Florida's weakened motorcycle helmet law: effects on death rates in motorcycle crashes

OBJECTIVES: Effective July 1, 2000, Florida's universal helmet law was amended to exclude riders ages 21 and older with insurance coverage providing at least 10,000 US dollars in medical benefits for injuries sustained in a motorcycle crash. Observed helmet use in Florida was reported to have declined from nearly 100% in 1998, before the law change, to 53% after. This study examined the effects of the law change on the likelihood of death, given involvement in a motorcycle crash. METHODS: Rates of motorcyclist deaths per crash involvement in Florida for 2001-2002 (after the law change) were compared with those for 1998-1999 (before the law change). Before/after death rate ratios (95% CIs) were examined, and logistic regression models estimated the effect of the helmet law change on the odds of death in a crash, while controlling for rider gender, age, and seating position, and number of vehicles. RESULTS: The motorcyclist death rate increased significantly after the law change, from 30.8 to 38.8 deaths per 1,000 crash involvements. Motorcyclist death rates increased for single- and multiple-vehicle crashes, for male and female operators, and for riders of all ages including those younger than 21. After controlling for gender and age, the likelihood of death given involvement in a motorcycle crash was 25% higher than expected after the law change. It is estimated that 117 motorcyclist deaths could have been avoided during 2001-2002 if Florida's universal helmet law had remained in place. CONCLUSIONS: This study provides evidence of the life-saving benefits of universal helmet laws. The results also suggest that age-specific helmet laws are not effective in protecting the youngest drivers. This is not surprising, as these laws are largely unenforceable.     

Examination of factors associated with use rates after transition from a universal to partial motorcycle helmet use law

Objectives: Motorcycle riders account for a disproportionately high number of traffic injuries and fatalities compared to occupants of other vehicle types. Though research has demonstrated the benefits of helmet use in preventing serious and fatal injuries in the event of a crash, helmet use has remained relatively stable in the United States, where the most recent national estimates show a 64% use rate. Use rates have been markedly lower among those states that do not have a universal helmet law for all riders. In 2012, the state of Michigan repealed its longstanding mandatory helmet use law. In order to gain insights as to the effects of this legislative change, a study was conducted to examine short-term changes in helmet use and identify factors associated with use rates.

Methods: A statewide direct observation survey was conducted 1 year after the transition from a universal helmet law to a partial helmet law. A random parameters logistic regression model was estimated to identify motorcyclist, roadway, and environmental characteristics associated with helmet use. This modeling framework accounts for both intravehicle correlation (between riders and passengers on the same motorcycle) as well as unobserved heterogeneity across riders due to important unobserved factors.

Results: Helmet use was shown to vary across demographic segments of the motorcyclist population. Use rates were higher among Caucasian riders, as well as among those age 60 and above. No significant difference was observed between male and female riders. Use was also found to vary geographically, temporally, and with respect to various environmental characteristics. Geographically, helmet use rates tended to be correlated with historical restraint use trends, which may be reflective of riding environment and general differences in the riding population. To this end, rates were also highly variable based upon the type of motorcycle and whether the motorcyclist was wearing high-visibility gear.

Conclusions: The study results demonstrate the short-term reduction in helmet use following transition from a universal to partial motorcycle helmet law. The reduction in use is somewhat less pronounced than has been experienced in other states, which may be reflective of general differences among Michigan motorcyclists because the state has also generally exhibited higher use rates of seat belts and other forms of occupant protection. The study results also highlight potential target areas for subsequent education and public awareness initiatives aimed at increasing helmet use.     

