Head injuries and bicycle helmet laws

doi:10.1016/0001-4575(96)00016-4

Accident Analysis & Prevention

Volume 28, Issue 4, July 1996, Pages 463-475

https://doi.org/10.1016/0001-4575(96)00016-4 Get rights and content

Abstract

The first year of the mandatory bicycle helmet laws in Australia saw increased helmet wearing from 31% to 75% of cyclists in Victoria and from 31% of children and 26% of adults in New South Wales (NSW) to 76% and 85%. However, the two major surveys using matched before and after samples in Melbourne (Finch et al. 1993; Report No. 45, Monash Univ. Accident Research Centre) and throughout NSW (Smith and Milthorpe 1993; Roads and Traffic Authority) observed reductions in numbers of child cyclists 15 and 2.2 times greater than the increase in numbers of children wearing helmets. This suggests the greatest effect of the helmet law was not to encourage cyclists to wear helmets, but to discourage cycling. In contrast, despite increases to at least 75% helmet wearing, the proportion of head injuries in cyclists admitted or treated at hospital declined by an average of only 13%. The percentage of cyclists with head injuries after collisions with motor vehicles in Victoria declined by more, but the proportion of head injured pedestrians also declined; the two followed a very similar trend. These trends may have been caused by major road safety initiatives introduced at the same time as the helmet law and directed at both speeding and drink-driving. The initiatives seem to have been remarkably effective in reducing road trauma for all road users, perhaps affecting the proportions of victims suffering head injuries as well as total injuries. The benefits of cycling, even without a helmet, have been estimated to outweigh the hazards by a factor of 20 to 1 (Hillman 1993; Cycle helmets—the case for and against. Policy Studies Institute, London). Consequently, a helmet law, whose most notable effect was to reduce cycling, may have generated a net loss of health benefits to the nation. Despite the risk of dying from head injury per hour being similar for unhelmeted cyclists and motor vehicle occupants, cyclists alone have been required to wear head protection. Helmets for motor vehicle occupants are now being marketed and a mandatory helmet law for these road users has the potential to save 17 times as many people from death by head injury as a helmet law for cyclists without the adverse effects of discouraging a healthy and pollution free mode of transport.

