Bicycle Helmet Use Research Articles

Cycle safe or cycle cool? Adolescents’ views on bicycle helmet use and injury prevention campaigns in Belgium

ObjectivesAlthough cycling is a healthy, ecological and practical way of transportation, it is not without risk. The effect of bicycle helmets to prevent head injuries on crashing has been extensively...

Enhancing urban cycling safety: The role of automated helmet compliance monitoring with EasyDL

With an increasing emphasis on individual safety in urban transportation, our study addresses the critical issue of bicycle helmet compliance. Helmets play an essential role in preventing cycling-related injuries, yet their usage often falls short of safety standards. We utilize Baidus EasyDL, an automated machine learning tool, to detect the use of bicycle helmets in varied urban environments. This approach leverages a large, annotated dataset dedicated to bicycle helmets, achieving high precision in identifying helmet usage. Our preliminary tests in simulated urban settings show the methods capability to enhance safety measures effectively. This tool aids in real-time monitoring and pinpointing areas where helmet usage is neglected, aiming to elevate safety consciousness among cyclists. The study demonstrates the practicality of using automated helmet detection to improve urban cycling safety, providing a user-friendly option for those without a deep programming background. Our work underscores the value of EasyDL in analyzing bicycle helmet datasets and its potential role in reinforcing essential safety practices in urban cycling scenarios.

Impact of a Helmet Distribution Program in the Pediatric Emergency Department.

Bicycle helmet use has repeatedly been shown to protect riders from serious injury. Despite this, a majority of children and adolescents do not regularly wear helmets. Our primary objective was to determine if an emergency department (ED)-based helmet distribution program could increase the amount of time children report wearing helmets. This was a prospective cohort study of children aged 3 to 17 years presenting to the ED of an urban, tertiary care hospital. Participants were surveyed on their helmet use habits and perceptions regarding the efficacy and importance of helmets. Participants then received a bicycle helmet along with safety counseling in the ED and bicycle safety handouts provided by the American Academy of Pediatrics. Participants were contacted for follow-up 8 weeks after enrollment. We enrolled a total of 94 patients. Post-intervention surveys were obtained from 47% of participants. Our helmet program resulted in a statistically significant increase in the amount of time children reported wearing bicycle helmets. Prior to ED intervention, 48% of participants reported wearing a helmet "most of the time" or "all of the time." After participating, 86% of participants indicated that they wore a helmet "most of the time" or "all of the time." Participants indicated a variety of reasons for not wearing helmets. Of all patients contacted for follow-up, 16% indicated that they were involved in an accident after participating where the helmet they were given prevented a head injury. Helmet distribution programs based in the pediatric ED increase rates of bicycle helmet usage among pediatric patients. Additional study is needed to determine effect on head injury prevention.

Head injuries related to bicycle collisions and helmet use – an observational study

Objectives In Denmark, the use of bicycles is widespread, and head injuries are often seen in cyclists involved in collisions. Despite the well-known effects of using a helmet to reduce head injuries, using helmets is not mandatory in Denmark. The primary objective of this study was to provide data regarding injury outcomes and helmet usage. Methods Participants were bicyclists who sustained head injuries in bicycle collisions and were assessed by the Copenhagen Emergency Medical Services between 1 January 2016; and 15 June 2019. Patients with suspected head injury were identified in an electronic prehospital patient record. Data were linked to the Danish National Patient Registry to retrieve the diagnosis and were categorized into head injury or no head injury based on the diagnosis. Adjusted logistic regression analyses were reported with odds ratios and corresponding confidence intervals to assess the risk of head injury while adjusting for risk factors like age, sex, alcohol consumption, occurrence during weekends and traumatic brain injury. Results A total of 407 patients were included in this study. Within this entity, 247 (61%) had sustained a head injury. The use of a helmet was reported in one-third of the included patients. Among the head-injured patients, 13% sustained moderate to severe head injuries. Patients with suspected alcohol involvement were significantly less likely to report the use of a helmet. Helmet use reduced the risk of head injury with an odds ratio of 0.52, (95% CI 0.31 − 0.86). In high-energy trauma, the use of a helmet showed a significant reduction in the risk of sustaining a head injury with an odds ratio of 0.28, (95% CI 0.12 − 0.80). Conclusions In this study, using a helmet was associated with a significantly decreased risk of head injury; this association was even more significant in high-energy trauma.

