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.     

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.     

School regulations governing bicycle helmet use and head injuries among Japanese junior high school students

We examined the effectiveness of school regulations concerning bicycle helmet use in reducing head injuries among student bicycle commuters to junior high schools in the Japanese prefecture of Saitama. This was done by comparing the rates of head injuries and the ratios of head injuries to non-head injuries between junior high schools with and without school regulations concerning helmet use. Bicycle injury data were derived from school insurance records. Information relating to numbers of bicycle commuters and demographics was collected for each school. We identified that the head injury rate was significantly higher in schools that had no regulations governing the use of bicycle helmets (rate ratio 2.97, 95% confidence interval (CI) 1.03-8.56; odds ratio 2.46, 95% CI 0.80-7.60). The observed trend was more prominent in male students than in female students. The actual rate of bicycle injuries did not significantly differ between the schools with and without regulations concerning helmet use. This suggests that students at schools with regulations were no more cautious in riding their bicycles than their counterparts in schools with no regulations, and that there was no significant difference in the traffic environments surrounding each school. Thus implicating that the observed difference in the head injury rate was most accounted for by the presence of school regulations governing helmet use.     

Risk factors for injury accidents among moped and motorcycle riders

Objective

To study and quantify the effect of factors related to the riders of powered two-wheelers on the risk of injury accident involvement.

Methodology

Based on national data held by the police from 1996 to 2005, we conducted a case–control study with responsibility for the accident as the event of interest. We estimated the odds ratios for accident responsibility. Making the hypothesis that the non-responsible riders in the study are representative of all the riders on the road, we thus identified risk factors for being responsible for injury accidents. The studied factors are age, gender, helmet wearing, alcohol consumption, validity of the subject's driving licence and for how long it has been held, the trip purpose and the presence of a passenger on the vehicle. Moped and motorcycle riders are analyzed separately, adjusting for the main characteristics of the accident.

Results

For both moped and motorcycle riders, being male, not wearing a helmet, exceeding the legal limit for alcohol and travelling for leisure purposes increased the risk of accident involvement. The youngest and oldest users had a greater risk of accident involvement. The largest risk factor was alcohol, and we identified a dose–effect relationship between alcohol consumption and accident risk, with an estimated odds ratio of over 10 for motorcycle and moped riders with a BAC of 2 g/l or over. Among motorcycle users, riders without a licence had twice the risk of being involved in an accident than those holding a valid licence. However, the number of years the rider had held a licence reduced the risk of accident involvement. One difference between moped and motorcycle riders involved the presence of a passenger on the vehicle: while carrying a passenger increased the risk of being responsible for the accident among moped riders, it protected against this risk among motorcycle riders.

Conclusion

This analysis of responsibility has identified the major factors contributing to excess risk of injury accidents, some of which could be targeted by prevention programmes.     

Trends in helmet use and head injuries in San Diego County: the effect of bicycle helmet legislation

The purpose of this study is to evaluate the effect of California's bicycle helmet law on bicycle-related head injuries in San Diego County with a year 2000 population of approximately 3 million people. The study design is an ecological trend design based on observational data from a Trauma Registry. Outcome measures include helmet use compliance, site/severity of injury and abbreviated injury scale (AIS). There were 1116 bicycle trauma patients recorded in the San Diego County Trauma Registry between 1992 and 1996. The percentages of pre-law and post-law helmet use were 13.2 and 31.7%, respectively. Over the whole study period, the overall helmet use increased by an average of 43% per year with an averaged 84% rate increase in helmet use among children. Only 16.1% of patients with serious head injury used helmets, compared to 28.2% in those who did not have serious head injury. The odds ratio of helmet use against serious head injuries is 0.43 (95% CI 0.28-0.66) after adjusting for age, ethnicity and time. The p-values for comparing pre- and post-legislation serious head injury rates are p=0.764, 0.4 and 0.194 for the overall, adult and child populations, respectively. Helmet legislation increased helmet use in the targeted child population and the effect was carried over to the adult population. Helmet use has a protective effect against serious head injury. Probably due to several of its limitations, the current study did not confirm that helmet legislation alone significantly reduced head injury rates in San Diego County during the study period.     

