Cracking The Helmet Debate: Part 2

This is Part 2 of Kevin Ransom’s 2-part series that explores the many issues related to the wearing and safety of bicycle helmets – including how much protection they offer, the debate over whether states or cities should pass mandatory helmet laws; the efficacy of those laws and the various medical studies on cycling head injuries. See Part 1. Today, we discuss how different studies on the efficacy of helmet laws sometimes reach different conclusions.

One recent study, published in late May in the Journal of Pediatrics, was conducted by researchers at Boston Children’s Hospital, which found that having bicycle helmet laws in place resulted in a 20-percent decrease in deaths and injuries for children younger than age 16 who were in bicycle-motor vehicle collisions.

At the start of the 12-year study (1999 to 2010), 16 states had bike helmet laws, and 35 did not. The researchers identified all 1,612 relevant fatalities in states with and without bike helmet laws.

After adjusting for factors previously associated with rates of motor vehicle fatalities (elderly driver licensing laws, legal blood alcohol limit and household income), the adjusted fatality rate was still significantly lower in states with helmet laws, according to the study.

However, a Canadian study, published earlier in May, and conducted by researchers at the University of Toronto, was less certain about the success of helmet laws. The researchers initially found that that there was indeed a decrease in bicycle-related head injuries after various Canadian provinces passed mandatory helmet laws – but also reported that their later statistical analysis led them to question the actual effect of the laws. Here's how:

Six Canadian provinces passed helmet laws between 1994 and 2003. During that period, head injuries declined by 54 percent among those under age 18, and by 26.2 adults among adults.

But after drilling deeper into the data and taking into account baseline trends in bicycle safety, the research team doubted whether there was an independent association between helmet legislation and rates of hospitalization for head injury.

For example, while the researchers reported a big decrease in rate of cyclists' head injuries in cyclists between 1994 and 2003 in the Canadian provinces with helmet laws – from 15.9 to 7.3 per 100,000 person-years – there also was a 33.2 percent decrease in cyclists' head injuries the country’s other provinces and territories, from 19.1 to 12.9 per 100,000.

So, in the end, the Canadian researchers questioned whether helmet laws were the a main factor in the reduction of head injuries to cyclists, or whether other factors were just as important – like bicycle-safety education programs, media campaigns focusing on safe riding, and the increase in cycling infrastructure, including adding more bicycle lanes.

Local cycling advocates weigh in

That conclusion echoes the sentiments of local cycling advocates like John Lindenmayer, advocacy and policy director for the League of Michigan Bicyclists.

“We definitely encourage helmet use, and we require them at our riding events, and we encourage other event organizers to do the same, but we don’t advocate for a mandatory helmet law,” says Lindenmayer. “Instead, we prefer to focus our safety efforts on the prevention of accidents, partly via biking-safety education – and part of that is educating cyclists and drivers on how to co-exist, and share the road, and watch out for each other.”

The League’s accident-prevention and safety efforts also include advocating for improvements to the biking infrastructure, like adding more biking lanes and more protection for those lanes, as well as traffic calming, says Lindenmayer – that is, reducing the speed of auto traffic, and / or reducing the number of auto-traffic lanes.

“If cars are moving at higher speeds, that’s definitely going to increase the likelihood of a bicyclist suffering a serious injury or being killed if he or she is struck by a car,” he notes.

He’s also concerned that passing a mandatory helmet laws somehow conveys the message that cycling is a dangerous activity – “which could also discourage people from riding, when what we’re trying to do is to promote more riding. I also think people would be discouraged from riding if they thought there was a threat of getting a ticket for not wearing a helmet,” says Lindenmayer.

Todd Scott is the Detroit greenways coordinator for the Michigan Trails and Greenways Alliance, which advocates for more Michigan trails – which by extension means that it advocates for more cycling and walking – and he thinks mandatory helmet laws “are a bad idea.”

Like Lindenmayer, Scott is concerned that there is too much focus on “people who have accidents,” and instead prefers to work on how to prevent accidents – via the kind of education programs, infrastructure improvements and policy changes that Lindemayer also cited.

“This reminds me of a joke,” says Scott: “‘What do you call cyclists in the Netherlands who are wearing helmets? Answer: Tourists.’ That’s because cycling is much safer in the Netherlands, and the people who live there know that, because the Netherlands – like some other European countries – have already built up the kind of cycling infrastructure that we’re still in the process of building here in the U.S.”

More riders means safer cycling

A strong infrastructure like that means more people will ride, Scott points out. In turn, “the more people who ride, the safer it is to be a cyclist because drivers will have more and more of an expectation that there will be cyclists on the road. So, as a result, drivers modify their behavior – they’re a lot more alert to the presence of cyclists,” he says.

“We don’t have that kind of infrastructure in place here in Detroit now, but even so, drivers here still expect to see cyclists on the road much more than they did 10 years ago.

“Now, there are definitely many people who absolutely should be wearing helmets all the time,” stresses Scott – “like those in the riding clubs who are going down the road, in large groups, at high speeds, riding so close together. But the average person, riding 10 miles an hour on a residential street, is not likely going to be involved in a crash.”

Some have suggested that wearing a helmet – whether you’re riding a bicycle, or a skateboard – prompts people to take more chances, and ride in more risky fashion.

“I think that’s true,” says Scott. “I take more chances because I’m wearing a helmet, and that was especially true back when I was participating in mountain-biking races and events. But at the end of the day, you’re still much better off wearing a helmet.”

“Yes, that’s a reality,” concurs U-M’s Teddy. “The use of safety equipment may bring a false sense of security and lead to riskier behavior. However, the benefits of a properly fitted helmet are clear …. You only get one brain.”

Other research/surveys have reported that, when drivers see a cyclist who is not wearing a helmet, they are more careful, and drive more cautiously, than if the cyclist’s head is protected by a helmet.

“That’s an interesting finding,” says Teddy. “But, speaking for myself, when I see a cyclist who is sharing the road with motor vehicles, and is unhelmeted, I’m not thinking about driving more carefully. I’m asking myself, ‘Why they would be willing to take such a risk?’”

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