Universal Motorcycle Helmet Laws Research Articles

Alcohol and marijuana use among young injured drivers in Arizona, 2008–2014

Objective: We examined alcohol and marijuana use among injured drivers aged 16–20 years evaluated at Arizona level 1 trauma centers during 2008–2014.Methods: Using data from the Arizona State Trauma Registry, we conducted a descriptive analysis of blood alcohol concentration (BAC) and qualitative test results (positive or negative) for delta-9-tetrahydrocannabinol (THC) by year of age, sex, race, ethnicity, injury severity, seat belt use, motorcycle helmet use, and type of vehicle driven. To explore compliance with Arizona’s motorcycle helmet law requiring helmet use for riders <18 years old, we examined helmet use by age.Results: Data on 5,069 injured young drivers were analyzed; the annual number of injured drivers declined by 41% during the 7-year study period. Among the 76% (n = 3,849) of drivers with BAC results, 19% tested positive, indicating that at least 15% of all drivers had positive BACs. Eighty-two percent of the BAC-positive drivers had BACs ≥0.08 g/dL, the illegal threshold for drivers aged ≥21 years. Among the 49% (n = 2,476) of drivers with THC results, 30% tested positive, indicating that at least 14% of all drivers were THC-positive. American Indians and blacks had the highest proportion of THC-tested drivers with positive THC results (38%). In addition, 28% of tested American Indians had positive results for both substances, more than twice the proportion seen in all other race or ethnic groups. Crude prevalence ratios suggested that drivers who tested positive for alcohol or THC were less likely than those who tested negative to wear a helmet or seat belt, further increasing their injury risk. Helmet use among motorcyclists was lower among 16- and 17-year-old riders compared to 18- to 20-year-olds, despite Arizona’s motorcycle helmet law requiring riders aged <18 years to wear a helmet.Conclusions: About 1 in 4 injured drivers aged 16–20 years tested positive for alcohol, THC, or both substances. Most drivers with positive BACs were legally intoxicated (BAC ≥0.08 g/dL). All substance-using young drivers in this study were candidates for substance abuse screening and possible referral to treatment. Broader enforcement of existing laws targeting underage access to alcohol and alcohol-impaired driving could further reduce injuries among young Arizona drivers. To further reduce crash-related injuries and fatalities among all road users, the state could consider implementing a primary enforcement seat belt law and a universal motorcycle helmet law.

Helmets Matter: Kentucky Motorcycle Crash Victims Seen at a Tennessee Trauma Center.

Motorcycle helmet laws vary by state, with Kentucky requiring helmets only for younger riders. We hypothesized that motorcyclists injured in Kentucky and seen at a Tennessee trauma center would be more likely to be unhelmeted, have more severe head injuries, and sustain more fatal injuries than those injured in Tennessee or Virginia. A Trauma Registry review of 729 injured motorcyclists from January 2005 through June 2015 examined state location of crash, demographics, helmet use, and clinical outcomes. Multivariate logistic regression analysis evaluated predictors for head injury severity and death. Unhelmeted motorcycle rider status predicted more severe head injuries (relative risk 15.3, P < 0.001) and death (relative risk 4.2, P < 0.001). Motorcyclists injured in the state of Kentucky were more likely to be unhelmeted, require an operative procedure, have more severe head injuries, have longer lengths of stay, and sustain more fatal injuries (all with < 0.001) than motorcyclists injured in Tennessee or Virginia. This study lends support for maintaining and enforcing current universal motorcycle helmet laws for all ages in states where they are in effect and for upgrading helmet laws that apply only to some riders.

The impact of the repeal of Michigan's universal helmet law on traumatic brain injury: A statewide analysis

In April of 2012, Michigan repealed its 35-year-old universal motorcycle helmet law in favor of a partial helmet law, which permits motorcyclists older than 21 years old with sufficient insurance and experience to drive un-helmeted. We evaluated the clinical impact of the repeal. The Michigan Trauma Quality Improvement Program's trauma database was queried for motorcycle crash patients between 1/1/09-4/12/12 and between 4/13/12-12/31/14. There were 1970 patients in the pre-repeal analysis and 2673 patients in the post-repeal analysis. Following the repeal, patients were more likely to be un-helmeted (p<0.001) and to have a traumatic brain injury (p<0.001). Patients were also more likely to require neurosurgical interventions (relative risk 1.4, p=0.011). Following the repeal of the universal helmet law, there has been a significant increase in traumatic brain injuries and neurosurgical interventions. This analysis highlights another detrimental impact of the repeal of the universal helmet law.

The Effects of Motorcycle Helmet Legislation on Craniomaxillofacial Injuries.

