Changes in head injury with the New Zealand bicycle helmet law
D L Robinson.
a peer-reviewed article published in Accident Analysis & Prevention 33(5):687-691, 2001
Abstract: It was claimed that the bicycle helmet law in New Zealand reduced head injuries to adult cyclists by 28% (Povey, L.J., Frith, W.J., Graham, P.G., 1999. Cycle helmet effectiveness in New Zealand. Accident Analysis and Prevention 31, 763-770). However, the pre-law increase in adults wearing helmets (from 30% in 1990 to 43% in 1993) was accompanied by a fall of 45 head injuries per 100 limb injuries (i.e. -3.47 for every 1% increase in helmet wearing) compared with a fall of 11 when wearing increased from 43 to 93% with the law (-0.23 for every 1% increase in wearing). Unless voluntary wearing is 15 times more effective in reducing head injuries, it seems likely that the apparent effects (as described by Povey et al., 1999) were an artefact caused by failure to fit time trends in their model. Such inconsistency of effects over periods of substantial change compared with periods of little change in helmet wearing may be a useful indicator of the presence of trends. Because the large increases in wearing with helmet laws have not resulted in any obvious change over and above existing trends, helmet laws and major helmet promotion campaigns are likely to prove less beneficial and less cost effective than proven road-safety measures, such as enforcement of speed limits and drink-driving laws, education of motorists and cyclists and treatment of accident black spots and known hazards for cyclists.


HEAD INJURIES AND BICYCLE HELMET LAWS
Robinson DL.
a peer-reviewed article published in Accident Analysis & Prevention 28(4):463-475, 1996 Jul.
Abstract: The first year of the mandatory bicycle helmet laws in Australia saw increased helmet wearing from 31% to 75% of cyclists in Victoria and from 31% of children and 26% of adults in New South Wales (NSW) to 76% and 85%. However, the two major surveys using matched before and after samples in Melbourne (Finch et al. 1993; Report No. 45, Monash Univ. Accident Research Centre) and throughout NSW (Smith and Milthorpe 1993; Roads and Traffic Authority) observed reductions in numbers of child cyclists 15 and 2.2 times greater than the increase in numbers of children wearing helmets. This suggests the greatest effect of the helmet law was not to encourage cyclists to wear helmets, but to discourage cycling. In contrast, despite increases to at least 75% helmet wearing, the proportion of head injuries in cyclists admitted or treated at hospital declined by an average of only 13%. The percentage of cyclists with head injuries after collisions with motor vehicles in Victoria declined by more, but the proportion of head injured pedestrians also declined; the two followed a very similar trend. These trends may have been caused by major road safety initiatives introduced at the same time as the helmet law and directed at both speeding and drink-driving. The initiatives seem to have been remarkably effective in reducing road trauma for all road users, perhaps affecting the proportions of victims suffering head injuries as well as total injuries. The benefits of cycling, even without a helmet, have been estimated to outweigh the hazards by a factor of 20 to 1 (Hillman 1993; Cycle helmets-the case for and against. Policy Studies Institute, London). Consequently, a helmet law, whose most notable effect was to reduce cycling, may have generated a net loss of health benefits to the nation. Despite the risk of dying from head injury per hour being similar for unhelmeted cyclists and motor vehicle occupants, cyclists alone have been required to wear head protection. Helmets for motor vehicle occupants are now being marketed and a mandatory helmet law for these road users has the potential to save 17 times as many people from death by head injury as a helmet law for cyclists without the adverse effects of discouraging a healthy and pollution free mode of transport. Copyright (C) 1996 Elsevier Science Ltd. [References: 59]