing helmets (1019 in NSW and 43 in Vic), suggesting that the main effect of the law was to discourage cycling rather than persuade cyclists to wear helmets.[19]​

In Melbourne, where regular annual surveys of helmet wearing have been conducted, there was "a 36% reduction in bicycle use by children during the first year of the law and an estimated increase in adult use of 44%."[21]​ The claim relating to adult use was criticized because MUARC ignored the number of adults actually counted in 1990, and instead "estimated the effect of the law by comparing adult cycle use in 1991 with a much earlier survey (1987/88) at a different time of year. This is... invalid because... cycle use has a marked seasonal variation."[38]​ Surveys in Western Australia showed a 33% decline in cycling to work from 1986 to 2006 (from about 1.5 to 1.0 trips per weekday per 100 people), consistent with the census data. Shopping trips fell by 55%, from about 5.2 to 2.3 per weekday per 100 people; trips for education by 79%, from about 8.2 to 1.7 per weekday per 100 people.[39]​

Bicycle usage: trends before and after helmet compulsion

In the mid to late 1980s, cycling was undergoing a surge in popularity. In Western Australia (WA), numbers cycling more than once a week increased from 300,000 in 1986 to 400,000 (27% of population) in 1989. Cycling increased significantly (+250%) in the Sydney metropolitan area.[19]​ Cycling to work increased from 1.72% in 1986 to 1.85% in 1991 in WA and from 2.4% to 2.56% in Queensland.[40]​ In 2011, a national survey of cycling by persons aged 9 or over found a 21% increase in cycle trips between 1985/86 and 2011, compared to a 58% increase in the population aged 9+ years. The per capita increases from 1985/86 were therefore reversed, with a further 24% reduction in the number of cycle trips per person compared to 1985/86 levels.[41]​

In Metropolitan Melbourne, cycling trips to work decreased from 1.3% of work trips in 1991 to 1.0% in 1996, increasing to 1.6% in 2006. The increase from 1.0% to 1.6% of work trips from 1996-2006 represents a 175% increased in total cycle trips to work.[42]​ However, cycling to work in Victoria as a whole (including Metropolitan Melbourne) decreased from 1.75% before the helmet law in 1986 to 1.40% in 2006. In Queensland, the decrease was from 2.56% of work trips in 1991, before the helmet law was enforced, to 1.41% in 2006[40]​

In Australia as a whole between 2000 and 2009, there was an overall increase in cycling to full-time work or study, from 1.1% to 1.5% modal share. There was also a 47% increase in cycling "on the top five commuter routes into capital city centres between 2005 and 2008." As of 2010, the number of cyclists in Australia was at an all-time high. 1.93 million people cycled in 2008, "representing a 21% increase in cycling participation since 2005 and a 34% increase since 2001. Cycling is now the 4th most popular physical activity behind walking, aerobics and swimming."[43]​

As of 2010, bicycles had outsold cars in Australia each year during the previous decade by over 2,000,000, with over 1.3 million bikes sold in 2010, a 12% increase over the previous year and a 67% increase over 2001.[44]​ Half of Australian households now own at least one bicycle, and today, "more people in Australia are cycling than ever before."[45]​ A national yearly survey shows that people who had ever cycled in the previous year increased from 9.5% of all adults in 2001 to 11.6% in 2008, an increase of 2.1% [95% CI: 1.14 to 2.76]. This 2.1% represents an overall increase in cyclists of around 343,552. The difference between the estimated number bought and the actual industry total average number of bicycles sold (n = 753,843 per annum) numbered at least 395,000 unused adult bicycles sold each year after sensitivity analyses. There appear to be many more bicycles sold in Australia than are used.[46]​

Helmets and Melbourne's bike-share scheme

Melbourne inaugurated a bicycle sharing system in 2010. Mandatory helmet laws have been cited as one reason for its low initial usage.[47]​ Increased access to helmets in local shops saw usage of the bike share scheme almost double in late 2010 to an average of 183 trips a day.[48]​[49]​[50]​ The bike share scheme has seen its usage increase in 2011 from a low point of 257 average daily trips in July, to 519 in January 2012.[51]​ Nonetheless, this is still low by international standards at 0.4 trips per bike per day in July and 0.8 trips per bike per day in January,[52]​ while 8 to 10 trips per day is usual elsewhere.[53]​

Public attitude to helmets

A survey of 1000 Australians by the Cycling Promotion fund found that 515 respondents were not interested in cycling for transport, with 15.7% citing "don't like wearing a helmet" as one of their reasons. This was the 13th most popular response with safety issues ("Unsafe road conditions" "Speed/volume of traffic" and "Don't feel safe riding" the top three responses). 158 people had cycled for transport in the past month.[54]​ In 2010, two researchers conducted a telephone survey of 600 Sydney residents, in which 1 in 5 respondents claimed they would cycle more if they didn't have to wear a helmet. From this, the researchers concluded that, "To the extent that Sydney is representative of the rest of Australia, the repeal of mandatory helmet legislation would be likely to substantially increase cycling in Australia."[55]​

