Prevalence rates of helmet use among motorcycle riders in a developed region in China

This study aimed to determine the prevalence rates of helmet use, and of correct helmet use (chinstrap firmly fastened) among motorcycle riders and their passengers in Zhongshan, Guangdong Province, China. A cross-sectional survey involving direct observation of motorcycle riders was conducted at 20 randomly selected intersections. A total of 13,410 motorcycles were observed during a 10-day period in February 2009. The overall prevalence of helmet use was 72.6% (95% CI: 71.8–73.3%) among drivers and 34.1% (95% CI: 32.7–35.5%) among pillion passengers. The prevalence of correct use was 43.2% (95% CI: 42.4–44.0%) and 20.9% (95% CI: 19.8–22.1%) for drivers and passengers respectively. The helmet wearing rate on city streets was almost 95%, however city riders were more likely than rural riders to wear non-motorcycle helmets while riding. In multivariate analyses, factors associated with increased helmet use included riding on city streets, male gender, being a driver, carrying less passengers and riding a registered motorcycle. The results indicated enforcement and education activities need to be strengthened with respect to both helmet use and helmet quality, especially in rural areas, in order to improve wearing rates.     

The impact response of traditional and BMX-style bicycle helmets at different impact severities

Bicycle helmets reduce the frequency and severity of severe to fatal head and brain injuries in bicycle crashes. Our goal here was to measure the impact attenuation performance of common bicycle helmets over a range of impact speeds. We performed 127 drop tests using 13 different bicycle helmet models (6 traditional style helmets and 7 BMX-style helmets) at impact speeds ranging from 1 to 10 m/s onto a flat anvil. Helmets were struck on their left front and/or right front areas, a common impact location that was at or just below the test line of most bicycle helmet standards. All but one of the 10 certified helmet models remained below the 300 g level at an impact speed of 6 m/s, whereas none of the 3 uncertified helmets met this criterion. We found that the helmets with expanded polystyrene liners performed similarly and universally well. The single certified helmet with a polyurethane liner performed below the level expected by the Consumer Product Safety Commission (CPSC) standard at our impact location and the helmet structure failed during one of two supplemental tests of this helmet above the test line. Overall, we found that increased liner thickness generally reduced peak headform acceleration, particularly at higher impact speeds.     

Monitoring speed before and during a speed publicity campaign

Driving speeds were monitored during a period of 16 weeks encompassing different stages of an anti-speeding campaign in the Netherlands. This campaign targeted speed limit violations in built-up areas. The observation periods differed in terms of intensity and media used for the campaign. Small road-side radars, mounted in light poles, were used and registered the speeds on 20 locations in built-up areas. Speeds of over 10 million vehicles were measured. Ten locations had a posted speed limit of 50 km/h; the other ten had a posted speed limit of 30 km/h. Posters were placed at half of each group of locations to remind drivers of the speed limit. The average speed on the 50 km/h roads was 46.2 km/h, and 36.1 km/h on the 30 km/h roads. The average proportions of vehicles exceeding the speed limit were 33.3% and 70.1% respectively. For the 30 km/h roads, the data shows differences in speed and speeding behaviour between the six distinguished observation periods, but overall these differences cannot be logically linked to the contents of the phases and, hence, cannot be explained as an effect of the campaign. The only exception was an effect of local speed limit reminders on the 30 km/h roads. This effect, however, was temporary and had disappeared within a week.     

Discrepancy in bicycle helmet use among college students between two bicycle use purposes: Commuting and recreation

Objectives

The purpose of the study was to examine associations between bicycle helmet use and attitudes among U.S. college students. Bicycle helmet use was assessed for two different bicycle use purposes: commuting to school and recreation.