Automated detection of bicycle helmets using deep learning

Bicycle helmets are a main measure for injury prevention in case of a crash and are a central variable in transport safety studies. Despite this, helmet use data is only collected sporadically, as the observation of helmet use in traffic by human observers is costly and time-consuming. An automated method for the accurate registration of bicycle helmet use would enable the broad and precise registration of cyclists’ helmet use. In this paper, we develop and test a computer vision-based detection method that can be applied to traffic video data. We record bicycle traffic at two observation sites in Copenhagen, Denmark, and annotate a dataset of 4000 cyclists, registering their helmet use. We then train a state-of-the-art object detection algorithm on the detection of cyclists and helmet use. The developed model has good accuracy in registering active cyclists. For helmet use registration on the test data set, there was an underestimation of 0.52% (algorithm registered helmet use: 50.23%; actual helmet use: 50.75%). Cross-testing the algorithm, i.e., training on one observation site and applying it to another, results in a larger underestimation of bicycle helmet use between 5.28% and 6.31%. Finally, we apply the algorithm to a week of video data from two Copenhagen sites, identifying commuting-related peaks of cyclists and registering helmet use differences between the observation sites. This study shows that computer vision algorithms are a feasible method for the automated detection of bicycle helmet use. Further research needs to be conducted to make the site transfer more robust and to increase accuracy levels.

Comparison of single bicycle crashes and collisions among severely injured cyclists–A 16-year analysis based on the Helsinki Trauma Registry (HTR)

ObjectiveThe Finnish national Traffic Safety Strategy 2022–2026 seeks to halve the number of road fatalities and serious injuries from 2020 to 2030. The strategy states that better information on bicycle crashes is needed for safety promotion. The aim of this study was to describe the demographics, injury characteristics, alcohol involvement, and helmet use of severely injured cyclists and to compare single bicycle crashes (falling alone or hitting a fixed object) to collisions. Material and methodsWe identified all bicycle crashes between 2006 and 2021 from the Helsinki Trauma Registry (HTR). Variables analysed were basic patient demographics, Abbreviated Injury Scale (AIS) codes, AIS 3+ injuries, injured body regions, patient Injury Severity Score (ISS) and New Injury Severity Score (NISS), 30-day in-hospital mortality, ICU length of stay, injury mechanism, alcohol use by the injured cyclists, and helmet use. ResultsOf the 325 severe (NISS >15) cycling injury patients in the HTR, 53.5 % were injured in single crashes and 46.5 % in collisions with a moving object. Most (71.4 %) patients were men and mean age of all patients was 54.1 years (SD 16.7). Alcohol was detected in 23.1 % of cases and more often in single crashes (32.8 %) than in collisions (11.9 %). Less than a third (29.2 %) of all cyclists wore a helmet; those who wore a helmet had fewer serious (AIS 3+) head injuries than those who did not. Cyclists injured in collisions had higher ISS and NISS scores than those injured in single crashes. Serious (AIS 3+) injuries in extremities or in pelvic girdle were more common in collisions than in single crashes. ConclusionsAmong severely injured cyclists, single bicycle crashes were more common; alcohol was more often detected in single bicycle crashes than in collisions. Overall injury severity was higher in collisions than in single crashes. Helmet users had less AIS 3+ head injuries than non-users. Attention should be focused on preventing alcohol-related cycling injuries, promoting use of bicycle helmets, and more precise and comprehensive documentation of bicycle crashes in health care units.

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

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

Social Disparities in Helmet Usage in Bicycle Accidents Involving Children.

