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.     

A critical examination of arguments against bicycle helmet use and legislation

In a recent paper published in Accident Analysis & Prevention, Curnow puts forward a number of arguments against legislating bike helmet use [Curnow, W.J., 2005 The Cochrane Collaboration and bicycle helmets. Accid. Anal. Prevent. 37(3), 569-573]. He begins by criticizing the scientific evidence that helmets protect against head and brain injuries. The crux of his argument is that in theory helmets should not protect all mechanisms of brain injury and, therefore, all epidemiological research showing they are beneficial in a variety of circumstances is invalid. This short communication identifies some of the questionable elements in Curnow's assertions.     

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.     

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

This paper challenges the conclusion of a recent paper by Walter et al. (Accident Analysis and Prevention 2011, doi:10.1016/j.aap.2011.05.029) reporting that despite numerous data limitations repealing the helmet legislation in Australia could not be justified. This conclusion is not warranted because of the limited time period used in their analysis and the lack of data beyond a few years before the introduction of legislation, the failure to adequately account for the effect of the phasing in of the legislation, the effect of the marked reduction in child cyclists, and the non-comparability of the pedestrian and cycling injuries and related lack of consideration of the severity of head injuries. The extent to which helmet legislation deters people from cycling is discussed.     

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.     

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.     

Evaluation of motorcycle safety strategies using the severity of injuries

The growth of motorcycle fatalities in California has been especially prominent, specifically with regard to the 24 and under age group and those aged 45–54. This research quantitatively examined factors associated with motorcyclist fatalities and assessed strategies that could improve motorcyclist safety, specifically focusing on the two age groups mentioned above. Severity of injury was estimated separately for both age groups with multinomial logit models and pseudo-elasticity using motorcycle-related collision data that was collected between 2005 and 2009. The results were compared with motorcyclists aged 35–44, a group that shows a consistent trend of fatalities.     

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.     

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.     

Incidence and costs of bicycle-related traumatic brain injuries in the Netherlands

The main cause of death and serious disability in bicycle accidents is traumatic brain injury (TBI). The aim of this population-based study was to assess the incidence and costs of bicycle-related TBI across various age groups, and in comparison to all bicycle-related injuries, to identify main risk groups for the development of preventive strategies.Data from the National Injury Surveillance System and National Medical Registration were used for all patients with bicycle-related injuries and TBI who visited a Dutch emergency department (ED) between 1998 and 2012. Demographics and national, weighted estimates of injury mechanism, injury severity and costs were analysed per age group. Direct healthcare costs and indirect costs were determined using the incidence-based Dutch Burden of Injury Model.Between 1998 and 2012, the incidence of ED treatments due to bicycle-related TBI strongly increased with 54%, to 43 per 100,000 persons in 2012. However, the incidence of all bicycle-related injuries remained stable, from 444 in 1998 to 456/100,000 in 2012. Incidence of hospital admission increased in both TBI (92%) and all injuries from cycling (71%). Highest increase in incidence of both ED treatments and hospital admissions was seen in adults aged 55+. The injury rate of TBI per kilometre travelled increased (44%) except in children, but decreased (−4%) for all injuries, showing a strong decrease in children (−36%) but an increase in men aged 25+, and women aged 15+. Total costs of bicycle-related TBI were €74.5 million annually. Although bicycle-related TBI accounted for 9% of the incidence of all ED treatments due to cycling, it accounted for 18% of the total costs due to all bicycle-related injuries (€410.7 million). Children and adolescents (aged 0–24) had highest incidence of ED treatments due to bicycle-related injuries. Men in the working population (aged 15–64) had highest indirect costs following injuries from cycling, including TBI. Older cyclists (aged 55+) were identified as main risk group for TBI, as they had highest ED attendance, injury rate, injury severity, admission to hospital or intensive care unit, and costs.Incidence of ED treatments due to cycling are high and often involve TBI, imposing a high burden on individuals and society. Older cyclists aged 55+ were identified as main risk group for TBI to be targeted in preventive strategies, due to their high risk for (serious) injuries and ever-increasing share of ED visits and hospital admissions.     

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

Objectives

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

Materials and methods

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

Results

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

Analysis of driver injury severity in rural single-vehicle crashes

Rural roads carry less than fifty percent of the traffic in the United States. However, more than half of the traffic accident fatalities occurred on rural roads. This research focuses on analyzing injury severities involving single-vehicle crashes on rural roads, utilizing a latent class logit (LCL) model. Similar to multinomial logit (MNL) models, the LCL model has the advantage of not restricting the coefficients of each explanatory variable in different severity functions to be the same, making it possible to identify the impacts of the same explanatory variable on different injury outcomes. In addition, its unique model structure allows the LCL model to better address issues pertinent to the independence from irrelevant alternatives (IIA) property. A MNL model is also included as the benchmark simply because of its popularity in injury severity modeling. The model fitting results of the MNL and LCL models are presented and discussed. Key injury severity impact factors are identified for rural single-vehicle crashes. Also, a comparison of the model fitting, analysis marginal effects, and prediction performance of the MNL and LCL models are conducted, suggesting that the LCL model may be another viable modeling alternative for crash-severity analysis.     

