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November 14, 2018

News Brief: The 2018 APHA Meeting in San Diego


A national survey of bicycle helmet laws at the state and local levels found no statewide laws requiring riders of all ages to wear bicycle helmets and a total of 47 municipalities in eight states having what are known as “all-rider” bicycle helmet laws, ordinances that mandate riders of all ages to wear helmets. 

The findings, presented at the APHA meeting in San Diego by Johns Hopkins Bloomberg School of Public Health PhD candidate Molly Merrill-Francis, suggest a legal patchwork that may not adequately address bicycle safety. Bicycle helmets reduce the odds of head injury, and evidence suggests that mandatory helmet laws may increase their use.

The study is thought to be the first examining all-rider helmet laws. It looked at laws that applied to bicycle riders, including rentals. The research is part of a larger ongoing study led by researchers at the Johns Hopkins Center for Injury Research and Policy examining bicycle helmet laws in the U.S. The researchers have published the first-ever compilation of the full text of these all-rider bicycle helmet laws, available here.

For this analysis, the team abstracted the full text of all-rider bicycle helmet ordinances in the U.S. and identified 47 in eight states that required bicycle riders of all ages to wear a helmet. (Some states and many municipalities require children under certain ages to wear helmets, but do not extend these requirements to older children and adults. These laws were not part of this analysis.) The researchers identified ordinances that have been adopted through a combination of internet-based research and direct phone or email contact with local governments. 

Among the themes the researchers assessed: 1) places where the ordinance applied, including public versus private property; 2) who must wear a helmet; 3) helmet specifications; 4) rules imposed on renters, including bikeshare programs; 5) inclusion of ways to promote helmet use, such as providing information about the law or subsidizing the cost of helmets; 6) parental responsibility for helmet use; 7) penalties; and 8) options for waiving penalty for violations.

Of the 47 all-rider helmet laws analyzed, all of them applied to riders on public property, while seven also applied to private property. Forty-five ordinances required both passengers and riders to wear helmets, and 46 required helmets to meet certain safety standards. About half, or 24, of the ordinances put some responsibility on bicycle rental establishments.

Forty-three ordinances specify a penalty for noncompliance, but 36 include some mechanism to waive penalties with the purchase of a helmet. Forty ordinances make parents responsible for their child’s helmet wearing. Seventeen ordinances included provisions aimed at increasing compliance such as education or helmet programs.

“Legislators considering all-rider ordinances can use this information to determine what works best for their communities,” says Merrill-Frances.

Bicycle Helmets: Elements of local all-rider bicycle helmet laws in the U.S.” was presented at the annual APHA meeting Monday Nov. 12 at 10:30 a.m. Pacific Standard Time.

Keshia Pollack Porter, PhD, a professor in the Bloomberg School’s Department of Health Policy and Management, is the study’s PI. This study was conducted by Molly Merrill-Francis, MPH, Keshia Pollack Porter, PhD, MPH, Bryanna Wakefield, MS, and Jon S. Vernick, JD, MPH.  

The study was funded by a grant from the Centers for Disease Control and Prevention to the Johns Hopkins Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the U.S. Department of Health and Human Services.  


A study of ads for two e-cigarette brands popular with young people—JUUL and VUSE—found that JUUL focused on technical and design innovation while VUSE played up the appeal of product flavors. The study was conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. 

Together, JUUL and VUSE represent an estimated 81.5 percent of the U.S. e-cigarette market.

Flavors are the most commonly cited reason for using e-cigarettes among youth and young adults, and more than 85 percent of e-cigarette users between the ages of 12 and 17 use flavored e-cigarettes, according to a 2016 report from the U.S. Surgeon General that revealed an alarming spike in e-cigarette use among middle and high school students.

“Our findings suggest that flavors were not a major focus of JUUL advertising, as opposed to other e-cigarette brands, such as VUSE,” says Meghan Moran, the study’s lead author and an assistant professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health. Moran will present the findings at the APHA meeting. “Future work examining other advertising modes such as social media and events-based marketing may help us understand how JUUL and VUSE attract consumers.”

The researchers obtained the ads for their analysis from two market research agencies that track a variety of media channels, including print, radio, television and direct-to-consumer mail. They identified all unique ads that ran from 2015 to 2017—20 JUUL ads and 239 VUSE ads—and assessed each for the presence and prominence of flavor, how flavor was conveyed—such as through text or imagery—as well as for other common advertising characteristics, including product claims and promotions. The numbers of analyzed ads for the two brands reflect how many different ads ran from 2015 to 2017 but do not account for how widely the ads were distributed.

