Bicycle helmet use among children in the United States: The effects of legislation, personal and household factors

Introduction

Children ages 5-14 years have the highest rate of bicycle-related injuries in the country. Bicycle helmets can prevent head and brain injuries, which represent the most serious type of bicycle-related injury.

Objectives

This paper compares children's bicycle helmet use to that estimated from an earlier study, and explores regional differences in helmet use by existing helmet legislation.

Methods

This study was a cross-sectional, list-assisted random-digit-dial telephone survey. Interviews were completed by 9,684 respondents during 2001-2003. The subset with at least one child in the household age 5-14 years (2,409 respondents) answered questions about bicycle helmet use for a randomly selected child in their household.

Results

Almost half (48%) of the children always wore their helmet, 23% sometimes wore their helmet, and 29% never wore their helmet. Helmet wearing was significantly associated with race, ethnicity, and child age but was not associated with the sex of the child. Other significant predictors of use included household income, household education, census region, and bicycle helmet law status. Statewide laws were more effective than laws covering smaller areas. The proportion of children who always wore a helmet increased from 25% in 1994 to 48% in 2001-2002. Significant increases in helmet use from 20% to 26% were seen among both sexes, younger (5-9 years) and older (10-14 years) children, and in all four regions of the country.

Conclusions

While there has been substantial progress in the number of children who always wear their helmets, more than half do not. Further progress will require using a combination of methods that have been shown to successfully promote consistent helmet use. Impact on industry: minimal.     

Substance exposure and helmet use in all-terrain vehicle accidents: Nine years of experience at a level 1 trauma center

IntroductionThe surging popularity of all-terrain vehicles (ATV) in the United States has caused an “epidemic of injuries and mortality.” The U.S. Consumer Product Safety Commission reported 99,600 injuries and 426 fatalities from ATV accidents in 2013. The aim of this study was to examine the relationship between helmet use and positive toxicology screenings on outcomes in ATV accident victims.MethodsThis is a retrospective study of patients admitted to a Level 1 Trauma Center in southwestern West Virginia following an ATV accident between 2005 and 2013. Data were obtained from the institution's Trauma Registry.ResultsA total of 1,857 patients were admitted during the study period with 39 (1.9%) reported deaths. Positive serum alcohol and/or urine drug screens were obtained in 66.4% of the patients tested (n = 1,293). Those with positive screenings were 9.5% less likely to utilize a helmet (13.2% vs. 22.7%, p < 0.001); and the lack of helmet use was associated with an increase in traumatic brain injury (57.1% vs. 41.7%, p < 0.001). Positivity for substances or the lack of helmet use was significantly associated with higher morbidity. Lack of helmet use resulted in a 3.94-fold increase in the risk of discharge in a vegetative state or death.ConclusionsDrugs and alcohol use may predispose riders to be less likely to wear helmets and significantly increase the risk of a poor clinical outcome following an ATV accident. Rigorous efforts should be made to enhance safety measures through educational endeavors and amendment of current regulations to promote safe and responsible use of ATVs.Practical applicationsModification of regulatory requirements should be considered in order to mandate the wearing of helmets during ATV operation. In addition, expansion of safety programs should be considered in an effort to improve availability, affordability and awareness of safe ATV practices.     

The determinants of motorcyclists helmet use: Urban arterial road in Khon Kaen City,Thailand

IntroductionCurrently, Thailand incurs the highest death toll of motorcyclists in the world. The aim of this study was to explore the factors influencing helmet use of motorcyclists in Khon Kaen City, Thailand by using the Logistic regression analysis.MethodThe samples, consisting of 27,977 riders and 6,947 riding passengers, were collected by CCTV installed at several signalized intersections along urban arterial roads.ResultsThe observation results reveal that only 67% of motorcyclists wore the helmets. The analysis results reveal that the helmet use of motorcyclists was significantly associated with the riding status, number of passengers, apparent age, motorcycle class, time of day, the presence of police booths at intersections and, especially, red light running behavior. The riders tended to wear helmets at 2.7 times higher rates than passengers. Adult motorcyclists tended to wear the helmets at 2.8 times higher rates than children. The motorcyclists riding the motorcycles over 125 cc tended to wear the helmets 1.9 times higher than those riding motorcycles under 125 cc. The motorcyclists riding in the morning and the afternoon tended to wear the helmets 5.0 and 3.8 times higher than in the evening. The motorcyclists riding through intersections with police booths tended to wear the helmets 2.2 times higher than those riding through intersection without police booths. However, the red light running riders intend to wear the helmets 0.6 times less than the legal riders.ConclusionsThe outcome of this study could determine the factors influencing motorcyclist's helmet use.Practical ImplicationsIt will be useful for a development of 100% helmet use program designed to lessen the fatality of motorcyclists along the urban arterial roads.     

