Bicycle Helmet Laws for Children
The purpose of bicycle helmet laws for children is to reduce the number of severe and fatal head injuries to children involved in bicycle crashes. Bicycle helmets, when used properly, reduce head injuries and fatalities. Attewell, Glase, and McFadden (2001) examined all research studies published between 1987 and 1998. They found that helmets reduced overall head injuries by about 60 percent and reduced fatalities by about 73 percent. A Cochrane review and meta-analysis reported a reduction in injury rates between 63 and 88 percent ([Thompson, Rivara, and Thompson, 1999]). (UNC Highway Safety Research Center, 2011, p. 9-9)
“A helmet use law is a significant tool in increasing helmet use, but as with all laws effectiveness is related to implementation” (UNC Highway Safety Research Center, 2011, p. 9-9).
Legislation effectiveness is enhanced when combined with supportive publicity and education campaigns. See, for example, [Rivara et al., 1998], [Kanny et al. (2001)], and [G. Rodgers, 2002]. The practical effect of bicycle helmet laws is to encourage parents to require their children to use helmets (and educate parents to serve as role models and wear a helmet despite the lack of a law). (UNC Highway Safety Research Center, 2011, p. 9-9)
Law enforcement and other safety officials can reinforce the need to wear a helmet through positive interactions such as free or discounted helmet distribution programs and incentives for helmet use. Publicizing helmet laws, and child/parent education on helmet fitting and the importance of wearing a helmet every ride may enhance effectiveness. Schools may also implement policies requiring helmet use by children riding to school. (UNC Highway Safety Research Center, 2011, p. 9-9)
States and cities started passing bicycle helmet legislation in the late 1980s (Dunlap, 2011). California and New York were among the first, mandating helmets for bicycle passengers age 5 and younger.
As of December 2011, “21 States, the District of Columbia, and at least 201 municipalities or counties [had] child helmet laws ([Bicycle Helmet Safety Institute (BHSI), 2014] [and [IIHS, 2011a]]). Most laws cover all bicyclists under age 16. Only 13 States have no State or local bicycle helmet laws” (UNC Highway Safety Research Center, 2011, p. 9-9).
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 et al., 2006]; [Macpherson and Spinks, 2008]). 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 and Spinks, 2008]). There was a non-significant trend toward a greater overall increase in helmet use in communities with laws covering all cyclists compared to those covering only children, and effects were larger among children (Karkhaneh et al., 2006). Study methods also explained some of the variation, with before-after studies resulting in a smaller effect sizes than cross-sectional control studies. (UNC Highway Safety Research Center, 2011, p. 9-9)
A Cochrane review examined the effectiveness of helmet use laws in reducing head injuries. Again, only three hospital-based studies met the strict inclusion criteria with respect to injury reductions. Two of the three controlled studies reported reductions in head or traumatic brain injury following legislation ([Macpherson and Spinks, 2008]). (UNC Highway Safety Research Center, 2011, pp. 9-9–9-10)
Earlier crash-trend analyses using FARS data suggested that State helmet-use laws for children reduce child bicycle fatalities by about 15 percent in the long run ([Grant and Rutner, 2004]). Wesson et al. (2008) examined before and after trends in child and adult fatalities in Ontario, Canada following implementation of a law requiring helmets for riders under 18 years of age. A reduction was found in child fatalities but not in adult bicycle-related deaths. Supporting data from one community suggested that the declines were not due to decreases in child bicycling. The authors attributed the lower child mortality rates to multiple factors including education, promotion, and general trends. (UNC Highway Safety Research Center, 2011, p. 9-10)
Researchers looked at bicycle-related injuries in Los Angeles County before and after California enacted a statewide helmet law for minors and found no difference in the rate of helmet use or injury patterns, although lack of a concurrent control group prevented the authors from concluding that the legislation had no effect (Castle et al., 2012).
The comprehensiveness of helmet legislation may play a critical role in effectiveness by creating a culture of bicycle safety. One cross-sectional study of three provinces in Canada showed that self-reported helmet use was lowest in the province without a helmet regulation (26.9 percent) and lower among youth in Ontario, where a helmet law for minors was in effect, than in Nova Scotia, where a universal helmet law had been in effect for approximately the same amount of time (46.7 percent versus 77.5 percent) (Dennis, Potter, et al., 2010). Another cross-sectional study using nationally representative data found that more children ages 5 to 14 years who lived in places with statewide helmet laws always wore helmets while riding bicycles (59.3 percent) than children living in places with local laws (44.9 percent) or no law (25.5 percent) (Dellinger and Kresnow, 2010).
There are several ways to measure the effectiveness of bicycle helmet laws. Rates of helmet use can be estimated through parental self-reporting, self-reporting by adolescents, or observation. Additionally, hospitals and surveillance systems can track the number of bicycle-related fatalities, head injuries, and traumatic brain injuries (TBIs).
To be effective,
[a] helmet law should be supported with appropriate communications and outreach to parents, children, schools, pediatric health care providers, and law enforcement. NHTSA has a wide range of material that can be used to educate and promote the use of a helmet every ride, demonstrate helmet effectiveness, and educate and demonstrate how to properly fit a helmet. While helmets that meet safety requirements can be purchased for under $20, States may wish to provide free or discounted helmets to some children. When considering the costs of providing helmets, agencies should consider the benefits. A NHTSA summary of helmet laws reported that “every dollar spent on bicycle helmets saves society $30 in indirect medical and other costs” ([NHTSA, 2008c]). (UNC Highway Safety Research Center, 2011, p. 9-10)
A bicycle helmet law can be implemented as soon as the appropriate legislation is enacted. Enacting local ordinances may take less time than enacting statewide legislation. To develop custom communications and outreach, train law enforcement officers on implementing the law, or start a helmet distribution or subsidy program in support of the law may require a medium-to longer-term effort. (UNC Highway Safety Research Center, 2011, p. 9-10)