Helmet Legislation Research Articles

Evaluation of the effectiveness of road safety measures and their impact on the pattern and distribution of extracranial and intracranial hemorrhages in fatal head injury cases in Uttar Pradesh, India

Introduction: In Uttar Pradesh, India, there are many fatal head injuries as a result of road traffic accidents (RTAs). Studying the pattern and distribution of intracranial hemorrhages, a frequent complication of severe head trauma might provide vital information on the efficacy of traffic safety regulations. To improve road safety tactics and lower fatal head injuries in Uttar Pradesh, this study intends to assess the effect of road safety measures on the frequency and distribution of intracranial hemorrhages in fatal head injury patients. Aim: This study’s objective is to assess the influence of current road safety initiatives on intracranial bleeding distribution and patterns in fatal head injury cases in Uttar Pradesh. Methodology: The 604 RTA cases with head injuries that were brought to the mortuary of the S.R.N. Hospital in Prayagraj for a medical-legal postmortem assessment over the course of a year, from April 2021 to March 2022, make up the entirety of this prospective study. Following receiving institutional ethical approval and informed consent, structured interviews with attendees utilizing a questionnaire were done to gather the data. Result: The results show that certain traffic safety measures have reduced the frequency of fatal head injuries in RTAs. A decreased incidence of intracranial hemorrhages was linked to improved traffic infrastructure, including well-planned junctions, pedestrian crossings, and distinct bicycle lanes. Similar results were shown in serious head injuries when traffic restrictions including speed limits, seat belt use, and helmet legislation were strictly enforced. Conclusion: There are still issues with fatal brain injuries from car accidents, despite some encouraging results. Safety legislation violations, a lack of public knowledge, and inadequate enforcement all contribute to the issue. Disadvantaged groups like walkers and users on two-wheelers continue to be especially susceptible. The results of this investigation offer important new understandings of the efficiency of traffic safety measures and their influence on the distribution and pattern of cerebral hemorrhages in Uttar Pradesh, India. The results point to the necessity of improved public education efforts and traffic safety laws. More research and focused interventions are required to address specific risk factors among various road user groups. This will result in a safer driving environment and a decline in catastrophic brain injuries.

Qualitative perspectives of bike share schemes in Melbourne, Australia

BackgroundBike share schemes are operational in many countries and aim to encourage modal shift from sedentary to active modes of transport. Understanding user experiences of bike share schemes can contribute to knowledge of motivations to use the schemes and barriers to use. Qualitative research into user experiences of bike share schemes in Australia has been conducted in Brisbane but not Melbourne, and most bike share scheme research is non-peer reviewed literature. This study describes experiences of bike share schemes in Melbourne. MethodsSemi-structured interviews were conducted with 21 bike riders in Melbourne, Australia some of whom used bike share schemes and some who did not. Interviewees were asked about their experiences using bike share schemes in Melbourne. ResultsBike share schemes provide a way for non-users to try bike riding without needing to purchase a bicycle. E-bike schemes are beneficial to people with health issues. User experiences of bike share schemes are not only related to the service itself, but also interactions with other road users and the overall bike riding environment. Mandatory helmet legislation was a barrier to using bike share schemes due to hygiene and convenience concerns. ConclusionsBike share schemes act as an entry to bike riding for people who do not own a bicycle. E-bike fleets are more accessible to people with health or mobility issues. Mandatory helmet legislation could be limiting bike riding's mode share in Melbourne. These findings are relevant to policy makers aiming to increase bike riding's mode share, introduce or expand bike share schemes or mandatory helmet legislation, or a combination of the two.

Pattern of Head Injury in Fatal Road Traffic Accident: Retrospective Study

Road traffic Accident have been reported to be a major cause of morbidity and mortality. Due to increasing modernization, road traffic accidents have become exponentially more frequent and dangerous. Mortality rate from road traffic injuries accounts 29.2 per 100000 people5. This study was conducted in the Department of Forensic Medicine, Silchar Medical College, Silchar, from 1st November 2021 to 31st October 2022. The aim of the study is the pattern of head injuries in fatal road traffic accident. Out of the 981 autopsy cases were conducted during the above-mentioned period, a total of 200 cases were found deaths due to head injuries. Out of 200 cases, common age group involved was from 40-50 years, the deceased were more from rural areas. Maximum cases during winter season. Commonest injuries were scalp abrasion, linear fracture of skull and subdural haemorrhage. Head injury has become a common cause of death and disability among Road Traffic Accident cases. This further shows the need of strict implementations of traffic rules. Positive policy initiatives such as mandatory helmet legislation need reliable and consistent data to support ongoing monitoring and enforcement of such initiatives.

