Universal Helmet Laws Research Articles

(P2-87) Policy Study of the Helmet Legislation in Kerala, India and its Implications

BackgroundWhen implemented properly, universal helmet law increases helmet use substantially, bringing along a reduction in mortality and morbidity due to head injuries. Kerala has seen tremendous success in regards to various indicators for health within India. But when it comes to wearing helmets, the state lags behind others with reported rates as less as 27%.MethodA cross-sectional survey of 300 two-wheel drivers in Thiruvananthapuram City was preformed, which looked into helmet wearing patterns, their determinants, and the risk perception among the respondents. Further, a content analysis of newspaper reports pertaining to helmet legislation from the Thiruvananthapuram edition of two leading newspapers was performed. The reports included were from the periods of July 2003 to June 2005 and July 2008 to June 2010. Lastly, in-depth interviews were conducted with informants from among the key stakeholders in helmet policy of the state.ResultsThe study found 36.8% of the respondents wear a helmet. A scale to measure risk perception was developed for the purpose of this study. The four-item scale has been found to have internal consistency with a Cronbach alpha value of 0.74. The risk perception measured by using this scale has significant relation with helmet-wearing behavior. The content analysis helped in deriving a historical perspective of the policy along with the themes of reporting. The informant interviews provided expert opinions, problem identification, and specific recommendations.DiscussionThe practice of wearing a helmet is low, and people with lower risk perception have greater tendency not to wear helmets. Other findings also show that there are gaps in policy and lack of visionary leadership as far as the policy toward helmet legislation and its implementation.

Motorcycle Helmets Associated with Lower Risk of Cervical Spine Injury: Debunking the Myth

There has been a repeal of the universal helmet law in several states despite definitive evidence that helmets reduce mortality, traumatic brain injury, and hospital expenditures. Opponents of the universal helmet law have successfully claimed that helmets should not be required because of greater torque on the neck, which is thought to increase the likelihood of a cervical spine injury. There is currently insufficient evidence to counter claims that helmets do not increase the risk of cervical spine injury after a motorcycle collision. The objective of this study was to determine the impact of motorcycle helmets on the likelihood of developing a cervical spine injury after a motorcycle collision. We reviewed cases in the National Trauma Databank (NTDB) v7.0 involving motorcycle collisions. Multiple logistic regression was used to analyze the independent effect of helmets on cervical spine injury. Cases were adjusted for age, race, sex, insurance status, anatomic (Injury Severity Score) and physiologic injury severity (systolic blood pressure < 90 mmHg), and head injury (Abbreviated Injury Score > 3). Between 2002 and 2006, 62,840 cases of motorcycle collision were entered into the NTDB; 40,588 had complete data and were included in the adjusted analysis. Helmeted riders had a lower adjusted odds (0.80 [CI 0.72 to 0.90]) and a lower proportion of cervical spine injury (3.5% vs 4.4%, p < 0.05) compared with nonhelmeted riders. Helmeted motorcyclists are less likely to suffer a cervical spine injury after a motorcycle collision. This finding challenges a long-standing objection to mandatory helmet use that claims helmets are associated with cervical spine injury. Re-enactment of the universal helmet law should be considered in states where it has been repealed.

Panel Backs Wider Pertussis Vaccination to Curb Outbreaks, Prevent Deaths

universal helmet laws. In a telephone survey of 1606 motorcyclists released by her institute in September, about 75% of participants—including about two-thirds of respondents who oppose universal helmet laws and almost half of riders who rarely or never wear helmets—said they believe helmets keep riders safer. The apparent contradiction may be explained by a belief among some motorcyclists that they understand the risks of riding but do not want the government telling them how to behave. “If you are going to ride a motorcycle, the best thing you can do to keep yourself safe is to wear a helmet, and the best way to make sure people are wearing helmets is enforce an enforceable law,” McCartt said. Coben said public health advocates seem to face an uphill battle when arguing for mandatory helmet laws among motorcyclists, but he hoped the continued publication of valid research will one day sway legislators and the public. He noted that the cost of such injuries is borne not just by the involved individual. “The public picks up a large portion of the costs when riders are injured, so hopefully policy makers will look at the research and the cost to our government and do the right thing,” Coben said.