Materials and methods

Student bicycle riders were recruited on the campus of a large public university in Colorado. Questionnaire development was guided by the Theory of Reasoned Action and Health Belief Model. Bicycle use and helmet use for the two purposes, attitudes toward helmet use and bicycle helmet regulations on campus, perceived risk of bicycle-related injury, subjective norms were asked. Bicycle helmet use was defined by current behaviors and intentions for the future, based on the Stages of Change model.

Results

A total of 192 questionnaires collected from students who rode bicycles for both commuting and recreation was used for the analysis. Bicycle helmet use differed depending on purposes of bicycle riding: 9.4% of bicycle riders wore bicycle helmets every time for commuting, while 36.5% did so for recreation. Different variables were associated with bicycle helmet use for commuting and recreation in logistic regression models, suggesting that psychosocial structures behind bicycle helmet use behaviors might differ between two bicycle use purposes, commuting and recreation.     

Risk factors for severe injury in cyclists involved in traffic crashes in Victoria,Australia

This study examines the impact of cyclist, road and crash characteristics on the injury severity of cyclists involved in traffic crashes reported to the police in Victoria, Australia between 2004 and 2008. Logistic regression analysis was carried out to identify predictors of severe injury (serious injury and fatality) in cyclist crashes reported to the police. There were 6432 cyclist crashes reported to the police in Victoria between 2004 and 2008 with 2181 (33.9%) resulting in severe injury of the cyclist involved. The multivariate analysis found that factors that increase the risk of severe injury in cyclists involved in traffic crashes were age (50 years and older), not wearing a helmet, riding in the dark on unlit roads, riding on roads zoned 70 km/h or above, on curved sections of the road, in rural locations and being involved in head-on collisions as well as off path crashes, which include losing control of vehicle, and on path crashes which include striking the door of a parked vehicle. While this study did not test effectiveness of preventative measures, policy makers should consider implementation of programs that address these risk factors including helmet programs and environmental modifications such as speed reduction on roads that are frequented by cyclists.     

Does an on-road motorcycle coaching program reduce crashes in novice riders? A randomised control trial

ObjectivesMotorcycle riding is increasing globally and confers a high risk of crash-related injury and death. There is community demand for investment in rider training programs but no high-quality evidence about its effectiveness in preventing crashes. This randomised trial of an on-road rider coaching program aimed to determine its effectiveness in reducing crashes in novice motorcycle riders.MethodsBetween May 2010 and October 2012, 2399 newly-licensed provisional riders were recruited in Victoria, Australia and completed a telephone interview before randomisation to intervention or control groups. Riders in the intervention group were offered an on-road motorcycle rider coaching program which involved pre-program activities, 4 h riding and facilitated discussion in small groups with a riding coach. Outcome measures were collected for all participants via telephone interviews at 3 and 12 months after program delivery (or equivalent for controls), and via linkage to police-recorded crash and offence data. The primary outcome was a composite measure of police-recorded and self-reported crashes; secondary outcomes included traffic offences, near crashes, riding exposure, and riding behaviours and motivations.ResultsFollow-up was 89% at 3 months and 88% at 12 months; 60% of the intervention group completed the program. Intention-to-treat analyses conducted in 2014 indicated no effect on crash risk at 3 months (adjusted OR 0.90, 95% CI: 0.65–1.27) or 12 months (adjusted OR 1.00, 95% CI: 0.78–1.29). Riders in the intervention group reported increased riding exposure, speeding behaviours and rider confidence.ConclusionsThere was no evidence that this on-road motorcycle rider coaching program reduced the risk of crash, and we found an increase in crash-related risk factors.     