Mandatory helmet legislation and risk perception: A qualitative study in Melbourne, Australia

BackgroundAccess to safe and equitable bike riding infrastructure is an important public health goal. Australia is one of nine countries that mandates wearing bike helmets for adults. The policy is controversial and is theorised to discourage bike riding. This study aimed to describe understandings of mandatory helmet legislation and how it might impact decisions to wear a helmet and to ride a bike. MethodsSemi-structured interviews were conducted with 21 bike riders in Melbourne, Australia to discuss their experiences and how this law factors into their decision to ride a bike and impacts their perception of risk when riding. Data were analysed using grounded theory. ResultsThis study provides evidence on the complex intersection of mandatory helmet legislation and the cycling environment. Specifically, this study identified that bike riders consider risk within the overall cycling context and not in binary decisions of ‘risky’ and ‘not risky’. Interviewees saw the law as a small benefit to safety, but not an adequate substitute for meaningful infrastructure and other actions that could reduce the risk posed to bike riders by drivers of motor vehicles. Interviewees also felt that mandating helmets was an ‘easy’ policy choice as it does not require any behavioural changes from drivers of motor vehicles. ConclusionsMandatory helmet legislation is not considered a barrier to bike riding but may prevent others from exploring it as a transport option by contributing to the perception of bike riding as an unsafe activity. Policies aimed at improving safety for bike riders should focus on the development of safer infrastructure first and then use personal protective equipment to mitigate any residual risk. Policies focusing on personal protective equipment legitimise blaming bike riders for getting injured and contributes to judgement and victim blaming experienced by bike riders.

Increased bicycle helmet use in the absence of mandatory bicycle helmet legislation: Prevalence and trends from longitudinal observational studies on the use of bicycle helmets among cyclists in Denmark 2004–2022

Introduction: Using a bicycle helmet reduces the risk of serious head injuries among cyclists substantially. This makes it highly relevant to increase the use of helmets and to measure the prevalence of bicycle helmet use over time and across different groups. Method: Since 2004, the use of bicycle helmets in Denmark has been measured observationally in two nationwide time series: one among cyclists in city traffic across all age groups, and one among cycling school children (aged 6–16) around schools. The observations have been conducted on a regular basis in different parts of the country following the same methodology over the years. Results: Bicycle helmet use among cyclists in city traffic in Denmark has increased from 6% in 2004 to 50% in 2022. Among cycling school children, helmet use has increased from 33% in 2004 to 79% in 2022. Throughout the years, helmet wearing rates have been highest among young children and lowest among young adults. Since 2015, female cyclists in city traffic have had a slightly higher helmet use than male cyclists. Discussion: Several factors might have affected bicycle helmet use in Denmark. One possible factor is a nationwide focus on traffic safety education and behavior change campaigns to encourage helmet wearing. Furthermore, among stakeholders on cycling safety there has been consensus on recommending bicycle helmet use and supporting the promotion of helmets while not recommending or promoting helmet legislation. Finally, more safety-oriented behavior in road traffic in general, and self-reinforcing effects of increased helmet use have plausibly been important factors. Practical Applications: Increasing bicycle helmet use in a country where cycling is popular is possible in the absence of mandatory bicycle helmet legislation. Persistent behavior change campaigning and education, stakeholder consensus, higher levels of road safety-oriented behaviors, and self-reinforcing processes could potentially be important factors.

Paternalism in Historical Context: Helmet and Seatbelt Legislation in the UK.

