Bicycle helmets in Australia

Cyclists wearing helmets on a street in Melbourne, during a climate protest event

Between 1990 and 1992, Australian states introduced laws requiring people riding bicycles to wear bicycle helmets.

Australia was the first country to do this, and much of the evidence on the effects of mass helmet use comes from Australia. Debate continues, without consensus, on the results of helmet compulsion.

History

Modern varieties of bicycle helmet first became commercially successful from 1975. Industry helmet standards were developed from the 1970s and are still under development. Empirical studies on the effects of helmets were published from the late 1980s.

The Royal Australasian College of Surgeons (RACS) played a leading role in gaining public awareness, acceptance, and demand for helmet compulsion after a commissioned study showed "bicyclist casualties sustained head injuries three times more frequently than motorcyclist casualties". The RACS had been influential in bringing compulsory seat belts and motorcycle helmets and was urging for a bicycle helmet law as the "third major step" Its spokesman in 1978 said to the House of Representatives Standing Committee on Road Safety : "We could perhaps worry a little less about and take a little less time in proving what is precisely right according to all standards … As doctors we are impatient. We cannot wait for 2 or 3 years’ evaluation." The Committee recommended that "cyclists be advised of the safety benefits of protective helmets and the possibility of requiring cyclists to wear helmets be kept under review".

McDermott and Klug 1982 reported on data from 1975 to 1980 for Victoria, with 73 fractures of the skull for pedal cyclists compared with 31 for motorcyclists and concluded that pedal cyclists had a significant greater incident of fractured vault of the skull. Their study reported the number of fatalities as 181 for pedal cyclists compared with 451 for motorcyclists but did not include information regarding exposure. The travel survey data available for 1985/6 details bicyclists spending 114,500 hours per day cycling in Victoria compared with 17,500 hours per day for motorcycling. Per hour of travel motorcyclists generally wearing helmets were more likely to be killed or suffer a skull fracture compared with bicyclists who were generally not wearing helmets at that time. Both McDermott and Klug were members of the Road Trauma Committee, Royal Australian College of Surgeons that requested the Government of Victoria to introduce bicycle helmet legislation.

The 1978 inquiry issued a final report in 1985. It recommended that cooperation of states and territories should be sought to "review the benefits of bicycle helmet wearing … and unless there are persuasive arguments to the contrary introduce compulsory wearing of helmets by cyclists on roads and other public places". A federal parliament committee was set up in 1985. Early in the course of its inquiry (before it had reviewed all the evidence), it said: "It is, of course, this Committee’s belief that all cyclists should wear a helmet to increase cycling safety."

It was reported at the 1986 Bikesafe Conference in Newcastle, Australia that "Some authorities, for example South Australia (Hallion, 1985) in their submission to the Parliamentary Committee have grave concerns about the adoption of such legislation, because of the enormous difficulties of enforcement even with reasonably high levels of wearing." The proceedings of the Bikesafe conference contained a 24 page report by a research psychologist on promoting helmets, which detailed how mass media campaigns can be applied to parents and children and make use of schools and doctors as part of a promotional plan.

A report from the Australian Department of Transport in 1987 examined cycling accident victims and found that "of the unhelmeted cases involving severe head injury, over 40 percent would definitely have had an improved outcome if a substantial bicycle helmet had been worn". Substantial bicycle helmet means a bicycle helmet with a hard shell, which was the requirement under the standard prepared by Standards Australia. The report also warned about deficiencies in bicycle helmets: "The substantial elastic deformation of the child head that can occur during impact can result in quite extensive diffuse brain damage … rotational accelerations were found to be 30% higher than those found in similar tests using a full face polymer motorcycle helmet." Bicycle helmets are not suitable for children more deformable heads, which can result in brain injury. Soft-shell helmets showed high rotational acceleration, the main cause of brain injury. The report recommended changes to the helmet standard to remedy those deficiencies.

In 1987 O’Rourke reported “Generally, the younger age group (those five to seven years), were in favour of wearing helmets, whereas older children were opposed to the wearing of helmets.” In Victoria the average wearing rate (all ages) was 32% in 1989. In NSW the average wearing rate in 1990 was 26%.

In 1987 the Victorian Parliamentary Road Safety Committee tabled a report in the Parliament of Victoria which included a recommendation for mandatory wearing of helmets. The report details TAC claims 1980 - 85, involving motor vehicles and cyclists and the rate per 100,000 population for deaths and injuries. For the 0-16 age range, they had a rate of 77.9 and for other age groups 21.2. The highest rate of 154.7 was for those aged 12–16 years. The report detailed the percentage severe head injury in 1985 for child cyclists 5.6% and for child pedestrians 8.5%.

