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.     

Bicycle helmet efficacy: a meta-analysis

Bicycle helmet efficacy was quantified using a formal meta-analytic approach based on peer-reviewed studies. Only those studies with individual injury and helmet use data were included. Based on studies from several countries published in the period 1987-1998, the summary odds ratio estimate for efficacy is 0.40 (95% confidence interval 0.29, 0.55) for head injury, 0.42 (0.26, 0.67) for brain injury, 0.53 (0.39, 0.73) for facial injury and 0.27 (0.10, 0.71) for fatal injury. This indicates a statistically significant protective effect of helmets. Three studies provided neck injury results that were unfavourable to helmets with a summary estimate of 1.36 (1.00, 1.86), but this result may not be applicable to the lighter helmets currently in use. In conclusion, the evidence is clear that bicycle helmets prevent serious injury and even death. Despite this, the use of helmets is sub-optimal. Helmet use for all riders should be further encouraged to the extent that it is uniformly accepted and analogous to the use of seat belts by motor vehicle occupants.     

Motorcycle protective clothing: protection from injury or just the weather?

Background

Apart from helmets, little is known about the effectiveness of motorcycle protective clothing in reducing injuries in crashes. The study aimed to quantify the association between usage of motorcycle clothing and injury in crashes.

Methods and findings

Cross-sectional analytic study. Crashed motorcyclists (n = 212, 71% of identified eligible cases) were recruited through hospitals and motorcycle repair services. Data was obtained through structured face-to-face interviews. The main outcome was hospitalization and motorcycle crash-related injury. Poisson regression was used to estimate relative risk (RR) and 95% confidence intervals for injury adjusting for potential confounders.

Results

Motorcyclists were significantly less likely to be admitted to hospital if they crashed wearing motorcycle jackets (RR = 0.79, 95% CI: 0.69–0.91), pants (RR = 0.49, 95% CI: 0.25–0.94), or gloves (RR = 0.41, 95% CI: 0.26–0.66). When garments included fitted body armour there was a significantly reduced risk of injury to the upper body (RR = 0.77, 95% CI: 0.66–0.89), hands and wrists (RR = 0.55, 95% CI: 0.38–0.81), legs (RR = 0.60, 95% CI: 0.40–0.90), feet and ankles (RR = 0.54, 95% CI: 0.35–0.83). Non-motorcycle boots were also associated with a reduced risk of injury compared to shoes or joggers (RR = 0.46, 95% CI: 0.28–0.75). No association between use of body armour and risk of fracture injuries was detected. A substantial proportion of motorcycle designed gloves (25.7%), jackets (29.7%) and pants (28.1%) were assessed to have failed due to material damage in the crash.

Conclusions

Motorcycle protective clothing is associated with reduced risk and severity of crash related injury and hospitalization, particularly when fitted with body armour. The proportion of clothing items that failed under crash conditions indicates a need for improved quality control. While mandating usage of protective clothing is not recommended, consideration could be given to providing incentives for usage of protective clothing, such as tax exemptions for safety gear, health insurance premium reductions and rebates.     

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.     

The prevalence of non-standard helmet use and head injuries among motorcycle riders

OBJECTIVES: This study examined the prevalence of non-standard helmet use among motorcycle riders following introduction of a mandatory helmet use law and the prevalence of head injuries among a sample of non-standard helmet users involved in motorcycle crashes. METHODS: Motorcycle rider observations were conducted at 29 statewide locations in the 2 years following the introduction of the mandatory helmet use law in January, 1992. Medical records of motorcyclists who were injured in 1992 for whom a crash report was available and for whom medical care was administered in one of 28 hospitals were reviewed. Chi-squares and analysis of variance were used to describe differences between groups. RESULTS: Prevalence of non-standard helmet use averaged 10.2%, with a range across observation sites from 0 to 48.0%. Non-standard helmet use varied by type of roadway, day of week, and time of day. Injuries to the head were more frequent and of greater severity among those wearing non-standard helmets than both those wearing no helmet and those wearing standard helmets. CONCLUSIONS: Non-standard helmets appear to offer little head protection during a crash. Future study is needed to understand the dynamics leading to head injury when different types of helmets are worn.     