Youth Motorcycle-Related Brain Injury by State Helmet Law Type: United States, 2005–2007

Twenty-seven states have youth-specific helmet laws even though such laws have been shown to decrease helmet use and increase youth mortality compared with all-age (universal) laws. Our goal was to quantify the impact of age-specific helmet laws on youth under age 20 hospitalized with traumatic brain injury (TBI). Our cross-sectional ecological group analysis compared TBI proportions among US states with different helmet laws. We examined the following null hypothesis: If age-specific helmet laws are as effective as universal laws, there will be no difference in the proportion of hospitalized young motorcycle riders with TBI in the respective states. The data are derived from the 2005 to 2007 State Inpatient Databases of the Healthcare Cost and Utilization Project. We examined data for 17 states with universal laws, 6 states with laws for ages <21, and 12 states with laws for children younger than 18 (9287 motorcycle injury discharges). In states with a <21 law, serious TBI among youth was 38% higher than in universal-law states. Motorcycle riders aged 12 to 17 in 18 helmet-law states had a higher proportion of serious/severe TBI and higher average Abbreviated Injury Scores for head-region injuries than riders from universal-law states. States with youth-specific laws had an increased risk of TBI that required hospitalization, serious and severe TBI, TBI-related disability, and in-hospital death among the youth they are supposed to protect. The only method known to keep motorcycle-helmet use high among youth is to adopt or maintain universal helmet laws.

An Evidence-Based Review: Helmet Efficacy to Reduce Head Injury and Mortality in Motorcycle Crashes: EAST Practice Management Guidelines

According to the National Highway Traffic Safety Association, in 2008, 5,290 motorcyclists died and 96,000 were injured. Motorcycles make up ∼3% of all registered vehicles in the United States and account for only 0.4% of all vehicle miles traveled. However, motorcycle crashes accounted for ∼10% of all motor vehicle crash fatalities, and per mile traveled, motor cycle crashes are ∼37 times more lethal than automobile crashes. Head injuries are one of the most common injuries after motorcycle crashes and were estimated to be the cause of death in >50% of these fatalities. In close to a third of these victims, the head injury is the sole organ system that is injured. However, in the majority of patients, estimated as high as 90% of some patient cohorts, a head injury is present along with other injuries. Despite these facts, it is estimated that only 50% of motorcyclists routinely wear helmets. It was intuitive even to our earliest ancestors that a hard shell would protect the head from injury. However, establishing the effectiveness of the motorcycle helmet remains a challenging effort especially in light of the powerful opposition to universal helmet laws. Furthermore, quantifying the protective effect of helmets supports the promotion of helmet programs regardless of the controversial nature of legislative efforts. In the United States, an increasing recognition that helmet use is associated with reductions in fatalities without apparent harm increased the implementation of universal helmet laws. In response to the 1966 Federal Highway Act, which withheld federal funds from states that did not enact a helmet law, Georgia became the first state to enact a mandatory universal motorcycle helmet law in 1967. By 1975, 47 of the 50 states had universal helmet laws. However, public and political concerns over individual rights versus public safety opened a new debate. In the following years, political changes reversed and/or limited previous sanctions and grants that encouraged states to enact universal helmet laws, which further eroded support for helmet laws. An increasing number of states either repealed their mandatory laws altogether or significantly reduced the laws to apply only to minors. At present, only 20 states have universal helmet laws, another 26 states require only partial coverage, and 4 states have no helmet laws (Colorado, Illinois, Iowa, and New Hampshire). A large volume of literature has quantified the consequences of not wearing a helmet while riding a motorcycle. Although motorcycle riding and registration are increasing and more states with universal helmet laws are introducing bills to repeal their laws, the debate continues on the personal advantages of helmet usage. Therefore, we have reviewed the literature and summarize the evidence basis for the use of motorcycle helmets. In particular, we have sought to assess the impact of helmet use on overall mortality, head injury-related mortality, nonlethal head injury after a motorcycle crash, and the impact universal helmet laws on helmet use. STATEMENT OF PROBLEM Motorcycles are a significant cause of injury-related fatality and disability. In particular, head injury is a common associated cause of death and long-term disability after a motorcycle crash. Despite these facts, there remains an ongoing controversy as to the survival and disability advantages for riders who wear motorcycle helmets. In the public and legislative sectors, there remains a significant policy controversy resulting in a push to retain partial coverage helmet laws and to repeal universal helmet laws in many others. QUESTIONS TO BE ADDRESSED Do nonhelmeted riders in comparison with helmeted riders have a higher or lower overall death rate after a motorcycle crash? Do nonhelmeted riders in comparison with helmeted riders incur higher or lower rates of lethal head injury after a motorcycle crash? Do nonhelmeted riders in comparison with helmeted riders incur higher or lower rates of nonlethal head injury or is the nonlethal head injury more or less severe after a motorcycle crash? Do geographical areas (i.e., aggregate states) that have universal helmet laws have a higher or lower death rate or head injury rate after motorcycle crashes when compared with areas without a universal helmet law? METHODS AND PROCESS A computerized search of the world's literature was undertaken using PubMed, of the US National Library of Medicine, extending back to 1990 to the present (2009) using the key words: helmet + (motorcycle OR crash). There were 507 citations identified. The abstract for each was reviewed, and 197 candidate articles having possible applicability to the guideline topic were retrieved and reviewed. General reviews, letters to the editor, single case reports, and retrospective reviews of poor quality were excluded. This left 45 articles that were felt to have sufficient merit to form the basis for the guidelines (Table 1). The articles were reviewed in detail by the authors J.M., G.H.T., and J.C.D.TABLE 1:

