Promote Helmet Use Research Articles

Bicycle helmet use among persons 5 years and older in the United States, 2012

IntroductionIn 2013, injuries to bicyclists accounted for 925 fatalities and 493,884 nonfatal, emergency department-treated injuries in the United States. Bicyclist deaths increased by 19% from 2010 to 2013. The greatest risk of death and disability to bicyclists is head injuries. The objective of this study was to provide estimates of prevalence and associated factors of bicycle riding and helmet use among children and adults in the United States. MethodCDC analyzed self-reported data from the 2012 Summer ConsumerStyles survey. Adult respondents (18+years) were asked about bicycle riding and helmet use in the last 30days for themselves and their children (5 to 17years). For bicycle riders, CDC estimated the prevalence of helmet use and conducted multivariable regression analyses to identify factors associated with helmet use. ResultsAmong adults, 21% rode bicycles within the past 30days and 29% always wore helmets. Respondents reported that, of the 61% of children who rode bicycles within the past 30days, 42% always wore helmets. Children were more likely to always wear helmets (90%) when their adult respondents always wore helmets than when their adult respondents did not always wear helmets (38%). Children who lived in states with a child bicycle helmet law were more likely to always wear helmets (47%) than those in states without a law (39%). ConclusionsDespite the fact that bicycle helmets are highly effective at reducing the risk for head injuries, including severe brain injuries and death, less than half of children and adults always wore bicycle helmets while riding. Practical applicationStates and communities should consider interventions that improve the safety of riding such as policies to promote helmet use, modeling of helmet wearing by adults, and focusing on high risk groups, including Hispanic cyclists, occasional riders, adults, and children ages 10 to 14.

The Effect of an All-Ages Bicycle Helmet Law on Bicycle-Related Trauma.

In 2003, Seattle implemented an all-ages bicycle helmet law; King County outside of Seattle had implemented a similar law since 1994. For the period 2000-2010, the effect of the helmet legislation on helmet use, helmet-preventable injuries, and bicycle-related fatalities was examined, comparing Seattle to the rest of King County. Data was retrieved from the Washington State Trauma Registry and the King County Medical Examiner. Results comparing the proportions of bicycle related head injuries before (2000-2002) and after (2004-2010) the law show no significant change in the proportion of bicyclists admitted to the hospital and treated for head injuries in either Seattle (37.9 vs 40.2% p=0.75) nor in the rest of King County (30.7 vs 31.4%, p=0.84) with the extension of the helmet law to Seattle in 2003. However, bicycle-related major head trauma as a proportion of all bicycle-related head trauma did decrease significantly in Seattle (83.9 vs 64.9%, p=0.04), while there was no significant change in King County (64.4 vs 57.6%, p=0.41). While the results do not show an overall decrease in head injuries, they do reveal a decrease in the severity of head injuries, as well as bicycle-related fatalities, suggesting that the helmet legislation was effective in reducing severe disability and death, contributing to injury prevention in Seattle and King County. The promotion of helmet use through an all ages helmet law is a vital preventative strategy for reducing major bicycle-related head trauma.

Prevalence and predictors of bicycle helmet use in a southeastern, US city

Fatalities and head injuries from bicycle-related crashes remain a concern in the United States. Despite legislation in many states, helmet use remains low. This observational study examined the helmet use and related factors in a North Carolina city. The sample consisted of 2088 observations of bicyclists. The objectives were to (1) determine helmet use; (2) describe other safe bicycling practices; and (3) examine the relationship of demographic variables and safe riding practices with helmet use. Helmet use was observed for 25% of the sample. Demographic factors related to helmet use were being female (OR = 1.32), 26 years old or older (OR = 4.94), and White (OR = 2.17). Bicyclists riding on the road with traffic were more likely to wear a helmet than bicyclists riding on the sidewalk (OR = 2.04). Findings indicate that helmet use remains low in the city. Research to monitor, better understand, and promote helmet use is needed.