Background Bicycle helmet use has a known protective health benefit; yet, pediatric populations have suboptimal helmetrates, which increases the risk of severe injuries. It is imperative to have an updated assessment of behavioral social disparities and for providers to be aware of them to better counsel patients. The study objective was to identify social determinants correlated with helmet use in children involved in bicycle accidents. Based on previous literature, we hypothesized that higher socioeconomic status, female sex, and Caucasian race were associated with increased helmet use. Methods A retrospective case series of 140 pediatric cases of bicycle-related traumas assessing helmet status. Participants presented to the emergency room with injuries due to a bicycle-related trauma and were subsequently admitted to the University of North Carolina (UNC) Hospital System in Chapel Hill, North Carolina (NC), from June 2006 to May 2020. The Institutional Review Board (IRB) approved study comprised a retrospective chart review of 140 cases from the pediatric (<18 years of age) trauma database with coding indicating bicycle-related injury. Zip codes were used to approximate the median household income utilizing the Proximity One government database. The primary exposure was helmet status, which was determined from the electronic record chart review. The hypothesis was formulated before the start of the study. The main outcomesmeasured in the study includedage, sex, race, helmet status, zip code, insurance status, injury types, and mortality. Results There were a total of 140 study participants, of which 35 were female and 105 were male. Males comprised 79.6% of the non-helmeted group, while females were in the minority in both helmet status groups, with 65.7% still being non-helmeted. Additionally, 51.9% of patients who were helmeted used private insurance, and 59.3% of those non-helmeted used public insurance. Of the 71 head injuries, 88.7% were non-helmeted. Principally, this study found that 80.7% of children involved in a bicycle-related accident were not helmeted. Conclusions Despite NC legislation mandating that children under 16 years of age wear helmets while operating bicycles, many children injured in bicycle-related trauma are not complying with this requirement. This study demonstrates that specific populations have decreased rates of helmet usage and emphasize the continued need to monitor helmet behaviors.

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

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

A modelling framework for local thermal comfort assessment related to bicycle helmet use

Thermal discomfort due to accumulated sweat increasing head skin wettedness may contribute to low wearing rates of bicycle helmets. Using curated data on human head sweating and helmet thermal properties, a modelling framework for the thermal comfort assessment of bicycle helmet use is proposed. Local sweat rates (LSR) at the head were predicted as the ratio to the gross sweat rate (GSR) of the whole body or by sudomotor sensitivity (SUD), the change in LSR per change in body core temperature (Δtre). Combining those local models with Δtre and GSR output from thermoregulation models, we simulated head sweating depending on the characteristics of the thermal environment, clothing, activity, and exposure duration. Local thermal comfort thresholds for head skin wettedness were derived in relation to thermal properties of bicycle helmets. The modelling framework was supplemented by regression equations predicting the wind-related reductions in thermal insulation and evaporative resistance of the headgear and boundary air layer, respectively. Comparing the predictions of local models coupled with different thermoregulation models to LSR measured at the frontal, lateral and medial head under bicycle helmet use revealed a large spread in LSR predictions predominantly determined by the local models and the considered head region. SUD tended to overestimate frontal LSR but performed better for lateral and medial head regions, whereas predictions by LSR/GSR ratios were lower and agreed better with measured frontal LSR. However, even for the best models root mean squared prediction errors exceeded experimental SD by 18–30%. From the high correlation (R > 0.9) of skin wettedness comfort thresholds with local sweating sensitivity reported for different body regions, we derived a threshold value of 0.37 for head skin wettedness. We illustrate the application of the modelling framework using a commuter-cycling scenario, and discuss its potential as well as the needs for further research.

Biomechanical Investigation of the Efficacy of Conventional Bicycle Helmets at Preventing Facial Injury

Many studies indicate that wearing a bicycle helmet significantly reduces the risk of accident-related head injuries. Less is reported, however, about bicycle helmet use, about preventing facial injury. Epidemiological studies typically report incidences of 'head injury,' though rarely categorize head, brain, and facial injuries separately. Studies that do focus on facial injury suggest that helmets do not provide adequate protection. A 3D biofidelic child head form and two conventional bicycle helmets (that is,” open face") were created in MSC ADAMS™ computer modelling and simulation software. Peak force and linear accelerations were measured for a series of head form impact simulations corresponding to an established testing standard and a newly proposed series of tests derived from modified motorcycle standards, incorporating injury thresholds from the facial bone impact tolerance literature. Almost all impact simulations exceeded the threshold for fracture, soft tissue, and dental trauma. An observational study was conducted using MSC ADAMS™ to assess a helmeted headform's face exposure during impact simulations. Helmets failed to reduce face impact exposure, during all simulations, except for perpendicular cheek impacts. International test standards, therefore, require urgent revision to ensure that face protection is included.

Firearms, Physicians, Families, and Kids: Finding Words that Work

Firearms, Physicians, Families, and Kids: Finding Words that Work

Preventing Unintentional Injuries in School-Aged Children: A Systematic Review.