Identification of Risk Factors Associated with Motorcycle-Related Fatalities in Ohio

Ohio crash data for 2003–2007 were used to investigate the odds of a motorcyclist being fatally injured in a crash and the risk factors involved. The results show that risk factors for fatality/severe injury significantly increase when the following circumstances apply: the motorcyclist is a female, being the motorcycle rider, use of excessive speeding, use of alcohol and/or drugs, riding without a helmet, being involved in a single-vehicle crash or at a nonintersection location, crashing on horizontal curves or on graded segments, and on major roadways. To reduce the number of fatal crashes, this study indicates that the dangers of excessive speed and operating a motorcycle while intoxicated must be fully stressed to the public and both require an elevated enforcement. The enactment of an Ohio universal helmet law is particularly recommended.

The development and implementation of mandatory motorcycle helmet legislation in Vietnam

Road traffic injuries are a leading cause of death and disability in Vietnam with 11 243 deaths and 7771 serious injuries on the roads in 2008, of which an estimated...

Determinants of motorcycle helmet use among recent graduates of a motorcycle training course

BackgroundHelmets significantly decrease morbidity and mortality from motorcycle crashes. Many areas of the world lack universal helmet laws. To educate motorcyclists in areas without helmet laws, more knowledge of motorcyclists...

Correlates of motorcycle helmet use among recent graduates of a motorcycle training course

Helmets significantly decrease morbidity and mortality from motorcycle crashes, but many areas of the world lack universal helmet laws. To educate motorcyclists in areas without helmet laws, more knowledge of motorcyclists’ helmet beliefs is needed. A web-based survey was therefore designed to assess motorcyclists’ attitudes, norms and behaviors towards helmets in a U.S. state with a limited helmet law. Of 445 survey respondents, 68.4% of respondents reported always wearing a helmet. The not-always-helmeted riders were more likely than the always-helmeted to be male; to bave less education; and to have a history of previous motorcycle crashes and injuries. Although both groups had taken rider training classes, fewer of the not-always-helmeted had learned how to ride in a class. The strongest correlates of being not-always-helmeted (vs. always-helmeted) were attitudes that helmets were not protective and impaired sight/hearing; and the normative belief that they would only wear helmets if forced by law. Because attitudes are often more easily changed than normative beliefs, education may increase helmet use. However, less than half of riders in this state with a mandatory education program learned how to ride from a rider education course, and 44% of non-helmeted said they would only wear a helmet if forced by law. Legislation may therefore be a more efficient and effective strategy than education to increase helmet use.

Are Youth-Only Motorcycle Helmet Laws Better Than None at All?

The trend in state motorcycle helmet laws has been a reduction from universal coverage requiring all riders to wear helmets, to partial coverage requiring only younger riders to wear helmets. In the current study we evaluate whether partial helmet laws reduce motorcycle fatalities and increase helmet compliance among young riders. We compared a decade of motorcycle fatalities from the only 3 states with no helmet laws (New Hampshire, Iowa, Illinois) to 3 states with <or=17-year-old partial helmet laws (Connecticut, Indiana, Wisconsin). We excluded highway speeds, blood alcohol laws, and minimum legal drinking age as being significant variables. Overall, there was no significant difference in the average fatality rate per 10,000 motorcycle registrations for <or=17-year-old riders in partial helmet law states versus no helmet law states (P = 0.45). Furthermore, there was no significant difference in the helmet wearing rate of <or=17-year-old fatalities in partial helmet law versus no helmet law states (P = 0.79). Partial helmet laws neither significantly reduce fatality rates nor increase helmet compliance rates among young riders. A partial helmet law is roughly equivalent to none at all; only universal helmet laws have been shown to effectively protect young motorcyclists.

