Improper motorcycle helmet use in provincial areas of a developing country

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

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.     

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.     

Helmet effectiveness in preventing motorcycle driver and passenger fatalities

Helmet effectiveness in preventing fatalities to motorcycle drivers and passengers was determined by applying the double pair comparison method to the Fatal Accident Reporting System (PARS) data for 1975 through 1986. Motorcycles with a driver and a passenger, at least one of whom was killed, were used. In order to reduce as much as possible potentially confounding effects due to the dependence of survivability on sex and age, the analysis is confined to male drivers (there were insufficient female driver data), and to cases in which the driver and passenger age do not differ by more than three years. Motorcycle helmet effectiveness estimates are found to be relatively unaffected by performing the analyses in a number of ways different from that indicated above. It was found that helmets are (28 ± 8)% effective in preventing fatalities to motorcycle riders (the error is one standard error), the effectiveness being similar for male and female passengers, and similar for drivers and passengers. An additional result found was that the fatality risk in the driver seat exceeds that in the passenger seat by (26 ± 2)%. The 28% effectiveness found generates calculated fatality increases from repeal of mandatory helmetwearing laws that are compatible with observed increases.     

Methodological issues in motorcycle injury epidemiology

Motorcycle riders are over 30 times more likely than car occupants to die in a traffic crash. While this fact is well known, specific issues of methodology in epidemiological motorcycle-injury research have been rarely researched. To facilitate more-valid research on motorcycle injuries, this article evaluates the current state of our knowledge on how we measure the population at risk of injury, completeness of case finding and identification, validity of crash/injury data sources, and completeness of information on important exposures such as alcohol consumption, helmet status, crash severity, and crash speeds, as well as problems of existing injury severity scales and statistical analyses for correlated injury data.     

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

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

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

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

A review of risk factors and patterns of motorcycle injuries

Per vehicle mile traveled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving other types of motor vehicles. While lower-extremity injuries most commonly occur in all motorcycle crashes, head injuries are most frequent in fatal crashes. Helmets and helmet use laws have been shown to be effective in reducing head injuries and deaths from motorcycle crashes. Alcohol is the major contributing factor to fatal crashes. Enforcement of legal limits on the blood alcohol concentration is effective in reducing motorcycle deaths, while some alcohol-related interventions such as a minimal legal drinking age, increased alcohol excise taxes, and responsible beverage service specifically for motorcycle riders have not been examined. Other modifiable protective or risk factors comprise inexperience and driver training, conspicuity and daytime headlight laws, motorcycle licensure and ownership, riding speed, and risk-taking behaviors. Features of motorcycle use and potentially effective prevention programs for motorcycle crash injuries in developing countries are discussed. Finally, recommendations for future motorcycle-injury research are made.     

A longitudinal study of risk factors for motorcycle crashes among junior college students in Taiwan

A cohort of 4729 junior college students in an urban and a rural area in Taiwan was followed up for a period of 20 months. Students' characteristics, including riding exposures, as well as human, vehicular, and environmental factors were collected using one initial and three follow-up questionnaires. The Anderson-Gill (AG) multiplicative intensity model was used to determine the risk of a motorcycle crash over time while also allowing for the modeling of multiple events. The average response rate for the four assessments was 92%. The adjusted relative hazard (RH) for students living in the rural as opposed to the urban area for crashes was 1.67 at the beginning of the study but decreased to 0.66 by the end. Past motorcycle crash history, number of riding days, average riding distance, risk-taking level, alcohol consumption, and traffic violations were all significantly associated with an increased risk of being involved in a crash. Conversely, increasing age, riding experience, and automobile licensure were related to a decreased risk of crashing. Furthermore, helmet use was not independently related to the risk of crashing. In conclusion, a high-risk group predisposed to involvement in a motorcycle crash, including both non-injury and injury-related crashes, can be identified using selected risk factors for crash prevention among young riders.     

