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.     

An observational study of secondary task engagement while driving on urban streets in Iranian Safe Communities

In Iran the prevalence of traffic injuries and death from vehicle collisions are high. Driver engagement in non-driving-related tasks has been previously identified as an important contributing factor to crashes. Therefore, the objective of the present study was to investigate the prevalence of drivers’ engagement in potentially distracting activities in Kashmar, Khalilabad and Bardaskan, which are three Iranian International Safe Communities. Observations took place at 12 randomly selected roadside locations in each city, which were comprised of six main streets and six side streets. In total 7979 drivers were observed. The prevalence rates of potentially distracting activities in Kashmar, Khalilabad and Bardaskan were 24.3%, 26% and 24.9%, respectively. In both Kashmar and Khalilabad the most frequently observed secondary tasks were drivers talking to passengers (10.6% and 11.5%, respectively) followed by mobile phone use (3.4% and 4.0%, respectively). Although in Bardaskan the most commonly observed secondary task was also talking to passengers (12.7%), the second most common was reaching for an object (3.2%). In all three cities younger drivers were significantly more likely to be observed engaged in a secondary task while driving. Furthermore, involvement in secondary tasks while driving was significantly higher amongst females and those driving on a working day. The percentage of drivers identified as potentially distracted in these three Safe Communities was worryingly high. Thus, interventions should be integrated into the WHO Safe Community network in these cities, including: education regarding the risks associated with engaging in secondary activities while driving, law enforcement, tougher legislation, periodic assessment, raising public awareness, as well as attracting political and social support.     

Patterns of safety belt usage following introduction of a safety belt wearing law

The paper reviews the process of enacting a safety belt wearing law in Israel, and studies the impact it has had on belt usage and on casualty reductions. Safety belt legislation in Israel had several unique features in that, on the one hand, all passenger vehicles were retrofitted with safety belts, but, on the other hand, it exempted drivers and front-seat passengers of pre-1969 model vehicles from the compulsory use of belts. Also, the legislation applied only to the use of belts on interurban roads. Repeated counts of safety belt usage, before and after the implementation of the law, provided strong evidence for the efficacy of the legislative act as such. Usage rates rose from an average of 6% to upward of 70%. There was a marked carryover effect of the law on belt wearing rates on urban roads and on the use by drivers of pre-1969 model cars. However, this effect diminished with time. Results of a questionnaire survey provided further evidence for the general acceptance of the law by the public. Only a small minority of drivers completely rejected the use of safety belts. A comparison with data from other countries shows that the impact of a compulsory safety belt wearing law on safety belt usage and on casualty reduction is a universal phenomenon. This fact should encourage researchers, legislators and adminstrators in jurisdictions which are still deliberating the value of mandatory safety belt legislation. On the basis of the trends in fatalities and casualties to car drivers and passengers on urban roads during the two and one-half year period following the introduction of the seat belt law, it is estimated that a reduction of 42% in car fatalities and 44% in car passengers occurred on interurban roads during those two and one-half years. The corresponding reductions in casualties were 18% and eight percent respectively.     

Factors related to seatbelt-wearing among rear-seat passengers in Malaysia

The benefit of wearing a rear seatbelt in reducing the risk of motor vehicle crash-related fatalities and injuries has been well documented in previous studies. Wearing a seatbelt not only reduces the risk of injury to rear-seat passengers, but also reduces the risk of injury to front-seat occupant who could be crushed by unbelted rear-seat passengers in a motor vehicle crash. Despite the benefits of wearing a rear seatbelt, its rate of use in Malaysia is generally low. The objective of this study was to identify factors that are associated with the wearing of a seatbelt among rear-seat passengers in Malaysia. Multinomial logistic regression analysis of the results of a questionnaire survey of 1651 rear-seat passengers revealed that rear-seat passengers who were younger, male, single and less educated and who had a perception of a low level of legislation enforcement, a lower risk-aversion and less driving experience (only for passengers who are also drivers) were less likely to wear a rear seatbelt. There was also a significant positive correlation between driver seatbelt and rear seatbelt-wearing behaviour. This implies that, in regards to seatbelt-wearing behaviour, drivers are more likely to adopt the same seatbelt-wearing behaviour when travelling as rear-seat passengers as they do when driving. These findings are crucial to the development of new interventions to increase the compliance rate of wearing a rear seatbelt.     