By 1989, just before the government decided to introduce compulsory wearing of bicycle helmets, an officially commissioned survey showed that public support for it was 92% for children and 83% for all riders. In May 1990 a bike helmet survey based on 61% who already owned helmets was conducted in Victoria. It reported "Lower awareness of compulsory bike helmet wearing was apparent amongst adults cyclists, metropolitan and less frequent riders" and also 8% said they would cycle less and 5% would not continue to ride.

A controlled study of 1,710 cyclists undertaken throughout the 1980s "demonstrated that bicyclist casualties wearing Standards Australia Association approved helmets had a 45% reduction in the frequency of head injuries." The RACS used this study to push for mandatory bicycle helmets in Victoria. A position paper released in 2009 reaffirmed the policy position of the College position that mandatory helmet laws be retained.

McDermott 1993 report involving 1710 cycling collisions found a trend toward a protective effect of helmets, but included only 14 fatalities. It was based on accident data (approximately 18 months in total) between 1987-89 for hospitals in Melbourne and Geelong. Cyclist deaths in Melbourne and Barwon areas (Barwon includes Geelong) for the period 1987-89 totaled 46. Victoria young children tended to have high wearing rates, pre law in 1989, 5-12 yrs about 60% wearing when cycling to school, 30% for recreational use. For 13-18 yrs, about 15% and 12% wearing. Females had a slightly higher wearing rate than males. In most accidents the younger age group would be cycling slower and have less distance to fall. Their average length of hospital stay is significantly shorter than for older cyclists.

There was a cycling boom in the late 1980s, associated with increased safety for cyclists. In Western Australia, the number of regular cyclists increased from 300,000 in 1986 to 400,000 in 1989 , while deaths and serious injuries per 10,000 regular cyclists fell from 5.7 to 3.8. There was a similar phenomenon in the eastern states, for example cycling increased 250% in the 1980s in the Sydney metropolitan area.

Mandatory helmet laws were first introduced in Victoria in July 1990, followed in January 1991 by laws for adult cyclists in New South Wales and all cyclists in Tasmania, then in July 1991 for child cyclists in New South Wales and all cyclists in South Australia as well as Queensland, where the law was not enforced until 1 January 1993. In January 1992 helmet laws were introduced in the Northern Territory and Western Australia (not enforced first 6 months) and in July 1992 in the ACT. In Tasmania the law only applies on public streets, while in the NT since March 1994 there is an exemption for adults cycling along footpaths or on cycle paths.

In May 1991 Tom Wallace MLA presented a petition with 1005 signatures, organised by Colin Clarke, to the Victorian parliament, calling for repeal of the mandatory bike helmet legislation for cyclists aged 18 years and over in that State. Various concerns were mentioned in the petition (see footnote )

Legal requirements

The current legally required standard for a bicycle helmet is AS/NZS 2063. The law is laid out in Part 15 of the Australian Road Rules, approved by the Australian Transport Council. It specifies that "The rider of a bicycle must wear an approved bicycle helmet securely fitted and fastened on the rider’s head, unless the rider is exempt from wearing a bicycle helmet under another law of this jurisdiction." The law also requires helmet use by certain bicycle passengers.

Surveys of helmet use and cycling participation before and after the introduction of helmet laws

Chart by Colin Clarke: 36% reduction in cycling Melbourne

A 1993 study by Finch et al. analysed the results of surveys carried out in May 1990, 1991 and 1992 at 64 sites in metropolitan Melbourne. Overall, 3121 cyclists were observed in 1990. In 1991, 1110 (36%) fewer cyclists were counted, compared to an increase of 293 cyclists wearing helmets. Although surveys conducted on weekdays had similar weather, there appears to have been some differences for counts conducted on weekends. About 32% of weekend observations in the pre-law survey were affected by rain, compared with about half in 1991 but only 14% in 1992. Counts in 1992 were also inflated by a bicycle rally passing through one of the sites in 1992. Finch et al. noted that from a statistical point of view, it would not be valid to exclude that site. (Excluding the site would have excluded cyclists who would have been cycling anyway, but through a different site, had it not been for the rally.) A study by Robinson that re-analysed the data from the Finch study, excluding the site with the rally, concluded that 27% fewer cyclists were counted in 1992 than 1990. (see also ).