Self reported risk taking and risk compensation in skiers and snowboarders are associated with sensation seeking

In alpine skiing, a controversial discussion has been taking place regarding the potential influence of wearing a ski helmet on the individual level of risk taking behaviour. The aim of this study was to evaluate whether self reported risk taking behaviour and self reported risk compensation are associated with the personality trait sensation seeking (SS) in alpine skiing and snowboarding. In total, 683 persons (36% males and 64% females) completed an online-survey about attitudes and use of protective gear in winter sports including the German version of the sensation seeking scale form V. A logistic regression analysis including gender, age, nationality, preferred winter sport, self reported skiing ability, mean skiing time per season, use of ski helmets, and SS total score was used to estimated adjusted odds ratios (ORs) and their 95% confidence intervals (95 CI) for self reported risk taking behaviour. Regression analysis revealed that a more risky behaviour increased with male gender (OR: 2.7), with an age < 25 years (OR: 1.6), with skiing (OR: 1.3), higher skill level (OR: 5.7), and a mean skiing time > 28 days per season (OR: 2.2). In addition, SS total score was significantly higher in more risky compared to more cautious people (23.8 vs. 20.3, p < .001). Ski helmet use was not found to be predictive for a more risky behaviour (p > .05). Also, skiers and snowboarders with self reported risk compensation while wearing a ski helmet had higher SS total scores compared to those who did not report risk compensation (23.8 vs. 20.9, p = .001). In addition, self reported risk compensation in helmet wearers increased with an age < 25 years (OR: 2.2), a higher skill level (OR: 2.5) and a mean skiing time > 28 days per season (OR: 2.1). In conclusion, self reported risk taking and self reported risk compensation are associated with higher sensation seeking total scores. The personality trait sensation seeking, not wearing of a ski helmet, appears to be associated with riskier behaviour on the ski slopes.     

The protective effect of a helmet in three bicycle accidents—A finite element study

There is some controversy regarding the effectiveness of helmets in preventing head injuries among cyclists. Epidemiological, experimental and computer simulation studies have suggested that helmets do indeed have a protective effect, whereas other studies based on epidemiological data have argued that there is no evidence that the helmet protects the brain. The objective of this study was to evaluate the protective effect of a helmet in single bicycle accident reconstructions using detailed finite element simulations.Strain in the brain tissue, which is associated with brain injuries, was reduced by up to 43% for the accident cases studied when a helmet was included. This resulted in a reduction of the risk of concussion of up to 54%. The stress to the skull bone went from fracture level of 80 MPa down to 13–16 MPa when a helmet was included and the skull fracture risk was reduced by up to 98% based on linear acceleration. Even with a 10% increased riding velocity for the helmeted impacts, to take into account possible increased risk taking, the risk of concussion was still reduced by up to 46% when compared with the unhelmeted impacts with original velocity. The results of this study show that the brain injury risk and risk of skull fracture could have been reduced in these three cases if a helmet had been worn.     

Exploration of the barriers to bicycle helmet use among 12 and 13 year old children.

Despite the fact that bicycle helmet usage reduces the risk of bicycle-related head injuries, only a small percentage of children routinely wear helmets. The aim of this study was to qualitatively explore the barriers to bicycle helmet usage among 12 and 13 year old children. The study is based on four focus groups with 31 children from schools is an urban New York City area. A majority of both boys and girls did not perceive a need for wearing helmets for routine riding or short trips, and felt that helmet usage was uncomfortable and made them appear dumb. Also, students could not recall any health promotion efforts by a variety of health providers and felt local legislation had little impact on usage rates. The qualitative findings of this study provide valuable material for researchers seeking to understand the factors associated with non-use of bicycle helmets.     

A cross-sectional observational study of helmet use among motorcyclists in Wa,Ghana