China belting up or down? Seat belt wearing trends in Nanjing and Zhoushan

National seat belt wearing legislation became effective in China May 2004 and associated provincial and city regulations followed. Despite rapid motorisation seat belt studies in China have been scarce. Patterns and trends in urban seat belt wearing were observed for all driver, front and rear seating positions over the years 2005–2007 in two eastern cities Nanjing (Jiangsu Province) and Zhoushan (Zhejiang Province). There were 35,256 vehicles observed in Nanjing, 20,939 in Zhoushan and 95,933 occupants overall. Males dominated all seating positions, especially drivers. Seat belt wearing overall was significantly higher for drivers (49.9% Nanjing, 47.4% Zhoushan) than for front seat passengers (9.1% Nanjing, 1.0% Zhoushan) and virtually nonexistent for rear passengers (0.5% Nanjing, 0.2% Zhoushan). Generally levels declined significantly from year to year (drivers Nanjing 66.7%, 47.7%, 38.6%; Zhoushan 57.4%, 57.9%, 30.6%; front passengers Nanjing 19.2%, 6.6%, 3.2%). Zhoushan wearing did not initially decline, 2006 observations coinciding with anticipation of provincial regulations (July 2006). Observations revealed an absence of child restraints. Pretend wearing/belt tampering was observed almost exclusively in taxi drivers (14.2% of Nanjing taxi drivers, 11.3% of Zhoushan’s). Awareness of and attitudes to urban seat belt laws should be investigated, appropriate countermeasures developed and enforcement reassessed.     

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.     

Seatbelt wearing rates in middle income countries: A cross-country analysis

In settings with low seatbelt use prevalence, self-reported seatbelt use estimates often lack validity, and routine observational studies are scarce. In this paper, we aim to describe the prevalence of seatbelt use and associated factors in drivers and front-seat passengers across eight sites in four countries (Egypt, Mexico, Russia, Turkey) using observational studies as well as to produce estimates of country-level and site-level variance. As part of the Bloomberg Philanthropies Global Road Safety Program, data on driver and passenger seatbelt use across four middle-income countries was collected between October 2010 and May 2011 (n = 122,931 vehicles). Logistic regression and Intraclass Correlation Coefficient analyses for sites- and country-level clustering were performed. We found high variability of seatbelt wearing rates ranging from 4 to 72% in drivers and 3–50% in front-seat passengers. Overall, average seatbelt wearing rates were low (under 60% in most sites). At the individual level, older and female drivers were more likely to wear seatbelts, as well as drivers of vehicles transiting at times of increased vehicle flow. We also found that 26–32% and 37–41% of the variance in seatbelt use among drivers and front-seat passengers respectively was explained by differences across sites and countries. Our results demonstrate that there is room for improvement on seatbelt use in middle-income countries and that standardized cross-country studies on road safety risk factors are feasible, providing valuable information for prevention and monitoring activities.     

Effect of the helmet act for motorcyclists in Thailand

OBJECTIVES: This study investigated the effect of the helmet act for motorcyclists on increasing helmet use and reducing motorcycle-related deaths and severe injuries in Thailand. METHODS: Data were derived from a trauma registry at the Khon Kaen Regional Hospital in the northeast Thailand. Helmet use and outcome in motorcycle crashes were compared 2 years before (1994-1995) and after (1996-1997) enforcement of the helmet act. During the study period, there were 12002 injured motorcyclists including 129 death cases in the municipality of Khon Kaen Province who were brought to the regional hospital. RESULTS: After enforcement of the helmet act, helmet-wearers increased five-fold while head injuries decreased by 41.4% and deaths by 20.8%. Those who had head or neck injuries or died were less likely wearing a helmet. Compliance of helmet use was lower at night. Fatality of injured motorcyclists did not significantly decrease in the post-act period and among helmet-wearers. CONCLUSION: Enforcement of the helmet act increased helmet-wearers among motorcyclists but helmet use did not significantly reduce deaths among injured motorcyclists. Motorcyclists should be instructed to properly and consistently wear a helmet for their safety.     

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 evaluation of effects on driver behavior and accidents of concentrated general enforcement on interurban roads in Israel