Role of motorcycle type in fatal motorcycle crashes

IntroductionMotorcycles vary in design and performance capability, and motorcyclists may select certain motorcycle types based on driving preferences. Conversely, motorcycle performance capability may influence the likelihood of risky driving behaviors such as speeding. Both mechanisms may affect fatal crash risk when examined by motorcycle type. Although it was not possible to estimate the effect of each mechanism, the current study analyzed fatal crash data for evidence of motorcycle type differences in risky driving behaviors and risk of driver death.MethodsStreet legal motorcycles were classified into 10 types based on design characteristics and then further grouped as cruiser/standard, touring, sport touring, sport/unclad sport, supersport, and all others. For each motorcycle type, driver death rates per 10,000 registered vehicle years and the prevalence of fatal crash characteristics such as speeding were analyzed. Differences among motorcycle types concerning the effect of engine displacement were examined using Poisson regression.ResultsOverall, driver death rates for supersport motorcycles were four times as high as those for cruiser/standard motorcycles. Fatally injured supersport drivers were most likely to have been speeding and most likely to have worn helmets, but least likely to have been impaired by alcohol compared with drivers of other motorcycle types. The patterns in driver factors held after accounting for the effects of age and gender. Increased engine displacement was associated with higher driver death rates for each motorcycle type.ConclusionStrong effects of motorcycle type were observed on driver death rates and on the likelihood of risky driving behaviors such as speeding and alcohol impairment. Although the current study could not completely disentangle the effects of motorcycle type and rider characteristics such as age on driver death rates, the effects of both motorcycle type and rider age on the likelihood of risky driving behaviors were observed among fatally injured motorcycle drivers.Impact on IndustryCertain motorcycle designs, particularly supersport motorcycles, are associated with increases in risky driving behaviors and higher driver death rates. At present, there are no proven countermeasures for this situation. However, existing countermeasures such as helmet laws and automated speed enforcement could have a substantial benefit.     

The effects of a mandatory motorcycle helmet law on helmet use and injury patterns among motorcyclist fatalities

BACKGROUND: The National Highway Traffic Safety Administration (NHTSA) has found that motorcycle helmets are 37% effective in preventing death and 65% effective in preventing brain injuries in a crash. Unfortunately, in 1995 Congress lifted federal sanctions against states without helmet laws and since then there have been a number of primary motorcycle helmet laws repealed or weakened. More lives could be saved and serious injuries avoided if there was increased helmet use throughout the United States. METHODS: This study analyzed helmet use and injury patterns among motorcycle riders in the United States involved in fatal crashes from 1995 through 2003 and compared the results between states with and without a primary helmet law. Age, sex, injury severity and helmet use are some of the variables obtained from the Fatality Analysis Reporting System (FARS). RESULTS: In the 20 states and the District of Columbia, which currently have a primary helmet law, 84.0% of fatally injured riders were wearing a helmet. In the 27 states with a secondary helmet law, 36.2% of fatalities used a helmet, and in the remaining three states with no law at all, helmet use dropped to 17.6%. In the two states (Arkansas and Texas) that changed from a primary helmet law to a secondary helmet law in 1997, helmet use decreased from 78.2% in 1996 to 31.7% in 2000. CONCLUSION: If all states were to enact a primary motorcycle helmet law, helmet use would dramatically increase while decreasing the number of motorcyclist head injuries and fatalities. IMPACT ON INDUSTRY: The results of this study will hopefully persuade law makers to enact primary helmet laws in all states throughout the nation. Helmet manufacturers can use this data to design more comfortable helmets while also improving upon the protective qualities of these safety devices.     

Mobile phone use while riding a motorcycle and crashes among university students

Objective: Motorcycle crashes are a significant road safety challenge, particularly in many low- and middle-income countries where motorcycles represent the vast majority of their vehicle fleet. Though risky riding behaviors, such as speeding and riding under the influence of alcohol, have been identified as important contributors to motorcycle crashes, little is understood about the effect of using a mobile phone while riding on motorcycle crash involvement. This article investigates crash involvement among motorcycle riders with risky riding behaviors, particularly using a mobile phone while riding.

Methods: Data were obtained from an online survey of university students’ risky riding behaviors in Vietnam administered between March and May 2016 (n?=?665).