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In recent years, dockless bike-sharing programs have been introduced to either substitute or complement docked bike-sharing programs. Riders of these devices always have perceived differences of one system over the other, which could vary across gender. This study applied a text network approach to explore the residents' perceptions of the dockless bike-sharing program across gender. The study used over 700 responses collected between February and March 2018 in Seattle, Washington. The results revealed that ease of use, convenience, safety, pricing, and quality areas make a tremendous difference in the perception of dockless over docked bike-sharing systems. The perception of ease of use and convenience does not vary significantly across genders. On the other hand, male respondents were more aligned on the better pricing scheme and the bikes' quality than female respondents. Conversely, female respondents did care more about safety in terms of helmet use. Moreover, female respondents were more explicit in explaining the negative characteristics of the dockless bike-sharing system over docked ones. Study findings can help policymakers and operators of dockless bikes to provide equity in service for both genders.
The effect of motorcycle safety campaign on helmet use: A systematic review and meta-analysis
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This systematic review and meta-analysis was undertaken to estimate the effectiveness of motorcycle safety campaigns for increasing helmet use among motorcycle riders and passengers.
PubMed, Scopus, EMBASE, and the Web of Science (WOS) databases were systematically searched up June 2020 for all relevant studies. The National Institute of Health (NIH) tool was used to assess the quality of all included studies. Inter-study heterogeneity was measured using the Chi-Squared and I² statistics, with the odds ratio (OR) being used as a measure of the pooled effect size.
Out of the 561 records identified from the literature searches, eight articles (or 11 studies) were eligible for inclusion in the present meta-analysis. Using a random effects model, the results of the meta-analysis demonstrated statistically significant increases in helmet use among motorcycle riders (OR = 4.52, 95% CI: 1.01–20.14, I² = 99.9%) and passengers (OR = 6.57, 95% CI: 1.41–30.56, I² = 99.9%). The findings of sensitivity analyses, based on alternative levels of r for imputing the standard error (SE) of the ORs, showed the pooled OR of helmet use among motorcycle riders (r = 0.7; 3.49; 95% CI: 0.78, 16.44; r = 0.9; 3.49; 95% CI: 0.76, 16.11) was sensitive to different levels of r. However, no significant effect was detected on the pooled effect size for different correlation coefficients for motorcycle passengers (r = 0.7; 6.56; 95% CI: 1.59, 27.00; r = 0.9; 6.56; 95% CI: 2.25, 19.13). Increases in helmet use among motorcycle passengers were found in studies that: monitored pre and post campaign periods for longer than one year and were conducted in Thailand or Vietnam. However, the effect of motorcycle safety campaigns on helmet use among motorcycle riders remained significant for all of the different strata included.
The present meta-analysis found that motorcycle safety campaigns can lead to a significant increase in helmet use among both motorcycle riders and passengers. Due to the high degree of inter study heterogeneity, these findings should be interpreted with some caution. Despite the apparent favourable influence of motorcycle safety campaigns, more robust research is required.
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Risk is the probability of harm, such as the probability of getting into an accident when driving a car. Perceived risks are based on subjective assessments and often deviate from actual probabilities of harm. Both cognitive analysis and feelings inform people's risk perceptions. Laypeople are especially susceptible to emotional factors when judging risks and often focus more on the severity of the outcome than the probability of a risk. When driving, reliance on feelings and intuition is a useful strategy to react quickly to complex situations, but feelings can also distort judgments. Risks that are perceived as dreadful or new are often overestimated, while risks that are perceived as familiar and controllable—such as driving a car—are often underestimated. Repeated exposure to risks without negative consequences can also decrease risk perceptions. Relevant phenomena in this context are speeding and the use of mobile phones while driving; effective risk communication is essential to combat such risky behavior.
Recommend or mandate? A systematic review and meta-analysis of the effects of mandatory bicycle helmet legislation
2018, Accident Analysis and Prevention
If all cyclistswere wearing helmets, significant numbers of head injuries might theoretically be prevented. Mandatory bicycle helmet legislation increases helmet use but is a controversial measure. Results from 21 studies of the effects of mandatory bicycle helmet legislation on injuries among crash involved cyclists were investigated by means of meta-analysis and the effects of several potential biases were investigated. The summary effect of mandatory bicycle helmet legislation for all cyclists on head injuries is a statistically significant reduction by 20% (95% confidence interval [−27; −13]). Larger effects were found for serious head injury (−55%; 95% confidence interval; [−78; −8]). Among children, larger effects were found when legislation applies to all cyclists than when it applies to children only. There is no clear indication of the results being affected by publication bias. Publication bias may exist, but any existing biases seem to more or less outweigh each other. Results from meta-analysis do not indicate that the results are systematically affected by a lack of control for time trend bias, choice of comparison group or study design (before-after vs. case control). Summary effects may be somewhat overestimated because of a lack of control for potential confounding variables in some of the studies. However, such a bias, if it exists, is not likely to be large. Empirical evidence for the hypotheses that mandatory bicycle helmet legislation deters people from cycling and that helmet wearing leads to behavioral adaptation is mixed. In summary, mandatory bicycle helmet legislation can be expected to reduce head injury among crash involved cyclists. Some adverse effects may occur, but will not necessarily be large or long-lasting. People who may be deterred from cycling, are among those with the highest injury risk and the smallest health effects from cycling. If the overall goal is to improve safety for all cyclists and to increase cycling, mandatory bicycle helmet legislation should be supplemented by other measures, especially improved bicycle infrastructure.
Risk compensation and bicycle helmets: A false conclusion and uncritical citations
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Some researchers and many anti-helmet advocates often state that when cyclists wear a helmet they feel safer and take more risks. This hypothesis – risk compensation – if true, would reduce, annul or even reverse the assumed benefits of helmets in reducing head injuries. Consequently, this hypothesis is often used to oppose mandatory helmet laws. In this article, we illustrate how one of the few studies that attempted to experimentally test the hypothesis in relation to bicycle helmets arrives at a false conclusion. As a result it is often cited as evidence of risk compensation. Given the lack of experimental studies in this research area, the impact of a single study in shaping the opinions of the general public and of policy makers can be significant.
Are head injuries to cyclists an important cause of death in road travel fatalities?
2018, Journal of Transport and Health
Citation Excerpt :
There are few studies that have examined fatal head injuries by travel mode, so we also considered the published literature on non-fatal head injuries. Hospital admission rates for head injuries were 2.2/mhu for cyclists, 2.0/mhu for pedestrians, 1.6/mhu for motor vehicle occupants and 18.0/mhu for motorcyclists in Victoria in 1990 (D.L. Robinson, 1996). In Sweden, 20% of people aged 16–64 who had specialised or inpatient treatment after a cycle crash then took sickness absence for more than 14 days; traumatic brain injury accounted for 1.4% of those receiving such healthcare and 15% of people taking more than 180 days of sickness absence (Ohlin et al., 2018).
Despite the well-recognised benefit for individuals and communities of increased active travel, cycling remains a minority travel mode in many high income countries. Fear of injury is often cited as a reason. Campaigns to promote cycle helmet wear are alleged to contribute to this. However, there is little information on whether head injuries to cyclists are an important cause of death in road travel fatalities, compared with other road users.
We examined secondary causes of death for road travel deaths in England 2007–2012, comparing travel modes and grouped causes of death (from national mortality statistics) as numbers and as rates, using distance travelled and time spent travelling by mode, age, and sex from National Travel Surveys for the same six years.
Head injury was the main cause of death for 269 cyclists, 1324 pedestrians and 1046 drivers, accounting for 46%, 42% and 25% of road travel deaths at all ages in each mode respectively. Head injury was the commonest cause of death in cyclists, but most pedestrian and driver fatalities were from multiple injuries. Rates of fatal head injury per bnkm in males aged 17+ for cycling, walking, and driving were 11.2(95% CI 9.7–12.9), 23.4(21.8–25.0) and 0.7(0.6–0.7) respectively. Female fatality rates were 8.8(6.2–12.0), 9.6(8.7–10.7) and 0.4(0.4–0.5) per bnkm respectively. Using time as the denominator, rates were 0.16(0.14–0.19),0.10(0.10–0.11) and 0.03 (0.028–0.032) respectively in men and 0.10 (0.07–0.14), 0.04(0.037–0.045), and 0.01(0.012–0.016) respectively in women, per million hours travelled.
Answering the question ‘How important are head injuries in cyclists as a cause of road travel death?’ depends on the metric used for assessing importance. Pedestrians and drivers account for five and four times the number of fatal head injuries as cyclists. The fatal head injury rate is highest for cyclists by time travelled and for pedestrians using distance travelled.