In NSW, surveys to assess helmet wearing rates in multiple locations, both metropolitan and regional/rural, were carried out in September 1990 and April 1991, 1992 and 1993. Compared to April 1991 (6072 child cyclists counted), the reduction in children's cycling the first year of the helmet law (April 1992) was 36%, with almost identical reductions in rural NSW (35%) and the Sydney metropolitan area (37%). In April 1993, the NSW surveys counted 3414 child cyclists, 44% fewer than the pre-law survey in April 1991. Because cycling participation is weather dependent (fewer cyclists ride when it is raining, uncomfortably cold or hot, or very windy), and may also vary with holiday periods, surveys taken at different times of year, or in different weather conditions, may be subject to statistical confounding, and care should be taken when interpreting results. In NSW, the only pre-law data for adults at road sites was in September 1990 (with overcast weather conditions for Sydney) and at a different time of year to the post-law surveys. In the first post-law Sydney survey, in April 1991 (with sunny conditions), 22% more adult cyclists were counted than in the pre-law survey. In the second Sydney post-law survey, in April 1992, 2% more adult cyclists were counted than in the pre-law survey. In 1993 5% fewer were counted than in the pre-law survey. For road sites in regional areas adults counted reduced by 9% in 1991 and by 37% in 1993. In 1993 the weather was variable, with the threat of rain, across NSW on all survey days, with rain at one of the rural sites on 2 of these 3 days. In 1996, Walker reported the results of a consistent series of counts (adults and children) at the same 25 sites and observation times in Sydney. In October, 3798 were counted in 1990, compared to 2749 cyclists in 1994. In April, the counts were 4405 (1991), 3249 (1992), 3070 (1993) and 2269 (1996). In 1996, 25% of the observational hours were associated with overcast conditions and threatened rain.

Several précis of and commentaries on these surveys have appeared on websites and blogs.

In 1994 Marshall and White reported on the effects of bicycle helmet legislation in South Australia and stated that “...due to the disparate nature of the results from different sources, it is not possible to be conclusive about the effect of the requirement to wear bicycle helmets on the number of cyclists". City of Adelaide cordon counts of cyclists recorded very similar results for the years 1985 through to 1992 (except for 1988 which was attributed to changed survey methods for that particular year). The counts for 1993 showed a 15 per cent drop in cyclist numbers, though the authors attributed this to poor weather and street closures due to the impending Grand Prix car race in the city. They also examined South Australian household health survey data for 1990 and 1993 (about 3000 people in each survey) and found no statistically significant evidence of a change in cycling participation in any age group after the helmet law introduction, except for a decrease in females aged less than 15 years riding to school. However, the authors noted that surveys of helmet wearing in school children by Harrison Market Research showed a 38 per cent decline in cycling from September 1988 to March 1994, although they also note that cycling to school represented only 20% of cycling participation in under 15 year olds at that time. Helmet wearing rates increased substantially after the introduction of helmet legislation, with rates of wearing over 90% in cyclists aged 15 years or older, and rates up to 86% in school children. The helmet wearing rate in commuter cyclists observed in the cordon counts was 98%.

Injury rates

In 1993 North et al. reported the number of patients injured in road traffic accidents treated in the neurosurgery unit at Royal Adelaide Hospital had reduced: between 1989 to 1992 there was a greater than 50% decrease in neurosurgical admissions for all road users: motorcyclists from 28 cases to 5, cyclists from 11 cases to 2, pedestrians from 18 cases to 7 and vehicle occupants from 54 cases to 25. They noted improvements in road safety, with deaths in South Australia declining from 223 in 1988 to 165 in 1992, may have contributed to reduced head injury cases.

A 1994 MUARC study of cycling in Victoria found that "...the number of insurance claims from bicyclists killed or admitted to hospital after sustaining a head injury decreased by 48% and 70% in the first and second years after the law, respectively. Analysis of the injury data also showed a 23% and 28% reduction in the number of bicyclists killed or admitted to hospital who did not sustain head injuries in the first and second post-law years, respectively." Robinson criticised this study on the grounds that it ignored the similar trends for pedestrians, in particular that numbers of pedestrians with concussion fell by 29% and 75% in the first and second years after the introduction of the bicycle helmet law in Victoria. In 2013, Vicroads reported "Two years after the legislation was introduced, there was a 16% reduction in head injuries in metropolitan Melbourne and 23% reduction in head injuries throughout Victoria". Road safety improved substantially with deaths reducing from 776 in 1989 to 396 in 1992.

Newstead et al. 1994 provided details of TAC claims (from motor vehicle/cyclist accidents) with the percentage reduction in severe bicyclist casualties relative to the 1989/90 financial year. For Melbourne bicyclists without head injuries fell by 4% and 12% for the years 1990/91 and 1991/92. Clarke asserted that, because the Melbourne helmet wearing surveys reported reductions in generally cycling of 36%, compared to the reported 4% and 12% reductions in non-head injury rates in cyclists, this indicates that accident involvement increased by 37% to 50%.

A final MUARC report on the helmet law in Victoria (published in 1995) reported that after taking into account changes in the funding arrangements for publicly funded hospitals, cyclist non-head injuries dropped by about 25%, and serious and severe cyclist head/brain injuries dropped by 40%. The report noted improvements to road safety and increased availability of bicycle paths. They mention "we were unable to include any reliable measures of exposure, and thus it is impossible to distingish between reductions due to helmet wearing and reductions solely due to possible reductions in exposure".