Results: Results show that 40% of motorcycle riders reported to have experienced a crash/fall and nearly 24% of motorcycle riders indicated that they had been injured in a crash/fall. Effects of mobile phone use while riding on safety of motorcycle riders are highlighted. Specifically, more frequent use of a mobile phone for texting or searching for information while riding is associated with a higher chance of being involved in a crash/fall. The results also show that drink riding is associated with a higher chance of being injured.

Conclusions: Overall this article reveals significant safety issues of using a mobile phone while riding a motorcycle, providing valuable insight for designing education and publicity campaigns.     

A multinomial logit analysis of factors associated with severity of motorcycle crashes in Ghana

Objective: The objective of this study was to explore the factors affecting motorcycle crash severity in Ghana.

Methods: A retrospective analysis of motorcycle crash data between 2011 and 2015 was conducted using a motorcycle crash data set extracted from the National Road Traffic Crash Database at the Building and Road Research Institute (BRRI) in Ghana. Injury severity was classified into 4 categories: Fatal, hospitalized, injured, and damage only. A multinomial logit modeling framework was used to identify the possible determinants of motorcycle crash severity.

Results: During the study period, a total of 8,516 motorcycle crashes were recorded, of which 22.9% were classified as fatal, 42.1% were classified as hospitalized injuries, 29.4% were classified as slight injuries, and 5.6% were classified as damage-only crashes. The estimation results indicate that the following factors increase the probability of fatal injuries: At a junction; weekend; signage; poor road shoulder; village settlement; tarred and good road surface; and collision between motorcycle and heavy goods vehicle (HGV). Motorcycle crashes occurring during the daytime and on the weekend increases the probability of hospitalized injury. The results also suggest that motorcycle crashes occurring during the daytime, in curves or inclined portions of roads, or in unclear weather conditions decrease the probability of fatal injury.

Conclusions: This study provides further empirical evidence to support motorcycle crash modeling research, which is lacking in developing countries. The ability to understand the various factors that influence motorcycle crash severity is a step forward in providing an appropriate basis upon which informed motorcycle crash policies can be developed. Particular attention should be given to the provision of road signage at junctions and speed humps and controlling traffic during the weekend. In addition, road maintenance should be carried out periodically to address motorcycle safety in Ghana.     

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.     

Severity of motorcycle crashes in Dar es Salaam,Tanzania

Objective: Motorcycles are a common mode of transportation in low- and middle-income countries. Tanzania, in particular, has experienced an increased use of motorcycles in the last decade. In Dar es Salaam, motorcycles provide door-to-door travel and often operate where more conventional services are uneconomical or physically impossible to maneuver. Although motorcycles play a crucial role in improving mobility in the city, they have several safety issues. This study focuses on identifying factors influencing the severity of motorcycle crashes.

Method: A multinomial logit analysis was conducted to identify factors influencing the severity of motorcycle crashes in Dar es Salaam, Tanzania. The severity categories were fatal, severe injury, minor injury, and property damage only (PDO). The analysis was based on a total of 784 motorcycle crashes that occurred from 2013 to 2016.

Results: The following factors were found to increase the probability of a fatality: Speeding, driving under the influence, head-on impact, presence of horizontal curves, reckless riding, off-peak hours, violations, and riding without a helmet. The results indicate that crashes occurring on weekdays, during peak hours, at intersections, involving a rear-end impact, in daylight, on street roads, and under clear weather conditions decrease the probability of a fatality. However, minor injury and PDO crashes were found to be associated with crashes occurring during peak hours, at intersections, and on street roads, as well as failure to yield right-of-way.

Conclusions: Several countermeasures are recommended based on the study findings. The recommended countermeasures focus on the holistic safety improvement strategies constituting the three Es of highway safety, namely, engineering, education, and enforcement.     