Motorcycle helmet legislation has been a contentious topic for over a half-century. Benefits of helmet use in motorcycle trauma patients are well documented. In 2012, Michigan repealed its universal motorcycle helmet law in favor of a partial helmet law. The authors describe the early clinical effects on facial injuries throughout Michigan. Retrospective data from the Michigan Trauma Quality Improvement Program trauma database were evaluated. Included were 4643 motorcycle trauma patients presenting to 29 Level I and II trauma centers throughout Michigan 3 years before and after the law repeal (2009 to 2014). Demographics, external cause of injury codes, International Classification of Diseases, Ninth Revision diagnosis codes, and injury details were gathered. The proportion of unhelmeted trauma patients increased from 20 percent to 44 percent. Compared with helmeted trauma patients, unhelmeted patients were nearly twice as likely to sustain craniomaxillofacial injuries (relative risk, 1.90), including fractures (relative risk, 2.02) and soft-tissue injuries (relative risk, 1.94). Unhelmeted patients had a lower Glasgow Coma Scale score and higher Injury Severity Scores. Patients presenting after helmet law repeal were more likely to sustain craniomaxillofacial injuries (relative risk, 1.46), including fractures (relative risk, 1.28) and soft-tissue injuries (relative risk, 1.56). No significant differences were observed for age, sex, Injury Severity Score, or Glasgow Coma Scale score (p > 0.05). This study highlights the significant negative impact of relaxed motorcycle helmet laws leading to an increase in craniomaxillofacial injuries. The authors urge state and national legislators to reestablish universal motorcycle helmet laws.

Universal Motorcycle Helmet Laws to Reduce Injuries: A Community Guide Systematic Review.

Motorcycle crashes account for a disproportionate number of motor vehicle deaths and injuries in the U.S. Motorcycle helmet use can lead to an estimated 42% reduction in risk for fatal injuries and a 69% reduction in risk for head injuries. However, helmet use in the U.S. has been declining and was at 60% in 2013. The current review examines the effectiveness of motorcycle helmet laws in increasing helmet use and reducing motorcycle-related deaths and injuries. Databases relevant to health or transportation were searched from database inception to August 2012. Reference lists of reviews, reports, and gray literature were also searched. Analysis of the data was completed in 2014. A total of 60 U.S. studies qualified for inclusion in the review. Implementing universal helmet laws increased helmet use (median, 47 percentage points); reduced total deaths (median, -32%) and deaths per registered motorcycle (median, -29%); and reduced total injuries (median, -32%) and injuries per registered motorcycle (median, -24%). Repealing universal helmet laws decreased helmet use (median, -39 percentage points); increased total deaths (median, 42%) and deaths per registered motorcycle (median, 24%); and increased total injuries (median, 41%) and injuries per registered motorcycle (median, 8%). Universal helmet laws are effective in increasing motorcycle helmet use and reducing deaths and injuries. These laws are effective for motorcyclists of all ages, including younger operators and passengers who would have already been covered by partial helmet laws. Repealing universal helmet laws decreased helmet use and increased deaths and injuries.

The Impact of Michigan's Partial Repeal of the Universal Motorcycle Helmet Law on Helmet Use, Fatalities, and Head Injuries.

To evaluate the impact of the partial repeal of Michigan's universal motorcycle helmet law on helmet use, fatalities, and head injuries. We compared helmet use rates and motorcycle crash fatality risk for the 12 months before and after the April 13, 2012, repeal with a statewide police-reported crash data set. We linked police-reported crashes to injured riders in a statewide trauma registry. We compared head injury before and after the repeal. Regression examined the effect of helmet use on fatality and head injury risk. Helmet use decreased in crash (93.2% vs 70.8%; P < .001) and trauma data (91.1% vs 66.2%; P < .001) after the repeal. Although fatalities did not change overall (3.3% vs 3.2%; P = .87), head injuries (43.4% vs 49.6%; P < .05) and neurosurgical intervention increased (3.7% vs 6.5%; P < .05). Male gender (adjusted odds ratio [AOR] = 1.65), helmet nonuse (AOR = 1.84), alcohol intoxication (AOR = 11.31), intersection crashes (AOR = 1.62), and crashes at higher speed limits (AOR = 1.04) increased fatality risk. Helmet nonuse (AOR = 2.31) and alcohol intoxication (AOR = 2.81) increased odds of head injury. Michigan's helmet law repeal resulted in a 24% to 27% helmet use decline among riders in crashes and a 14% increase in head injury.

Trends in helmet use by motorcycle riders in the decades following the repeal of mandatory helmet laws

Several US states repealed universal motorcycle helmet laws in the 1990s and 2000s. The purpose of this study was to examine national trends in helmet use among adult trauma patients with motorcycle-related injuries. We hypothesized that motorcycle helmet use declined over time. We retrospectively analyzed the National Trauma Data Bank's National Sample Program for 2003–2010. We also obtained data on US motorcycle fatalities reported in the Fatality Analysis Reporting System and population data from the U.S. Census Bureau to calculate motorcycle-related fatality rates over time. A total of 255,914 patients met inclusion criteria, of whom 148,524 (58%) were helmeted. During the study period, helmet use increased from 56% in 2003 to 60% in 2010 (p < 0.001). However, motorcycle-related fatality rates also increased in states with and without universal helmet laws. Nationally, rates of helmet use have increased. However, fatalities due to motorcycle crashes have also increased during the same period.