Unintentional injuries constitute the leading causes of death and long-term disabilities among children aged 5 to 15 years. We aimed to systematically review published literature on interventions designed to prevent unintentional injuries among school-aged children. We searched MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO and screened the reference lists of included studies and relevant reviews. We included randomized controlled trials, controlled before-and-after studies, and interrupted time series studies. The focus of included studies was on primary prevention measures. Two reviewers collected data on type of study design, setting, population, intervention, types of injuries, outcomes assessed, and statistical results. Of 30 179 identified studies, 117 were included in this review. Most of these studies were conducted in high-income countries and addressed traffic-related injuries. Evidence from included studies reveals that multicomponent educational interventions may be effective in improving safety knowledge, attitudes, and behaviors in school-aged children mainly when coupled with other approaches. Laws/legislation were shown to be effective in increasing cycle helmet use and reducing traffic-related injury rates. Findings reveal the relevance of infrastructure modification in reducing falls and improving pedestrian safety among children. Additional studies are needed to evaluate the impact of unintentional injury prevention interventions on injury, hospitalizations, and mortality rates and the impact of laws and legislation and infrastructure modification on preventing unintentional injuries among school-aged children.

The frequency of bicycle helmet use among college students and health beliefs for bicycle helmet attitude

Objective: The aim of this study is to determine the frequency of bicycle helmet use among college students and health beliefs about bicycle helmet attitude. Participants: Turkish university students (n = 799). Methods: This descriptive and cross-sectional study was conducted over the period 2019. A sociodemographic and cycling related questionnaire form and the Bicycle Helmet Attitudes Scale were used in the data collection. Descriptive statistics, t-test, Anova and Kruskal Wallis tests were used in the statistical analysis. Results: Only 10.4% of students wear a bicycle helmet. Students who using bicycle helmets had higher benefit health belief scores compared to those who didn’t, while barrier health belief scores were lower. There is a significant relationship between health belief scores for bicycle helmet attitude and gender, obeying traffic rules, thinking about helmet (unnecessary/disturbing/expensive/ridiculous) and helmet use. Conclusion: In this study, the frequency of using bicycle helmets is very low.

Facilitators and barriers to bicycle helmet use: A qualitative evidence synthesis.

Bicycles are environment-friendly and is an effective physical activity intervention to decrease risk of non-communicable diseases. Family physicians and primary care workers play a key role in promoting its usage, including addressing safety concerns through the use of bicycle helmet use. The uptake of bicycle helmets is low in many settings. We aimed to understand facilitators and barriers to bicycle helmet use. We searched five major electronic databases, screened references and manually searched conference abstracts for qualitative studies that focused on facilitators and barriers to bicycle helmet use. We critically appraised the studies using the Critical Appraisal Skills Programme (CASP) checklist and used PROGRESS-Plus tool for an equity-focused analysis. We conducted a thematic synthesis for analysis and used GRADE-CERQual to report confidence in findings. We included 15 studies from high-income countries. We identified 4 themes: 1. Perceptions on helmet design, it's quality and cost together with experiences influencing helmet use (10 studies, low confidence); 2. Perceived risk and benefits of helmet use through a gender lens (10 studies, moderate confidence); 3. Parental strategies influencing children's behavior regarding helmet use (6 studies, moderate confidence); 4. Adoption and enforcement of laws that shape perception and usage of bicycle helmets (8 studies, very low confidence). Our study identified facilitators and barriers and can be considered for developing programs and strategies to influence bicycle helmet use, but the confidence in findings is not high. Family physicians and primary care workers should consider these factors when promoting bicycle helmet for injury prevention. There is a need for more qualitative studies in different contexts to develop more robust evidence.

A Modelling Framework for Local Thermal Comfort Assessment Related to Bicycle Helmet Use

A Modelling Framework for Local Thermal Comfort Assessment Related to Bicycle Helmet Use