Overview of motorcycling in the United States: a national telephone survey

Objectives

Motorcycle registrations have risen in recent years. Although motorcyclist crash fatalities in 2009 were 16% lower than in 2008, they were double the number of deaths in 1997. The present study examined current motorcyclists’ travel patterns and views of motorcycle helmets and other safety topics.

Methods

Motorcycle drivers were interviewed in a national telephone survey conducted in 2009. A weighted sample of 1,606 motorcyclists resulted from adjusting for the oversampling of those younger than 40 and those in the three states without a motorcycle helmet use law (Illinois, Iowa, New Hampshire). All analyses were based on the weighted sample, which was intended to result in a nationally representative sample of motorcyclists.

Results

About one-quarter of respondents said they did not always wear helmets. Of these respondents, 57% said a law requiring helmet use would persuade them to do so, and 27% said nothing would. Ninety-four percent of respondents in states with universal helmet laws said they always ride helmeted, compared with about half of respondents in other states. About half of all respondents favored these laws. About three-quarters said they believe helmets keep riders safer, including two-thirds of respondents who oppose universal laws and almost half of drivers who rarely/never wear helmets. Drivers ages 18–29 and drivers of sport/unclad sport, sport touring, and super sport motorcycles were more likely to always wear helmets, support universal helmet laws, and believe helmets keep riders safer. About half of respondents said antilock braking systems (ABS) enhance safety and that they would get ABS on their next motorcycle. Less than one-quarter thought an airbag would protect a motorcyclist in a crash, and even fewer would consider getting one on their next motorcycle. Forty-three percent of motorcyclists said they had crashed at least once; 62% of the most recent crashes involved no vehicles besides the motorcycle. Respondents reported riding their motorcycles about 5,400 miles, on average, during the past year. Drivers ages 18–29 reported riding fewer miles, on average, than older drivers and more often rode at night and to/from work or school. Drivers of touring and sport touring motorcycles traveled more miles and took more long trips.

Conclusions

Motorcyclists’ travel patterns and views vary widely, but there are distinct patterns by driver age and motorcycle type. Drivers who believe helmets keep riders safer are more likely to always wear them, but this belief appears insufficient to motivate some drivers to wear them. However, universal helmet laws appear effective in increasing helmet use. Many drivers are receptive to purchasing ABS on their next motorcycle.

Impact on industry

States should be encouraged to enact universal helmet laws, and motorcycle manufacturers should be encouraged to offer ABS.     

Independent factors associated with bicycle helmet use in a Korean population: A cross-sectional study

Objective: Although identification of factors that influence helmet use during bicycle riding is necessary for the selection of groups that require safe cycling education, limited baseline data are available. The aim of the present study was to analyze the rate of helmet use and the demographic factors that were independently associated with helmet use among Korean bicycle riders.

Methods: In this cross-sectional study, we used public data from the Sixth Korean National Health and Nutrition Examination Survey conducted in 2013 and 2014. Helmet users were defined as subjects who always, usually, or frequently wore helmets when cycling. Independent factors associated with helmet use were determined using odds ratios (ORss) adjusted for 5 demographic factors via multivariate logistic regression analysis.

Results: In the total population, 4,103 individuals were bicycle riders; among these, 782 individuals (19.1%) wore helmets. A total of 21.1% of male riders used helmets, compared to 15.5% of female riders (P <.001). The adjusted logistic regression model revealed that female sex (OR = 0.665; 95% confidence interval [CI], 0.554–0.797), teenage status (OR = 0.475, 95% CI, 0.333–0.678), and low household income (OR = 0.657, 95% CI 0.513–0.841) were significantly associated with nonuse of helmets.

Conclusions: Female sex, teenage status, and low household income were independent factors associated with the nonuse of helmets. We identified factors associated with helmet use during bicycle riding through analysis of baseline data on helmet usage.     