Optimization of the Chin Bar of a Composite-Shell Helmet to Mitigate the Upper Neck Force

The chin bar of motorcycle full-face helmets is the most likely region of the helmet to sustain impacts during accidents, with a large percentage of these impacts leading to basilar skull fracture. Currently, helmet chin bars are designed to mitigate the peak acceleration at the centre of gravity of isolated headforms, as required by standards, but they are not designed to mitigate the neck force, which is probably the cause of basilar skull fracture, a type of head injury that can lead to fatalities. Here we test whether it is possible to increase the protection of helmet chin bars while meeting standard requirements. Fibre-reinforced composite shells are commonly used in helmets due to their lightweight and energy absorption characteristics. We optimize the ply orientation of a chin bar made of fibre-reinforced composite layers for reduction of the neck force in a dummy model using a computational approach. We use the finite element model of a human head/neck surrogate and measure the neck axial force, which has been shown to be correlated with the risk of basilar skull fracture. The results show that by varying the orientation of the chin bar plies, thus keeping the helmet mass constant, the neck axial force can be reduced by approximately 30% while ensuring that the helmet complies with the impact attenuation requirements prescribed in helmet standards.     

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.     

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.     

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.     

Helmet use and motorcycle fatalities in Taiwan

Motorcycle deaths accounted for more than half of total traffic fatalities in Taiwan in 2002. This study uses the police-reported crash data from Taiwan between 1999 and 2001 to estimate the effectiveness of helmets, simultaneously taking into account of sample selection bias. Sample selection arises because helmet usage will affect the probability of death or injury, which in turn influences whether a crash is included in the data. The results show that sample selection does not seriously bias the estimate of helmet effectiveness and helmets reduce the probability of death in a crash by 40%, which is higher than what was previously found. Without helmets, the number of motorcyclists killed in 2001 would have jumped by 51%. The estimated proportion of helmeted motorcyclists has increased from 71 to 78% between 1999 and 2001, suggesting that helmet use is rising after the implementation of mandatory helmet law in 1997. Also, helmets significantly reduce the likelihood of head and neck injuries in a crash by 53%, and lead to a 71% reduction in the probability of death caused by head and neck injuries.     

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.     

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.     

Motorcycle protective clothing: Protection from injury or just the weather?

BackgroundApart from helmets, little is known about the effectiveness of motorcycle protective clothing in reducing injuries in crashes. The study aimed to quantify the association between usage of motorcycle clothing and injury in crashes.Methods and findingsCross-sectional analytic study. Crashed motorcyclists (n = 212, 71% of identified eligible cases) were recruited through hospitals and motorcycle repair services. Data was obtained through structured face-to-face interviews. The main outcome was hospitalization and motorcycle crash-related injury. Poisson regression was used to estimate relative risk (RR) and 95% confidence intervals for injury adjusting for potential confounders.ResultsMotorcyclists were significantly less likely to be admitted to hospital if they crashed wearing motorcycle jackets (RR = 0.79, 95% CI: 0.69–0.91), pants (RR = 0.49, 95% CI: 0.25–0.94), or gloves (RR = 0.41, 95% CI: 0.26–0.66). When garments included fitted body armour there was a significantly reduced risk of injury to the upper body (RR = 0.77, 95% CI: 0.66–0.89), hands and wrists (RR = 0.55, 95% CI: 0.38–0.81), legs (RR = 0.60, 95% CI: 0.40–0.90), feet and ankles (RR = 0.54, 95% CI: 0.35–0.83). Non-motorcycle boots were also associated with a reduced risk of injury compared to shoes or joggers (RR = 0.46, 95% CI: 0.28–0.75). No association between use of body armour and risk of fracture injuries was detected. A substantial proportion of motorcycle designed gloves (25.7%), jackets (29.7%) and pants (28.1%) were assessed to have failed due to material damage in the crash.ConclusionsMotorcycle protective clothing is associated with reduced risk and severity of crash related injury and hospitalization, particularly when fitted with body armour. The proportion of clothing items that failed under crash conditions indicates a need for improved quality control. While mandating usage of protective clothing is not recommended, consideration could be given to providing incentives for usage of protective clothing, such as tax exemptions for safety gear, health insurance premium reductions and rebates.     

The effectiveness of helmets in reducing all-terrain vehicle injuries and deaths

This article examines the effectiveness of helmets in reducing all-terrain vehicle (ATV) related deaths and head injuries, conditional on the occurrence of injury producing accidents. A logit regression model is used to analyze cross-section data on ATV-related fatal and nonfatal injuries, and to determine the factors that are associated with deaths and head injuries. The results suggest that, given an accident resulting in injury or death, helmet use reduces the risk of death by about 42%, and could reduce the likelihood that a given nonfatal injury involves the head by about 64%. Other factors that are associated with the risk of fatality for injury accidents include the use of alcohol or drugs, driving on paved roads, the driver's age and sex, and the vehicle's engine size. A benefit-cost analysis of helmet use is conducted and policy implications are discussed.     