Inequalities in the use of helmets by race and payer status among pediatric cyclists

Despite nationwide campaigns to increase the use of helmets among pediatric cyclists, many children continue to be injured while riding without a helmet. To determine where programs and policies intended to promote helmet use should be directed, we surveyed a large national dataset to identify variables associated with helmet use. The National Trauma Data Bank was queried during the years 2007, 2010, and 2011 for children younger than the age of 16 years who were involved in a bicycle accident. Children were grouped based on whether they had a helmet on during the accident. A multivariable logistic mixed-effects model was utilized to determine factors associated with helmet use. Of the 7,678 children included in the analysis, 1,695 (22.1%) were wearing a helmet during their accident. On unadjusted analysis, nonhelmeted riders were more likely to be older (median age 11 years vs 10 years, P < .001), black (10.1% vs 3.7%, P < .001) or insured by Medicaid (32.8% vs 14.3%, P < .001). After adjustment, black children were still less likely to have had worn a helmet compared with white children (adjusted odds ratio 0.38, 95% confidence interval 0.28-0.50). Children on Medicaid were also less likely to have been wearing a helmet compared to children with private insurance (adjusted odds ratio 0.33, 95% confidence interval 0.28-0.39). Children who are black or who are on Medicaid are less likely to be wearing a helmet when involved in a bicycle accident than white children or children with private insurance, respectively. Future efforts to promote helmet use should be directed towards these groups.

Helmet Attitudes and Practices among University Students of Dental and Medical Professional Courses in Vadodara, India

Background: Increasing motor-cycle accidents warrant strict adherence to helmet use regulations; however awareness and attitudes of people tend to largely govern helmet use. Objectives: To assess the practices and attitudes towards helmet use by medical and dental students of sumandeep vidyapeeth, Vadodara. Methods: A cross- sectional pre- tested questionnaire survey using modified bicycle helmet attitude scale was conducted among medical and dental college students of a University in Gujarat, India. Information on subjects’ personal characteristics, the subjects’ frequency of helmet use, situations determining the use of helmet, knowledge on consequences of road traffic accident, potential of helmet to prevent head injury or death from fatal accidents, attitudes towards helmet use and barriers to helmet use were assessed. Data was compiled and descriptive statistics was computed. Results: Only 30% of the surveyed subjects reported of unconditional helmet use while driving two- wheelers. More than half of the study participants believed that if they did not wear helmets, they were at a risk of injury from road accidents. 50% believed that injury as a consequence of not wearing helmet could affect their functioning at school. 50% of the study subjects reported that media was the chief contributor in promotion of helmet use for safe driving. Conclusion: Although the surveyed subjects knew about the importance of wearing helmets and had positive attitude towards helmet use, the same did not translate to greater helmet use. Hence, a need for strict regulatory approach is realized for implementation of helmet use among two-wheeler riders.

Helmet use among motorcycle and moped riders injured in Hawaii: Final medical dispositions from a linked database.

Reports regarding helmets in motorcycle crashes have been limited by the lack of data across the spectrum of injury outcomes, generally excluding low-severity injuries that do not require further medical treatment. We hypothesized that the protective effect of helmets may be underestimated in studies that focused only on patients who arrive at a trauma center and that it may differ depending on whether the crash involved a motorcycle or moped. The emergency medical service reports of 2,553 crash patients treated from 2007 to 2009 were linked to police crash reports, hospital billing data, death certificates, and the Fatal Analysis Reporting System for a more complete description of the crashes throughout the state. The number of unhelmeted riders (n = 1,674) was nearly double those who were helmeted (n = 879). Multivariate logistic regression models estimated 45% greater odds of a hospital admission (vs. no hospital treatment or a discharge from the emergency department setting) among unhelmeted riders, compared with helmeted riders. Unhelmeted riders also had an adjusted odds of a fatal injury that was more than double that of helmeted riders (odds ratio, 2.71; 95% confidence interval, 1.68-4.46). Stratified analyses showed that these protective associations between helmet use and medical disposition were apparent only among motorcyclists. The magnitude of the protective associations between helmets and medical outcomes was generally greater than that reported by other studies. Motorcyclists seem to benefit from helmet use more than moped riders. This data could be used to promote helmet use through education and public policy. Prognostic/epidemiologic study, level III.