Characteristics of bicycle crashes among children and the effect of bicycle helmets

Abstract

Objective: Focusing on children (0–17?years), this study aimed to investigate injury and accident characteristics for bicyclists and to evaluate the use and protective effect of bicycle helmets.

Method: This nationwide Swedish study included children who had visited an emergency care center due to injuries from a bicycle crash. In order to investigate the causes of bicycle crashes, data from 2014 to 2016 were analyzed thoroughly (n?=?7967). The causes of the crashes were analyzed and categorized, focusing on 3 subgroups: children 0–6, 7–12, and 13–17?years of age. To assess helmet effectiveness, the induced exposure approach was applied using data from 2006 to 2016 (n?=?24,623). In order to control for crash severity, only bicyclists who had sustained at least one Abbreviated Injury Scale (AIS) 2+ injury (moderate injury or more severe) in body regions other than the head were included.

Results: In 82% of the cases the children were injured in a single-bicycle crash, and the proportion decreased with age (0–6: 91%, 7–12: 84%, 13–17: 77%). Of AIS 2+ injuries, 8% were head injuries and 85% were injuries to the extremities (73% upper extremities and 13% lower extremities). Helmet use was relatively high up to the age of 10 (90%), after which it dropped. Helmets were much less frequently used by teenagers (14%), especially girls. Consistently, the share of head injuries increased as the children got older. Bicycle helmets were found to reduce all head injuries by 61% (95% confidence interval [CI], 10: +/? 10%) and AIS 2+ head injuries by 68% (95% CI, 12: +/? 12%). The effectiveness in reducing face injuries was lower (45% CI +/? 10% for all injuries and 54% CI +/? 32% for AIS2+ injuries).

Conclusions: This study indicated that bicycle helmets effectively reduce injuries to the head and face. The results thus point to the need for actions aimed at increasing helmet use, especially among teenagers. Protective measures are necessary to further reduce injuries, especially to the upper extremities.     

The effect of the Swedish bicycle helmet law for children: An interrupted time series study

BackgroundPrevious population-based research has shown that bicycle helmet laws can reduce head injury rates among cyclists. According to deterrence theory, such laws are mainly effective if there is a high likelihood of being apprehended. In this study, we investigated the effect of the Swedish helmet law for children under the age of 15, a population that cannot be fined.MethodAn interrupted time series design was used. Monthly inpatient data on injured cyclists from 1998–2012, stratified by age (0–14, 15 +), sex, and injury diagnosis, was obtained from the National Patient Register. The main outcome measure was the proportion of head injury admissions per month. Intervention effect estimates were obtained using generalized autoregressive moving average (GARMA) models. Pre-legislation trend and seasonality was adjusted for, and differences-in-differences estimation was obtained using adults as a non-equivalent control group.ResultsThere was a statistically significant intervention effect among male children, where the proportion of head injuries dropped by 7.8 percentage points. There was no evidence of an intervention effect on the proportion of head injuries among female children.ConclusionAccording to hospital admission data, the bicycle helmet law appears to have had an effect only on male children.Practical applicationsThis study, while quasi-experimental and thus not strictly generalizable, can contribute to increased knowledge regarding the effects of bicycle helmet laws.     

Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand

Background: In Thailand, road traffic injuries are the leading cause of death for youth ages 15–19 years, with 80% of the injuries and deaths from motorcycle accidents. Objectives: To determine the prevalence of child and young adolescent motorcyclists in Hat Yai municipality and their risk behaviors. Method: A cross-sectional study was conducted between June 2011 and March 2012 in which 2,471 students, ages 8 to 18 years, were recruited from 9 primary and secondary schools in Hat Yai municipality. The questionnaire included questions on being a motorcycle rider or passenger, risky behaviors, and helmet use while riding. Results: Of the total, 1,573 (63.7%) were riders and 898 (36.3%) were pillion passengers. The majority of the riders younger than 15 years rode their motorcycle mainly only in narrow streets for a short trip. Only 30% of the riders wore a helmet every time they rode a motorcycle. About 10% of the participants riding or a passenger on a motorcycle had consumed alcohol at least once before riding their motorcycle. Multiple logistic regression analysis found that motorcycle injuries were significantly associated with speeds greater than 60 km/h, not wearing a helmet while riding, and alcohol consumption before riding (odds ratios 1.63, 1.59, and 3.09, respectively). Conclusion: Nearly two thirds of young adolescents in Hat Yai municipality were motorcycle riders. These young adolescents were at risk of traffic injuries because more than 50% of them had ridden at high speed or not worn a helmet while riding, and some of them had consumed alcohol before riding.     