Paternalism is a frequent source of anxiety and scholarly enquiry within public health. This article examines debate in the UK from the 1950s to the early 1980s about two quintessentially paternalistic laws: those making it compulsory to use a motorcycle helmet, and a car seatbelt. This kind of historical analysis, looking at change over time and the circumstances that prevent or enable such change, draws attention to two significant features: the contingent nature of that which is perceived as paternalistic and therefore objectionable, and the wide range of arguments that can be marshalled for and against. It suggests that paternalism became a particularly disruptive accusation in the UK of the 1970s in relation to seatbelts, thanks to the population that would be affected and the wider socio-political context. It also suggests that arguments about the social cost of death and injury on the roads, along with overt acceptance that some element of paternalism could be acceptable, proved influential-as was the sense of inevitability that 10 years of regular debate helped to create.

Factors associated with bicycle helmet use and proper fit: a cross-sectional survey of Montreal cyclists during the COVID-19 pandemic.

With increased bicycle use during the COVID-19 pandemic and growing availability of bicycle-sharing programs in Montreal, we hypothesize helmet use has decreased. The aim of this study was to evaluate helmet use and proper fit among Montreal cyclists during the pandemic relative to historical data. Nine observers collected data on bike type, gender, helmet use, and ethnicity using the iHelmet© app at 18 locations across the island of Montreal from June to September 2021. Proper helmet wear was assessed at one busy location. Multiple logistic regression was used to identify factors associated with helmet wear and results were compared to a historical study. Of the 2200 cyclists observed, 1109 (50.4%) wore a helmet. Males (OR = 0.78, 95%CI = 0.65-0.95), young adults (OR = 0.65, 95%CI = 0.51-0.84), visible minorities (OR = 0.38, 95%CI = 0.28-0.53), and bike-share users (OR = 0.21, 95%CI = 0.15-0.28) were less likely to be wearing a helmet, whereas children (OR = 3.92, 95%CI = 2.17-7.08) and cyclists using racing bicycles (OR = 3.84, 95%CI = 2.62-5.62) were more likely to be wearing a helmet. The majority (139/213; 65.3%) of assessed cyclists wore properly fitting helmets. Children had the lowest odds of having a properly fitted helmet (OR = 0.13, 95%CI = 0.04-0.41). Compared to 2011, helmet use during the pandemic increased significantly (1109/2200 (50.4%) vs. 2192/4789 (45.8%); p = 0.032). Helmet use among Montreal cyclists was associated with age, gender, ethnicity, and type of bicycle. Children were least likely to have a properly fitted helmet. The recent increase in popularity of cycling and expansion of bicycle-sharing programs reinforce the need for bicycle helmet awareness initiatives, legislation, and funding prioritization.

The Impact of Information Presentation and Cognitive Dissonance on Processing Systematic Review Summaries: A Randomized Controlled Trial on Bicycle Helmet Legislation.

Background: Summaries of systematic reviews are a reference method for the dissemination of research evidence on the effectiveness of public health interventions beyond the scientific community. Motivated reasoning and cognitive dissonance may interfere with readers’ ability to process the information included in such summaries. Methods: We conducted a web experiment on a panel of university-educated North Americans (N = 259) using a systematic review of the effectiveness of bicycle helmet legislation as a test case. The outcome variables were the perceived tentativeness of review findings and attitude toward bicycle helmet legislation. We manipulated two types of uncertainty: (i) deficient uncertainty (inclusion vs. non-inclusion of information on limitations of the studies included in the review) and (ii) consensus uncertainty (consensual findings showing legislation effectiveness vs. no evidence of effectiveness). We also examined whether reported expertise in helmet legislation and the frequency of wearing a helmet while cycling interact with the experimental factors. Results: None of the experimental manipulations had a main effect on the perceived tentativeness. The presentation of consensual efficacy findings had a positive main effect on the attitude toward the legislation. Self-reported expertise had a significant main effect on the perceived tentativeness, and exposing participants with reported expertise to results showing a lack of evidence of efficacy increased their favorable attitude toward the legislation. Participants’ helmet use was positively associated with their attitude toward the legislation (but not with perceived tentativeness). Helmet use did not interact with the experimental manipulations. Conclusions: Motivated reasoning and cognitive dissonance influence a reader’s ability to process information contained in a systematic review summary.