Adolescent noncompliance with age-specific versus universal US motorcycle helmet laws: Systematic review and meta-analysis

Introduction: The U.S. experience with motorcycle helmets affords an important insight into the responses of adolescents to age-specific laws. Political contention has led to a number of U.S. state law changes back and forth between universal and age-specific laws. Because both kinds of law require adolescent motorcyclists to wear helmets, relatively few studies have focused on how the law type affects their behavior. Method: Differential behavior is tested by a systematic review of literature, leading to a meta-analysis, in relation to the experience of various states’ motorcycle helmet laws. An electronic search was conducted for before-and-after studies in U.S. states that include data on adolescent helmet usage – both with a universally applicable motorcycle helmet law, and with an age-restricted law (usually, under-21 or under-18) – from observational, injury or fatality records for a certain period (e.g., 12 months) pre and post the state law change. Results: The search yielded ten studies, including two that compared a set of age-specific law states with a set of universal law states over the same time period. Heterogeneity analysis of seven single-state studies with raw data revealed an acceptable fit for a random-effects model. Additional noncompliance with age-restricted laws was indicated by an attributable percentage among exposed of over 65% and odds ratio exceeding 4. Conclusions: About two-thirds of adolescent noncompliance with age-restricted motorcycle helmet usage laws disappears with universal applicability. Evidence from numerous international studies of youth reaction to helmet laws suggests that a large part of the greater compliance with universal laws is due to their conveying a more convincing message that helmets afford protection against injury. Practical Applications: The meta-analysis provides fresh, young-rider perspective on the continuing debate over motorcycle-helmet laws. Broader insight into adolescent psychology suggests considering alternatives to age-restricted laws more widely in safety and health policy.     

Fatal hit-and-run crashes: Factors associated with leaving the scene

Introduction: Hit-and-run crashes are a criminal offense that leave the victim without prompt medical care or the ability to receive financial compensation. Method: The purpose of the current study was to quantify the factors associated with the probability that a driver leaves the scene of a fatal crash, using multiple imputation to incorporate information from drivers who were never apprehended and thus whose characteristics were unknown. Results: The results of this study show that in addition to driver, vehicle, and environmental factors having significant impacts on the likelihood of a driver fleeing the scene, economic and demographic factors are important as well. Practical Applications: This analysis allows for a more holistic understanding of hit-and-run crashes and informs potential countermeasures and future research.     

Changes in motorcycle-related injuries and deaths after mandatory motorcycle helmet law in a district of Vietnam

Objective: Our study measured the change in head injuries and deaths among motorcycle users in Cu Chi district, a suburban district of Ho Chi Minh City.

Methods: Hospital records for road traffic injuries (RTIs) were collected from the Cu Chi Trauma Centre and motorcycle-related death records were obtained from mortality registries in commune health offices. Head injury severity was categorized using the Abbreviated Injury Score (AIS). Rate ratios (RRs) were used to compare rates pre- and post-law (2005/2006–2009/2010). Cu Chi's population, stratified by year, age, and sex, was used as the denominator.

Results: Of records identifying the transportation mode at the time of injury, motorcyclists accounted for most injuries (3,035, 87%) and deaths (238, 90%). Head injuries accounted for 70% of motorcycle-related hospitalizations. Helmet use was not recorded in any death records and not in 97% of medical records. Males accounted for most injuries (73%) and deaths (88%). The median age was 28 years and 32 years for injuries and deaths, respectively. Compared to the pre-law period, rates of motorcycle injuries (RR = 0.53; 95% confidence interval [CI], 0.49–0.58), head injuries (RR = 0.35; 95% CI, 0.31–0.39), severe head injuries (RR = 0.47; 95% CI, 0.34–0.63), and deaths (RR = 0.69; 95% CI, 0.53–0.89) significantly decreased in the post-law period.

Conclusions: Rates of head injuries and deaths among motorcycle riders decreased significantly after implementation of the mandatory helmet law in Vietnam. To further examine the impact of the motorcycle helmet law, including compliance and helmet quality, further emphasis should be placed on gathering helmet use data from injured motorcyclists.     

