Effectiveness of bicycle helmet legislation to increase helmet use: a systematic review

Abstract

Background: Head injuries related to bicycle use are common and can be serious. They can be prevented or reduced in severity with helmet use; however, education has resulted in modest helmet use in most developed countries. Helmet legislation has been proposed as a method to increase helmet wearing; while this social intervention is thought to be effective, no systematic review has been performed. Objectives: This review evaluates the scientific evidence for helmet use following legislation to identify the effectiveness of legislative interventions to increase bicycle helmet use among all age groups. Search strategy: Comprehensive searches of CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science, British Education Index, LILACS Database, TRIS (Transport Research Information Service), the grey literature, reference lists, and communication with authors was performed to identify eligible studies. Selection criteria: Eligible studies for this review were community based investigations including cohort studies, controlled before-after studies, interrupted time series studies, non-equivalent control group studies Data collection and analysis: Two reviewers extracted the data regarding the percentage of helmet use before and after legislation from each study. Individual and pooled odds ratios were calculated along with 95% confidence intervals. Main results: Out of 86 prescreened articles, 25 were potentially relevant to the topic and 11 were finally included in the review. Of 11 studies, eight were published articles, two were published reports, and one was an unpublished article. One additional survey was incorporated following personal communication with the author. While the baseline rate of helmet use among these studies varied between 4% and 59%, after legislation this range changed to 37% and 91%. Helmet wearing proportions increased less than 10% in one study, 10-30% in four studies, and more than 30% in seven studies. While the effectiveness of bicycle helmet legislation varied (n = 11 studies; OR range: 1.2-22), all studies demonstrated higher proportions of helmet use following legislation, particularly when the law was targeted to a specific age group. Conclusions: Legislation increased helmet use among cyclists, particularly younger age groups and those with low pre-intervention helmet wearing proportions. These results support legislative interventions in populations without helmet legislation.

Helmet-Wearing Practices and Barriers in Toronto Bike-Share Users: a Case-Control Study

“…28,37 Legislation has been found to effectively increase helmet use and decrease head injury rates. 38,39 After introduction of helmet laws in Victoria, Australia, helmet use increased from 31% to 75%, and cycling fatalities decreased by 48%. 36,40 A 2010 Canadian study found that youth and adults were significantly more likely to wear helmets as the comprehensiveness of helmet legislation increased, and that helmet legislation was not associated with changes in ridership.…”

Análisis de las lesiones causadas por el tránsito sufridas por ciclistas en México

“…Existe un debate sobre si legislar el uso obligatorio del casco, como han sugerido algunos autores [18][19][20] . Se considera una medida efectiva para incrementar su uso y disminuir el número de lesiones y de muertes en ciclistas 21 .…”

Helmets Matter: Kentucky Motorcycle Crash Victims Seen at a Tennessee Trauma Center

“…Effectiveness: Two systematic reviews, of 12 studies and three studies respectively, using different study inclusion criteria found that legislation may be effective at increasing helmet use (Karkhaneh, Kalenga, Hagel, & Rowe, 2006;Macpherson & Spinks, 2007). The degree of improvement varied but there was a lack of evidence to determine whether enforcement, supporting publicity, and helmet distribution efforts explain some of the variation (Karkhaneh et al, 2006;Macpherson & Spinks, 2007).…”