Parental attitudes and behaviours concerning helmet use in childhood activities: Rural focus group interviews

Previous research demonstrates the importance of parents in ensuring that their children practice proper helmet use. Parents encourage helmet use by setting an example when they wear helmets, as well as establishing rules that the children are expected to follow. Research in the area of helmet use predominantly focuses on bicycle helmets, but there are a number of childhood activities for which a helmet is required. The purpose of this research was to examine rural parents’ attitudes toward helmet use and investigate when, and for what activities, they require their children to wear helmets. Rural parents were selected as there is evidence that helmet use is less frequent among children in rural settings.Expanding on the literature, an exploratory qualitative methodology was used to gather data. Eight focus groups were held in rural Saskatchewan to explore what influences parents’ decisions to wear helmets themselves, and when and why they enforce helmet rules with their children. A thematic analysis was subsequently conducted on the data.The results suggest that parents recognize that their rules and their example influence their children. Participants mentioned being consistent, establishing rules and using positive reinforcement as ways to encourage helmet use among their children. Helmet costs and lack of awareness of helmet necessity in particular activities were barriers to helmet use. Specific barriers to helmet use in rural areas included the difficulty in finding proper helmets, the lack of exposure to helmet promotion initiatives, and the perception that activities in rural areas were safer than in the city. Parents tended to make their own helmet decisions based on personal experience and threat perception of the activity. This reasoning was the basis for when and why they established helmet rules.It is important to raise awareness of the risks of head injury and the benefits of wearing a helmet in other activities besides bicycling. More effort is needed to reach rural populations with information and opportunities to access appropriate and affordable helmets. Legislating mandatory helmet use could be useful in promoting helmet use in adults and children. Alternatively, the use of incentives for children wearing helmets could also serve as a reinforcement mechanism to increase use. A synthesis of the data gathered suggests that a theoretical approach based on increasing predisposing, enabling and reinforcing factors for helmet use may be useful in future interventions.

Helmet Use Among Users of the Citi Bike Bicycle-Sharing Program: A Pilot Study in New York City

The use of bicycle helmets to prevent or reduce serious head injuries is well established. However, it is unclear how to effectively promote helmet use, particularly in the context of bicycle-sharing programs. The need to determine rates of helmet use specifically among users of bicycle-sharing programs and understand if certain characteristics, such as time of day, affect helmet use, is imperative if effective promotion and/or legislative efforts addressing helmet use are to be developed. We estimated the prevalence of helmet use among a sample of Citi Bike program users in New York City. A total of 1,054 cyclists were observed over 44 h and across the 22 busiest Citi Bike locations. Overall, 85.3% (95% CI 82.2, 88.4%) of the cyclists observed did not wear a helmet. Rates of helmet non-use were also consistent whether cyclists were entering or leaving the docking station, among cyclists using the Citi Bikes earlier versus later in the day, and among cyclists using the Citi Bikes on weekends versus weekdays. Improved understanding about factors that facilitate and hinder helmet use is needed to help reduce head injury risk among users of bicycle sharing programs.

Evaluation of motorcycle safety strategies using the severity of injuries

The growth of motorcycle fatalities in California has been especially prominent, specifically with regard to the 24 and under age group and those aged 45–54. This research quantitatively examined factors associated with motorcyclist fatalities and assessed strategies that could improve motorcyclist safety, specifically focusing on the two age groups mentioned above. Severity of injury was estimated separately for both age groups with multinomial logit models and pseudo-elasticity using motorcycle-related collision data that was collected between 2005 and 2009. The results were compared with motorcyclists aged 35–44, a group that shows a consistent trend of fatalities.This research found that lack or improper use of helmets, victim ejection, alcohol/drug effects, collisions (head-on, broadside, hit-object), and truck involvement were more likely to result in fatal injuries regardless of age group. Weekend and non-peak hour activity was found to have a strong effect in both the younger and older age groups. Two factors, movement of running off the road preceding a collision and multi-vehicle involvement, were found to be statistically significant factors in increasing older motorcyclist fatalities. Use of street lights in the dark was found to decrease the probability of severe injury for older motorcyclists. Driver type of victim, at-fault driver, local road, and speed violation were significant factors in increasing the fatalities of younger motorcyclists. Road conditions and collision location factors were not found to be statistically significant to motorcyclist fatalities.Based on the statistically significant factors identified in this research, the following safety strategies appear to be effective methods of reducing motorcyclist fatalities: public education of alcohol use, promoting helmet use, enforcing heavy vehicle and speed violations, improving roadway facilities, clearer roadway guidance and street lighting systems, and motorcyclist training.