Robinson 1996 reported reductions in numbers of child cyclists 15 and 2.2 times greater than the increase in numbers of children wearing helmets and analysed children's accident data from New South Wales and Victoria to investigate injury changes. For NSW and Victoria the number of children’s injuries was compared to the level of cycling activity to provide estimates of the ‘equivalent number of injuries for pre law numbers of cyclists’, Table 2 and 5 in the report. For NSW the equivalent number of injuries for pre-law number of cyclists increased from 1310 (384 head + 926 other injuries) in 1991 to 2083 (488 head + 1595 other injuries) in 1993. For Victoria from 1990 to 1992 the equivalent numbers increased from 897 to 1035. Robinson concludes that the injury data suggest that the overall accident rate may even have increased.

An analysis by Curnow found that from 1988 to 1994, for all road users, deaths from head injury fell by 42%, and by 38% for pedestrians, with no evidence of reduced driving or walking over this time period. For cyclists, the reduction in deaths from head injury (30%) was less than estimates noted above of the reduction in cycling. ATSB road fatality data shows that between 1992 and 1994, compared to 1987-1989, the number of pedestrian fatalities fell by 32%, motorcyclist by 40% and the number of cyclist fatalities fell by 45%.

In 1998 the European Cycling Federation issued a policy position statement titled "Improving bicycle safety without making helmet-use compulsory" in which it presented the conclusions of the 1996 paper by Robinson and concluding that "...the evidence from Australia and New Zealand suggests that the wearing of helmets might even make cycling more dangerous".

King and Fraine studied data from the southern part of Brisbane, concluding that helmet wearing legislation and enforcement was associated with a reduction in head injuries, 26% more than expected if they had followed the trend for other injury types. The addition of the penalty for non-compliance had a larger effect, reducing severe head injuries by a further 55% and less severe injuries by a further 8% compared with the expected values.

Neither King's study, nor the 1994 study of cycling in Victoria, made allowance for declining trends in the proportion of head injuries to all road users. In 1996, an analysis by Robinson of data for cyclists of all ages in Victoria and child cyclists in New South Wales was published, noting almost identical declining trends in the percentage of injuries that involved head injuries for both cyclists and pedestrians, and that the decline in cycle use after the helmet law in NSW and Victoria was greater than the decline in injuries. Bruce Robinson used information on head injuries, recorded for hospital admissions in Western Australia (WA) since 1971, to show the remarkably similar trends for all road users, and noted that a divergence between the injury rates from 1991 was unexplained, suggesting that it might just be random variation. The WA data were later analysed by Hendrie et al., using a statistical model to estimate the effect of the helmet law on cyclist head injuries, after taking the downward trends in both pedestrian and cyclist head injuries into account. The model showed that the divergence was not due to random variation (p<0.001); that before the helmet law the proportion of cyclists with a head injury was on average 6% higher than the proportion of pedestrians with a head injury; and that after the law the proportion of cyclists with a head injury was on average 16% lower than the proportion of pedestrians with a head injury. (This divergence can be seen on the graph, where the green/pedestrian line crosses the black/cyclist line the year before the helmet law is introduced.) With respect to the cost-benefit of the helmet law, Hendrie et al concluded that "In monetary terms, it is unlikely that the helmet wearing legislation would have achieved net savings of any sizeable magnitude." ATSB data shows that in NSW, during the 3 years following legislation 1992-1994, compared to the 3 years prior to legislation of 1988-1990, pedestrian fatalities dropped by 34% (from an average of 185 to 122 per year), cyclist fatalities dropped by 49% (from an average of 24 to 12 per year) and motorcyclists dropped by 49% (an average of 107 to 54). A 1995 NSW RTA analysis reported the total reduction in cyclist casualties since helmet legislation (including the effects of safer roads and reduced cycling) as 33 fewer cyclist deaths and 1040 fewer injuries, a saving of $47,863,820 in casualty costs.

A 2006 review by Robinson of available data head injuries and cycle use in four Australian states (Victoria, New South Wales, South Australia, Western Australia) and New Zealand concluded that there was no evidence at the population level that the laws had reduced head injuries. Several authors have criticised the 2006 Robinson review. Robinson's review included a Victorian study by Carr et al. which noted: "the change is largely due to the introduction of the mandatory helmet wearing legislation although it is possible that a part of the change relates to reduced exposure to crash risk of bicyclists since the legislation's introduction." Robinson noted that pedestrian deaths and serious injuries declined to 74% of pre-law casualties. The same 74% reduction in deaths and serious head injuries, together with 30% fewer cyclists, should have led to a 48% reduction in cyclists' deaths and serious head injuries. The actual fall of only 43% therefore implied increased risk of death and serious injury per cyclist (compared to pedestrians) after the introduction of helmet laws in Australia.