Framing the nanny (state): an analysis of public submissions to a parliamentary inquiry on personal choice and community safety

ObjectiveTo examine public submissions to a parliamentary inquiry on personal choice and community safety, exploring framing used to support or oppose current public health regulatory approaches. MethodsDescriptive content analysis summarised the characteristics of electronic submissions. Framing analysis examined submissions according to the devices: problem and causes; principles and values; recommendations; data and evidence; and salience. ResultsWe categorised one hundred and five (n=105) submissions by source as Individual, Industry, Public Health and Other. Individuals made more than half the submissions. Overarching frames were choice and rights (Individuals); progress and freedom (Industry); protection and responsibility (Public Health). Most submissions opposed current regulations. Cycling, including mandatory helmet legislation, was most cited, with three‐quarters of submissions opposing current legislation. ConclusionsFraming analysis provided insights into policy actor agendas concerning government regulation. We found a high degree of resistance to public health regulation that curtails individual autonomy across various health issues. Investigating the influence of different frames on community perception of public health regulation is warranted. Implications for public healthAction is required to counteract ‘nanny state’ framing by industry and to problematise community understanding of the ‘nanny state’ in the context of balancing the public's liberties and the public's health.

Risks for bicycle-related injuries in Al Ain city, United Arab Emirates: An observational study.

Traffic-related injuries are a serious health problem. Traffic safety is a priority reflected in the United Nations Sustainable Development Goals. Data on current hazards for bicycle-related injuries from the United Arab Emirates are lacking. The aim of our observational study was to assess the behavior of bicyclists on the roads in Al Ain City, United Arab Emirates and compare our current results with a previous study from 2004.We adapted and tested a structured data collection form. Different sectors of Al Ain were randomly selected to cover the whole city during different times. Bicyclists were observed without direct contact.Out of 1129 bicyclists, 97.6% were males and 13.2% children. 39.4% were cycling on main roads with high-density traffic, 33.1% were cycling against the traffic, 39.3% were cycling at night, and 96.8% of them were not using lights. Only 2.1% of the bicyclists used helmets. A higher proportion of female than male cyclists used helmets (25.9% vs 1.5%; P < .001, Fisher exact test). There was an increase in cycling with the traffic (P < .001) and in use of helmets (P < .025) compared with the previous study.Unsafe practices of bicyclists and low use of helmets despite legislation persist in Al Ain. There is a need to raise bicycle safety awareness and improve enforcement of bicycle helmet legislation. This should be directed toward expatriate workers, children, parents, and maids. Environmental changes, namely building separate bicycle lanes, can increase safety for cycling.

Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis.

The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present. In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.

To helmet or not to helmet: a global perspective on the bicycle compulsory protective helmet law.

Child injury from bike accidents is a significant component of morbidity, mortality and health expenditure in many countries. Universal use of bicycle helmets by children could prevent between 135 and 155 deaths, and between 39,000 and 45,000 head injuries annually. Surprisingly, epidemiologic data indicate a worldwide low prevalence of helmet use. A global view on the law on the compulsory use of safety helmets involving 58 different countries is provided in order to bring this critical debate back to the table. A broad search using "bicycle-related injuries," "bicycle helmet," "bicycle helmet legislation" and "compulsory bicycle helmet law by countries" was performed in order to identify and select the most pertinent information on the issue as well as all the information available on bicycle helmet law by countries. The papers identified permitted us to assess the main topics related to the use of bicycle helmets discussed over the years which are still relevant and without consensus even today, as well as alphabetically enlist the approach of 58 countries to the compulsory helmet law. Our review on the many faces of the bicycle helmet use (pros and cons), personal aspects, head injuries, legislation, promotion, socioeconomic influence, and finally a global view on the law on the compulsory use of safety helmets allowed us to bring here many suggestions and a few conclusions, mainly because "to helmet or not to helmet" should not be a question anymore. A universal consensus on their compulsory use has to be achieved in order to improve children's safety.

Motorized Two-Wheeler Accidents; A leading Cause of Death and Disabilities: Autopsy Based Study in Tertiary Care Hospital