Effectiveness of the 100% motorcycle helmet use campaign in Thailand

BackgroundAlthough motorcycle helmet use has been mandatory in Thailand since the enactment of the helmet law in 1994, the non-compliance in helmet use has been considerably profound. In January 2011,...

Investigating Helmet Promotion for Cyclists: Results from a Randomised Study with Observation of Behaviour, Using a Semi-Automatic Video System

IntroductionHalf of fatal injuries among bicyclists are head injuries. While helmet use is likely to provide protection, their use often remains rare. We assessed the influence of strategies for promotion of helmet use with direct observation of behaviour by a semi-automatic video system.MethodsWe performed a single-centre randomised controlled study, with 4 balanced randomisation groups. Participants were non-helmet users, aged 18–75 years, recruited at a loan facility in the city of Bordeaux, France. After completing a questionnaire investigating their attitudes towards road safety and helmet use, participants were randomly assigned to three groups with the provision of “helmet only”, “helmet and information” or “information only”, and to a fourth control group. Bikes were labelled with a colour code designed to enable observation of helmet use by participants while cycling, using a 7-spot semi-automatic video system located in the city. A total of 1557 participants were included in the study.ResultsBetween October 15th 2009 and September 28th 2010, 2621 cyclists' movements, made by 587 participants, were captured by the video system. Participants seen at least once with a helmet amounted to 6.6% of all observed participants, with higher rates in the two groups that received a helmet at baseline. The likelihood of observed helmet use was significantly increased among participants of the “helmet only” group (OR = 7.73 [2.09–28.5]) and this impact faded within six months following the intervention. No effect of information delivery was found.ConclusionProviding a helmet may be of value, but will not be sufficient to achieve high rates of helmet wearing among adult cyclists. Integrated and repeated prevention programmes will be needed, including free provision of helmets, but also information on the protective effect of helmets and strategies to increase peer and parental pressure.

Non-legislative interventions for the promotion of cycle helmet wearing by children