Improper motorcycle helmet use in provincial areas of a developing country

Motorcycle helmet wearing rates remain low in smaller cities in developing countries. We therefore examined the knowledge, attitudes, and behavior of motorcyclists towards helmet use in two mid-sized cities in China. The methods included roadside observation and interview. Observational sites were randomly selected from main roads and secondary streets; all motorcycles passing by were observed. Riders near the sites were opportunistically approached and asked about knowledge of and perceptions about helmet use. Altogether, 75,949 drivers and 17,230 passengers were observed. A large proportion of both drivers and passengers (34% and 71%, respectively) did not wear a helmet, or did not have their helmet fastened (34% and 14%). Proper helmet usage rates were lower among male drivers, younger people, on secondary streets, and during the evenings and weekends. The majority of the 2325 drivers interviewed (90%) acknowledged the benefits of helmet wearing, but 72% reported that helmets are not always comfortable, and only 20% said they would wear a helmet for preventive purposes. Furthermore, many felt that police enforcement was not strict (62%). These results suggest that educational programs about helmet use in provincial China should emphasize the risks of improper use. Strict enforcement, especially on secondary roads and during non-peak hours, could also improve helmet usage.     

A study of reported injury accidents among novice motorcycle riders in a Scottish region

A study is reported of the effect of sex, age, cubic capacity, and training on the rate of reported injury accidents in a cohort of 304 first time learner motorcycle riders resident in the Lothian and Borders of Scotland in 1983. Motorcycle in this paper includes all types of registerable two wheeled motor vehicle. Injury accidents as reported by the police were observed in this cohort over an average period of one year. The overall reported injury accident rate within the cohort was 8.2 per hundred riders. This rate does not seem to be markedly different to the Scottish rate for all riders. It was found that the cubic capacity of the motorcycle was the single most important risk factor of the four studied. The risk was disproportionately high in the 200+ cc category. Lower reported injury accident rates were observed for females and trained riders but these differences did not reach statistical significance mainly due to the low numbers of these two categories within the cohort. Contrary to popular assumption, younger riders within this cohort did not have higher injury accidents. A large proportion of the riders who had been involved in injury accidents within the cohort and who had registered 50 cc motorcycles were found to be riding higher capacity (mainly 200+ cc) motorcycles at the time of accident. There was a very low uptake of motorcycle training (7.3%) by the cohort. Approximately 15% of the cohort was female, a higher percentage than those reported by other studies.     

The visual search patterns and hazard responses of experienced and inexperienced motorcycle riders

Hazard perception is a critical skill for road users. In this study, an open-loop motorcycle simulator was used to examine the effects of motorcycle riding and car driving experience on hazard perception and visual scanning patterns. Three groups of participants were tested: experienced motorcycle riders who were experienced drivers (EM-ED), inexperienced riders/experienced drivers (IM-ED), and inexperienced riders/inexperienced drivers (IM-ID). Participants were asked to search for hazards in simulated scenarios, and click a response button when a hazard was identified. The results revealed a significant monotonic decrease in hazard response times as experience increased from IM-ID to IM-ED to EM-ED. Compared to the IM-ID group, both the EM-ED and IM-ED groups exhibited more flexible visual scanning patterns that were sensitive to the presence of hazards. These results point to the potential benefit of training hazard perception and visual scanning in motorcycle riders, as has been successfully demonstrated in previous studies with car drivers.     

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.     

Modeling motorcycle helmet use in Iowa: Evidence from six roadside observational surveys

This paper investigates the influence of type of roadway, weather conditions and other factors on motorcycle helmet use rates in Iowa. Using data from six statewide roadside observational surveys of motorcycle helmet use, a bivariate probit model is estimated. The applied methodological approach allows for potentially interrelated choices of motorcycle helmet use by drivers and passengers to be examined. The estimation results can enhance our understanding of other factors than state helmet laws which correlate with motorcycle rider helmet use, and the effect that the presence of a passenger has on motorcycle driver helmet use rates.     