Background: More than half of all road traffic deaths in the world occur among vulnerable road users including pedestrians, motorcyclists and cyclists whereas; motorcyclists contribute almost one fourth of the death toll of road traffic crashes. Implementation of suitable strategies to address the issues of road traffic crashes is much difficult without information, absolute value of the problem, patterns and risks of injuries &amp; death. Objective: To determine the different patterns, severity and distribution of injuries &amp; their frequency in motorized two wheelers accidents. Study Design: Cross-sectional Study. Settings: Study was conducted in the department of Forensic Medicine at Nishtar Medical University, Multan Pakistan. Duration: One year from January 01, 2018 to December 31, 2018. Methodology: Total 167 cases died of road traffic accidents brought for autopsy and of those, 104 cases were reported to be died of motorcycle accidents involving both riders &amp; pillion riders. The data of victim’s age, gender, site and pattern of injuries were obtained through detailed examination of the hospital record, autopsy reports and police inquest. The injuries over head, neck &amp; thoraco abdominal region were given due consideration being dangerous to life. Statistical analysis was done using SPSS version 20. Results: Of the total 104 cases died in motorcycle accidents; 99 (95.20%) were males &amp; 5 (4.80%) female. Riders died in 81 (77.89%) cases &amp; pillion riders 23 (22.11%). The age group between 21-40 years involved 67 (64.42%) cases; maximum injuries were observed on Head/Face affecting 84 (80.8%) cases while on thorax 26 (25%) cases, Neck/Spine 12 (11.5%), pelvis 14 (13.4%) and abdominal area sustained injuries in 8 (7.6%) cases. As regard pattern of injuries; abrasions were found in 48 (31%) cases, lacerations 38 (24%), contusions 14 (9%) while fractures were observed in 56 (36%) cases. Among fatal injuries, 74 (71%) were found on Head, 7 (6.7%) over cervical spines, 3 (2.8%) on limbs whereas fatal injuries on thorax &amp; Abdomino-pelvic areas were found 6 (9.6%) in each category. Of the total 81 riders, fractures of skull were observed in 59 (73%) cases and of 23 pillion riders, 16 (69.5%) got fracture of skull. Conclusion: Male riders of motorcycles belonging to age range 21-40 years were more prone to fatal injuries i.e., fractures of skull, neck, spine &amp; Abdomino-thoracic injuries. Abrasions, contusions and lacerations were the most common type of injuries. Helmet legislation needs to be supported by strong enforcement and social marketing campaigns. Reducing the incidence by strict implementation of traffic rules and safety education via electronic &amp; print media is need of the day.

Are motorcycles really “donorcycles”? Examining organ donation rates between unhelmeted and helmeted motorcyclists

Introduction: Motorcycles are colloquially referred to as “donorcycles” among medical staff. However, the actual impact of helmet laws and helmet use on organ donation is unknown. Michigan’s 35-year-old universal helmet law (UHL) was repealed in April 2012 and replaced by a partial-helmet law. We hypothesized that there would be an increase in organ donation rates from unhelmeted motorcyclist fatalities. Methods: Michigan's Gift of Life Michigan organ donation database was queried from April 2008 through May 2015 in conjunction with the Michigan Trauma Quality Improvement Program database from the same time period. All in-hospital motorcycle crash fatalities were examined. Results: A three-fold increase was found in the rate of organ donation for unhelmeted motorcyclists compared to helmeted motorcyclists (p = 0.006). Motorcycle crash fatalities tended to be younger in age after the UHL repeal with an average age of 32.8 years versus 40.8, however, this finding was not statistically significant (p = 0.071). Additionally, there was no significant difference in organ donation rates pre-UHL repeal (2008–2012) versus post-repeal (2012–2015). Conclusions: This is the first study to demonstrate an increased rate of organ donation among unhelmeted motorcyclist fatalities compared to helmeted rider fatalities. There was no significant increase in the rate of organ donation following the Michigan UHL repeal. However, we identified that some motorcycle crash fatalities were from illegally unhelmeted riders in the past, prior to the repeal. Practical Application: Unhelmeted motorcyclists are three times more likely than helmeted riders to become organ donors, possibly due to the well documented increase in severe traumatic brain injuries in this population. From a public health perspective, helmets should be required for all motorcyclists and efforts to advocate in favor of helmet legislation should be supported by trauma systems and health professionals.