Helmets reduce bicycle-related head injuries, particularly in single vehicle crashes and those where the head strikes the ground. We aimed to identify non-legislative interventions for promoting helmet use among children, so future interventions can be designed on a firm evidence base. To assess the effectiveness of non-legislative interventions in increasing helmet use among children; to identify possible reasons for differences in effectiveness of interventions; to evaluate effectiveness with respect to social group; to identify adverse consequences of interventions. We searched the following databases: Cochrane Injuries Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; PsycINFO (Ovid); PsycEXTRA (Ovid); CINAHL (EBSCO); ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED); Social Sciences Citation Index (SSCI); Conference Proceedings Citation Index-Science (CPCI-S); and PubMed from inception to April 2009; TRANSPORT to 2007; and manually searched other sources of data. We included RCTs and CBAs. Studies included participants aged 0 to 18 years, described interventions promoting helmet use not requiring enactment of legislation and reported observed helmet wearing, self reported helmet ownership or self reported helmet wearing. Two independent review authors selected studies for inclusion and extracted data. We used random-effects models to estimate pooled odds ratios (ORs) (with 95% confidence interval (CI)). We explored heterogeneity with subgroup analyses. We included 29 studies in the review, 21 of which were included in at least one meta-analysis. Non-legislative interventions increased observed helmet wearing (11 studies: OR 2.08, 95% CI 1.29 to 3.34). The effect was most marked amongst community-based interventions (four studies: OR 4.30, 95% 2.24 to 8.25) and those providing free helmets (two studies: OR 4.35, 95% CI 2.13 to 8.89). Significant effects were also found amongst school-based interventions (eight studies: OR 1.73, CI 95% 1.03 to 2.91), with a smaller effect found for interventions providing education only (three studies: OR 1.43, 95% CI 1.09 to 1.88). No significant effect was found for providing subsidised helmets (seven studies: OR 2.02, 95% CI 0.98 to 4.17). Interventions provided to younger children (aged under 12) may be more effective (five studies: OR 2.50, 95% CI 1.17 to 5.37) than those provided to children of all ages (five studies: OR 1.83, 95% CI 0.98 to 3.42).Interventions were only effective in increasing self reported helmet ownership where they provided free helmets (three studies: OR 11.63, 95% CI 2.14 to 63.16).Interventions were effective in increasing self reported helmet wearing (nine studies: OR 3.27, 95% CI 1.56 to 6.87), including those undertaken in schools (six studies: OR 4.21, 95% CI 1.06 to 16.74), providing free helmets (three studies: OR 7.27, 95% CI 1.28 to 41.44), providing education only (seven studies: OR 1.93, 95% CI 1.03 to 3.63) and in healthcare settings (two studies: OR 2.78, 95% CI 1.38 to 5.61). Non-legislative interventions appear to be effective in increasing observed helmet use, particularly community-based interventions and those providing free helmets. Those set in schools appear to be effective but possibly less so than community-based interventions. Interventions providing education only are less effective than those providing free helmets. There is insufficient evidence to recommend providing subsidised helmets at present. Interventions may be more effective if provided to younger rather than older children. There is evidence that interventions offered in healthcare settings can increase self reported helmet wearing.Further high-quality studies are needed to explore whether non-legislative interventions increase helmet wearing, and particularly the effect of providing subsided as opposed to free helmets, and of providing interventions in healthcare settings as opposed to in schools or communities. Alternative interventions (e.g. those including peer educators, those aimed at developing safety skills including skills in decision making and resisting peer pressure or those aimed at improving self esteem or self efficacy) need developing and testing, particularly for 11 to 18 year olds. The effect of interventions in countries with existing cycle helmet legislation and in low and middle-income countries also requires investigation.

The promotion of bicycle helmet use in children and youth: an overview of reviews

AbstractBackgroundBicycle‐related head injuries are a common reason for paediatric emergency department visits. Helmets have been designed to reduce head injuries, and helmet use has been encouraged through mandatory helmet legislation and nonlegislation helmet promotion activities.ObjectivesTo synthesize the evidence published in the Cochrane Database of Systematic Reviews regarding bicycle helmet use among children, including helmet effectiveness and methods to promote helmet use.MethodsThe Cochrane Database of Systematic Reviews was searched for all systematic reviews where ‘bicycle*’ or ‘helmet’ appeared in title, abstract or keywords. Reviews were included if they examined paediatric data concerning head injuries among helmeted and nonhelmeted cyclists, helmet use or adverse consequences of helmets. Data pertaining to adults were excluded. Relevant data were extracted, entered into tables and synthesized using qualitative and quantitative methods.Main resultsThree systematic reviews were identified and included 21 observational studies and 14 experimental studies. The methodological quality was assessed in only two of the reviews: the quality was similar in studies examining legislative interventions and several weaknesses were identified in the nonlegislative interventions. Among children, helmet use resulted in a 63% reduction in medically reported head injuries [adjusted odds ratio (OR): 0.37; 95% confidence interval (CI): 0.20, 0.66] and an 86% reduction in the odds of brain injuries (OR: 0.14; 95% CI: 0.05, 0.38). Enactment of mandatory helmet legislation for child cyclists reduced the odds of head injury hospitalizations by 45%, while the odds of head injury hospitalizations reduced by 27% among children in jurisdictions without legislation. There was a significant reduction in traumatic brain injury among children cycling after the passage of helmet legislation (OR: 0.82; 95% CI: 0.76, 0.89); however, there was no significant decrease in other head and facial injuries post‐legislation (OR: 1.08; 95% CI: 0.90, 1.23). Legislation also resulted in a significant increase in the number of children observed wearing a helmet (prevalence ratio: 3.69; 95% CI: 2.65, 5.14). Compared with children who received no intervention, those who received nonlegislative helmet promotion activities had a significant increase in observed helmet wearing (OR: 2.08; 95% CI: 1.29, 3.34), self‐reported helmet wearing (OR: 3.27; 95% CI: 1.56, 6.87) and self‐reported helmet ownership (OR: 2.67; 95% CI: 0.89, 8.03). No adverse events were associated with helmet use among cyclists.Authors' conclusionsBicycle helmets appear to be an effective way to reduce head injuries among children. Interventions to increase helmet use may be effective, particularly community‐based, school‐based, and those that provide free helmets; however, no effect of the interventions on helmet use were reported in randomized controlled trials. Finally, helmet legislation appears to be effective in increasing helmet use and reducing head injuries. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Still Unsafe, Still in Use: Ongoing Epidemic of All-Terrain Vehicle Injury Hospitalizations Among Children