Motorcycle helmet type and the risk of head injury and neck injury during motorcycle collisions in California

The use of novelty motorcycle helmets is often prompted by beliefs that wearing a standard helmet can contribute to neck injury during traffic collisions. The goal of this analysis was to examine the association between helmet type and neck injury risk and the association between helmet type and head injury. Data were collected during the investigation of motorcycle collisions of any injury severity by the California Highway Patrol (CHP) and 83 local law enforcement agencies in California between June 2012 and July 2013. We estimated head injury and neck injury risk ratios from data on 7051 collision-involved motorcyclists using log-binomial regression. Helmet type was strongly associated with head injury occurrence but was not associated with the occurrence of neck injury. Rider age, rider alcohol use, and motorcycle speed were strong, positive predictors of both head and neck injury. Interventions to improve motorcycle helmet choice and to counteract misplaced concerns surrounding neck injury risk are likely to lead to reductions in head injury, brain injury, and death.     

Novice riders and the predictors of riding without motorcycle protective clothing

Background

While helmet usage is often mandated, few motorcycle and scooter riders make full use of protection for the rest of the body. Little is known about the factors associated with riders’ usage or non-usage of protective clothing.

Methods

Novice riders were surveyed prior to their provisional licence test in NSW, Australia. Questions related to usage and beliefs about protective clothing, riding experience and exposure, risk taking and demographic details. Multivariable Poisson regression models were used to identify factors associated with two measures of usage, comparing those who sometimes vs rarely/never rode unprotected and who usually wore non-motorcycle pants vs motorcycle pants.

Results

Ninety-four percent of eligible riders participated and usable data was obtained from 66% (n = 776). Factors significantly associated with riding unprotected were: youth (17–25 years) (RR = 2.00, 95% CI: 1.50–2.65), not seeking protective clothing information (RR = 1.29, 95% CI = 1.07–1.56), non-usage in hot weather (RR = 3.01, 95% CI: 2.38–3.82), awareness of social pressure to wear more protection (RR = 1.48, 95% CI: 1.12–1.95), scepticism about protective benefits (RR = 2.00, 95% CI: 1.22–3.28) and riding a scooter vs any type of motorcycle. A similar cluster of factors including youth (RR = 1.17, 95% CI: 1.04–1.32), social pressure (RR = 1.32, 95% CI: 1.16–1.50), hot weather (RR = 1.30, 95% CI: 1.19–1.41) and scooter vs motorcycles were also associated with wearing non-motorcycle pants. There was no evidence of an association between use of protective clothing and other indicators of risk taking behaviour.

Conclusions

Factors strongly associated with non-use of protective clothing include not having sought information about protective clothing and not believing in its injury reduction value. Interventions to increase use may therefore need to focus on development of credible information sources about crash risk and the benefits of protective clothing. Further work is required to develop motorcycle protective clothing suitable for hot climates.     

Fatal motorcycle accidents and helmet laws in Peninsular Malaysia

The objectives of this research are to determine the effect of helmet laws on fatalities associated with motor cycle accidents in Peninsular Malaysia. The prevalence of accidents and deaths occurring in the 10 groups of states of the Peninsula between 1973 and 1979 is analyzed. Differences in rates, especially the deaths/accidents, from before to after the introduction of the helmet law are emphasized. The rates accidents/1000 registrations and deaths/10,000 registrations decreased in almost all of the states after the law was introduced. There was not a uniform reduction in the rate of deaths/100 accidents after introduction of the law in individual states. However, a weighted linear regression shows that the effect of the introduction of the helmet law on deaths/accidents was significant. An odds ratio of 0.70 is the estimated risk of deaths associated with motorcycle accident after introduction of the helmet law compared with no helmet law. The 30 per cent estimated reduction in fatalities in Malaysia is similar in magnitude to that reported in the U.S.A. It is estimated that in 1979 the number of fatalities in Peninsular Malaysia was about 140 lower than could be expected without the helmet law.     

