Legislation on the use of bicycle helmets (legislation)

Conclusion: Indications for effectiveness

There are indications for the effectiveness of legislation on helmet use, particlarly when there has been low levels of wearing before legislation. There are are indications for reduction of head brain and facial injuries. Assuming that helmets are a good fit and worn correctly, cycle helmets should be effective at reducing the risk of head injury, in particular cranium fracture, scalp injury and intracranial (brain) injury (Hynd et al, 2009 pp. 10)
There are indications for reduction of bicycle-related fatalities among children (<16 years) following legislation.
Two recent studies and two reviews based on 17 studies found that implementation of bicycle helmet legislation is associated with increased helmet use. Where legislation only applies to youth (<18 years), compliance may be decreased when compared to all-ages legislation.
Implementation of helmet legislation was not associated with changes in recreational or commuting bicycle use among youth or adults.
It is also stated that the level of enforcement will impact effectiveness.
There is also some evidence that the level of enforcement of legislation will impact effectiveness. All studies were performed in North America, Australia and New Zealand. It may be questioned whether the results are transferrable to the European context, as the traffic situation and the bicycle culture differ in European countries from the study regions.
There has been considerable debate on the effectiveness of bicycle helmet legislation. Opponents argue that legislation has not resulted in reduction of cyclist hospital admissions with head injury and that enforced laws discourage cycling (Robinson 2006, 2007; Rissel 2012).

Additional References:
D Hynd D, Cuerden R, Reid S, Adams S (2009). The potential for cycle helmets to prevent injury - A review of the evidence. TRL Report PPR 446. http://www.trl.co.uk.
Rissel C (2012). The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia: A rejoinder. Accident Analysis & Prevention, 2012, 45:107-109.
DL Robinson D L (2006). No clear evidence from countries that have enforced the wearing of helmets. BMJ 2006; 332 doi: 10.1136/bmj.332.7543.
Robinson DL (2007). Bicycle helmet legislation: Can we reach a consensus? Accident Analysis & Prevention, 2007;39(1):86-93.

Recommendations (for research & practice)

There is a need for further studies which examine whether rates of cycling in different age groups have changed as a result of legislation and whether there are any adverse consequences of legislation.
There is need for more research where the influences of other factors (such as media campaigns or educational programmes) are controlled for. More research is needed to examine helmet use and bicycle behavour in European countries.se consequences of legislation.

Review Date: 02/05/2012
Version: 1.1
Status: Publish

Articles (reviews) and reports were included that were published between 2002 and 2012, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.

Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).

The outcomes of the study were reviewed by an expert in the field of child safety in the spring of 2012.

Background documents

Child Safety Good Practice Guide : good investments in unintential child injury prevention and safety promotion (version 1)
M. MacKay, J. Vincenten, M. Brussoni, L. Towner ...[et al.] (2006)

Bicycle helmets : a review of their effectiveness : a critical review of the literature (version 1)
Elisabeth Towner, Theresa Dowswell, Matthew Burkes ... [et al.] (2002)

Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries (review) (version 1.0)
A. Macpherson, A. Spinks (2008)

The effects of provincial bicycle helmet legislation on helmet use and bicycle ridership in Canada (version 1.0)
Jessica Dennis, Beth Potter, Tim Ramsay ...[et al.] (2010)

Effectiveness of bicycle helmet legislation to increase helmet use : a systematic review (version 1.0)
M. Karkhaneh, J.C. Kalenga, B.E. Hagel ... [et al.] (2006)

Bicycle helmet use four years after the introduction of helmet legislation in Alberta, Canada (version 1.0)
M. Karkhaneh, B.H. Rowe, L.D. Saunders ...[et al.] (2011)

Trends in pediatric and adult bicycling deaths before and after passage of a bicycle helmet law (version 1.3)
D.E. Wesson, D. Stephens, K. Lam, ... [et al.] (2008)

The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia (version 1.0)
Scott R. Walker, Jake Olivier, Tim Churches ...[et al.] (2011)