Observation of motorcycle helmet use rates in Michigan after partial repeal of the universal motorcycle helmet law

Motorcycle crashes result in a significant health burden, including many fatal injuries and serious non-fatal head injuries. Helmets are highly effective in preventing such trauma, and jurisdictions that require helmet use of all motorcyclists have higher rates of helmet use and lower rates of head injuries among motorcyclists. The current study examines helmet use and characteristics of helmeted operators and their riding conditions in Michigan, following a weakening of the state's universal motorcycle helmet use law in April 2012. Data on police-reported crashes occurring during 2012-14 and from a stratified roadside observational survey undertaken in Southeast Michigan during May-September 2014 were used to estimate statewide helmet use rates. Observed helmet use was more common among operators of sports motorcycles, on freeways, and in the morning, and least common among operators of cruisers, on minor arterials, and in the afternoon. The rate of helmet use across the state was estimated at 75%, adjusted for roadway type, motorcycle class, and time of day. Similarly, the helmet use rate found from examination of crash records was 73%. In the observation survey, 47% of operators wore jackets, 94% wore long pants, 54% wore boots, and 80% wore gloves. Protective clothing of jackets and gloves was most often worn by sport motorcycle operators and long pants and boots most often by riders of touring motorcycles. Findings highlight the much lower rate of helmet use in Michigan compared with states that have a universal helmet use law, although the rate is higher than observed in many states with partial helmet laws. Targeted interventions aimed at specific groups of motorcyclists and situations where helmet use rates are particularly low should be considered to increase helmet use.

Federally mandating motorcycle helmets in the United States.

BackgroundMotorcycle helmets reduce both motorcycle-related fatalities and head injuries. Motorcycle crashes are a major public health concern which place economic stress on the U.S. healthcare system.DiscussionAlthough statewide universal motorcycle helmet laws effectively increase helmet use, most state helmet laws do not require every motorcycle rider to wear a helmet. Herein, we propose and outline the solution of implementing federal motorcycle helmet law, while addressing potential counterarguments.ConclusionsThe decision to ride a motorcycle without a helmet has consequences that affect more than just the motorcyclist. In an effort to prevent unnecessary healthcare costs, injuries, and deaths, public health efforts to increase helmet use through education and legislation should be strongly considered. Helmet use on motorcycles fits squarely within the purview of the federal government public health and economic considerations.

Impact of North Carolina’s Motorcycle Helmet Law on Hospital Admissions and Charges for Care of Traumatic Brain Injuries: TABLE 1.

BACKGROUND North Carolina requires motorcyclists of all ages to wear federally approved safety helmets. The purpose of this article is to estimate the impact of this state law in terms of hospital admissions for traumatic brain injury (TBI) and associated hospital charges. METHODS Hospital admissions of North Carolina motorcyclists with TBIs and associated hospital charges in 2011 were extracted from the North Carolina Hospital Discharge Data system. We estimated hospital admissions and charges for the same year under the counterfactual condition of North Carolina without a universal motorcycle helmet law by using various substitutes (Florida, Pennsylvania, and South Carolina residents treated in North Carolina). RESULTS North Carolina's universal helmet law prevented an estimated 190 to 226 hospital admissions of North Carolina motorcyclists with TBI in 2011. Averted hospital charges to taxpayer-funded sources (ie, government and public charges) were estimated to be between $9.5 million and $11.6 million for 2011, and total averted hospital charges for 2011 were estimated to be between $25.3 million and $31.0 million. LIMITATIONS Cost estimates are limited to inpatients during the initial period of hospital care. This study was unable to capture long-term health care costs and productivity losses incurred by North Carolina's TBI patients and their caregivers. CONCLUSIONS North Carolina's universal motorcycle helmet law generates health and economic benefits for the state and its taxpayers.

Measuring the Use of Motorcycle Helmets

According to NHTSA, a universal motorcycle helmet law is the most efficient way to prevent serious injuries to motorcyclists in traffic crashes. However, more than half of all U.S. states do not have a universal helmet law or a law that covers any specific segment of the population; as a result, the average rate of helmet use in the United States is 42% to 59%. Given these circumstances, the investigation and promotion of voluntary helmet use have become of primary interest for many states, motorcycle safety advocates, and NHTSA. To measure the use of helmets effectively and efficiently, it is important to understand how information on helmet use is collected and to identify preferred collection methods. This study discussed the advantages and disadvantages of three common data collection methods for motorcycle helmet use in the United States, including recent technical advances, and presented methodology and findings from an observational survey conducted in 2014.

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:

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.

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.

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 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.