In a 2007 report, Erke and Elvik cited a Swedish report in which it was stated: "...there is evidence of increased accident risk per cycling-km for cyclists wearing a helmet. In Australia and New Zealand, the increase is estimated to be around 14 per cent."

A 2011 study by researchers at the University of New South Wales and the Sax Institute concluded that helmet laws led to an immediate 29% reduction in cycling related head injuries over and above any reductions in cycling participation immediately after the introduction of the legislation in NSW. A rejoinder by Rissel to this paper criticised aspects of its methods and challenged its conclusions. A response to this critique by the authors of the original paper addressed each of the criticisms and provided some additional analyses of the data used in the original paper, which confirmed the original results and conclusions.

A 2012 study by the same University of New South Wales researchers found that the population-based hospitalisation rate for cyclist arm injuries had increased by 145 percent in NSW from 1991 to 2010. In the same time period head injuries rates only increased by 20 percent. When trends are assessed relative to available estimates of cycling participation from 2001-2010, arm injuries increased by 46% while head injuries remained flat. In terms of absolute numbers of hospitalisations, between 1991 and 2000, the number of arm injuries doubled, while the number of head injuries increased by 40%.

Curnow has claimed that bicycle helmets cannot protect against, and may increase, diffuse axonal injury brain injuries caused by rotational acceleration, and has described his theory that standard bicycle helmet designs are inadequate to protect against injury to the brain. Rissel argues that helmets can only prevent superficial head scrapes and abrasions. In an article discussing a 2012 UNSW study by Bambach et al. , which analysed 6745 cyclist collisions with motor vehicles, Rissel is quoted as saying that helmets are not effective in impacts involving motor vehicles. Bicycle Network Victoria claims that the 2012 UNSW Bambach et al. study overturns the belief that helmets are not effective in impacts involving motor vehicles, and indicates that injuries caused by rotational acceleration are insignificant. The 2012 UNSW study found that of all reported cycling crashes with motor vehicles in NSW between 2001 and 2009 where helmet and hospitalisation information was present, DAI could have occurred in at most 0.2% of cases (12/6745); seven of these twelve possible cases of DAI were unhelmeted. With respect to diffuse axonal injury (DAI) in their 2012 study, Bambach et al. stated: "Unfortunately, DAI is not specifically identified in the ICD-10-AM classification system...Only 8 individuals sustained loss of consciousness on a time scale satisfying one of the requirements for the diagnosis of DAI (more than six hours, AAAM 2005), thus in the current study DAI could have occurred in no more than 8 cases of brain injury (2.9%). Therefore in the present study, the possibility of DAI was at mosta very minor proportion of brain injury, and not specifically addressing it is thus unlikely to affect the conclusions regarding the protective effect of helmets in preventing intracranial injury."

An experimental study by McIntosh et al. in 2012 tested Curnow’s hypothesis that bicycle helmets may increase angular acceleration during a crash, and found that they actually reduced both linear and angular acceleration by a considerable margin.

See also: Bicycle_helmet § Rotational_injury

In a meta-analysis of published helmet effectiveness studies, Attewell et al. found in 2000 that "...three studies provided neck injury results that were unfavourable to helmets with a summary [odds ratio] estimate of 1.36 (95% confidence interval 1.00 to 1.86), but this result may not be applicable to the lighter helmets currently in use".

See also: Bicycle_helmet § Meta-analyses

Cyclists hospitalized with different types of injury; comparing reported rates of helmet use

Main article: Bicycle_helmet § Case-control_studies

Case-control studies supporting the effectiveness of helmets, including some from Australia, have been cited in a literature review regarding the health outcomes of cycling and bicycle helmets by the Centre for Accident Research & Road Safety - Queensland (CARRS-Q). The Australian Transport Safety Bureau (ATSB) analyzed sixteen such studies, four from Australia. All these studies are disputed by Curnow. Robinson pointed out the that use of case-control studies in other areas (e.g. hormone replacement therapy and heart disease) has produced misleading results and set out the information needed to determine whether helmet laws were beneficial.

Bicycle usage

Bicycle usage: studies with control groups

The Australian census asks about about method of travel to work on census day. Some states made bicycle helmets compulsory before the 1991 census (Vic: 1 July 1990; Tas: 1 Jan 1991; NSW (adults): 1 Jan 1991. The trend from 1986-91 in all these states was below that from 1981-86. In SA the law was introduced on 1 Jul 1991, a few days before the 1991 census on 6 August. As in some other states, the law may not have been enforced immediately. In SA, there was a greater reduction in cycling to work from the 1991 to the 1996 census than from 1986-91. In WA, the law was introduced on 1 Jan 1992 and enforced from 1 July 1992. In Qld, no provision was made for penalties and the law was widely ignored (about 50% of adults wore helmets) until 1 Jan 1993, when penalties were introduced. The greatest declines in cycling to work in these states were seen from the 1991 to 1996 census. In the seat of government, the Australian Capital Territory, cycling continued to increase despite the helmet law.