The injury risks to children who ride all-terrain vehicles (ATVs) are well documented and include increased risk of death or hospitalization. We identify pediatric hospitalization trends for ATV injuries, provide national benchmarks, and discuss policy and prevention implications. We used data (1997-2006) from the kid's inpatient database, the only all-payer inpatient care database for children in the United States. Children and adolescents aged 0 year to 17 years were included. We generate national estimates of hospitalizations. Total pediatric hospitalizations for ATV injuries have increased 150% from an estimated 1,618 in 1997 to 4,039 in 2006. The overall ATV-related injury hospitalization rate increased 139% from 2.3 per 100,000 in 1997 to 5.5 per 100,000 in 2006. Rates increased for both males and females, although the rate for males remained much larger than for females in 2006 (8.1 per 100,000 vs. 2.7 per 100,000, p < 0.001). For all age groups, ATV hospitalizations increased significantly between 1997 and 2006, but this change was most pronounced among those aged 15 years to 17 years. ATV hospitalization rates also increased significantly for patients hospitalized with traumatic brain injuries. ATVs are associated with a significant and increasing number of hospitalizations for children. Reexamination of previous federal policies, including the potential for a new consent decree between the Consumer Product Safety Commission and ATV industry representatives, should be considered to address this alarming trend and to adopt effective strategies to minimize the use by children. Enforceable state-level policy to promote helmet use among ATV riders seems to be critically needed.

The determinants of bicycle helmet use: Evidence from Germany

Previous research has shown that the risks of serious injury or death from bicycling can be mitigated by the decision to wear a helmet. Drawing on a nationwide household survey conducted in 2008 in Germany, this analysis investigates the determinants of voluntary helmet use through a combination of descriptive analyses and econometric methods, the latter relying on variants of the probit- and heteroskedastic probit model. Confirming results uncovered elsewhere in the literature, we find that household demographics, residential location, and riding patterns are significant correlates of helmet use. Contrasting with other studies, however, we also find that women are significantly less likely to use a helmet than men, a discrepancy that holds over most of the adult life-cycle. The paper concludes by highlighting the scope for designing strategic information campaigns to promote helmet use.

322: Factors Associated With Increased Compliance of Helmet Laws In Dominican Motorcyclists