See also

References

  1. ↑ Australian Government: Trade Practices (Consumer Product Safety Standard) (Bicycle Helmets) Regulations 2001
  2. ↑ http://www.ntc.gov.au/filemedia/Reports/ARRFeb12.pdf Australian Road Rules February 2012 version
  3. ↑ Curnow, W. J. "Bicycle Helmets: A Scientific Evaluation" in Anton De Smet (2008). Transportation Accident Analysis and Prevention. Commack, N.Y: Nova Science Publishers. ISBN 1-60456-288-9. 
  4. ↑ Bell bike helmets timeline
  5. ↑ [1],"Bicycle Helmet Standards." Bicycle Helmet Safety Institute. 26 February 2009, accessed 12 February 2011.
  6. ↑ "The standard, known as 2063:2008, is designed to force manufacturers to improve the safety of helmets in three ways. It requires them to use a softer polystyrene in the shell providing more cushioning for the brain, to use straps that will stretch sufficiently in an accident to allow the helmet to come off a rider's head, after absorbing the initial impact and to ensure sun visors do not twist a cyclist's head excessively when hitting the road." New bike helmet standards send retailers into a spin. Matthew Moore URBAN AFFAIRS EDITOR Sydney Morning Herald 19 November 2010 http://www.smh.com.au/lifestyle/wellbeing/new-bike-helmet-standards-send-retailers-into-a-spin-20101118-17zeq.html Accessed 26 Feb 2011
  7. ↑ Mandatory standard—Bicycle helmets. Product Safety Australia. http://www.productsafety.gov.au/content/index.phtml/itemId/974624 Accessed 26 Feb 2011
  8. ↑ House of Representatives Standing Committee on Transport Safety. McDermott evidence, 1984, p. 1081
  9. ↑ Evidence to the House of Representatives Standing Committee on Road Safety 28.6.77, p. 833.
  10. ↑ House of Representatives Standing Committee on Road Safety. Report on motorcycle and bicycle safety. AGPS, Canberra, 1978.
  11. ↑ http://crag.asn.au/?p=19 "A Brief History of the Bicycle Helmets Law in Australia"
  12. ↑ Department of Transport, Federal Office of Road Safety. Report No. CR 55 Date May, 1987 Pages 160 f xi ISBN 0-642-51043-1 ISSN CR = 0810-770 Title: Motorcycle and bicycle protective helmets: Requirements resulting from a post crash study and experimental research. Authors: J.P. Corner, C.W. Whitney, N. O'Rourke, D.E. Morgan CR 55: Motorcycle and bicycle protective helmets requirements resulting from a post crash study and experimental research (1987) [2]
  13. ↑ http://www.cyclehelmets.org/papers/p787.pdf "Bicycle Helmets: A Scientific Evaluation"
  14. ↑ http://crag.asn.au/?p=2046 "History of the Helmet Law in Australia"
  15. ↑ http://crag.asn.au/?p=189 "CRAG submission to the Prime Minister April 2009"
  16. ↑ Rodgers, G.B., Reducing bicycle accidents: a reevaluation of the impacts of the CPSC bicycle standard and helmet use, Journal of Products Liability, 11, pp. 307-317, 1988.
  17. ↑ "The results of a comparative study of the injury profiles of Victorian motorcyclist and bicyclist casualties were used by the Royal Australasian College of Surgeons in initiating a state-wide campaign to promote the wearing of approved safety helmets by Victorian bicyclists and to obtain the necessary legislation whereby such wearing would become compulsory." World Journal of Surgery Volume 16, Number 3, 379-383, doi 10.1007/BF02104435 World Progress In Surgery. Helmet efficacy in the prevention of bicyclist head injuries: Royal Australasian college of surgeons initiatives in the introduction of compulsory safety helmet wearing in Victoria, Australia. F. T. McDermott. http://www.springerlink.com/content/q3448667v4p21611/ Accessed 28 Feb 2011.
  18. ↑ "Royal Australasian College of Surgeons 2009 Road Trauma Cycling Position Paper" http://www.surgeons.org/media/14490/POS_2009-06-25_Road_Trauma_Cycling_Position_Paper.pdf
  19. ↑ a b c d e f Robinson DL. Head injuries and bicycle helmet laws. Accid Anal Prev. 1996 Jul;28(4):463-75.
  20. ↑ Bicycle Helmet Research Foundation: Helmet laws, retrieved 4 March 2012
  21. ↑ a b Cameron et al. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia--an evaluation. Accid Anal Prev. 1994
  22. ↑ Robinson DL. Head injuries and bicycle helmet laws. Accid Anal Prev. 1996 Jul;28(4):463-75.
  23. ↑ Curnow, W. J. 2005. The Cochrane collaboration and bicycle helmets. Acc Anal Prevent 37: 569-573.
  24. ↑ King, M. and Fraine, G. (1994). Bicycle helmet legislation and enforcement in Queensland 1991-1993: Effects on helmet wearing and crashes. Road User Behaviour Section, Road Transport and Safety Division, Queensland Transport.