Bicycle usage: capital cities vs all other areas

Aggregating all data for states with (Vic, Tas and NSW) or that may have had (SA) enforced helmet laws, and those that did not (Qld, WA and ACT) provides a clearer picture for the country as a whole, and allows comparison of the difference between capital cities (which generally have higher traffic levels) and regional areas such as small country towns, with less traffic and shorter distances between home and work. Before helmet legislation in 1986, capital cities had similar numbers (43,218 vs 40,798 in regional/rural areas) cycling to work but much lower percentages (1.14% compared to 3.14%). In Vic, NSW, Tas and SA, the fall in non capital cities was from 2.9% in 1986 to 2.0% in 1991. Excluding the capital cities of Perth and Brisbane, in 1991, in Qld and WA, 3.57% of journeys to work were by bicycle. This fell to 2.45% by the 1996 census when these areas had enforced helmet laws, with continued declines to 1.7% by the 2006 census. Bicycle usage in all capital cites was 1.14% in 1986 when no helmet laws existed. In 1991, it was 0.99% in Vic, NSW, Tas and SA - states that had (or for SA may have had) enforced laws - and 1.57% in Qld, ACT and WA. From 1986-1996, cycling to work in capital cities dropped from 1.14% to 0.89%, (a difference of 0.25 percentage points, but a decrease of 22%). Census data for Adelaide for 1986, 1991 and 1996 have commuter cycling counts on Census day of 8061, 7186 and 4494 respectively and represent a reduction from 1986 to 1996 of 44%. (note, pre law surveys were conducted on 30 June of each census year and post law surveys in early August (slightly warmer conditions and approximately 42 minutes extra daylight).

Opinions on cycling in relation to the helmet laws

An opinion piece by Ron Shepherd in a 1991 issue of an Australian cycling magazine noted that a draft report from the Monash University Accident Research Centre (MUARC) had found that after helmets became compulsory in Victoria, "the number of cyclists admitted to public hospital with head injuries decreased by 56%. But wait on! Over the same period the number of cyclists admitted with all other injuries decreased by 47%, almost the same as the decrease in head injuries". Shepherd also commented that a likely interpretation was "much less cycling is being done in Victoria since the helmet law was introduced ...many older people who have cycled all their lives without head injury are either furious or devastated by the compulsory helmet requirement", but also that "no-one disputes that helmets work. But why aren't motorists required to wear them? .... on average you'd have to be wearing your (bicycle) helmet since 509 BC for it to protect you.".

In a telephone survey shortly after the helmet law was introduced, the equivalent of 64% of adult cyclists in Western Australia, said they would ride more except for the helmet law. Two years after the helmet law in New South Wales, 51% of schoolchildren owning bikes, who hadn’t cycled in the past week, cited helmet restrictions as the reason for not cycling. A street survey in the Northern Territory found 20% of cyclists had given up because of the law and 42% said they had reduced their cycling. When 325 cyclists in ACT in May 1992 were asked "Would you cycle less if helmets became compulsory?" (by members of group lobbying to against the proposed helmet law) 28% said they would. A 1994 evaluation report on the helmet laws by the NSW Roads and Traffic Authority stated:

On examination of bicycling magazines at the time of legislation, the feeling of many individuals in the Australian bicycle fraternity was anti-helmet and particularly, against compulsory legislation. There was, however, the occasional pro-helmet advocate. The magazine editorial approach tended to be antagonistic toward compulsory helmet legislation, but some, e.g., Bicycle Victoria, encouraged helmet wearing. Articles within the body of the magazines, although primarily against the idea of bicycle helmet legislation, did proyide a more balanced perspective on the topic. Bicycle user groups throughout Australia supported helmet usage, although there were some concerns with helmet design, e.g., in the Northern Territory, the lack of air flow through helmets was of particular concern. The RTA's Bicycle Advisory Council also supported the legislation.

In 2007, John C. Harland, a Melbourne cycling activist, put forward the following views, citing two 1996 cycling conference papers, in a history conference paper titled "Cycling cultures and the mismeasurement of cycling":

"Helmets and social equity - It is believed widely that bicycle helmets reduce the risk of brain damage in bicycle crashes. The data, however, is very thin even now, and was skeletal at the time of mandation of helmet use. Bruce Robinson and Dorre Robinson have both presented good analyses of these issues and will be familiar to most readers from the Velo Australis conference of 1996. A key problem is the use of limited data on head injury to infer data on brain damage - the real issue of concern. The two parameters are far less-well correlated than is believed widely, and Dorre Robinson’s 1996 paper is a good analysis of that. On the scant evidence available, helmet use should never have been mandated. Another issue that raised far too little concern at the time, though, was that of social equity."