Impact dynamics of metal foam shells for motorcycle helmets: Experiments & numerical modeling

To reduce the weight of motorcycle helmet, metal foam for outer shell in place of conventional thermoplastics was tested. The dynamic behaviour of this new helmet was studied through experiments and numerical modeling. Open-face motorcycle helmets were designed with metal foam shell and impact experiments were performed with these helmets fitted on a headform. A finite element model was developed and the predicted acceleration of headform from this model was validated against the experiments. The mechanical behaviour of full-face helmets with metal foam shell was investigated next. The FE analysis was performed separately with rigid and deformable heads. Head injury criterion (with rigid head) and stresses in brain (with deformable head) were evaluated separately for metal foam shell and ABS shell helmets. The helmet impact performance is examined with two separate densities of metal foam. The shell with low-density metal foam (150 kg/m³) gives a better performance compared to ABS shell. The metal foam shell showed significant visible plastic deformation in the impact region.     

Bicycle helmets are highly effective at preventing head injury during head impact: Head-form accelerations and injury criteria for helmeted and unhelmeted impacts

Cycling is a popular form of recreation and method of commuting with clear health benefits. However, cycling is not without risk. In Canada, cycling injuries are more common than in any other summer sport; and according to the US National Highway and Traffic Safety Administration, 52,000 cyclists were injured in the US in 2010. Head injuries account for approximately two-thirds of hospital admissions and three-quarters of fatal injuries among injured cyclists. In many jurisdictions and across all age levels, helmets have been adopted to mitigate risk of serious head injuries among cyclists and the majority of epidemiological literature suggests that helmets effectively reduce risk of injury. Critics have raised questions over the actual efficacy of helmets by pointing to weaknesses in existing helmet epidemiology including selection bias and lack of appropriate control for the type of impact sustained by the cyclist and the severity of the head impact. These criticisms demonstrate the difficulty in conducting epidemiology studies that will be regarded as definitive and the need for complementary biomechanical studies where confounding factors can be adequately controlled. In the bicycle helmet context, there is a paucity of biomechanical data comparing helmeted to unhelmeted head impacts and, to our knowledge, there is no data of this type available with contemporary helmets. In this research, our objective was to perform biomechanical testing of paired helmeted and unhelmeted head impacts using a validated anthropomorphic test headform and a range of drop heights between 0.5 m and 3.0 m, while measuring headform acceleration and Head Injury Criterion (HIC). In the 2 m (6.3 m/s) drops, the middle of our drop height range, the helmet reduced peak accelerations from 824 g (unhelmeted) to 181 g (helmeted) and HIC was reduced from 9667 (unhelmeted) to 1250 (helmeted). At realistic impact speeds of 5.4 m/s (1.5 m drop) and 6.3 m/s (2.0 m drop), bicycle helmets changed the probability of severe brain injury from extremely likely (99.9% risk at both 5.4 and 6.3 m/s) to unlikely (9.3% and 30.6% risk at 1.5 m and 2.0 m drops respectively). These biomechanical results for acceleration and HIC, and the corresponding results for reduced risk of severe brain injury show that contemporary bicycle helmets are highly effective at reducing head injury metrics and the risk for severe brain injury in head impacts characteristic of bicycle crashes.     

Investigating population level trends in head injuries amongst child cyclists in the UK

Case control studies suggest that cycle helmets offer their wearers protection from injury in the event of an accident. Nevertheless, encouragement and even compulsion of cycle helmet wearing has been controversial. This paper will re-examine another potential source of evidence for the role of cycle helmets. Administrative datasets are attractive because of their availability, but require careful analysis. The results presented here are obtained from analysing such data with an appropriate form of generalised additive model. Whilst helmet wearing surveys in the UK suggest strongly divergent trends in wearing rates between male and female children, there is little evidence from "Hospital Episode Statistics" to indicate similarly divergent trends in terms of head injury. Conversely, it can be confirmed that head injuries are falling faster among cyclists than pedestrians. Although case control studies suggest cycle helmets are not effective in reducing overall injuries, it is worth noting an increase in the proportion of male child cyclists reported by the police as being killed or seriously injured in road collisions. It might be tempting to use these results to suggest that helmets are not effective in reducing head injury at the population level. Whilst the careful analysis of population level data presented here is clearly important, this paper will discuss the reasons why population and individual level analyses of cycle helmets might be different and consider some of the difficulties in assigning cause and effect with imperfect observational data.     