  25. ↑ Is There Any Reliable Evidence That Australian Helmet Legislation Works? Bruce Robinson, Bicycle Federation of Australia. Proceedings of Velo Australis, a conference held in Fremantle, Australia, 30 October 1996. http://www.bhsi.org/veloaust.htm
  26. ↑ [Hendrie, D., M. Legge, D. Rosman, and C. Kirov. 1999. An economic evaluation of the mandatory bicycle helmet legislation in Western Australia, Road Accident Prevention Unit.]
  27. ↑ a b c Robinson, D L (2006). «No clear evidence from countries that have enforced the wearing of helmets». BMJ 332 (7543): 722-725. PMC 1410838. PMID 16565131. doi:10.1136/bmj.332.7543.722-a. 
  28. ↑ Matthew Moore: Heady freedom as judge agrees helmet laws are unnecessary, in The Sydney Morning Herald, 28 August 2010
  29. ↑ The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia http://www.bv.com.au/file/file/Bike%20Helmets%20UNSW.pdf bv.com.au
  30. ↑ Chris Rissel. The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia: A rejoinder. Accid Anal Prev. 2012
  31. ↑ Center for Accident research and bike safety Bike Helmet Research
  32. ↑ Robinson, D. L. 2007. Bicycle helmet legislation: can we reach a consensus? Accid Anal Prev 39: 86-93. http://www.sciencedirect.com/science/article/pii/S0001457506001126
  33. ↑ http://www.infrastructure.gov.au/roads/safety/publications/2000/pdf/Bic_Crash_5.pdf Bicycle helmets and injury prevention: A formal review"This formal summarisation of studies of individual cyclists in various settings has confirmed the clear benefits of helmets in terms of injury risk. The upper bounds of the 95% confidence intervals provide conservative risk reduction estimates of at least 45% for head injury, 33% for brain injury, 27% for facial injury and 29% for fatal injury." accessed 4 January 2012
  34. ↑ Changes in cycle use in Australia. Bicycle Helmet Research Foundation
  35. ↑ ABS census data
  36. ↑ Cyclists Rights Action Group. Brief summary of surveys showing a decline in cycling due to MHL
  37. ↑ Comprehensive analysis of census data by the Bicycle Helmet Research Foundation (accessed 4 Feb 2012
  38. ↑ Head Injuries and Helmet Laws in Australia and New Zealand. Robinson DL
  39. ↑ Ian Ker, 2011. Empty Cells, Damned Half-Truths and Pseudo-Statistics:The Lot(tery) of the Bicycle Planner. Paper presented at the PATREC Planning and Transport Research Centre Forum, 13 September 2011.
  40. ↑ a b Bicycle Helmet Research Foundation. Changes in cycle use in Australia
  41. ↑ Australian cyclist numbers and population
  42. ↑ Vic Roads. http://www.vicroads.vic.gov.au/NR/rdonlyres/29A3CEDE-B1A0-492E-8158-2210C11E5D01/0/Report_on_Cycling_to_work.pdf Cycling to Work in Melbourne 1976-2006
  43. ↑ Australian Bicycle Council. http://www.austroads.com.au/abc/images/pdf/Australian_National_Cycling_Strategy_2011-16.pdf "National Cycling Strategy 2011-2016"
  44. ↑ http://www.carrsq.qut.edu.au/publications/corporate/bicycle_safety_fs.pdf "CARRS Bicyle Safety:State of the Road"
  45. ↑ Australian Bicycle Council. "National Cycling Strategy 2011-2016">
  46. ↑ Bauman, Adrian; Dafna Merom, Chris Rissel (2011-10). «Where have all the bicycles gone? Are bicycle sales in Australia translated into health-enhancing levels of bicycle usage?». Preventive Medicine. ISSN 0091-7435. doi:10.1016/j.ypmed.2011.09.011. Consultado el 26 de octubre de 2011. 
  47. ↑ http://www.theage.com.au/victoria/helmet-law-makes-nonsense-of-bike-hire-scheme-20100722-10my2.html accessed 4 January 2012
  48. ↑ Clay Lucas: Helmet law hurting shared bike scheme in The Age, 29 November 2010
  49. ↑ ABC: Cyclists fined during anti-helmet protest, 24 July 2010
  50. ↑ [3] Brisbane Times
  51. ↑ Bike share scheme starts to gain traction The Age http://www.theage.com.au/victoria/bike-share-scheme-starts-to-gain-traction-20120209-1rwsx.html
  52. ↑ http://www.cyclehelmets.org/1211.html accessed 4 January 2012
  53. ↑ The Role of Smart Bike-sharing Systems in Urban Mobility. Peter MIDGLEY. JOURNEYS. May 2009. http://www.scribd.com/doc/63059837/IS02-p23-Bike-Sharing
  54. ↑ Riding a Bike for Transport 2011 Survey Findings
  55. ↑ Chris Rissel and Li Ming Wen. The possible effect on frequency of cycling if mandatory bicycle helmet legislation was repealed in Sydney, Australia: a cross sectional survey Health Promotion Journal of Australia 2011; 22: 178-83 http://www.healthpromotion.org.au/journal/journal-downloads/article/hpja/35-hpja-vol-22-no-3-december-2011/426

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