A multinomial logit model-Bayesian network hybrid approach for driver injury severity analyses in rear-end crashes

Rear-end crash is one of the most common types of traffic crashes in the U.S. A good understanding of its characteristics and contributing factors is of practical importance. Previously, both multinomial Logit models and Bayesian network methods have been used in crash modeling and analysis, respectively, although each of them has its own application restrictions and limitations. In this study, a hybrid approach is developed to combine multinomial logit models and Bayesian network methods for comprehensively analyzing driver injury severities in rear-end crashes based on state-wide crash data collected in New Mexico from 2010 to 2011. A multinomial logit model is developed to investigate and identify significant contributing factors for rear-end crash driver injury severities classified into three categories: no injury, injury, and fatality. Then, the identified significant factors are utilized to establish a Bayesian network to explicitly formulate statistical associations between injury severity outcomes and explanatory attributes, including driver behavior, demographic features, vehicle factors, geometric and environmental characteristics, etc. The test results demonstrate that the proposed hybrid approach performs reasonably well. The Bayesian network reference analyses indicate that the factors including truck-involvement, inferior lighting conditions, windy weather conditions, the number of vehicles involved, etc. could significantly increase driver injury severities in rear-end crashes. The developed methodology and estimation results provide insights for developing effective countermeasures to reduce rear-end crash injury severities and improve traffic system safety performance.     

Cyclist safety on bicycle boulevards and parallel arterial routes in Berkeley,California

This study compares the safety of bicyclists riding on bicycle boulevards to those riding on parallel arterial routes in Berkeley, California. Literature on the impact of motor vehicle traffic characteristics on cyclist safety shows that high motor vehicle speeds and volumes and the presence of heavy vehicles are all detrimental to cyclist safety. This suggests that cyclists may be safer on side streets than on busy arterials. Bicycle boulevards—traffic-calmed side streets signed and improved for cyclist use—purport to offer cyclists a safer alternative to riding on arterials. Police-reported bicycle collision data and manually collected cyclist count data from bicycle boulevards and parallel arterial routes in Berkeley, California from 2003 to 2010 are used to test the hypothesis that Berkeley's bicycle boulevards have lower cyclist collision rates and a lower proportion of bicycle collisions resulting in severe injury. While no significant difference is found in the proportion of collisions that are severe, results show that collision rates on Berkeley's bicycle boulevards are two to eight times lower than those on parallel, adjacent arterial routes. The difference in collision rate is highly statistically significant, unlikely to be caused by any bias in the collision and count data, and cannot be easily explained away by self-selection or safety in numbers. Though the used dataset is limited and the study design is correlational, this study provides some evidence that Berkeley's bicycle boulevards are safer for cyclists than its parallel arterial routes. The results may be suggestive that, more generally, properly implemented bicycle boulevards can provide cyclists with a safer alternative to riding on arterials.     

A multinomial logit analysis of risk factors influencing road traffic injury severities in the Erzurum and Kars Provinces of Turkey

A retrospective cross-sectional study is conducted analysing 11,771 traffic accidents reported by the police between January 2008 and December 2013 which are classified into three injury severity categories: fatal, injury, and no injury. Based on this classification, a multinomial logit analysis is performed to determine the risk factors affecting the severity of traffic injuries. The estimation results reveal that the following factors increase the probability of fatal injuries: drivers over the age of 65; primary-educated drivers; single-vehicle accidents; accidents occurring on state routes, highways or provincial roads; and the presence of pedestrian crosswalks. The results also indicate that accidents involving cars or private vehicles or those occurring during the evening peak, under clear weather conditions, on local city streets or in the presence of traffic lights decrease the probability of fatal injuries. This study comprises the most comprehensive database ever created for a Turkish sample. This study is also the first attempt to use an unordered response model to determine risk factors influencing the severity of traffic injuries in Turkey.     