FEA of oblique impact tests on a motorcycle helmet

In accidents, motorcycle riders full-face helmets often make oblique impacts with road surfaces. Finite element analysis was used to predict the rotational and linear acceleration of a Hybrid II headform, representing a motorcyclist's head, in such impacts, considering the effects of friction at the head/helmet and helmet/road interfaces. Simulations of the oblique impact test in British Standard BS 6658 were validated by comparison with published data. This showed that COST 327 experimental data was largely determined by the friction coefficient (0.55) between the helmet shell and abrasive paper, and hardly affected by that between the head and helmet. Slip was predicted at the shell/paper interface throughout the impact, due to the high angular inertia of the helmet, and the normal force remaining below 3.5 kN. Simulations of more severe motorcycle helmet impacts explored the effects of impact site and direction, impact velocity components, helmet fit and the scalp. In these impacts, the higher velocity component normal to the road caused high frictional forces on the helmet shell, eventually causing it to roll on the road. The peak headform rotational accelerations, at some impact sites, were potentially injurious. The most effective method of reducing head rotational acceleration could be a reduction in the linear acceleration limit of the helmet standards.     

Trends in head injuries associated with mandatory bicycle helmet legislation targeting children and adolescents

Background

Bicycling related head injuries (HIs) can be severe. Helmet use reduces head injury risk; however, there are few controlled studies of the effect of helmet legislation. We conducted this study to investigate changes in HIs after bicycle helmet legislation targeting those <18 in Alberta, Canada in 2002.

Methods

Bicyclist and pedestrian (control) HI rates and HIs as a proportion of all injuries were compared for the three years (1999–2001) before and four years (2003–2006) after bicycle helmet legislation in three age groups (children: <13, adolescents: 13–17, and adults: 18+).

Results

There were 41,270 ED visits and 2782 hospitalizations for bicyclists and 9836 ED visits and 2029 hospitalizations for pedestrians (excluding the legislation year 2002). The rate of ED HIs declined for child bicyclists and child pedestrians, while the rate of non-HIs declined in adult bicyclists and child pedestrians. The rate of hospitalized HIs declined in child bicyclists and all ages of pedestrians while non-HI rates declined for child and adult pedestrians. Non-HI rates for adolescent and adult bicyclists increased. After adjusting for sex and location, the proportion of ED bicycle HIs declined by 9% (APR = 0.91; 95% CI: 0.86, 0.95) in children, was unchanged among adolescents and increased in adults (APR = 1.08; 95% CI: 1.01, 1.15). The proportion of bicycle HI related hospitalizations decreased by 30% (APR = 0.70; 95% CI: 0.55, 0.90) in children, 36% (APR = 0.64; 95% CI: 0.49, 0.84) in adolescents and 24% (APR = 0.76; 95% CI: 0.63, 0.91) in adults. There were no observed changes in the proportion of pedestrian HIs resulting in ED visits or hospitalizations.

Interpretation

Our data indicate significant declines in the proportion of child bicyclist ED HIs and child, adolescent and adult bicyclist HI hospitalizations. This is in contrast to no significant trends in the proportion of ED or hospitalized HIs among pedestrians and the unexpected increases in the proportion of ED HIs for adult bicyclists. Comparing bicyclist and pedestrian trends in the proportion of child and adolescent HIs suggests a bicycle helmet legislation effect.     

The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia

The study aimed to assess the effect of compulsory cycle helmet legislation on cyclist head injuries given the ongoing debate in Australia as to the efficacy of this measure at a population level. We used hospital admissions data from New South Wales, Australia, from a 36 month period centred at the time legislation came into effect. Negative binomial regression of hospital admission counts of head and limb injuries to cyclists were performed to identify differential changes in head and limb injury rates at the time of legislation. Interaction terms were included to allow different trends between injury types and pre- and post-law time periods. To avoid the issue of lack of cyclist exposure data, we assumed equal exposures between head and limb injuries which allowed an arbitrary proxy exposure to be used in the model. As a comparison, analyses were also performed for pedestrian data to identify which of the observed effects were specific to cyclists. In general, the models identified a decreasing trend in injury rates prior to legislation, an increasing trend thereafter and a drop in rates at the time legislation was enacted, all of which were thought to represent background effects in transport safety. Head injury rates decreased significantly more than limb injury rates at the time of legislation among cyclists but not among pedestrians. This additional benefit was attributed to compulsory helmet legislation. Despite numerous data limitations, we identified evidence of a positive effect of compulsory cycle helmet legislation on cyclist head injuries at a population level such that repealing the law cannot be justified.     