Bicycle usage: changes without concurrent control groups around the time of helmet compulsion

The most recent census data (2011) shows much lower percentages cycling to work than before helmet laws were introduced.

Robinson noted that for children, the decrease in numbers of cyclists counted (2215 in New South Wales, 649 in Victoria) was much greater than the increase in numbers wearing helmets (1019 in NSW and 43 in Vic), suggesting that the main effect of the law was to discourage cycling rather than persuade cyclists to wear helmets.

In Melbourne, where 4 surveys of helmet wearing were conducted, Cameron et al. reported "a 36% reduction in bicycle use by children during the first year of the law and an estimated increase in adult use of 44%." On a Bicycle Helmet Research Foundation web page, Robinson criticised the claim relating to adult use on the basis that MUARC ignored the 29% fewer adults counted post-law at the same sites and observation periods as the pre-law survey, and instead "estimated the effect of the law by comparing adult cycle use in 1991 with a much earlier survey (1987/88) at a different time of year. This is... invalid because... cycle use has a marked seasonal variation."

Automatic counters installed on two key cyclist bridges over the Swan river, Perth, Western Australia, recorded an average of 16,326 cycle movements weekly for the three months October to December 1991 (pre-law). The same months in the post law years 1992-94 recorded 13067, 12470 and 10701 cyclist movements per week, reductions of 20%, 24% and 34% on pre-law cycling. A telephone survey in which adults responded on behalf of themselves and their children found 13% of Perth and 8% of country cyclists had given up or cycled less because of the law. However, when the adult respondents in the telephone survey replied for themselves an estimated 27% of the State's adult population - cyclists and non cyclists - (the equivalent of 64% of current adult cyclists) would cycle more if not legally required to wear a helmet. Before the helmet law cycling was in increasing in WA, e.g. an increase from 220,000 regular cyclists in 1982 to 300,000 in 1986 and 400,000 in 1989. Census show cycling to work increased from 1.5% in 1981 to 1.7% in 1986 to 1.9% in 1991, falling to a much lower rate 1.2% in 1996. Travel surveys showed a 33% decline in cycling to work from 1986 to 2006 (from about 1.5 to 1.0 trips per weekday per 100 people), consistent with the census data. Shopping trips fell by 55%, from about 5.2 to 2.3 per weekday per 100 people; trips for education by 79%, from about 8.2 to 1.7 per weekday per 100 people. Significant upgrades to the Perth rail system, including electrification of the 3 existing lines in 1992, and the opening of a new line in 1993, have been the subject of a transport mega project case study. Census data also shows that between 1986 and 2006, in Perth train travel to work more than doubled (from 2.2% to 5.1%), and travel to work by bus in Perth decreased by almost 50% (from 8.6% to 5.3%).

Regular telephone surveys conducted by the South Australian Health Commission reported a decrease in the proportion of people aged 15 years and over who cycled at least once a week from 12% to 10.4%, but no change in the frequency of at least weekly cycling for younger people (61%). However, from 1988 to 1994, cycling to school (which comprises about 20% of trips for children under 15) declined by 38.1%. Reductions in cycling to school were offset largely by an increase from 25% to 34% of children cycling on their "own property" (where mandatory helmet laws do not apply). Census data shows that the proportion cycling to work in South Australia dropped from 2.4% in 1981, to 2.3% in 1986, to 1.9% in 1991, to 1.3% in 1996. In discussing a big increase in car travel to work in Adelaide between 1976 and 2006, Mees et al noted that large-scale road construction had caused car driving to increase faster in Adelaide than in any other city apart from Melbourne, and that in 2006 Adelaide had the highest proportion of car driving to work in the nation.

Bicycle usage: trends before and after helmet compulsion

In the mid to late 1980s, cycling was undergoing a surge in popularity. In Western Australia (WA), numbers cycling more than once a week increased from 300,000 in 1986 to 400,000 (27% of population) in 1989. Cycling increased significantly (+250%) in the Sydney metropolitan area. Cycling to work increased from 1.72% in 1986 to 1.85% in 1991 in WA and from 2.4% to 2.56% in Queensland. Cycling numbers kept declining in the early 1990s, a 1996 cycling survey in Sydney revealed that cycling counts were 48% below the level before the law. In 2011, a national survey of cycling by persons aged 9 or over found a 21% increase in cycle trips between 1985/86 and 2011, compared to a 58% increase in the population aged 9+ years. The per capita increases from 1985/86 were therefore reversed, with a further 24% reduction in the number of cycle trips per person compared to 1985/86 levels.

