Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia—An evaluation

doi:10.1016/0001-4575(94)90006-X

Accident Analysis & Prevention

Volume 26, Issue 3, June 1994, Pages 325-337

https://doi.org/10.1016/0001-4575(94)90006-X Get rights and content

Abstract

On July 1, 1990, a law requiring wearing of an approved safety helmet by all bicyclists (unless exempted) came into effect in Victoria, Australia. Some of the more important steps that paved the way for this important initiative (believed to be the first statewide legislation of its type in the world) are described, and the initiative's effects are analysed. There was an immediate increase in average helmet-wearing rates from 31% in March 1990 to 75% in March 1991, although teenagers continued to show lower rates than younger children and adults. The number of insurance claims from bicyclists killed or admitted to hospital after sustaining a head injury decreased by 48% and 70% in the first and second years after the law, respectively. Analysis of the injury data also showed a 23% and 28% reduction in the number of bicyclists killed or admitted to hospital who did not sustain head injuries in the first and second post-law years, respectively. For Melbourne, where regular annual surveys of helmet wearing have been conducted, it was possible to fit a logistic regression model that related the reduction in head injuries to increased helmet wearing. Surveys in Melbourne also indicated a 36% reduction in bicycle use by children during the first year of the law and an estimated increase in adult use of 44%.