The unintended impact of helmet use on bicyclists’ risk-taking behaviors

Introduction: Safety is a critical factor in promoting sustainable urban non-motorized travel modes like bicycles. Helmets have shown to be effective in reducing injury severity in bicycle crashes, however, their effects on bicyclists’ behaviors still requires deeper understanding, especially amid the emerging trend of using shared bicycles. Risk compensation effects suggest that bicyclists may offset perceived gains in safety from wearing a helmet by increasing risk-taking behaviors. A better understanding of these compensation effects can be useful in assessing various bicycle safety related programs. Method: Using a sample of 131 bicyclists from the San Francisco Bay area, this research studies how bicyclists respond with respect to risk-taking behaviors under various urban-street conditions, as a function of helmet use. Study participants were each shown 12 videos, shot in Berkeley, California, from the perspective of a bicyclist riding behind another bicyclist. A fractional factorial experiment design was used to systematically vary contextual attributes (e.g., speed, bike lane facilities, on-street parking, passing vehicles) across the videos. After each video, participants were asked to indicate if they would overtake the bicyclist in the video. With the help of data adaptive estimation techniques, targeted maximum likelihood estimation (TMLE) was applied to estimate the average risk difference between helmeted users and non-users, controlling for self-selection effects. Individual-based nonparametric bootstrap was performed to assess the uncertainty associated with the estimator. Results: Our findings suggest, on average, individuals more likely to wear a helmet are 15.6% more likely to undertake a risky overtaking maneuver. Practical Applications: This study doesn’t try to oppose mandatory helmet laws, but rather serves as a cautionary warning that road safety programs may need to consider strategies in which unintended impact of bicycle helmet use can be mitigated. Moreover, our findings also provide additional evaluation component when it comes to the cost-benefit assessment of helmet-related laws.

Y-014. Two-year infant and maternal outcomes after planned delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial

Introduction: Safety is a critical factor in promoting sustainable urban non-motorized travel modes like bicycles. Helmets have shown to be effective in reducing injury severity in bicycle crashes, however, their effects on bicyclists’ behaviors still requires deeper understanding, especially amid the emerging trend of using shared bicycles. Risk compensation effects suggest that bicyclists may offset perceived gains in safety from wearing a helmet by increasing risk-taking behaviors. A better understanding of these compensation effects can be useful in assessing various bicycle safety related programs. Method: Using a sample of 131 bicyclists from the San Francisco Bay area, this research studies how bicyclists respond with respect to risk-taking behaviors under various urban-street conditions, as a function of helmet use. Study participants were each shown 12 videos, shot in Berkeley, California, from the perspective of a bicyclist riding behind another bicyclist. A fractional factorial experiment design was used to systematically vary contextual attributes (e.g., speed, bike lane facilities, on-street parking, passing vehicles) across the videos. After each video, participants were asked to indicate if they would overtake the bicyclist in the video. With the help of data adaptive estimation techniques, targeted maximum likelihood estimation (TMLE) was applied to estimate the average risk difference between helmeted users and non-users, controlling for self-selection effects. Individual-based nonparametric bootstrap was performed to assess the uncertainty associated with the estimator. Results: Our findings suggest, on average, individuals more likely to wear a helmet are 15.6% more likely to undertake a risky overtaking maneuver. Practical Applications: This study doesn’t try to oppose mandatory helmet laws, but rather serves as a cautionary warning that road safety programs may need to consider strategies in which unintended impact of bicycle helmet use can be mitigated. Moreover, our findings also provide additional evaluation component when it comes to the cost-benefit assessment of helmet-related laws.

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

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

The Association Between Risk Behaviors and Vaping Among Youth in New Mexico.

Electronic-cigarette use, or vaping, among youth has increased substantially in recent years. Tobacco smoking shows a strong association with other risk behaviors, but the association between vaping and other risk behaviors has rarely been explored. We examine the relationship between youth vaping and substance use, risky driving behaviors, and lack of bicycle helmet use. Data from the 2015 and 2017 New Mexico Youth Risk and Resiliency Survey were analyzed to evaluate the association between the use of e-cigarettes and other youth risk behaviors. Study participants were high school students, grades 9 to 12. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). A majority of students reported ever using e-cigarettes (54%). In 2015, e-cigarette users were more likely than nonusers to be Hispanic (65% vs 54%, P ≤ .001) and 16 years of age or older (58% vs 42%, P = .018). We found strong, statistically significant associations between e-cigarette use and not wearing a bicycle helmet (OR = 2.62, 95% CI: 1.95-3.51), texting while driving (OR = 2.18, 95% CI: 1.79-2.66), driving after drinking (OR = 2.95, 95% CI: 1.61-5.40), current marijuana use (OR = 6.38, 95% CI: 4.65-8.76), current painkiller use (OR = 2.47, 95% CI: 1.63-3.77), and current heroin use (OR = 0.15, 95% CI: 0.06-0.33). Driving after drinking was not significantly associated with e-cigarette use in 2017. E-cigarette use is associated with multiple other risk behaviors among youth. Further research should focus on environmental and policy efforts to reduce access to e-cigarettes by youth as well as interventions that address the underlying causes of the constellation of risk behaviors.