The study deals with the evaluation of the effects of a new deployment of the National Traffic Police in Israel--a concentrated general enforcement on 700 km of interurban roads, which contain 60% of all rural accidents and about half of the severe accident locations. The enforcement project began in April 1997 and lasted for 1 year, aiming at a 10% reduction of severe accidents on those roads. The evaluation study consisted of three main parts: (a) monitoring of everyday police operations on the project roads; (b) periodic evaluation of the project's influence on drivers' behavior and attitudes; and (c) the evaluation of accident changes within the project area, at the end of the project year. Speed measurements, performed before the police project launch, demonstrated that, depending on road type, up to 85% of drivers violated the rural road speed limits. Two rounds of field observations, before and during the project, took place at 32 sites throughout the project area and comprised eight behavior types: turning performance; signaling while turning; compliance with 'stop' and 'yield' signs; safety belt use by drivers and front-seat passengers, at the intersections; 'keeping to the right' on dual carriageway roads; and 'not-crossing of the white separating line' at single carriageway roads. A comparison revealed a general reduction in violation rates of most behaviors, during-the-project, except for compliance with 'stop' signs and signaling. Concurrently, two rounds of driver surveys were performed which examined the project's influence on the drivers' attitudes towards the police enforcement effectiveness and risk connected with traffic rule violations. An improvement was identified in perceived general level of police activity, during the project, whereas a lower or similar risk of apprehension was attributed by drivers to most specific violations of the traffic rules. Three groups of indices of police activity were estimated monthly during the study: inputs; outputs; and efficiency indices, which characterized the police presence on the project roads, the citations produced and the usage rates of the vehicle fleet and the enforcement tools. Analyzing these indices, two periods in the project performance were determined, and three criteria were proposed to subdivide the project roads into two groups, according to the level of enforcement intensity. Both periods and enforcement levels, as well as geographic zone, were accounted for in the analysis of accident trends on the project roads. For the accident analysis, a statistical model combining the odds ratio and longitudinal methods, was developed and applied to the severe accident counts, all injury accidents and severe casualties. A statistically significant reduction in severe accidents and severe casualties, as opposed to the comparison group, was found on the highly enforced roads in the center of the country. At the same time, since the police project began, an increase in accidents was observed on most interurban roads, including the northern parts of the project area. However, it was noted that in four of the five project road groups the mean value of the odds ratio was much less than one. Thus, although the enforcement project did not attain its full purpose, it seemed to be a deterrent factor for the increasing accident trend that appeared that year on the interurban roads. The findings pointed out that the National Traffic Police did not exhaust its potential in the project's performance and needs more flexible enforcement and deployment tactics.     

Characteristics of belted and unbelted drivers

Drivers who had been observed wearing or not wearing shoulder belts were compared using vehicle registration data, driver records, and telephone interviews. The observations were made on the New York Thruway during a special seat belt publicity and enforcement program, which achieved a 75% overall belt use. The results showed that those drivers who still did not wear a shoulder belt despite New York law and the special Thruway program were more likely to be male, to be driving older vehicles, to have more prior traffic convictions, to have more prior injury crash involvements, and to say they are more likely to take risks than others. Although drivers reported that assessing points against the drivers license for belt law violations could increase belt use, citations for belt use law violations were very rare, and enforcement would probably have to increase before any new penalty could be effective.     

Seat belt use among 13-15 year olds in primary and secondary enforcement law states

CONTEXT: Coverage and enforcement provisions of safety belt use laws vary by state. Most laws cover drivers and passengers age 16 and above. "Primary" enforcement laws allow police to stop and ticket a motorist for a safety belt law violation. With "secondary" enforcement laws, ticketing can only occur in the presence of another traffic infraction. Given the lower rates of restraint use among teen drivers and their passengers, the effect of primary enforcement laws on the restraint use of young teen passengers is of particular interest. OBJECTIVE: To compare restraint use by 13-15 year olds passengers in motor vehicle crashes in states with primary versus secondary enforcement safety belt laws. METHODS: Cross-sectional study of 3953 crashes involving 5372 children, representing 54,226 children aged 13-15 years in 41,198 crashes of insured vehicles in 16 states and Washington, DC between December 1, 1998 and December 31, 2004, with data collected via insurance claims records and a telephone survey. RESULTS: Non-use of restraints by 13-15 year olds was 7.2% (95% CI 4.3-10.1%) greater in secondary enforcement states (10.8%) as compared to states with primary enforcement laws (3.6%). After controlling for driver's age and restraint status and the seating row of the occupant, a 13-15 year olds was over twice as likely to be unrestrained in a secondary enforcement state as compared to a primary enforcement state (adjusted RR=2.2, 95% CI 1.5-3.1). CONCLUSIONS: States considering primary enforcement provisions to their restraint laws should consider the potential benefits these laws may have to all occupants in the vehicle, particularly young adolescents who are nearing driving age.     

Method to evaluate the effect of safety belt use by rear seat passengers on the injury severity of front seat occupants