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PaperHead injuries and bicycle helmet laws

Abstract

Accid. Anal. Prev.

Accid. Anal. Prev.

Deaths Australia

Rpt. No. 3302.0

Road traffic accidents involving casualties

Rpt. No. 9405.0

Vic Police target unhelmeted cyclists

Crash hats in tin tops

Cycling towards health and safety

Evaluation of the bicycle helmet wearing law in Victoria during its first 12 months

Injury-control recommendations: bicycle helmets

Centre for Disease Control and Prevention, Morbidity and Mortality Weekly Report 44

Crashing small cars

Choice Magazine

Costing the benefits: the value of cycling

Submission to the Select Committee on Road Safety

Oz helmet fiasco

Cycling Weekly

Bicycle helmet use by children. Evaluation of a community-wide helmet campaign

Jama

Do bicycle safety helmets reduce severity of head injury in real crashes?

Accid. Anal. Prev.

The effect of seat belt legislation on road casualties in Great Britain: report on the assessment of statistical evidence

An exploratory study of high school students' reactions to bicycle helmets

Day-to-day travel in Australia 1985–1986

Road Fatality Statistics Australia

Fatal crash types; analysis of the 1988 fatality file

Bicycle use and helmet wearing rates in Melbourne, 1987 to 1992: the influence of the helmet wearing law

Driver response to antilock brakes: a demonstration of behavioural adaptation

Cameras keep death off the roads

Har bruk av sykkelhjelm skadereduserende effekt?

Bicycle use and attitudes to the helmet wearing law

Cycle Helmets the case for and against

Experimental and mathematical simulation of pedestrian-vehicle and cyclist-vehicle accidents

Bicycle helmet legislation and enforcement in Queensland 1991–1993: effects on helmet wearing and crashes

Incidence, severity and outcomes of brain injuries involving bicycles

Am. J. Public Health

Paper
Head injuries and bicycle helmet laws