Bicycle helmet use four years after the introduction of helmet legislation in Alberta, Canada

Background

Bicycle helmets reduce fatal and non-fatal head and face injuries. This study evaluated the effect of mandatory bicycle helmet legislation targeted at those less than 18 years old on helmet use for all ages in Alberta.

Methods

Two comparable studies were conducted two years before and four years after the introduction of helmet legislation in Alberta in 2002. Bicyclists were observed in randomly selected sites in Calgary and Edmonton and eight smaller communities from June to October. Helmet wearing and rider characteristics were recorded by trained observers. Poisson regression adjusting for clustering by site was used to obtain helmet prevalence (HP) and prevalence ratio (PR) (2006 vs. 2000) estimates.

Results

There were 4002 bicyclists observed in 2000 and 5365 in 2006. Overall, HP changed from 75% to 92% among children, 30% to 63% among adolescents and 52% to 55% among adults. Controlling for city, location, companionship, neighborhood age proportion <18, socioeconomic status, and weather conditions, helmet use increased 29% among children (PR = 1.29; 95% CI: 1.20–1.39), over 2-fold among adolescents (PR 2.12; 95% CI: 1.75–2.56), and 14% among adults: (PR = 1.14; CI: 1.02–1.27).

Conclusions

Bicycle helmet legislation was associated with a greater increase in helmet use among the target age group (<18). Though HP increased over 2-fold among adolescents to an estimated 63% in 2006, this percentage was approximately 30% lower than among children <13.     

Angular Impact Mitigation system for bicycle helmets to reduce head acceleration and risk of traumatic brain injury

Angular acceleration of the head is a known cause of traumatic brain injury (TBI), but contemporary bicycle helmets lack dedicated mechanisms to mitigate angular acceleration. A novel Angular Impact Mitigation (AIM) system for bicycle helmets has been developed that employs an elastically suspended aluminum honeycomb liner to absorb linear acceleration in normal impacts as well as angular acceleration in oblique impacts. This study tested bicycle helmets with and without AIM technology to comparatively assess impact mitigation. Normal impact tests were performed to measure linear head acceleration. Oblique impact tests were performed to measure angular head acceleration and neck loading. Furthermore, acceleration histories of oblique impacts were analyzed in a computational head model to predict the resulting risk of TBI in the form of concussion and diffuse axonal injury (DAI). Compared to standard helmets, AIM helmets resulted in a 14% reduction in peak linear acceleration (p < 0.001), a 34% reduction in peak angular acceleration (p < 0.001), and a 22–32% reduction in neck loading (p < 0.001). Computational results predicted that AIM helmets reduced the risk of concussion and DAI by 27% and 44%, respectively. In conclusion, these results demonstrated that AIM technology could effectively improve impact mitigation compared to a contemporary expanded polystyrene-based bicycle helmet, and may enhance prevention of bicycle-related TBI. Further research is required.     

Mandatory helmet legislation and the print media in Viet Nam

With motorcycle ownership high and rising in Viet Nam, and motorcycle riders vulnerable to both fatal and non-fatal injury, the re-introduction of mandatory helmet legislation in 2007 has been a priority for the Vietnamese government. The paper uses a qualitative analysis of web-based versions of the eight most popular newspapers in Viet Nam to track reporting over four phases of the implementation of the legislation, identifying codes and constructing the dominant themes of the media coverage. The study documents the justification and promotion of the legislation, and the mechanisms for preparing for its implementation at a national and local level, developing solutions and encouraging the replication of successful strategies. It records opposition and obstacles to helmet use, and concerns raised around the quality of helmets purchased. In return, the press notes the response of the market in innovative solutions to these problems. With the successful implementation of the legislation, the functions of the print media in promulgating and promoting the legislation, together with the reporting of ongoing resistance to the process, serve to enable a dialogue between the State and population around expressed concerns. In highlighting quality control of helmets as a key issue, the media have identified a potential ongoing role in monitoring the state's initiative in reducing the road toll from traumatic brain injury in motorcyclists.