A conceptual framework for road safety and mobility applied to cycling safety

Scientific literature lacks a model which combines exposure to risk, risk, and the relationship between them. This paper presents a conceptual road safety framework comprising mutually interacting factors for exposure to risk resulting from travel behaviour (volumes, modal split, and distribution of traffic over time and space) and for risk (crash and injury risk). The framework's three determinants for travel behaviour are locations of activities; resistances (generalized transport costs); needs, opportunities, and abilities. Crash and injury risks are modelled by the three ‘safety pillars’: infrastructure, road users and the vehicles they use. Creating a link in the framework between risk and exposure is important because of the ‘non-linear relationship’ between them, i.e. risk tends to decrease as exposure increases. Furthermore, ‘perceived’ risk (a type of travel resistance) plays a role in mode choice, i.e. the perception that a certain type of vehicle is unsafe can be a deterrent to its use. This paper uses theories to explain how the elements in the model interact. Cycling is an area where governments typically have goals for both mobility and safety. To exemplify application of the model, the paper uses the framework to link research on cycling (safety) to land use and infrastructure. The model's value lies in its ability to identify potential consequences of measures and policies for both exposure and risk. This is important from a scientific perspective and for policy makers who often have objectives for both mobility and safety.     

Investigating the impact of economic,political, and social factors on augmented reality technology acceptance in agriculture (livestock farming) sector in a developing country

The discussion of factors affecting the acceptance of new technologies in developing countries is very important. The lack of modern technology uses in developing countries, especially in the agricultural (livestock farming) sector, leads to negative effects on the quality and quantity of products and the country loses its ability to compete in the international arena. The main purpose of this study is to investigate the factors affecting on Augmented Reality (AR) technology acceptance in the agricultural (livestock) sector of Iran. In this study, using Meta method, effective factor codes were extracted from AR. The SWARA method was used to weigh the factors affecting the dependent variable based on the opinion of experts. The dependent variable is a qualitative variable that is classified into five levels based on the opinion of experts. We used the multinomial logit model due to the dependent variable is a qualitative variable and has more than two categories. The results showed that, the variables of public participation, and education have a significant effect to accept augmented reality technology at all levels among farmers. The policy recommendations of this research are that councils can play an important role in raising the level of public participation and conveying the demands of the people to the government. To do this, they must receive the necessary training in order to attract public participation. This is possible through training workshops to increase the level of farmers’ awareness.     

Individual and occupational factors related to fatal occupational injuries: a case-control study

This study has been designed in order to identify factors increasing the risk of a fatal outcome when occupational accidents occur. The aim is to provide further evidence for the design and implementation of preventive measures in occupational settings. The Spanish Ministry of Labour registry of occupational injuries causing absence from work includes information on individual and occupational characteristics of injured workers and events. Registered fatal occupational injuries in 2001 (n = 539) were compared to a sample of non-fatal injuries in the same year (n = 3493). Risks for a fatal result of occupational injuries, adjusted by individual and occupational factors significantly associated, were obtained through logistic regression models. Compared to non-fatal injuries, fatal occupational injuries were mostly produced by trapping or by natural causes, mostly related to elevation and transport devices and power generators, and injured parts of body more frequently affected were head, multiple parts or internal organs. Adjusted analyses showed increased risk of fatality after an occupational injury for males (adjusted odds ratio aOR = 10.92; 95%CI 4.80–24.84) and temporary workers (aOR = 5.18; 95%CI 2.63–10.18), and the risk increased with age and with advancing hour of the work shift (p for trends <0.01). Injuries taking place out of the usual occupational setting (aOR = 2.85, 95%CI 2.27–3.59), or carrying out atypical tasks (aOR = 2.08; 95%CI 1.27–3.39) showed increased risks of a fatal result too, as occupational accidents in agricultural or construction companies. These data can help to select and define priorities for programmes aimed to prevent fatal consequences of occupational injuries.     

Association between setting quantified road safety targets and road fatality reduction

Since the 1980s, many countries have set quantified road safety targets as part of their comprehensive road safety strategies. This paper studies the association between the setting of quantified road safety targets and road fatality reduction over the past two decades. Both aggregate and disaggregate levels of hypothesis tests are performed on data from 14 countries that set road safety targets during the period 1981-1999. A before-and-after analysis of the treatment and comparison groups is conducted, and the results show that the majority of countries with quantified road safety targets experienced a reduction in road fatalities in this period. Overall, the establishment of quantified road safety targets is found to have an appreciable association with an improvement in road safety.     

An update on the association between setting quantified road safety targets and road fatality reduction

This note is intended to rectify estimates provided in a previous paper (Wong et al., 2006) of the short-term effectiveness in terms of road fatality reduction of the setting of quantified road safety targets using data from 14 OECD countries during the period 1980–1999. This work is important in measuring the association between target setting and road safety improvement, because such targets are intended to serve as a useful tool to motivate timely road safety measures by the road authorities and others. The estimates to be rectified were based on before-and-after analysis using a comparison group of countries for each country that had set a target. This note first provides a correction to the qualification test for the inclusion of a country in any particular comparison group. It then presents the numerical effects of this correction on the estimates of the effectiveness of setting quantified road safety targets, both in individual countries and across the whole group of countries that set targets in the relevant period. Finally, impacts on the findings of the previous paper are discussed, with the conclusion that the changes in those of the numerical estimates that are affected do not alter the main message of the paper.