Determinants of standard motorcycle safety helmet usage among child pillion riders

The World Health Organization stressed that compliance with the use of safety helmet could significantly reduce the risk of injury by 72% and the probability of death by 39%. In Malaysia, the enforcement of the safety helmet legislation significantly reduced 30% of motorcycle crash fatalities in Malaysia. The aim of this study is to explore the use of motorcycle helmets and the determinants of standard helmet usage among child pillion riders. A cross-sectional survey of 200 adult riders accompanied by the child pillion riders aged 6–12 years old from Klang, Selangor, was conducted. The proper use of the helmet among the respondents and the child pillion riders was observed and recorded. A questionnaire was used to assess socio-demographic background and awareness of the use of child safety helmets. The data was analyzed using SPSS version 23. Only 3% of child pillion riders use standard child safety helmets, while 37% wear standard adult motorcycle helmets. Adult riders who were married, female, always wear helmets, have a higher household income and travel a long distance, are more likely to use a standard motorcycle helmet for their child pillion riders. Knowledge on Standard Certification (SIRIM) label and its importance, awareness of the campaign on child safety helmets, police enforcement, understanding the safety of toy/game helmet use have been identified as additional determinants of standard helmet use among child pillion riders. This study recommends prospective studies with continuous road safety educations programs that integrate behavioural change approaches to enhance the use of standard motorcycle helmets among the child pillion riders in Malaysia.

Abiding by the law when it does not exist: The case of the helmet bicycle law

To improve the safety of bicycle users, some countries have enacted, or considered enacting, mandatory helmet legislation. Of course, the enactment of such legislation in a country assumes that its citizens will be well-informed of it, and consequently, will use the helmet more frequently than before. However, in the survey described in this paper we found that many people are not aware of the legislation in force in their own country, or, even if they know, they may not necessarily behave as dictated by the law. Thus, the effects of mandatory helmet legislation may be somewhat different than desired or expected. Therefore, the goal of this paper is to ascertain the role of cyclists’ knowledge of the law in their country as a mediator between the law and the actual use of the helmet. Respondents from seventeen countries participated in an international survey about cyclists' habits, and answered questions about helmet legislation, and frequency of helmet use. The results indicate that the main effect of mandatory helmet legislation on the frequency of use of the helmet is mediated by the perception that such a law exists in their country—even when in fact sometimes it does not exist.

Does the Australian Bureau of Statistics Method of Travel to Work data accurately estimate commuter cycling in Australia?

The Australian Census of Population and Housing includes a responder’s Method of Travel to Work for Persons (MTWP) on Census Day. With some exceptions, responders can select multiple modes of transport. In Australia and overseas, this data has been used to estimate mode share and the proportion of Australians who utilize various active transport modes. This is especially true for cycling as there are scant data sources for Australian cycling exposure. The aims of this paper are to discuss weaknesses of MTWP data and the appropriateness of MTWP data to estimate cycling in Australia, and to assess changes in MTWP data relative to the introduction of bicycle helmet legislation. The use of MTWP data to estimate Australian cycling is limited due to: (1) data collection occurring on single days in winter once every five years, (2) it is not possible to identify a primary mode of transport, and (3) the 1976 data was not a full enumeration. MTWP data estimates about 1.5% of Australians cycle while other data sources are much higher ranging from 10% to 36%. With regard to bicycle helmet legislation, comparisons were made for each state/territory for the census immediately preceding helmet legislation and the following census. Overall, the proportion of cyclists among active transport users is similar from pre- to post-legislation (relative change=+1%, 95% CI: -13%, +18%), although all but two states/territories estimate an increase in cycling. In conclusion, the Australian government should invest in routinely collecting high-quality mobility data for all modes of travel to assist in the decision-making and assessment of road safety policies.

Childhood cycling fatalities in South Australia before and after the introduction of helmet legislation.

In the years following the introduction of legislation in Australian states mandating the wearing of helmets, there was a decline in the number of deaths. Debate has occurred, however, as to why this occurred. The Traffic Accident Reporting System database, which records data for all police-reported crashes in South Australia, was searched for all cases of deaths occurring in the state in bicycle riders aged ≤14 years from January 1982 to December 2001. The numbers of deaths were then compared over the 10-year periods before (1982-1991) and after (1992-2001) the introduction of helmet legislation, and also on a yearly basis from 1982 to 2001. Comparing the numbers of deaths in the two periods before and after helmet legislation in 1991 showed a marked decrease in cases from 36 to 12. However, in examining the numbers of deaths per year in greater detail, it appears that these were already steadily reducing from nine cases per year in 1982 (2.9/100,000) to two cases in 1991 (0.67/100,000) to a virtual plateau after 1991 (ranging from 0 to 2 cases annually). It seems that the introduction of compulsory bicycle helmet wearing in South Australia came at a time when the numbers of child cyclist deaths had been steadily declining over the preceding decade. While helmet wearing clearly protects children who are still riding bicycles, the reasons for the reduction in numbers of deaths appears more complex than legislative change and likely involves a subtle interaction with other behavioural and societal factors and preferences.

