Sunday, June 1, 2014

Why Didn’t Bostonians Follow Bike Safety? – Annie Liu

Author’s Note

Public health focuses on prevention and dissemination of interventions with the goal to deliver the intervention efficiently and effectively.  Unfortunately, public health campaigns may have focused on interventions that are not targeted on the correct human health models that so many other successful marketing campaigns have done.  Traditionally, the most widely used model in public health campaigns are from the Health Belief Model (1). I believe that this flaw hinders the effectiveness of public health interventions greatly.   In the following report, a bicycle safety intervention that was started in Boston, MA in 2012 to promote bicycle helmet use will be critically assessed.  Additionally, recommendations will be suggested to help reinforce Boston’s goal to promote bicycle safety and address the weaknesses of the intervention.  
According to the Centers for Disease Control and Prevention, more than half a million people each year are treated in emergency rooms for bicycle-related injuries (2). With few roadways dedicated exclusively to bicycles, cyclists often have to share the roads with cars and trucks (3).  The risks associated with cycling are further exacerbated in busy cities, as a cyclist needs to navigate through high trafficked streets.  Although federal and many state governments see the value in bicycling as a way to reduce traffic and air pollution, the availability of information for the general population is insufficient and often lacks the proper behavior tools to promote a significant change.
As a Boston University School of Public Health student and a cyclist, I focused on bicycle safety in Boston, MA.  Boston had not historically been a bicycle-friendly city (4).  In the Fall of 2007, the former Mayor Menino established Boston Bikes in an effort to help transform Boston into one of the best cities for cycling (5).  The task force was in charge of overseeing six universal bicycle-planning areas: Engineering, Enforcement, Education, Encouragement, Equity, and Evaluation.  
In the Spring of 2010, after three bicycle fatalities in Boston, former Mayor Menino announced a major bicycle safety initiative, which involved the partnerships of several departments (6).  The initiative included the first “Bicycling Safety Summit”, a low-cost helmet initiative, and a strict enforcement of traffic laws targeted at cyclists and motor vehicle drivers.  Although the goals of these interventions had its strengths and weakness, the interventions did not reach much of the intended population.  Therefore, the Boston Public Health Commission  (BPHC) was employed by former Mayor Menino to undertake the task of promoting bicycle safety (7).   This report will assess the methods involved in BPHC’s Bike Helmet Campaign.
Intervention Assessment
BPHC partnered with the Boston Police Department (BPD) to start the Bike Helmet Campaign in 2012.  A large emphasis was placed on helmet safety because they felt that it was a way to prevent bicycle fatalities since the assumption was that it is safer to ride with a helmet than without one (7).  
The assumption was not surprising, as there have been numerous amounts of published statistics that compare the number of bicycle fatalities with the number of cyclists wearing helmets.  For example, a survey was released in 2009, which indicated that 91% of the cyclists that were killed in a motor vehicle collision in the United States were not wearing helmets (8).  This leads people to conclude that the effect of not wearing bike helmets causes fatalities.  Unfortunately, the two are not exclusively linked to each other.  Although bicycle helmets are definitely important in safety, it is only a piece of the solution to the prevention of bicycle fatalities.  
Critique 1: Limited Appeal to the Target Population
The bicycle helmet campaign posted approximately two-dozen posters around the Boston area at bus stations and other public locations.  The illustrations were of various people injured after a bicycle accident, where the cyclist did not wear a helmet (Figure 1).  A viewer would infer that since these individuals did not wear bicycle helmets, they were injured.  The strategy behind these advertisements stemmed from surveys administered, which indicated that some cyclists do not wear helmets because it is unattractive and uncomfortable.  Therefore, several ads were made with the caption, “There are no good excuses” to not wear a bicycle helmet (9).