Role of flavor in electronic nicotine delivery system (ENDS) advertising: A comparison of the two leading brands” was presented at the annual APHA meeting on Tuesday, Nov. 13 at 1:00 p.m. Pacific Standard Time.

According to the analysis, none of the JUUL ads featured flavor as an explicit, central component, instead focusing largely on claims about the product’s technological and design innovation. The majority (90 percent) of JUUL ads featured bright colors, which the researchers say may have been used to imply flavor options, while just over a third (35 percent) featured young people, and the same number featured price reductions such as discounts on starter kits. More than two-thirds (70 percent) compared the product to smoking, and 50 percent of the ads described the products as satisfying; other commonly used descriptors were “simple” (used in 35 percent of ads) and “smart” (25 percent).

More than half of the analyzed VUSE ads (54 percent) explicitly advertised the product’s flavor, featuring products and packaging with clear flavor labels. Among the VUSE ads with flavor as a central component, most (91 percent) further illustrated the flavors with complementary colors, and nearly a third (30 percent) used imagery to reinforce the flavors—with blue orbs resembling ice or frost for mint, for example—while close to a quarter (23 percent) used such descriptors as “cool,” “vibrant” and “freshness.” 

This study was conducted by Meghan Moran, Lauren Czaplicki, Lisa Lagasse, Samantha Cino and Ryan David Kennedy of the Johns Hopkins Bloomberg School of Public Health; and Sarah Trigger, Izabella Zandberg, and Michael Sawdey of the Center for Tobacco Products at the U.S. Food and Drug Administration. 

This research is supported by the Food and Drug Administration, Department of Health and Human Services, under a cooperative agreement with the Johns Hopkins Center for Excellence in Regulatory Science and Innovation.


One of the great challenges for independent older people is using alternative forms of transportation—whether they are still driving or are no longer able to drive. An analysis of older drivers by researchers at the Johns Hopkins Bloomberg School of Public Health found that a majority—89 percent—reported having at least one alternative source of transportation. However, for the majority, that alternative source was a family member or friend.

“The good news is most respondents used another source for transportation,” says Vanya Jones, PhD, MPH, assistant professor in the Bloomberg School’s Department of Health, Behavior and Society. Jones will present the findings at APHA. “The challenge is that for most, that source was a friend or a family member. This suggests older drivers are not availing themselves of other transportation choices, like public transit or rideshare services such as Uber or Lyft, options they may need to use when they are no longer able to drive themselves and may not always have a friend or family member available to help them get around.”

For those older adults who need to reduce their driving, the availability of multiple transportation sources offers a way to maintain an active lifestyle. promotion of non-driving modes of transportation could maintain mobility while reducing injuries. 

Additional sources of transportation for older drivers increases their satisfaction for getting around town” was presented at the APHA meeting on Monday, Nov. 12 at 10:30 a.m. Pacific Standard Time.

For the study, the researchers surveyed 2,990 older drivers ages 65 to 79, using data from the Longitudinal Research on Aging Drivers. Respondents were asked about alternate sources of transportation and their levels of satisfaction about getting around. As noted, 89 percent reported having at least one alternate source of transportation in the three months prior to the survey. Thirteen percent reported having more than three sources of transportation in the three months prior to the survey.

Those reporting more than three alternate sources of transportation—402--were more likely to be no longer working (249) compared to currently working (153).

For older drivers, using alternative sources of transportation could be a way to help them maintain mobility, because they are familiarizing themselves with transportation choices they might need when they can no longer drive. Communities may want to consider how to improve access to alternate sources of transportation for older adults to reduce the impact that driving cessation has on social isolation and overall quality of life, the researchers say.

“We’d like to work with public transportation systems, to get them to encourage older drivers to use these services when they’re still able to drive,” says Jones.

Jones also notes that talking to older drivers about other transportation options besides family and friends is not as easy as it might sound. “They idea is we could help families to negotiate what it looks like, with the aim of promoting mobility and independence and also injury prevention.”

“Additional sources of transportation for older drivers increases their satisfaction for getting around town” was written by Vanya Jones, PhD, MPH, Kimberly Roth, MHS, Renee M. Johnson, PhD, MPH, Carey Borkoski, EdD, PhD, Andrea Gielen, ScD, ScM and George Rebok, PhD.

The AAA AFTS LongROAD study was funded by contract from the AAA Foundation for Traffic Safety.

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or and Robin Scullin at 410-955-7619 or