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Access to safe and equitable bike riding infrastructure is an important public health goal. Australia is one of nine countries that mandates wearing bike helmets for adults. The policy is controversial and is theorised to discourage bike riding. This study aimed to describe understandings of mandatory helmet legislation and how it might impact decisions to wear a helmet and to ride a bike.
Semi-structured interviews were conducted with 21 bike riders in Melbourne, Australia to discuss their experiences and how this law factors into their decision to ride a bike and impacts their perception of risk when riding. Data were analysed using grounded theory.
This study provides evidence on the complex intersection of mandatory helmet legislation and the cycling environment. Specifically, this study identified that bike riders consider risk within the overall cycling context and not in binary decisions of ‘risky’ and ‘not risky’. Interviewees saw the law as a small benefit to safety, but not an adequate substitute for meaningful infrastructure and other actions that could reduce the risk posed to bike riders by drivers of motor vehicles. Interviewees also felt that mandating helmets was an ‘easy’ policy choice as it does not require any behavioural changes from drivers of motor vehicles.
Mandatory helmet legislation is not considered a barrier to bike riding but may prevent others from exploring it as a transport option by contributing to the perception of bike riding as an unsafe activity. Policies aimed at improving safety for bike riders should focus on the development of safer infrastructure first and then use personal protective equipment to mitigate any residual risk. Policies focusing on personal protective equipment legitimise blaming bike riders for getting injured and contributes to judgement and victim blaming experienced by bike riders.
Mass media campaigns to increase the use of bicycle helmets: A systematic review and meta-analysis
2023, Journal of Transport and Health
Bicycle helmets protect against serious brain injuries caused by bicycle accidents. One strategy to increase helmet use is via mass media campaigns. This study systematically reviewed the effectiveness of mass media campaigns which aimed to increase bicycle helmet use.
The following electronic databases were systematically searched between January 2000 and February 2022: PubMed/Medline, Scopus, Web of Science (WOS), and others including the Transportation Research Information Service and International Transport Research Documentation. Inter-study heterogeneity was assessed using Chi-Squared and I² tests and a random effects model was applied to pool the Odd Ratios (ORs).
Only eight articles were found to be eligible for this meta-analysis. Using a random effects model, the pooled results showed statistically significant increases in helmet use among bicyclists (OR = 3.77, 95% CI: 1.16–12.20, P < 0.001; I²: 99.9%, p < 0.001). Although there was significant heterogeneity, in sensitivity analysis, based on alternative levels of I² = 25%, we found no significant change in the pooled result (OR = 10.70, 95% CI: 10.19–11.22, P < 0.001).
In conclusion, our research found that mass media campaigns may boost the usage of helmets among cyclists, particularly among those under the age of 18 and in campaigns without enforcement activities. Therefore, we suggest that these campaigns focus on children and adolescents. It is also recommended to use this type of campaign that can change the behavior of cyclists without coercion and activities.
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Citation Excerpt :
A common argument against this is that it may not be effective in reducing serious injuries and may even reduce the number of people cycling, thereby producing a net negative effect on population health. Bicycle helmet legislation has been introduced in Australia and New Zealand, and the reported effect has been mixed, ranging from a deterrence effect [37,38], to a children-only decrease [39], and no detrimental effect [40]. It is likely that mandatory bicycle helmet legislation represents only a small contribution to the attractiveness of cycling, and that other factors (cycle lanes and government campaigns) are confounding.
This study aims to characterise cycling related injuries presenting to a major trauma centre located within a region with the highest rates of cycling in the UK.
A retrospective analysis of cycling related trauma admissions occurring between January 2012 and June 2020 was performed. Our institution's electronic patient record system was used to collect relevant data for analysis including age, gender, mechanism of injury, Glasgow coma scale (GCS) on arrival, incident date and time, injured body regions, 30-day mortality, helmet use and intubation rate. Comparison was made between groups of patients based on mechanism of injury.
A total of 605 cycling related trauma cases were identified, with 52 being excluded due to incomplete data. The most common mechanism was ‘fall from cycle’ (53.5%). The ‘cyclist v vehicle’ group was associated with a significantly higher Injury Severity score (ISS), lower GCS and higher intubation rate. Helmet wearers were significantly older than non-wearers and helmet use was associated with a significantly reduced risk of head injury, lower ISS and intubation rate and a higher GCS.
With a likely increase in future cycling uptake, it is crucial that effective interventions are implemented to improve the safety of cyclists. The findings of this study may be used to guide any such intervention. A multi-faceted strategy involving driver and cyclist education, effective road infrastructure changes and helmet promotion campaigns specifically targeting the younger generation could be employed.
Fifty Years of Accident Analysis & Prevention: A Bibliometric and Scientometric Overview
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Accident Analysis & Prevention (AA&P) is a leading academic journal established in 1969 that serves as an important scientific communication platform for road safety studies. To celebrate its 50^th anniversary of publishing outstanding and insightful studies, a multi-dimensional statistical and visualized analysis of the AA&P publications between 1969 and 2018 was performed using the Web of Science (WoS) Core Collection database, bibliometrics and mapping-knowledge-domain (MKD) analytical methods, and scientometric tools. It was shown that the annual number of AA&P’s publications has grown exponentially and that over the course of its development, AA&P has been a leader in the field of road safety, both in terms of innovation and dissemination. By determining its key source countries and organizations, core authors, highly co-cited published documents, and high burst-strength publications, we showed that AA&P’s areas of focus include the “effects of hazard and risk perception on driving behavior”, “crash frequency modeling analysis”, “intentional driving violations and aberrant driving behavior”, “epidemiology, assessment and prevention of road traffic injuries”, and “crash-injury severity modeling analysis”. Furthermore, the key burst papers that have played an important role in advancing research and guiding AA&P in new directions – particularly those in the fields of crash frequency and crash-injury severity modeling analyses were identified. Finally, a modified Haddon matrix in the era of intelligent, connected and autonomous transportation systems is proposed to provide new insights into the emerging generation of road safety studies.
Modeling helmet usage behavior of motorized two-wheeler riders in developing countries
2020, Transportation Research Procedia
Motorcycle crashes make up a large proportion of road casualties in all over the world, particularly in developing countries like India, where motorcycle ownership is high. Wearing helmet decreases the risk and severity of injuries. To increase helmet usage, government has introduced a mandatory helmet usage law for two-wheeler driver and pillion riders in Mumbai, India from April 2016 onwards. Thus, the study objectives are to examine the various factors affecting helmet usage behavior and develop the model for estimating helmet usage behavior of motorcycle rider’s in cities. The data were collected in two different time frames, such as before and after helmet mandatory law at randomly selected ten study locations in Mumbai, India. From field survey, 28,209 and 37,245 samples were collected during 2015 and 2016 respectively. This study was performed the statistical analysis of the impact of the state strict law on helmet usage and it was found that helmet usage was increased from 62.81% to 83.53%. Further, Pearson’s R, Kendall’s tau, Spearman’s rho correlation and analysis of variance tests were conducted for identifying the impact of each variable with helmet wearing behavior of motorcyclists. Finally, binary logistic regression model was developed to estimate helmet usage behavior of the motorcycle rider. The model was validated, and their statistical performance results denote that developed model predicts helmet usage behavior more preciously. These study findings and model outcomes can be useful for policy makers to understand about the actual conditions of helmet usage behavior in cities and increase helmet usage rate, and also create policy level decision making on reduction in traffic crashes in India.
Recommend or mandate? A systematic review and meta-analysis of the effects of mandatory bicycle helmet legislation
2018, Accident Analysis and Prevention
If all cyclistswere wearing helmets, significant numbers of head injuries might theoretically be prevented. Mandatory bicycle helmet legislation increases helmet use but is a controversial measure. Results from 21 studies of the effects of mandatory bicycle helmet legislation on injuries among crash involved cyclists were investigated by means of meta-analysis and the effects of several potential biases were investigated. The summary effect of mandatory bicycle helmet legislation for all cyclists on head injuries is a statistically significant reduction by 20% (95% confidence interval [−27; −13]). Larger effects were found for serious head injury (−55%; 95% confidence interval; [−78; −8]). Among children, larger effects were found when legislation applies to all cyclists than when it applies to children only. There is no clear indication of the results being affected by publication bias. Publication bias may exist, but any existing biases seem to more or less outweigh each other. Results from meta-analysis do not indicate that the results are systematically affected by a lack of control for time trend bias, choice of comparison group or study design (before-after vs. case control). Summary effects may be somewhat overestimated because of a lack of control for potential confounding variables in some of the studies. However, such a bias, if it exists, is not likely to be large. Empirical evidence for the hypotheses that mandatory bicycle helmet legislation deters people from cycling and that helmet wearing leads to behavioral adaptation is mixed. In summary, mandatory bicycle helmet legislation can be expected to reduce head injury among crash involved cyclists. Some adverse effects may occur, but will not necessarily be large or long-lasting. People who may be deterred from cycling, are among those with the highest injury risk and the smallest health effects from cycling. If the overall goal is to improve safety for all cyclists and to increase cycling, mandatory bicycle helmet legislation should be supplemented by other measures, especially improved bicycle infrastructure.

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Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia—An evaluation

Abstract

Accid. Anal. Prev.

Accid. Anal. Prev.

BMDP statistical software manual

Evaluation of the bicycle helmet wearing law in Victoria during its first 12 months

Do bicycle safety helmets reduce severity of head injury in real crashes?

The risks of bicyclist accident involvement Report no. 2

The behaviour and crash involvement risk of child pedestrians and bicyclists: A traffic exposure study

Bicycle use and helmet wearing rates in Melbourne, 1987 to 1992

Trends in helmet usage rates and bicyclist numbers sustaining head injury—July 1981 to December 1985—Victoria

Bicycle helmet usage surveys of primary and secondary school children, adult commuter and recreational cyclists 1983–1987