The Case for Universal Motorcycle Helmet Laws

This editorial is written to accompany an article that reported that the repeal of the universal helmet law in Texas in 1997 has had a significant adverse effect on motorcyclist fatalities in Texas. In this commentary, the author first briefly outlines the recent trend in motorcyclist fatalities across the United States, noting that the national fatality rate increased from 55.3 fatalities per 100,000 registered motorcycles in 1997 to 72.2 in 2007, a 31% increase. The author stresses that these numbers are particularly distressing because that occur at a time when traffic safety in general is improving. For example, in 2007, the national motor vehicle occupant fatality rate was 12.3 fatalities per 100,000 registered motor vehicles as compared to 16.2 in 1997, a 24% decrease. The editorial considers three factors that increase the risk of motorcyclist fatalities: riders are older, motorcycle engines are more powerful, and helmets are being worn less frequently. The last factor is the one most easily addressed by public health officials. In 2009, only 20 states and the District of Columbia require all motorcyclists to wear a helmet (universal helmet law). The status of state helmet laws is troubling given the evidence that universal laws increase helmet use and reduce fatalities and that partial coverage laws do not provide protection for even the young motorcyclists that they target. However, the author notes that the trend in state laws appears to be moving even further away from universal helmet laws. From a public health perspective, the case for universal motorcycle helmet laws is strong although in many states the political will to adopt these laws is weak.

The Effect of the 1997 Texas Motorcycle Helmet Law on Motorcycle Crash Fatalities

This study seeks to determine the effect of the Texas motorcycle helmet law on fatalities since the repeal of the universal helmet law in 1997. Texas monthly motorcycle accident data between 1994 and 2004 were obtained from the National Highway Transportation Safety Administration's Fatality Analysis Reporting System (FARS) and supplemented with motorcycle registration data from the Texas Department of Transportation. An ARIMA model was used to estimate the impact of the law. A sharp increase in fatality rates occurred immediately following the implementation of the law in September 1997. Deaths increased by 30%, fatality rates per motorcycle registrations increased by 15.2%, and fatality rates per vehicle miles traveled increased by 25% after repeal. Helmet use decreased from 77% in 1996 to 63% in 1997 and 36% in 1998 and thereafter. The parameter estimates of the ARIMA model (0,0,0) (0,1,1) show that the change in the law led to statistically significant increases of 2.3 fatalities and 1.18 fatality rate per 100 billion vehicle miles traveled. The repeal of the universal helmet law in Texas in 1997 has had a significant adverse effect on motorcyclist fatalities in Texas.

Impact of Motorcycle Helmets and State Laws on Society's Burden

To analyze a large national database, the National Trauma Data Bank, regarding the contribution of motorcycle helmet use to outcome and the efficacy of state helmet laws. Motorcycle helmet laws remain controversial, and advocacy groups continue their lobbying efforts to rescind or weaken existing laws. One argument is that helmets contribute to severe injuries and are not associated with survival. The National Trauma Data Bank identified motorcycle crash patients from 2002 to 2007. Data collected included demographics, markers of injury severity, resource utilization, and outcome. Over 2.3 million patients were entered into the National Trauma Data Bank. A total of 76,944 were in motorcycle collisions and had helmet use documented. Mean age, admission Glasgow Coma Scale score, and Injury Severity Score were 36 years, 13.7, and 13.5, respectively. Of the patients 76% wore helmets, and had lower Glasgow coma scale, injury severity score, head abbreviated injury scale, resource utilization, and mortality than unhelmeted patients. There were more uninsured patients who did not wear helmets. Logistic regression analysis indicated that helmet use has a strong protective effect on in-hospital mortality. Helmet use could save approximately $32.5 million by reducing ICU stay. Unhelmeted motorcycle crash patients suffer more severe brain injuries, consume more resources, and have the worst payor mix. Society bears a large financial burden for these uninsured unhelmeted patients. There is a survival advantage for helmeted patients. All states should have universal motorcycle helmet laws that are aggressively enforced.

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.

Public policies and motorcycle safety

Numerous studies have examined the effectiveness of alcohol and traffic policies in reducing automobile crashes and fatalities, but only a few have analyzed the impact of state-specific policies on motorcycle safety. Given the growing popularity and inherent safety risks of motorcycle riding, this study provides a comprehensive investigation of both fatal and non-fatal injuries. State-level longitudinal data from 1990 to 2005 are analyzed to determine how various alcohol and traffic policies impact motorcycle safety and whether there are differential effects by type of injury. The results consistently show that universal helmet laws have the most significant effect on both non-fatal and fatal injuries. Mandatory rider education programs and speed limits on rural interstates significantly impact non-fatal injuries.