Although the effectiveness of seat belts for reducing injury to rear seat passengers in traffic accidents has been well documented, the ratio of rear-seat passengers restrained by seatbelts remains lower than that of drivers or passengers in front seats. If passengers in rear seats do not wear seat belts, they may sustain unexpected injury to themselves when involved in accidents, and also endanger front occupants (drivers or front seat passengers). This paper focuses on the tendency of front seat occupants to sustain severer injuries due to forward movement of passengers in rear seats at the moment of frontal collisions, and evaluates the effectiveness of rear passengers' wearing seat belts in reducing injuries of front seat occupants. Since the occurrence of occupant injuries depends considerably on the crash severity, we proposed to use pseudo-delta V in regression analysis to represent velocity change during a collision when analyzing statistical accident data. As the crash severity can be estimated from pseudo-delta V, it becomes possible to make appropriate estimations even when the crash severity differs in data. The binary model derived from the ordered response model was used to evaluate the influence on the injury level based on pseudo-delta V, belted or unbelted status, gender and age. Occupants in cars with a hood in the case of car-to-car frontal collisions were extracted from the statistical data on accidents in Japan. Among 81,817 cars, where at least one passenger was present, a total of 6847 cars in which all passengers sustained injuries and which had at least one rear seat passenger aboard were analyzed. The number of killed or seriously injured drivers is estimated to decrease by around 25% if rear seat occupants come to wear seat belts. Also, the number of killed or seriously injured passengers in front seats is estimated to decrease by 28% if unbelted rear seat occupants come to wear seat belts. Thus, wearing of seat belts by previously unbelted rear seat passengers is considered effective in reducing not only injuries to the rear seat passengers themselves but also injuries to front seat occupants.     

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.     

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.     

Seat belt use among African Americans,Hispanics, and Whites

OBJECTIVES: This study investigated seat belt use among White, Black, and Hispanic drivers, in cities in which standard enforcement of the belt use law is permitted (primary enforcement) and in cities in which a motorist has to be first cited for another offense (secondary enforcement). Socioeconomic and gender differences in belt use were also studied. METHODS: Belt use observations were obtained at gas stations in Boston, Chicago, Houston, and New York City. In short interviews with drivers, information on race/ethnicity and education was obtained. RESULTS: Belt use was higher in primary enforcement cities, among women, and among those with at least a college degree. In primary law cities there were no clear differences in belt use by race/ethnicity; in secondary cities African Americans were less likely than Whites or Hispanics to be belted, among populations both with and without college degrees. This is consistent with data from other studies indicating that African Americans are more sensitive than Whites to the enforcement of primary laws and are more likely to increase belt use when states shift from secondary to primary. There has been no evidence of enforcement bias against African Americans--increases in citations generally have been greater among Whites than African Americans once primary enforcement is implemented. CONCLUSIONS: More widespread application of primary laws--standard throughout the world but in only 17 US states and the District of Columbia--would increase belt use for all drivers, especially African Americans.     

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.     

Cycle helmet effectiveness in New Zealand

Since late 1989, the cycle helmet wearing rate in New Zealand has risen from around 20% for adults and teenagers, and 40% for younger children, to more than 90% in all age groups. Cycle helmet wearing became mandatory under New Zealand law in January 1994. This paper considers the effect of cycle helmet wearing on hospitalised head injuries between 1990 and 1996, using cyclist limb injuries as a measure of exposure to the risk of cycling trauma. Non-motor vehicle crashes were treated separately from those involving a motor vehicle. Non-motor vehicle crashes were further subdivided by age group. Cyclist head injuries decreased with increasing helmet wearing rates for non-motor vehicle crashes in all age groups, and for motor vehicle crashes. For an increase of 5 percentage points in the helmet wearing rate, the corresponding decreases in head injuries in non-motor vehicle accidents were estimated to be 10.2, 5.3 and 3.2% for children of primary school age (5–12 years), secondary school age (13–18 years), and adults respectively. The corresponding decrease in hospitalisations for motor vehicle crashes was 3.6%. All results were significant at the 95% level. The relatively large increase in helmet wearing associated with the passing of a compulsory helmet wearing law in 1994 reduced head injuries by between 24 and 32% in non-motor vehicle crashes, and by 20% in motor vehicle crashes. No increase or decrease in the severity of head injuries for which cyclists were hospitalised over this period could be detected. This may have been due to the small and highly variable number of ‘high severity’ injuries.     

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.     

Observational study of compliance with Queensland bicycle helmet laws

Mandatory bicycle helmet laws have been found to increase helmet wearing rates in Australia and internationally. However, much of the research on factors influencing compliance with the Australian helmet laws is dated or focuses on commuters and city areas only. To address this gap, video recordings of bicycle riders were undertaken at 17 sites across Queensland, Australia, representing a mixture of on- and off-road locations, speed limits and regions. Helmet status was able to be determined for 98% of riders observed. The level of compliance with the laws was very high, with 98.3% of the more than 27,000 riders observed wearing helmets. Riders riding on roads were less compliant than those riding on bicycle paths, but no significant differences were observed between the school-holiday and school-term periods. Among the on-road riders, boys were less compliant than girls and overall children were less compliant than adults. Higher compliance levels were found for group riders, road bike riders, lycra-clad riders, during morning hours, and on 50 km/h or lower speed limit roads. While the overall level of compliance was very high, certain subgroups were identified as a possible focus for interventions to further improve the compliance level, for example children (particularly boys) riding mountain bikes away from groups during the afternoon hours on 60 km/h roads.