A comparison of the hazard perception ability of accident-involved and accident-free motorcycle riders

Hazard perception is the ability to read the road and is closely related to involvement in traffic accidents. It consists of both cognitive and behavioral components. Within the cognitive component, visual attention is an important function of driving whereas driving behavior, which represents the behavioral component, can affect the hazard perception of the driver. Motorcycle riders are the most vulnerable types of road user. The primary purpose of this study was to deepen our understanding of the correlation of different subtypes of visual attention and driving violation behaviors and their effect on hazard perception between accident-free and accident-involved motorcycle riders. Sixty-three accident-free and 46 accident-involved motorcycle riders undertook four neuropsychological tests of attention (Digit Vigilance Test, Color Trails Test-1, Color Trails Test-2, and Symbol Digit Modalities Test), filled out the Chinese Motorcycle Rider Driving Violation (CMRDV) Questionnaire, and viewed a road-user-based hazard situation with an eye-tracking system to record the response latencies to potentially dangerous traffic situations. The results showed that both the divided and selective attention of accident-involved motorcycle riders were significantly inferior to those of accident-free motorcycle riders, and that accident-involved riders exhibited significantly higher driving violation behaviors and took longer to identify hazardous situations compared to their accident-free counterparts. However, the results of the regression analysis showed that aggressive driving violation CMRDV score significantly predicted hazard perception and accident involvement of motorcycle riders. Given that all participants were mature and experienced motorcycle riders, the most plausible explanation for the differences between them is their driving style (influenced by an undesirable driving attitude), rather than skill deficits per se. The present study points to the importance of conceptualizing the influence of different driving behaviors so as to enrich our understanding of the role of human factors in road accidents and consequently develop effective countermeasures to prevent traffic accidents involving motorcycles.     

Alcohol consumption,helmet use and head trauma in cycling collisions in Germany

Cycling, being easy, inexpensive and healthy, is becoming one of the most popular means of transport. Cyclists, however, are among the most vulnerable road users in traffic collisions.     

The frequency and predictors of helmet use among Iranian motorcyclists: A quantitative and qualitative study

Objective

This study examines the rate of helmet use and identifies barriers and facilitators of wearing helmets among Iranian motorcyclists. A mixed-method approach was used, including a structured seasonal survey with specific observations of a random sample of 6010 riders and qualitative methods that included 29 in-depth interviews and seven focus groups (n = 31).

Results

Only 10% of motorcyclists wear a standard helmet while riding. However, another 23% of motorcyclists used non-standard or partial helmets that covered only part of the head and do not prevent head trauma injuries effectively. We observed only 2 of 264 child passengers and 22 of 1951 adult passengers wearing helmets. Almost no one used protective pants or clothing made to be more visible in traffic. Themes emerged from qualitative interviews and were grouped into three main categories: (1) helmet characteristics; (2) social and cultural factors; and (3) personal and psychological factors.

Conclusion

Overall, the motorcyclists in our study believed that wearing a safety helmet protects them against serious injuries or death during a crash; however, only a small percentage of the motorcyclists used safety helmets. National intervention programs addressing motorcycle safety should aim to overcome barriers to and promote facilitators of helmet use, including providing inexpensive standard helmets, banning manufacturing/using unsafe partial or dummy helmets, as well as enforcing helmet use on a consistent basis.     

The impact of compulsory helmet legislation on cyclist head injuries in New South Wales,Australia: A response

This article responds to criticisms made in a rejoinder (Accident Analysis and Prevention 2012, 45: 107–109) questioning the validity of a study on the impact of mandatory helmet legislation (MHL) for cyclists in New South Wales, Australia. We systematically address the criticisms through clarification of our methods, extension of the original analysis and discussion of new evidence on the population-level effects of MHL. Extensions of our analysis confirm the original conclusions that MHL had a beneficial effect on head injury rates over and above background trends and changes in cycling participation. The ongoing debate around MHL draws attention away from important ways in which both safety and participation can be improved through investment in well-connected cycling infrastructure, fostering consideration between road users, and adequate legal protection for vulnerable road users. These are the essential elements for providing a cycling environment that encourages participation, with all its health, economic and environmental benefits, while maximising safety.