Differences in Outcomes of Mandatory Motorcycle Helmet Legislation by Country-Income Level: A Systematic Review and Meta-Analysis

Background: Even though over 90% of fatal road traffic injuries occur in Low-and-Middle-Income Countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has been undermined. We sought to evaluate the effects of mandatory motorcycle helmet legislation and determine whether the effectiveness differed across country-income levels. Methods: A systematic review and meta-analysis were completed using the PRISMA criteria to evaluate studies on helmet usage, mortality from motorcycle accident, or traumatic brain injury (TBI) incidence, before and after enactment of a mandatory helmet law. Pooled odds ratios and their 95% confidence intervals (CI) were stratified by high-income countries (HICs) vs. LMICs using the random-effects model. Findings: Twenty-four studies were included in the final analysis. All studies demonstrated higher odds of helmet usage; however, the effect was statistically significantly greater in HICs (OR: 73.2; 95% CI: 46.9; 114.3) than in LMICs (OR: 5.05; 95% CI: 2.93; 8.70), p-interaction comparing both strata < 0×01. There was a significantly lower rate of motorcycle fatalities after enactment of helmet legislation (OR: 0×67; 95% CI: 0×56; 0×81with no significant difference by income classification, p-interaction: 0×36. TBI incidence was statistically significantly lower in HICs (OR: 0×53, 95% CI 0×46-0×61) than in LMICs (0×77, 95% CI 0×59-1×01) (p-interaction: 0.01). Interpretation: The recent Lancet Commission on Legal Determinants of Global Health argues that effective law can provide the framework for achieving sustainable development goals. Our findings support that the potential public health impact that could follow implementation of mandatory helmet laws typifies this sentiment and should be a priority of international policy. Funding Statement: None. Declaration of Interests: None.

Primary prevention of road traffic accident-related traumatic brain injuries in younger populations: a systematic review of helmet legislation.

Road traffic accidents are the most frequent cause of severe traumatic brain injury (TBI), particularly among young populations worldwide. Helmets are proven to prevent injuries; however, estimates of helmet compliance are low globally. Surgical/critical care management of TBI is often used to treat these injuries, but primary prevention should be recommended. A key component in promoting TBI prevention among pediatric and young populations is through helmet legislation. The authors investigated helmet policies for motorcycles and bicycles globally to provide recommendations for how related legislation may impact TBI and guide advocacy in pediatric neurosurgery. The authors conducted a systematic review of helmet laws and/or policies by using the National Library of Medicine PubMed and SCOPUS databases. Additional articles were identified using citation searches of key publications. Abstracts from articles of all sources were read and selected for full-text review. Details of relevant full articles were extracted and analyzed for the following: bibliographic data, study aim, design and duration, study participants, intervention characteristics, and intervention effect data. Of 618 search results, 53 full-text articles were analyzed for recommendations. Helmet legislation is associated with increased helmet use among bicyclists and decreased road traffic accident-related head injuries and fatalities among motorcyclists and bicyclists. Laws are more effective if comprehensive and inclusive of the following: both primary riders and passengers, all age groups, all modes of transportation made safer by helmets, a proper use clause, and standardized helmet quality measures. Cultural, socioeconomic, and infrastructural circumstances are important as well, and legislation must consider enforcement mechanisms with penalties significant enough to incentivize behavioral changes, but proportional to community socioeconomic status. Compulsory use laws are the optimal primary intervention; however, concurrent programs to support financial access to helmets, change cultural attitudes, increase health literacy, and improve road infrastructure will augment legislative benefits. Pediatric neurosurgeons are caretakers of children suffering from TBI. Although extensive study has explored the surgical management of TBI, the authors believe that primary prevention is instrumental to improving outcomes and reducing injury. All helmet laws are not equal; based on these findings, a comprehensive, context-specific approach is the key to success, especially in resource-limited countries.