Adolescent driving: Characteristics associated with single-vehicle and injury crashes

The high motor-vehicle crash rate of young drivers may be attributed to both driving inexperience and a greater tendency to engage in risk-taking behavior. This study examines risk-taking behavior, as indicated by single-vehicle crashes and injury crashes, and factors associated with these behaviors, based on measures of demographic, psychosocial, and substance use obtained from high school senior questionnaires. Because previous work indicated different predictors for young men and young women, separate logistic regression analyses were conducted. For young women, propensity toward cigarette use was associated with higher rates of single-vehicle crashes; while race, alcohol misuse, and friends' involvement with alcohol and marijuana were associated with injury crashes. For young men, availability of substances, driving frequency, alcohol misuse, and propensity toward marijuana use were associated with higher rates of single-vehicle crashes. Young men's living situation, availability of substances, and marijuana use were related to injury crashes.     

Social and hospital costs of patients admitted to a university hospital in Brazil due to motorcycle crashes

Objective: This study aimed to investigate the social and hospital costs of patients treated at a public hospital who were motorcycle crash victims.

Method: This prospective study was on 68 motorcycle riders (drivers or passengers), who were followed up from hospital admission to 6 months after the crash. A questionnaire covering quantitative and qualitative questions was administered.

Results: Motorcycle crash victims were responsible for 12% of the institution's hospital admissions; 54.4% were young (18–28 years of age); 92.6% were the drivers; 91.2% were male; and 50% used their motorcycles as daily means of transportation. Six months afterward, 94.1% needed help from someone; 83.8% had changed their family dynamics; and 73.5% had not returned to their professional activities. Among the injuries, 94.7% had some type of fracture, of which 53.5% were exposed fractures; 35.3% presented temporary sequelae; and 32.4% presented permanent sequelae. They used the surgical center 2.53 times on average, with a mean hospital stay of 18 days. The per capita hospital cost of these victims’ treatment was US$17,481.50.

Conclusion: The social and hospital costs were high, relative to the characteristics of a public institution. Temporary or permanent disability caused changes to family dynamics, as shown by the high numbers of patients who were still away from their professional activities more than 6 months afterward.     

Fatal motorcycle crashes in wide urban area of Zagreb,Croatia—A 10-year review

Objective: The objective of our study was to determine the prevalence of alcohol and drug intoxication among fatally injured motorcyclists in a wide urban area of Zagreb, Croatia.

Methods: We conducted a single-center observational retrospective study over a 10-year period (2007–2016) in 3 counties covering an area including 1.2 million residents. We reviewed the records on fatally injured motorcyclists, collecting information relating to sex, age, cause of death, time of death in relation to the time of the crash, and the circumstances of the crash (time of day, day of the week, season). Blood alcohol concentration (BAC) and toxicology analysis results were collected and analyzed.

Results: We identified 163 deaths (95.7% males, 4.3% females). Overall, 64.2% of the victims were 20 to 39 years old. The majority (50.9%) of those fatally injured were responsible for causing the traffic crash; the rest were determined not to be responsible or the responsibility could not be determined. The most frequent causes of death were multiple injuries (55.8%) and isolated head trauma (23.3%). The rider’s BAC was above the legal limit for driving (>0.50?g/kg) in 53.8% of cases, with a mean BAC of 1.91?g/kg. There was no difference in riding a motorcycle with a BAC above the legal limit between groups defined as younger (≤39 years of age) and older (≥40 years of age). The number of people with an illegal BAC was significantly higher during weekends than during the work week. The BAC of riders who were responsible for the crash was significantly higher than that of those who were not responsible or whose responsibility could not be determined. Use of illegal drugs or nontherapeutic use of legal drugs was not common and was detected in 10.4% of fatally injured riders.