The unintended impact of helmet use on bicyclists’ risk-taking behaviors

Introduction: Safety is a critical factor in promoting sustainable urban non-motorized travel modes like bicycles. Helmets have shown to be effective in reducing injury severity in bicycle crashes, however, their effects on bicyclists’ behaviors still requires deeper understanding, especially amid the emerging trend of using shared bicycles. Risk compensation effects suggest that bicyclists may offset perceived gains in safety from wearing a helmet by increasing risk-taking behaviors. A better understanding of these compensation effects can be useful in assessing various bicycle safety related programs. Method: Using a sample of 131 bicyclists from the San Francisco Bay area, this research studies how bicyclists respond with respect to risk-taking behaviors under various urban-street conditions, as a function of helmet use. Study participants were each shown 12 videos, shot in Berkeley, California, from the perspective of a bicyclist riding behind another bicyclist. A fractional factorial experiment design was used to systematically vary contextual attributes (e.g., speed, bike lane facilities, on-street parking, passing vehicles) across the videos. After each video, participants were asked to indicate if they would overtake the bicyclist in the video. With the help of data adaptive estimation techniques, targeted maximum likelihood estimation (TMLE) was applied to estimate the average risk difference between helmeted users and non-users, controlling for self-selection effects. Individual-based nonparametric bootstrap was performed to assess the uncertainty associated with the estimator. Results: Our findings suggest, on average, individuals more likely to wear a helmet are 15.6% more likely to undertake a risky overtaking maneuver. Practical Applications: This study doesn’t try to oppose mandatory helmet laws, but rather serves as a cautionary warning that road safety programs may need to consider strategies in which unintended impact of bicycle helmet use can be mitigated. Moreover, our findings also provide additional evaluation component when it comes to the cost-benefit assessment of helmet-related laws.     

A study of pedestrian and bicyclist exposure to head injury in passenger car collisions based on accident data and simulations

The objective was to assess head injury risks and kinematics of adult pedestrians and bicyclists in primary impact to the passenger cars and secondary impact to the ground using real world accident data and computer reconstructions of the accidents. For this purpose, a subsample of 402 pedestrians and 940 bicyclists from the GIDAS database, Germany, was used for the statistical analysis, from which 22 pedestrian and 18 bicyclist accidents were further selected for reconstruction. PC-Crash was used to calculate impact conditions, such as vehicle impact velocity, vehicle kinematic sequence, and thrown distance. These conditions were employed to identify the initial conditions in reconstruction in MADYMO program. A comparable analysis was conducted based on the results from accident analysis and computer reconstructions for the impact configurations and the resulting injury patterns of pedestrians and bicyclists in view of head injury risks. Differences in HIC, head-relative impact velocity, linear acceleration, maximum angular velocity and acceleration, contact force, thrown distance, Wrap Around Distance (WAD), and head contact time were evaluated. Injury risk curves were generated by using a logistic regression model for vehicle impact velocity. The results indicate that bicyclists suffered less severe injuries compared with severity of pedestrian injuries. In the selected samples, the AIS 2+ and AIS 3+ head injury risks for pedestrians are 50% probability at impact speed of 38.87 km/h and 54.39 km/h respectively, while for bicyclists at 53.66 km/h and 58.89 km/h respectively. The findings of high injury risks suggested that in the area with high frequency car-pedestrian accidents, the vehicle speed limit should be 40 km/h, while in the area with high frequency car-cyclist accidents the vehicle speed limit should be 50 km/h.     