Study ObjectivesBy 2020, road traffic accidents (RTAs) are projected to place third on the list of “Global Burden of Diseases.” Latin American countries have the highest annual RTA fatality rates worldwide. Estimated at 41 deaths/100,000 in Dominican Republic (WHO), RTAs are the leading cause of death among males aged 15-44. This is the first study characterizing knowledge, experience, and helmet use among high-risk Dominican motorcyclists.MethodsThe Investigation Team administered surveys individually to a convenience sample of 258 randomly selected Dominican male motorcyclists at the 2008 Caribbean World Series.ResultsAge range: 14-68, (86.9% aged 15-44). 79.9% completed secondary education. 53% licensed. 31.2% helmet-owners. 55% report zero helmet use; the remainder use helmets up to 60% of riding time (average 37%). 47% experienced “severe personal injury” (29% head, 43% extremity, 6% thorax). 78% knew someone killed by RTA, 93% attributed to head injury.Predictors of helmet use by Logistic regression include: university education (OR=4.5, p=.027), having driver's license (OR=2.9., p<0.001). Of note, neither personal injury (p=0.11) nor death among relatives and friends (p=0.19) predict helmet use, nor does age.ConclusionsImportantly, 55% of Dominican male motorcyclists never use a helmet and the remainder report only sporadic use, despite 86% of participants having personally experienced injury or known someone killed by RTA. These data show that university education and being “licensed” independently predict helmet use, while personal experiences of danger apparently do not. These findings suggest legal measures and education are fundamental to future efforts promoting helmet use among motorcycle riders. Study ObjectivesBy 2020, road traffic accidents (RTAs) are projected to place third on the list of “Global Burden of Diseases.” Latin American countries have the highest annual RTA fatality rates worldwide. Estimated at 41 deaths/100,000 in Dominican Republic (WHO), RTAs are the leading cause of death among males aged 15-44. This is the first study characterizing knowledge, experience, and helmet use among high-risk Dominican motorcyclists. By 2020, road traffic accidents (RTAs) are projected to place third on the list of “Global Burden of Diseases.” Latin American countries have the highest annual RTA fatality rates worldwide. Estimated at 41 deaths/100,000 in Dominican Republic (WHO), RTAs are the leading cause of death among males aged 15-44. This is the first study characterizing knowledge, experience, and helmet use among high-risk Dominican motorcyclists. MethodsThe Investigation Team administered surveys individually to a convenience sample of 258 randomly selected Dominican male motorcyclists at the 2008 Caribbean World Series. The Investigation Team administered surveys individually to a convenience sample of 258 randomly selected Dominican male motorcyclists at the 2008 Caribbean World Series. ResultsAge range: 14-68, (86.9% aged 15-44). 79.9% completed secondary education. 53% licensed. 31.2% helmet-owners. 55% report zero helmet use; the remainder use helmets up to 60% of riding time (average 37%). 47% experienced “severe personal injury” (29% head, 43% extremity, 6% thorax). 78% knew someone killed by RTA, 93% attributed to head injury.Predictors of helmet use by Logistic regression include: university education (OR=4.5, p=.027), having driver's license (OR=2.9., p<0.001). Of note, neither personal injury (p=0.11) nor death among relatives and friends (p=0.19) predict helmet use, nor does age. Age range: 14-68, (86.9% aged 15-44). 79.9% completed secondary education. 53% licensed. 31.2% helmet-owners. 55% report zero helmet use; the remainder use helmets up to 60% of riding time (average 37%). 47% experienced “severe personal injury” (29% head, 43% extremity, 6% thorax). 78% knew someone killed by RTA, 93% attributed to head injury. Predictors of helmet use by Logistic regression include: university education (OR=4.5, p=.027), having driver's license (OR=2.9., p<0.001). Of note, neither personal injury (p=0.11) nor death among relatives and friends (p=0.19) predict helmet use, nor does age. ConclusionsImportantly, 55% of Dominican male motorcyclists never use a helmet and the remainder report only sporadic use, despite 86% of participants having personally experienced injury or known someone killed by RTA. These data show that university education and being “licensed” independently predict helmet use, while personal experiences of danger apparently do not. These findings suggest legal measures and education are fundamental to future efforts promoting helmet use among motorcycle riders. Importantly, 55% of Dominican male motorcyclists never use a helmet and the remainder report only sporadic use, despite 86% of participants having personally experienced injury or known someone killed by RTA. These data show that university education and being “licensed” independently predict helmet use, while personal experiences of danger apparently do not. These findings suggest legal measures and education are fundamental to future efforts promoting helmet use among motorcycle riders.

Promoting the Use of Equestrian Helmets: Another Opportunity for Injury Prevention

There has been much attention paid to the use of bicycle helmets in reducing the rate of injury in children. Bicycle injury prevention programs exist in many communities, including “bicycle rodeos” and free bicycle helmet giveaways. Thirty-six states have some form of bicycle helmet laws, mostly for cyclists aged under 18 years. 1 Bicycle Helmet Safety Institute Helmet laws for bicycle riders. http://www.helmets.org/mandator.htm Google Scholar Another type of athletic activity that has received less attention and for which there is no legal mandate but where the promotion of helmet use can also have a significant beneficial effect in the prevention of head injuries is horseback riding. Gordon H. Worley, Member, California Chapter, is Flight Nurse, REACH Air Medical Services, Santa Rosa, CA.