Motorcyclists’ injuries and fatalities are a major public health concern in many developing countries including Ghana. This study therefore aimed to investigate the prevalence of helmet use among motorcyclists in Wa, Ghana. The method used involved a cross-sectional roadside observation at 12 randomly selected sites within and outside the CBD of Wa. A total of 14,467 motorcyclists made up of 11,360 riders and 3107 pillion riders were observed during the study period. Most observed riders (86.5%) and pillion riders (61.7%) were males. The overall prevalence of helmet use among the observed motorcyclists was 36.9% (95% CI: 36.1–37.7). Helmet use for riders was 45.8% (95% CI: 44.8–46.7) whilst that for pillion riders was 3.7% (95 CI: 3.0–4.4). Based on logistic regression analysis, higher helmet wearing rates were found to be significantly associated with female gender, weekdays, morning periods and at locations within the CBD. Riders at locations outside the CBD were about 7 times less likely to wear a helmet than riders within the CBD (48.9% compared to 42.3%; χ²₍₁₎ = 49.526; p < 0.001). The study concluded that despite the existence of a national helmet legislation that mandates the use of helmets by both riders and pillion riders on all roads in Ghana, helmet use is generally low in Wa. This suggests that all stakeholders in road safety should jointly intensify education on helmet use and pursue rigorous enforcement on all road types especially at locations outside the CBD to improve helmet use in Wa.     

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.     

Attitudes towards current and lowered speed limits in Australia

The present study was concerned with gaining a greater understanding of the Australian community's attitudes towards both the current and proposed lower speed limits. An online survey was administered in four states (Victoria, South Australia, Western Australia, and Tasmania), with a total of 4100 respondents recruited. The survey focussed on attitudes towards speed limits for four different road types, and the sample was stratified according to age, gender, and area of residence. It was found that most respondents were able to correctly identify the speed limit for local residential streets and major urban arterials, although their knowledge of rural speed limits was considerably lower. The majority of respondents were in favour of the proposed lower speed limits on 100 km/h two-lane undivided rural roads and on rural gravel roads, but only about one-third supported lower limits in urban areas. A cluster analysis revealed that there were varying characteristics between respondents who were more or less likely to support speed limit reductions, across a number of demographic, socio-economic status, and driving behavior variables. These results provided important guidance regarding groups that could potentially be targeted in speed-related interventions, as well as highlighting the potential for lowering speed limits in Australia, particularly on rural roads.     

Changes in head injury with the New Zealand bicycle helmet law

It was claimed that the bicycle helmet law in New Zealand reduced head injuries to adult cyclists by 28% (Povey, L.J., Frith, W.J., Graham, P.G., 1999. Cycle helmet effectiveness in New Zealand. Accident Analysis and Prevention 31, 763-770). However, the pre-law increase in adults wearing helmets (from 30% in 1990 to 43% in 1993) was accompanied by a fall of 45 head injuries per 100 limb injuries (i.e. -3.47 for every 1% increase in helmet wearing) compared with a fall of 11 when wearing increased from 43 to 93% with the law (-0.23 for every 1% increase in wearing). Unless voluntary wearing is 15 times more effective in reducing head injuries, it seems likely that the apparent effects (as described by Povey et al., 1999) were an artefact caused by failure to fit time trends in their model. Such inconsistency of effects over periods of substantial change compared with periods of little change in helmet wearing may be a useful indicator of the presence of trends. Because the large increases in wearing with helmet laws have not resulted in any obvious change over and above existing trends, helmet laws and major helmet promotion campaigns are likely to prove less beneficial and less cost effective than proven road-safety measures, such as enforcement of speed limits and drink-driving laws, education of motorists and cyclists and treatment of accident black spots and known hazards for cyclists.     

Are electric self-balancing scooters safe in vehicle crash accidents?

With the pressing demand of environmentally friendly personal transportation vehicles, mobility scooters become more and more popular for the short-distance transportation. Similar to pedestrians and bicyclists, scooter riders are vulnerable road users and are expected to receive severe injuries during traffic accidents. In this research, a MADYMO model of vehicle–scooter crash scenarios is numerically set up. The model of the vehicle with the scenario is validated in pedestrian–vehicle accident investigation with previous literatures in terms of throwing distance and HIC₁₅ value. HIC₁₅ values gained at systematic parametric studies. Injury information from various vehicle crashing speeds (i.e. from 10 m/s to 24 m/s), angles (i.e. from 0 to 360°), scooter's speeds (i.e. from 0 m/s to 4 m/s), contact positions (i.e. left, middle and right bumper positions) are extracted, analyzed and then compared with those from widely studied pedestrian–vehicle and bicycle–vehicle accidents. Results show that the ESS provides better impact protection for the riders. Riding ESS would not increase the risk higher than walking at the same impact conditions in terms of head injury. The responsible reasons should be the smaller friction coefficient between the wheel-road than the heel-road interactions, different body gestures leading to different contact positions, forces and timing. Results may shed lights upon the future research of mobility scooter safety analysis and also the safety design guidance for the scooters.     