School transportation mode,by distance between home and school,United States,ConsumerStyles 2012

IntroductionMotor-vehicle crashes are a leading cause of death among children in the United States, and almost one-fourth of all trips by school-aged children are trips to and from school. This study sought to determine how children (5–18 years) travel to and from school and, among those living ≤ 1 mile of school, to explore the role of school bus service eligibility on school travel mode.MethodsWe used national 2012 survey data to determine prevalence of usual school travel mode, stratified by distance from school. For those living ≤ 1 mile of school, multivariable regression was conducted to assess the association between bus service eligibility and walking or bicycling.ResultsAlmost half (46.6%) of all children rode in passenger vehicles (PV) to school and 41.8% did so for the trip home. Results were similar among those living ≤ 1 mile (48.1%, PV to school; 41.3%, PV to home). Among those living ≤ 1 mile, 21.9% and 28.4% of children walked or bicycled to and from school, respectively. Ineligibility for school bus service was strongly associated with walking or bicycling to school [adjusted prevalence ratio (aPR: 5.36; p < 0.001)] and from school (aPR: 5.36; p < 0.001).ConclusionsRegardless of distance from school, passenger vehicles were a common mode of travel. For children who live close to school, the role that school bus service eligibility plays in walking or bicycling deserves further consideration.Practical applicationsGiven the large proportion of children who use passenger vehicles for school travel, effective interventions can be adopted to increase proper child restraint and seat belt use and reduce crash risks among teen drivers. Better understanding of conditions under which bus service is offered to children who live close to school could inform efforts to improve pedestrian and bicyclist safety for school travel.     

Can a unique appearance of e-bikes,coupled with information on their characteristics,influence drivers’ gap acceptance?

Abstract

Objective: Car drivers tend to underestimate the speed of e-bikes and accept smaller gaps for crossing in front of them compared to conventional bicycles. As an explanation, it has been suggested that car drivers rely on their previous experience with conventional bicycles, which tells them that those mostly travel at low speeds. E-bikes, which look just like regular bicycles, do not conform to this expectation, resulting in potentially dangerous interactions. Based on this assumption, researchers have suggested to increase other road users’ awareness of e-bikes’ higher speeds by giving them a distinct appearance. The goal of our experiment was to investigate the effects of such a unique appearance, aided by clear instructions about the higher speeds of e-bikes, on gap acceptance.

Method: In order to investigate the effect of appearance independent of the effect of bicycle type, we used video sequences of conventional bicycles and e-bikes approaching at different levels of speed. The riders (regardless of what type of bike they were actually riding) either wore an orange helmet as an indicator for an e-bike, or a gray helmet indicating a conventional bicycle. Fifty participants were asked to indicate the smallest acceptable gap for a left turn in front of the cyclist or e-bike rider.

Results: The results showed significantly smaller acceptable gaps when confronted with the gray helmet (signal for bicycle) compared to the orange helmet (signal for e-bike), whereas there was no difference between the actual bicycle types.

Conclusions: Overall, the results indicate that informing about e-bikes characteristics in combination with a unique appearance can lead to a more cautious behavior among car drivers.     

Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older,United States, 2006–2011

IntroductionWith the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern.MethodsWe analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups.ResultsFrom 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥ 65 years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥ 100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥ 65 years was $40 billion.ConclusionIncreasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥ 65 years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare.Practical applicationsWith the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.     

Protective effect of different types of bicycle helmets

The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross-table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21-0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41-1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58-1.41) among users of hard shell helmets, and 1.87 (CI = 1.03-3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling.     

Protective Effect of Different Types of Bicycle Helmets

The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross-table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21–0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41–1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58–1.41) among users of hard shell helmets, and 1.87 (CI = 1.03–3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling.     

The effects of co-presence on risk perception and intention to engage in risky behaviors

IntroductionThis study investigated the relation between co-presence and bicyclists' riding behavior. We assumed that the presence of peer riders would either facilitate or inhibit risky behaviors depending on bicyclists' perceptions of three traffic contexts conducive to risk taking (i.e., red-light, go straight, and turn to left).MethodYoung bicyclists (N = 207) were randomly assigned to two experimental conditions (alone vs. with peers). They filled in a scenario-based questionnaire about their intentions to adopt risky behaviors in three specific traffic situations as well as their risk perception of these situations and their general self-perceived efficacy as a bicyclist. We hypothesized that the presence of peer riders engaged in a risky behavior will facilitate the intention to adopt risky behaviors in situations where group risk is evaluated as lower than individual risk. In opposition, the presence of peer riders engaged in a risky behavior will inhibit the intention to adopt risky behaviors in situations where group risk is evaluated as higher than individual risk.ResultsThe results confirmed the hypotheses.Practical ApplicationsThe findings offer insights for developing new effective education and intervention programs in order to reduce the frequency of dangerous behavior among bicyclists.     