Using travel socialization and underlying motivations to better understand motorcycle usage in Taiwan

This study introduces self-determination theory (SDT) to refine previous models of vehicle usage motivation. We add travel socialization theory regarding parental influence on vehicle usage to enhance previous structural models describing motorcycle usage behavior. Our newly developed model was empirically verified in a sample of 721 motorcycle users in Taiwan. In addition to instrumental, symbolic, and affective motivations, perceived parental attitudes (PPAs) towards motorcycle riding were found to have a significant effect on individuals’ motorcycle use habits. Additionally, participants who perceived their parents to have more positive attitudes toward motorcycles were found to have more experience being chauffeured on motorcycles by their parents. Based on these results, we suggest means to confront the challenges brought on by the rapid growth of motorcycle usage, especially serious motorcycle traffic accidents. These results improve our understanding motorcycle usage in Taiwan and can be used by transportation professionals who are seeking solutions to the rapid growth of motorcycle usage.     

The effects of daylight and daylight saving time on US pedestrian fatalities and motor vehicle occupant fatalities

This paper analyzes the effects of daylight and daylight saving time (DST) on pedestrian and motor vehicle occupant fatalities in the United States. Multivariate analyses of county level data from the Fatality Analysis Reporting System for 2-week periods in 1998 and 1999 are used. Results show that full year daylight saving time would reduce pedestrian fatalities by 171 per year, or by 13% of all pedestrian fatalities in the 5:00-10.00 a.m. and in the 4:00-9:00 p.m. time periods. Motor vehicle occupant fatalities would be reduced by 195 per year, or 3%, during the same time periods.     

Analysis of fatal motorcycle crashes: crash typing

There were 2074 crashes fatal to a motorcycle driver in the United States during 1992. A computer program was developed to convert Fatal Accident Reporting System (FARS) data for these crashes into standard format English language “crash reports.” The computer generated reports were analyzed and crash type categories were defined. Five defined crash type categories accounted for 1785 (86%) of the 2074 crash events: Ran off-road (41%); ran traffic control (18%); oncoming or head-on (11%); left-turn oncoming (8%); and motorcyclist down (7%). Alcohol and excessive speed were common factors associated with motorcyclist crash involvement. Left turns and failure to yield were common factors associated with the involvement of other motorists. Suggested countermeasures include helmet use and enforcement of speed and impaired driving laws.     

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.     

The relationship between the travelling speed and motorcycle styles in urban settings: A case study in Belgrade

This report examines the difference in the distribution of the speeds of different motorcycle styles and the difference in the distribution of speeds of particular motorcycle styles and cars. The relationship between the speed of motorcycles that possess and those that do not possess vehicle registration plates was also explored. The speed was measured at six different locations on main roads in the city of Belgrade, Serbia. The study confirmed that, on average, motorcyclists drive faster than drivers of cars, but extreme speeding is recorded 2.3 times more often by motorcyclists than by car drivers. In this research, the styles of motorcycles were divided into three different groups according to their average speeds. The first group consists of sport motorcycles, which were faster than the other styles. The second group consists of scooter motorcycles, which were slower. The third group consists of conventional, touring, enduro, and chopper motorcycles with speeds that were statistically not significantly different. According to the differences of the mean speed of motorcyclists who use and do not use vehicle registration plates, the use of the registration plates can be considered a significant indicator of traffic safety. By classifying motorcycles in the three different groups, the issue of “generalizing” motorcyclists as a unique group is avoided and can be taken into consideration for future studies of motorcyclist safety.     

Temporal distribution of motorcyclist injuries and risk of fatalities in relation to age, helmet use, and riding while intoxicated in Khon Kaen, Thailand

This study investigated the temporal distribution of risky behaviors among injured motorcyclists, that is, riding unhelmeted or while intoxicated, and showed how they are associated with risk of fatal injuries. Data of motorcyclists injured in Khon Kaen municipality in northeastern Thailand and transferred to Khon Kaen Regional Hospital were obtained from the trauma registry system of the hospital. Case fatalities were compared by time of day, age group, helmet use, and alcohol intoxication. Unhelmeted riding peaked late in the evening and riding while intoxicated peaked around midnight. Both were associated with increased fatality risk after stratification by time of day; the odds ratios were 3.49 (95% confidence interval (CI) = 1.48-9.36) and 3.01 (CI = 1.71-5.19), respectively. Nighttime injuries were not significantly associated with increased fatality risk after stratification by helmet use or alcohol intoxication. Unhelmeted driving was prevalent and associated with higher fatality risk among younger drivers, whereas intoxicated driving was less prevalent among teens but associated with increased risk among those aged 20-39 years. This study shows that riding unhelmeted or while intoxicated can explain the increased fatality risk at night, suggesting that safety education or enforcements should be targeted at specific age groups and appropriate times.     