Conclusions: Alcohol intoxication has a major role in motorcycle crash–related mortality. A significant difference in BAC between fatally injured riders responsible for the accident and those who were not responsible implies that measures directed toward prevention of drinking and driving behavior could lower the number of fatal motorcycle crashes. Weekend measures, especially during spring and summer, could have particularly significant effects.     

The combined benefits of motorcycle antilock braking systems (ABS) in preventing crashes and reducing crash severity

Objective: Several studies have reported the benefits of motorcycle antilock braking systems (ABS) in reducing injury crashes, due to improved stability and braking performance. Both aspects may prevent crashes but may also reduce the crash severity when a collision occurs. However, it is still unknown to what extent the reductions in injury crashes with ABS may be due to a combination of these mechanisms.

Methods: Swedish hospital and police reports (2003–2012) were used. The risk for permanent medical impairment (RPMI) was calculated, showing the risk of at least 1 or 10% permanent medical impairment. In total, 165 crashes involving ABS-equipped motorcycles were compared with 500 crashes with similar motorcycles without ABS.

The analysis was performed in 3 steps. First, the reduction in emergency care visits with ABS was calculated using an induced exposure approach. Secondly, the injury mitigating effects of ABS were investigated. The mean RPMI 1+ and RPMI 10+ were analyzed for different crash types. The distributions of impairing injuries (PMI 1+) and severely impairing injuries (PMI 10+) were also analyzed. In the third step, the total reduction of PMI 1+ and PMI 10+ injured motorcyclists was calculated by combining the reductions found in the previous steps. An additional analysis of combined braking systems (CBS) together with ABS was also performed.

Results: The results showed that emergency care visits were reduced by 47% with ABS. In the second step, it was found that the mean RPMI 1+ and RPMI 10+ with ABS were 15 and 37% lower, respectively. Finally, the third step showed that the total reductions in terms of crash avoidance and mitigation of PMI 1+ and PMI 10+ injured motorcyclists with ABS were 67 and 55%, respectively. However, PMI 1+ and PMI 10+ leg injuries were not reduced by ABS to the same extent. Indications were found suggesting that the benefits of ABS together with CBS may be greater than ABS alone.

Conclusions: This article indicated that motorcycle ABS reduced impairing injuries, mostly due to fewer emergency care visits but also due to a reduction in crash severity. This may seem reasonable as the improved stability and braking performance provided by ABS could prevent some crashes but would also decrease crash severity if a collision still occurs. As suggested by previous studies, however, the lower extremities would be more exposed in a crash with ABS. It is recommended that future research should follow up these results with additional data.     

Reconstruction of crashes involving injured child occupants: the risk of serious injuries associated with sub-optimal restraint use may be reduced by better controlling occupant kinematics

OBJECTIVE: To determine whether injuries to sub-optimally restrained child occupants in real-world crashes were likely to be preventable by alternative restraint usage practices and to assess the usefulness of crash reconstruction for exploring injury mechanisms in child occupants. METHODS: Real-world crashes in which child occupants sustained significant injuries were reconstructed on a laboratory crash sled using the Hybrid III family of child dummies. Alternative restraint scenarios and cases in which children were not seriously injured were also simulated to compare dummy kinematics and dynamic responses in optimal restraint configurations. RESULTS: Restraint misuse was associated with greater motion of the dummy torso and head during crashes, often allowing contact between the child and the vehicle interior, resulting in injury. Poor pre-crash posture for a child inappropriately restrained in an adult belt appeared to worsen the geometry of the sash (shoulder) belt, resulting in a cervical injury due to direct interaction with the belt. Dynamic dummy data did not appear to discriminate between injury and non-injury cases. CONCLUSIONS: Dummy kinematics suggest that injuries in which inappropriate use and misuse were a factor were less likely if the most appropriate restraint was used correctly. Adequately controlling the head and upper body of the child occupant was seen to prevent undesirable interactions with the vehicle interior and restraint system, which were associated with injury in the real world. Neck forces and moments and injury criteria calculated from these did not predict injury reliably.