Fatally injured pedestrians and bicyclists in the United States with high blood alcohol concentrations

IntroductionLittle research has focused on the problem of alcohol impairment among pedestrians and bicyclists in the United States. The aim of the current study was to investigate the prevalence, trends, and characteristics of alcohol-impaired fatally injured pedestrians and bicyclists.MethodData from the Fatality Analysis Reporting System (FARS) were analyzed for fatally injured passenger vehicle drivers, pedestrians, and bicyclists 16 and older during 1982–2014. Logistic regression models examined whether personal, roadway, and crash characteristics were associated with high blood alcohol concentrations (BACs) among fatally injured pedestrians and bicyclists.ResultsFrom 1982 to 2014, the percentage of fatally injured pedestrians with high BACs (≥ 0.08 g/dL) declined from 45% to 35%, and the percentage of fatally injured bicyclists with high BACs declined from 28% to 21%. By comparison, the percentage of fatally injured passenger vehicle drivers with high BACs declined from 51% in 1982 to 32% in 2014. The largest reductions in alcohol impairment among fatally injured pedestrians and bicyclists were found among ages 16–20. During 2010–2014, fatally injured pedestrians and bicyclists ages 40–49 had the highest odds of having a high BAC, compared with other age groups.ConclusionsA substantial proportion of fatally injured pedestrians and bicyclists have high BACs, and this proportion has declined less dramatically than for fatally injured passenger vehicle drivers during the past three decades. Most countermeasures used to address alcohol-impaired driving may have only limited effectiveness in reducing fatalities among alcohol-impaired pedestrians and bicyclists.Practical applicationsEfforts should increase public awareness of the risk of walking or bicycling when impaired. Results suggest the primary target audience for educational campaigns directed at pedestrians and bicyclists is middle-age males. Further research should evaluate the effectiveness of potential countermeasures, such as lowering speeds or improving lighting in urban areas.     

Validation of the principles of injury risk zones for motorcycle protective clothing

IntroductionThe distributions of motorcycle crash impacts and injuries were compared to the four impact risk zones and protective performance specified in the European Standard for motorcycle clothing (EN 13595).MethodsCrashed motorcyclists' (n = 117) injuries and clothing damage were categorized by body area into the four risk zones. Three levels of protection were defined: protective clothing with impact protection, protective clothing only and non-protective clothing.ResultsThe distribution of impact/injury sites corresponded to the predictions of EN 13595, with the proportion of all injuries decreasing from 43.9% in Zone 1, to 18.0%, 16.7%, and 11.5% in Zones 2 to 4, respectively. Protective clothing modified the distribution of injuries with substantially more injuries (OR = 2.69, 95% CL: 20.1–3.59) at unprotected impact sites.Practical applicationThese findings support an appropriate framework for determining performance specifications for the manufacture of motorcycle clothing that will effectively reduce the risk of injury in crashes.     

Workers' compensation loss prevention representative contact and risk of lost-time injury in construction policyholders

IntroductionInsurance loss prevention (LP) representatives have access and contact with businesses and employees to provide targeted safety and health resources. Construction firms, especially those smaller in size, are a high-risk population. This research evaluated the association between LP rep contact and risk for lost-time injuries in construction policyholders.MethodsWorkers' compensation data were utilized to track LP rep contact with policyholders and incidence of lost-time injury over time. Survival analysis with repeated events modeling calculated hazard ratios (HR) and 95% confidence intervals (CI).ResultsCompared no LP contact, one contact was associated with a 27% reduction of risk (HR = 0.73, CI = 0.65–0.82), two with a 41% (HR = 0.59, CI = 0.51–0.68), and three or more contacts with a 28% reduction of risk (HR = 0.72, CI = 0.65–0.81).ConclusionsLP reps appear to be a valuable partner in efforts to reduce injury burden. Their presence or contact with policyholders is consistent with reduction in overall incidence of lost-time injuries.Practical applicationsReduction in lost-time injuries, resulting in reduced workers' compensation costs for policyholders and insurance companies, builds a business-case for safety and injury prevention. LP reps are often a low or no-cost benefit for insurance policyholders and may be an important injury prevention resource for small firms and/or those with lack of safety resources and staff.