Motorcycle helmet use and the risk of head,neck, and fatal injury: Revisiting the Hurt Study

Most studies find strong evidence that motorcycle helmets protect against injury, but a small number of controversial studies have reported a positive association between helmet use and neck injury. The most commonly cited paper is that of Goldstein (1986). Goldstein obtained and reanalyzed data from the Hurt Study, a prospective, on-scene investigation of 900 motorcycle collisions in the city of Los Angeles. The Goldstein results have been adopted by the anti-helmet community to justify resistance to compulsory motorcycle helmet use on the grounds that helmets may cause neck injuries due to their mass. In the current study, we replicated Goldstein’s models to understand how he obtained his unexpected results, and we then applied modern statistical methods to estimate the association of motorcycle helmet use with head injury, fatal injury, and neck injury among collision-involved motorcyclists. We found Goldstein’s analysis to be critically flawed due to improper data imputation, modeling of extremely sparse data, and misinterpretation of model coefficients. Our new analysis showed that motorcycle helmets were associated with markedly lower risk of head injury (RR 0.40, 95% CI 0.31–0.52) and fatal injury (RR 0.44, 95% CI 0.26–0.74) and with moderately lower but statistically significant risk of neck injury (RR 0.63, 95% CI 0.40–0.99), after controlling for multiple potential confounders.     

The efficacy of safety policies on traffic fatalities in Singapore

This paper uses regression models to investigate the efficacy of the seat belt regulation as well as the circuit training and testing system in reducing traffic related fatalities in Singapore. The effectiveness of alcohol breathalysers was also studied. Results suggest that the seat belt regulation does not have any impact on traffic fatalities. The use of breathalysers was found to be effective in reducing occupant fatalities. The circuit training and testing system, which aims to equip new pools of motorists with appropriate driving or riding skills, was found to be effective in reducing non-occupant fatalities and total fatalities.     

The role of alcohol in Thailand motorcycle crashes

In order to identify motorcycle accident cause factors and countermeasures in Thailand, a large prospective study was undertaken. Researchers conducted on-scene, in-depth investigation and reconstruction of 969 collisions involving 1082 motorcycle riders. Accidents were randomly sampled and included all levels of injury severity. Alcohol proved to be the most outstanding cause factor, with 393 drinking riders in crashes. Alcohol accidents were distinctly different from non-alcohol crashes. Alcohol accidents were more frequent on weekends and particularly at night, usually when the rider was on his way home. Drinking riders were more likely to lose control of the motorcycle, usually by running off the road. They were more likely to be in a single vehicle accident, to violate traffic control signals, and to be in non-intersection collisions. Males were far more likely to drink and ride than females. Drinking riders were far more likely to be inattentive to the driving task just before they crashed, and to be the primary or sole cause of the accident. One-fourth of all riders did not go to the hospital, and another 42% needed only treatment in the emergency room. Drinking riders were more likely to be hospitalized and far more likely to be killed. The higher hospitalization and fatality rates of drinking riders resulted from the kinds of accidents in which they were involved, not from the minimal differences in speeds and helmet use. Problems with balance and coordination were about equally rare among drinking and non-drinking riders. Inattention was a far greater contributing factor.     

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.     

Motorcycle helmets—A state of the art review

This paper tries to make an overview of the work carried out by scientific community in the area of road helmets safety. In an area that is constantly being pushed forward by market competition, self-awareness of danger and tighter standards, several research groups around the world have contributed to safety gear improvement.