Motorcycle helmets and rider safety: A legislative crisis

Over the past four decades, motorcycle helmet laws within the United States have been in a state of flux and have been shaped by the conflicting influences of the federal government's initiatives to shape state policies and motorcycle advocates' persistent lobbying efforts. Examination of individual state experiences with motorcycle helmet legislation demonstrates that universal motorcycle helmet laws effectively promote helmet use compliance, reduce morbidity and mortality in motorcycle crashes, and lower the health care costs and associated societal burdens of these crash victims. Motorcycle advocates have challenged the implementation of these laws and directly influenced the weakening or frank repeal of these laws to negative consequence. We offer this review as an educational resource to encourage and facilitate health care worker participation in legislative efforts to support implementation and maintenance of universal motorcycle helmet laws.

Fatal All-Terrain Vehicle Crashes: Injury Types and Alcohol Use

Since the 1990s, West Virginia has led the U.S. in the per-capita death rate from all-terrain vehicle (ATV) crashes, with rates eight times the national average and continually increasing. A comprehensive assessment was conducted of ATV fatalities to provide critical guidance for community interventions and public health policy to prevent further deaths. In 2007, death certificates for 2004 to 2006 with ICD-10 codes correlating to ATV crashes were used to identify decedents involved in crashes occurring in West Virginia. Data were abstracted from medical examiner records regarding crash circumstances, sustained injuries, and toxicology. During 2004-2006, a total of 112 fatal ATV crashes were identified. Nearly all (92%) decedents were the ATV operator, and only 15% were known to have worn helmets. Among 54 traffic crashes, collisions (56%) and head injuries (65%) predominated, whereas the majority of 58 nontraffic crashes were rollovers (55%) and were most commonly associated with compression injuries of the thorax and abdomen (36%). Regardless of crash class (i.e., traffic versus nontraffic), alcohol was detected in the blood of 50% of decedents; of those, 88% had blood alcohol concentrations >OR=0.08% (mean=0.17%), West Virginia's legal limit. Drugs of abuse were identified in 21% of decedents, including marijuana (11%); opioid analgesics (7%); diazepam (6%); cocaine (2%); and methamphetamine (1%). Fatal crash and injury types differ significantly depending on the location of ATV use, although alcohol and drug abuse are frequent risk factors in all types of ATV crashes. In addition to promoting helmet use, interventions are needed to address alcohol use among ATV users.

Trends in Pediatric and Adult Bicycling Deaths Before and After Passage of a Bicycle Helmet Law

The goals were to examine bicycle-related mortality rates in Ontario, Canada, from 1991 to 2002 among bicyclists 1 to 15 years of age and 16 years of age through adulthood and to determine the effect of legislation (introduced in October 1995 for bicyclists <18 years of age) on mortality rates. The average numbers of deaths per year and mortality rates per 100000 person-years for the prelegislation and postlegislation periods, and the percentage changes, were calculated for each of the 2 age groups (1-15 years and >/=16 years). Differences before and after legislation in the 2 age groups were modeled in a time series analysis. There were 362 bicycle-related deaths in the 12-year period (1-15 years: 107 deaths; >/=16 years: 255 deaths). For bicyclists 1 to 15 years of age, the average number of deaths per year decreased 52%, the mortality rate per 100000 person-years decreased 55%, and the time series analysis demonstrated a significant reduction in deaths after legislation. The estimated change in the number of deaths per month was -0.59 deaths per month. For bicyclists >/=16 years of age, there were only slight changes in the average number of deaths per year and the mortality rate per 100000 person-years, and the time series analysis demonstrated no significant change in deaths after legislation. The bicycle-related mortality rate in children 1 to 15 years of age has decreased significantly, which may be attributable in part to helmet legislation. A similar reduction for bicyclists 16 years of age through adulthood was not identified. These findings support promotion of helmet use, enforcement of the existing law, and extension of the law to adult bicyclists.