Motorcycle Safety and the Repeal of Universal Helmet Laws: Houston DJ, Richardson LE Jr. Am J Public Health 2007;97:2063–9

Motorcycle Safety and the Repeal of Universal Helmet Laws: Houston DJ, Richardson LE Jr. Am J Public Health 2007;97:2063–9

Increased Fatalities After Motorcycle Helmet Law Repeal: Is it All Because of Lack of Helmets?

During the last 10 years, the number of motorcycle riders in the United States has risen sharply. The corresponding increase in fatalities observed during this time may be because of the increase in riders, or because the number of states that mandate universal helmet use has decreased. We examined the effect of the repeal of Florida's helmet law in July 2000 to test the hypothesis that the increase in fatalities observed after repeal resulted from an increase in the number of motorcycle riders. We identified all motorcycle fatalities (N = 197) in Miami-Dade county for a 3.5-year period before repeal (prelaw), and a similar period after repeal (postlaw), using police crash reports and medical examiner records. We compared the number of fatalities, frequency of helmet use in fatal crashes, and number of registered motorcycles in the two time periods. There was a decrease in helmet use from 80% to 33%, and an increase in motorcycle fatalities after repeal: 72 to 125. However, repeal was also associated with a rise in annual motorcycle registrations from 17,270 to 39,043. Fatality rates adjusted for numbers of registered motorcycles did not change significantly; 11.6 deaths per 10,000 motorcycles prelaw, and 12.5 deaths postlaw. There was a significant rise in motorcycle fatalities after Florida's helmet law repeal, which appears to be associated with an increase in the number of motorcycle riders. Injury prevention efforts focusing on factors other than helmet use should be developed in light of continuing repeal of universal motorcycle helmet laws across the nation.

Motorcycle Safety and the Repeal of Universal Helmet Laws

We assessed the implications for motorcyclist safety of recent repeals of universal helmet laws in 6 US states. We examined cross-sectional time-series data from the 50 states and the District of Columbia for the period 1975 through 2004. On average, when compared to state experience with no helmet mandate, universal helmet laws were associated with an 11.1% reduction in motorcyclist fatality rates, whereas rates in states with partial coverage statutes were not statistically different from those with no helmet law. Furthermore, in the states in which recent repeals of universal coverage have been instituted, the motorcyclist fatality rate increased by an average of 12.2% over what would have been expected had universal coverage been maintained. Since 1997, an additional 615 motorcyclist fatalities have occurred in these states as a result of these changes in motorcycle helmet laws. Motorcyclist safety has been compromised in the states that have repealed universal coverage and is likely to be compromised in other states that abandon these statutes.

Motorcycle Helmet Laws: The Facts, What Can Be Done to Jump-Start Helmet Use, and Ways to Cap the Damages

States first enacted universal motorcycle helmet laws in 1966, and by 1975 forty-seven states and the District of Columbia had such laws. The laws were enacted by the states in order for those states to receive federal highway construction funds, which were contingent on the enactment of helmet laws. These incentives were withdrawn and motorcycle enthusiasts, organized in groups, successfully lobbied to have these state laws repealed. Currently only twenty states require helmets for all motorcycle riders while the remaining states do not require helmets or have partial laws usually requiring helmets for riders less than eighteen years of age. Medical studies have overwhelmingly shown an increased risk of both morbidity and mortality for non-helmeted motorcycle riders as opposed to helmeted riders. Further studies have demonstrated the increased cost to society associated with the elevated morbidity and mortality for non-helmeted riders. Although the medical literature and the cost analysis studies show universal helmet laws are in the best interest of the individual rider and society as a whole, motorcycle enthusiasts have fiercely lobbied against universal helmet laws proclaiming a right of individual choice. The motorcyclists have successfully organized and exerted significant influence over state legislatures in defeating universal helmet laws. Because society bears the burden of the increased costs associated with injuries and deaths of non-helmeted riders, the individual rider's freedom of choice may have to be curtailed. Increased education of the motorcycle enthusiasts and the public along with a concerted, directed and organized effort by health care organizations will be necessary to enact universal helmet laws. Other measures such as increased insurance requirements and the use of a helmet defense by defendants to allow for the mitigation of damages may help encourage the use of helmets.

Motorcyclist fatality rates and mandatory helmet-use laws

Using cross-sectional time series data for the 50 states and Washington, DC, covering the period 1975–2004, we estimate fixed effects regression models that examine the effects of universal and partial helmet laws on three different motorcyclist fatality rates, while controlling for other state policies and characteristics. Depending on the particular measure that is employed, states with universal helmet laws have motorcyclist fatality rates that are on average 22–33% lower in comparison to the experience with no helmet law. Additionally, partial coverage helmet laws are associated with reductions in motorcyclist fatality rates of 7–10%, on average.