Exposure survey of motorcyclists in New South Wales

This paper reports the results of an exposure survey of 794 registered motorcycle riders, with an average of 18.1 years of riding experience, in the State of New South Wales, Australia. Respondents completed two postal surveys, separated by about 6 months, that included items relating to their crash history, riding patterns, characteristics of their motorcycle, and its odometer reading. Odometer readings indicated that respondents rode a mean of 5208 km each year, and that annual exposure was related to gender, motorcycle type, and dominant riding location, time of week, and purpose. The amount of riding reported for different purposes changed with age, with older riders more likely than younger riders to ride for recreational reasons and on weekends. The mean crash rate (based on self-reported crash involvement) was 0.96 crashes/100,000 km. The crash rate declined with age, was highest in the Sydney metropolitan area, was lowest for motorcycles with large engines, and was highest for trail and dual-use motorcycles. There was a relationship between annual exposure and crash risk such that riders who rode relatively little had higher crash risks (per 100,000 km travelled) than riders who rode more often. A cluster analysis identified three groups of riders with higher-than-average risks of crash involvement.     

Bicycle helmet legislation: can we reach a consensus?

Debate continues over bicycle helmet laws. Proponents argue that case-control studies of voluntary wearing show helmets reduce head injuries. Opponents argue, even when legislation substantially increased percent helmet wearing, there was no obvious response in percentages of cyclist hospital admissions with head injury-trends for cyclists were virtually identical to those of other road users. Moreover, enforced laws discourage cycling, increasing the costs to society of obesity and lack of exercise and reducing overall safety of cycling through reduced safety in numbers. Countries with low helmet wearing have more cyclists and lower fatality rates per kilometre. Cost-benefit analyses are a useful tool to determine if interventions are worthwhile. The two published cost-benefit analyses of helmet law data found that the cost of buying helmets to satisfy legislation probably exceeded any savings in reduced head injuries. Analyses of other road safety measures, e.g. reducing speeding and drink-driving or treating accident blackspots, often show that benefits are significantly greater than costs. Assuming all parties agree that helmet laws should not be implemented unless benefits exceed costs, agreement is needed on how to derive monetary values for the consequences of helmet laws, including changes in injury rates, cycle-use and enjoyment of cycling. Suggestions are made concerning the data and methodology needed to help clarify the issue, e.g. relating pre- and post-law surveys of cycle use to numbers with head and other injuries and ensuring that trends are not confused with effects of increased helmet wearing.     

The impact response of motorcycle helmets at different impact severities

Helmets reduce the frequency and severity of head and brain injuries over a range of impact severities broader than those covered by the impact attenuation standards. Our goal was to document the impact attenuation performance of common helmet types over a wide range of impact speeds. Sixty-five drop tests were performed against the side of 10 different helmets onto a flat anvil at impact speeds of 0.9–10.1 m/s (energy = 2–260 J; equivalent drop heights of 0.04–5.2 m). Three non-approved beanie helmets performed poorly, with the worst helmet reaching a peak headform acceleration of 852g at 29 J. Three full-face and one open-face helmet responded similarly from about 100g at 30 J to between 292g and 344g at 256–260 J. Three shorty style helmets responded like the full-face helmets up to 150 J, above which varying degrees of foam densification appeared to occur. Impact restitution values varied from 0.19 to 0.46. A three-parameter model successfully captured the plateau and densification responses exhibited by the various helmets (R² = 0.95–0.99). Helmet responses varied with foam thickness, foam material and possibly shell material, with the largest response differences consistent with either the presence/absence of a foam liner or the densification of the foam liner.     

