Helmet sections only!

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Bicycle riding is also a risky activity, as indicated by the large numbers of injuries and deaths involving bicycles every year. According to the U.S. Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS), an injury reporting system that consists of a statistical sample of the nation's hospital emergency rooms, there have been about one-half million nonfatal bicycle-related injuries treated in hospital emergency rooms every year since the early 1970s, when NEISS became operational. When other medically-attended injuries are counted, such as injuries treated in physicians' offices, there may be on the order of one million medically-attended injuries involving bicycles every year. In addition, there are as many as 1,000 bicycle-related fatalities annually. The estimated costs of these injuries and deaths to society are high -- approximately $8 billion annually -- and suggest that injury reduction strategies with even modest levels of effectiveness could prove to be cost-effective.

Bicycle Helmet Findings

While recent studies show substantial safety benefits from helmet use, they also reveal that only a small proportion of riders actually use helmets. The exposure survey provides valuable insights into current helmet usage patterns and on the reasons why riders use or do not use helmets. This section summarizes the helmet usage patterns of bicyclists and the statistical analysis of factors associated with helmet use, which are detailed in Part II. It also describes the attempt in Part III to evaluate the impact of helmet use on the likelihood of head injury.

Descriptive Results

The exposure survey found that only 11.8 million (18 percent) of the entire population of about 67 million bicyclists wear helmets all or most of the time. Another 6 percent, representing about 4 million riders, reported that they wear helmets sometimes, but less than half of the time.

The proportion of children under age 15 who wear helmets all or most of the time was about 15 percent. HF reports (in Part IV) that the low usage rate for children may be partly related to peer pressure. Some studies show that children are not inclined to wear helmets if their social group disapproves of helmet use. However, helmet use in all age groups appears to be increasing. Just over half of the current users (53 percent) began wearing helmets in the last two years.

(Footnote: The Rodale Press findings for adults, described in Part VII, were similar. In 1990, only about 15 percent of adult bicyclists wore helmets all or some of the time. However, the results also suggested that helmet use was likely to increase substantially. About 10 percent of riders who did not own helmets said they planned to buy one within 2 years. If plans materialized, helmet usage rates would have increased to about 25 percent by 1992.)

Nearly all of the 9 million riders who always wear helmets described "safety" as an important reason for doing so. The "insistence of family members," was also important to about half of those who always wear helmets. Usage patterns for 6.8 million riders who wear helmets sometimes, but not all of the time, are apparently affected by risk perceptions. Many said that they usually wear helmets when in traffic (40 percent) and when on long rides (25 percent). Many also reported that they are less likely to wear helmets when riding only a short distance and when not riding in traffic.

Finally, when non-helmet users were asked why they do not wear helmets, nearly half (48 percent) reported that they had never considered wearing helmets, 21 percent said helmets were unnecessary, 19 percent said they did not wear helmets because they seldom ride in traffic, and 16 percent said they had not gotten around to wearing them.

Helmet Use Patterns

These relationships are illustrated for individual riders in a table at page 53. For example, consider a male who rides 300 hours per year on neighborhood streets, and who has (or, for children, whose parents have) no more than a high school education. The expected likelihood of helmet use decreases from 9.9 percent for a 10 year-old rider to 6.8 percent for a 20 year-old rider. However, it rises again to 10.5 percent for a 40 year-old rider. In contrast, for a 30 year-old female who rides about 50 hours a year on

neighborhood streets, the likelihood of helmet use rises from 5.4 percent if she has a high school education, to 16.4 percent if she has a college education. It rises further to 37.1 percent if she not only has a college education but also rides primarily on major thoroughfares.

The analysis of the Rodale Press survey data on helmet usage patterns (in Part VIII) came to similar conclusions. Helmet use increased with riding distances, and was higher for bicyclists who ride primarily on major thoroughfares and off-road trails. In addition, helmet use increased with household income, a variable not included in the analysis of helmet use patterns from the exposure survey.

Helmet Effectiveness

Since helmets are intended to reduce the likelihood of head injury, EP used injury survey data to examine the safety effects of helmet use by estimating the conditional probability of head injury given that a helmet was worn. As described in Part III, the results of this analysis were inconclusive, probably because the sample of helmet users was small (only about 12 percent of the injured riders were wearing a helmet at the time of accident), and possibly because no information was available on riders who avoided injuries or whose injuries were less severe because they were wearing helmets.

However, EP found evidence that helmets prevented or reduced the severity of some head injuries. Helmets were damaged in 16 of the injury cases, about one-third of the cases in which they were worn. In 11 of these cases (69 percent), the victim did not sustain a head injury. In addition, in all 16 cases, the victim expressed the opinion that the helmet prevented a head injury or made it less severe.

Conclusions and Implications for Injury Reduction

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Head injuries represent the most serious and potentially life threatening injuries that can be sustained by bicyclists. According to the injury survey results, almost one-third of hospital emergency room treated injuries involve the head, and children under age 10 are significantly more likely than older riders to suffer head injuries. In addition, Sacks et al. (1991) estimate that about 62 percent of all U.S. bicycle-related deaths involve injuries to the head. Based on these estimates, the societal costs associated with the bicycle-related injuries and deaths involving head injury amounted to more than $3 billion in 1991. Available evidence indicates that helmets reduce both the likelihood and severity of head injury (Dorsch et al, 1987; Thompson et al., 1989). Results from the exposure survey, however, indicate that only about 17.6 percent of bicyclists currently wear helmets. This is higher than the 5 to 10 percent usage rate estimated in studies conducted only a few years ago (see references at Part II), and suggests that attitudes towards helmet use are improving. Nevertheless, helmet usage rates remain low. Increasing helmet use may therefore be the single most important factor in reducing the incidence of serious bicycle injuries.

This page was last revised or reviewed on: April 17, 2010.

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