Figure 1. BPHC Advertising For Bike Helmet Use. Adopted from BPHC (7).
As one might suspect, the images were received by the public as violent and upsetting (9).  As quoted by a viewer, “This is some seriously heavy imagery, not the least of which because (it is) a young man with a bloody face posted in area of town heavily trafficked by young black people.  This is a seriously violent imagery for a public safety campaign.” The purpose of the intended advertisements was to make cyclists aware of bicycle helmets and to increase utilization, but the opposite effect took place.  For instance, due to the violent nature of the ad, people often turned away from the ad instead of reading the caption of what the purpose of the ad was about (9).  Secondly, cyclists are not often spending time while biking to read advertisements, even if they are displayed in public locations.
The Bike Helmet Campaign was largely focused around the Health Belief Model.   It is the belief that when individuals are informed about the severity of the consequences associated with an action, that the individuals would modify their behavior to avoid such consequences (10).  In this case, if cyclists, who did not wear bicycle helmets already, were made aware of the benefits of helmets; they would chose to wear them in order to avoid the bloody consequences. Therefore, it was believed that people who chose not to wear bicycle helmets were not aware of these consequences.  The main result of the advertising campaign was the instilment of fear, which has a negative effect on human behavior and often leads humans to behave in an opposite manner than planned. This behavior is best understood as the Psychological Reactance Theory; more will be discussed below (11).
Critique 2:  Ineffective Branding of Safety Efforts
The main slogan of the Bike Helmet Campaign, “No excuses, wear a helmet” unfortunately created an authoritarian approach to increasing bicycle safety awareness.  It strongly demonstrated the Psychological Reactance theory, which is also known as reverse psychology.  The theory indicates that the greater the degree of dominance, the more reactive it is from being adopted (11).  Therefore, due to the dominant language used to tell cyclists to use helmets, it led people to be less willing to agree to the intervention.  There was also discussion by city regulators to mandate bicycle helmets in Boston for all riders, which was another authoritarian approach (12).  
Additionally, there was a missed opportunity to showcase the positive effects of safe cycling, and examples of bike safety (aside from helmet use).  Instead, the advertisements highlighted the negative effects of cycling and demoted bicycling as a physical activity.  The identity thereby created a Big Brother figure, who insisted that people followed the rules or faced consequences, which violated traditional American core values.  
Furthermore, there were several aspects of better branding opportunities that were missed.  For example, a modernized symbol to encourage helmet use that was geared toward the target population of cyclists.  In the Boston Cyclist Safety Report published in 2013, the report indicated that men between the ages of 18 – 30 years old were heavily represented in the crash reports submitted by the Boston Police Department (12).  Therefore, the present logo indicated below, should be converted to not only a more modern one, but also a masculine symbol to target that specific population group.  This allows cyclists to take ownership of what the logo symbolizes – bike safety.
Figure 2. Image of BPHC’s Logo in Support of Helmet Use. Adopted from BPHC (7).
Critique 3: Misalignment of What Matters
Helmet use is just one of the many factors that are important to promoting bike safety.  However, there is a general belief that people do not think that bad outcomes are statistically as likely to happen to them than to another individual.  This is referred to as optimistic bias, which is the belief that a person overestimates the probability that fortunate events will happen to them (i.e. winning the lottery), and underestimates the probability that unfortunate events will happen to them (i.e. bicycle fatality) (13).
This is important in understanding the behaviors of cyclists, as to why they do not use helmets.  Given that cyclists believe that they are significantly more likely to be safe than injured while biking, the cyclist becomes more concerned with other aspects, such as convenience.  These factors become a larger influence when helmets need to be transported throughout the day (i.e. between classes or at work).  Additionally, the easy access to bicycles through Hubways, make carrying a helmet a nuisance because helmets need to be purchased individually, and it hinders the user from riding on short notice.
Therefore, the values that are significant to the cyclist need to be demonstrated in the advertisements.  For example, the independence of cycling and freedom to take control over their lives are more important, and stronger core values than the utilization of health and fear that bad consequences might occur.
Proposed Intervention

Given the strong authoritarian and fear-inducing tactics that BPHC utilized, it led to another failed bicycle safety initiative in Boston.  I recommend that Boston employ a different method to brand bicycle safety in order to spark changes to social norms surrounding bicycle safety, as these would lead to large-scale impacts.
Therefore, the alternative campaign would: target core values important to a cyclist, avoid psychological reactance, and empower the community to make changes to their behavior through better branding methods and the Social Norms Theory.  In Chicago, Moving Design started a project called Call to Action – a very different type of bicycle safety intervention than compared to Boston.  The intervention brought together cyclists within one city to focus efforts on bike safety, and created a brand for cyclist empowerment (14).  
Moving Design was a group started in 2011, which was comprised of artists and designers.  The group held interdisciplinary sessions to brainstorm and promote bike safety ideas.  Following these sessions, the design team would publicize bicycle safety and awareness throughout the neighborhood with different forms of art and media (15).  
Defense 1: Wider reach and effectiveness of marketing
A lot of the projects that the design team employed was not offensive, but instead generated interest by promoting curiosity from the community.  Since the majority of the designs were created at night, community members would find works of art the next morning. The figure below displays a storefront on a busy street in Chicago, with drawn pictures of cyclists wearing helmets and the words, “Feel Free” (15).  Not only was the picture inviting, it created a cycling culture and incorporated a very important core value – freedom.  This method used a very non-confrontational way of reminding cyclists to practice safety without invoking psychological reactance.  
In addition, Moving Design also used several forms of media to reach out to the community.  Every design that was completed in the community was posted on Vimeo so that people from Chicago, and all over the nation could experience a “real social currency” (15).
Figure 3. Storefront photo promoting bicycle awareness. Adopted from Moving Design (15).
ike Shop Windows
Defense 2: Powerful Branding Techniques
Moving Design started creating art projects, and invited the community to participate.  The movement was called Call to Action, and gave the cyclists an ownership in the process and also the community.  In the figure below, art was drawn on a main intersection of Chicago displaying, “Our Road” and a bicycle and car in a creative image together.  
This was a strong Marketing Theory technique to promote the brand, and give it an empowering name – Call to Action.  The sign “Our Road” also creates a powerful message to drivers, specifically that they have ownership of the road too and demand respect.

Figure 4. Photo of graffiti in Chicago. Adopted from Moving Design (15).
Defense 3: Ownership
On the Call to Action website, which is a forum for anyone to post about bicycle safety and express themselves, there is a section labeled, “Icon Identities” (15). People are able to create their own identity that incorporates the different modes of transportation within Chicago.  The identities created are not violent, but promote respect and artistically infer a sharing of the road. At the end of the sessions, the findings were revealed in Logan Square to serve as a “safe hub” for cyclists and pedestrians to view the work they did (15).
The ownership that this gives to cyclists is very important to promote empowerment on the road, and with their lives.  The Call to Action initiative drew a lot of attention from the community.  This was particularly important with the Social Expectations Theory.  It created a culture of bicycle safety within Chicago, which was previously not present.  More important, by changing social norms within the community, people started to change their individual behaviors (11).
Although, BPHC significantly reduced the price of helmets for consumers in Boston, the intervention did not focus on the correct models that dictate human behavior.  Therefore, the increased access to bicycle helmets in Boston did not increase use of the helmets because of the negative methods used to marketing it.  I believe that Moving Design accomplished an amazing feat.  By providing a strong brand to encourage bicycle safety, it made a large scale impact by influencing the community to change its behavior as a whole.


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12. Cyclist Safety Report. City of Boston; 2013 May p. 1–94.
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