Barriers to, and factors associated, with observed motorcycle helmet use in Vietnam

This study investigated barriers to, and factors associated with, observed motorcycle helmet use among motorcyclists in Hai Duong Province, Vietnam. The findings highlighted an array of factors associated with observed helmet use namely, support for universal helmet legislation and a positive attitude towards what might be perceived as negative attributes of helmet use such as inconvenience and discomfort in hot weather. As well, older age (greater than 25 years in age), riding on a compulsory road, being a driver, trips of greater than 10 km, higher levels of education (having a university degree and higher) were found to be key determinants of helmet use. Despite over 95% of motorcyclists disagreeing with the statement that wearing a helmet does not reduce the severity of head injury in a crash, most motorcyclists believed that helmets did not need to be worn for a short trip. Overall, only 23% of motorcyclists were observed wearing a helmet. The authors conclude that efforts to increase helmet use need to focus on the necessity for universal helmet legislation in association with identifying solutions to reduce the negative attitudes towards helmet use.     

Differential effects of traffic sign stimuli upon speeding in school zones following a traffic light interruption

Motorists whose journey has been interrupted by signalized traffic intersections in school zones resume their journey at a faster vehicle speed than motorists who have not been required to stop. Introducing a flashing “check speed” sign 70 m after the traffic intersections counteracts this interruptive effect. The present study examined which aspects of a reminder sign are responsible for reducing the speeding behavior of interrupted motorists. When a sign that combines both written text and flashing lights was introduced, interrupted motorists did not speed, traveling on average 0.82 km/h below the 40 km/h speed limit when measured 100 m from traffic intersections. Alternatively, when only the flashing lights were visible the interrupted motorists sped 3.36 km/h over the 40 km/h speed limit. Similar vehicular speeds were observed when only the written text was visible and when no sign was present (7.67 and 7.49 km/h over the 40 km/h speed limit, respectively). This indicates that static reminder signs add little value over the absence of a school zone reminder sign; the presence of both cues is necessary to fully offset the interruptive effect. This study also highlights the benefit of using exogenous visual cues in traffic signs to capture drivers’ attention. These findings have practical implications for the design and use of traffic signs to increase compliance with posted speed limits.     

The protective performance of bicyclists' helmets in accidents

A study of the injuries sustained by 1,892 bicycle riders during accidents indicated that 432 of the bicyclists had been wearing a helmet and 64 of the latter group had sustained an impact to the helmet. The 64 helmets were evaluated in this project to relate the nature and severity of the impact they had sustained to the head injury experienced by the wearer. The protective performance of the helmet shells, impact absorbing liners, and retention systems were evaluated, and the severity of the impacts sustained by the helmets was simulated in the test laboratory. The simulation was performed by dropping sample helmets from progressively greater heights in a test apparatus until the damage observed on a sample helmet matched that observed on an accident damaged helmet. The severity observed in the simulated impacts was compared with the severity of test impacts prescribed in established helmet performance standards (ANSI 1984; Snell 1984; AS 1986). It was found that all of the impacts occurred against flat objects; a high proportion of helmets sustained more than one impact; most impacts occurred on areas of a helmet which were not tested during certification to a standard; and many impacts were more severe than those stipulated in performance standards. The predominant form of head injury recorded was low severity concussion--AIS-1, AIS-2, AIS-3. All serious head injuries occurred when the helmet came off the rider's head and collapsed due to a material defect or was struck predominantly below the rim. A high proportion of helmets worn by young riders had been misused, and many helmets displayed defects in the impact-absorbing liners. Recommendations have been made for improving helmet construction and altering current standards to reflect the conditions encountered in the field.