In Metropolitan Melbourne, cycling trips to work decreased from 1.3% of work trips in 1991 to 1.0% in 1996, increasing to 1.6% in 2006. The increase from 1.0% to 1.6% of work trips from 1996-2006 represents a 175% increase (175% shown in report, actaul figure approximately 73%) in total cycle trips to work. However, cycling to work in Victoria as a whole (including Metropolitan Melbourne) decreased from 1.75% before the helmet law in 1986 to 1.40% in 2006. In Queensland, the decrease was from 2.56% of work trips in 1991, before the helmet law was enforced, to 1.41% in 2006.

The Australian National Cycling Strategy cites an ABS data series on Environmental Issues that the modal share of cycle commuting rose from 1.1% to 1.5% between 2000 and 2009, but omits to say that the same ABS data series reported a modal share of 1.9% in 1996. 1.93 million people cycled in 2008, "representing a 21% increase in cycling participation since 2005 and a 34% increase since 2001. However it was reported at a 1986 Australian cycling conference that in 1982 there were 2.58 million regular cyclists. In 1989 for Victoria alone it was estimated there were 2.21 million bicyclists, 51% of the population. Cycling is now the 4th most popular physical activity behind walking, aerobics and swimming."

As of 2010, bicycles had outsold cars in Australia each year during the previous decade by over 2,000,000, with over 1.3 million bikes sold in 2010, a 12% increase over the previous year and a 67% increase over 2001. Half of Australian households now own at least one bicycle, and today, "more people in Australia are cycling than ever before." A national yearly survey shows that people who had ever cycled in the previous year increased from 9.5% of all adults in 2001 to 11.6% in 2008, an increase of 2.1% [95% CI: 1.14 to 2.76]. This 2.1% represents an overall increase in cyclists of around 343,552. The difference between the estimated number bought and the actual industry total average number of bicycles sold (n = 753,843 per annum) numbered at least 395,000 unused adult bicycles sold each year after sensitivity analyses. There appear to be many more bicycles sold in Australia than are used.

Helmets and bike-share schemes

Melbourne inaugurated a bicycle sharing system in 2010. Mandatory helmet laws have been cited as one reason for its low initial usage. Increased access to helmets in local shops saw usage of the bike share scheme almost double in late 2010 to an average of 183 trips a day. The bike share scheme has seen its usage increase in 2011 from a low point of 257 average daily trips in July, to 519 in January 2012. Nonetheless, this is still low by international standards at 0.4 trips per bike per day in July and 0.8 trips per bike per day in January, while 8 to 10 trips per day is usual elsewhere. A call to relax helmet laws to improve the success of bike hire schemes was made by the Lord Mayor of Perth, Lisa Scaffidi who said "People should have a choice - it should be up to them whether or not they want to wear a helmet." Independent Fremantle MP Adele Carles and Fremantle mayor Brad Pettitt also proposed a "no helmet" trial as a way to encourage more people to take up cycling. The Lord Mayor of the City of Sydney, Clover Moore, has indicated that an exemption from compulsory helmet laws will be sought for a future bike hire scheme after a network of inner-city bikes lanes is completed.

Enforcement, fines and legal aspects of compulsory helmet use

In Victoria more than 19,000 fines for not wearing a helmet were issued in the first 12 months of their helmet law. Before the law was enforced in Queensland, bicycle travel represented about 2.3% of total vehicle kilometres; after the helmet law was enforced in 1993, bicycle offence notices increased to 7.9% of traffic offence notices, implying that per kilometre, bicycle offence notices were about four times higher than all other traffic offences put together - speeding, drink-driving, not wearing seatbelts, careless driving or riding, etc. In 2005 almost 10,000 cyclists in NSW were fined for not wearing a helmet.

One source of free legal advice states that "...if the injured person at the time of the accident was not wearing a safety helmet contrary to law, and there is a cause and effect connection between the injured person’s failure to wear a safety helmet at the time of the accident and the injured person’s injury the damages awarded will be reduced by 25%." In 1998, A UK newspaper for teachers reported that in the Northern Territory a 15-year-old Aboriginal girl was strip-searched and spent a night in a detention centre for not paying fines for failing to wearing a bicycle helmet and a 12 year old boy faced 3 months detention for not paying $2,000 of fines for not wearing a helmet. Alan Todd reported that his wife spent a night in jail, while 7 months pregnant, for refusing to pay a fine for not wearing a bike helmet. Kathy Francis, founding member of Freestyle Cyclists (an Australian organisation lobbying for repeal of mandatory helmet laws), explains: "I grew up without helmets in a country town where it was very safe to ride. I thought the helmet law was a crock and was fined repeatedly. I refused to pay, and was eventually was put in jail, pregnant, for 24 hours." In Perth, Grant Mahy spent 3 nights in jail for refusing to pay a helmet law fine. He explains: "I haven't ridden my bike since then and four of my five closest friends also have given up." In South Australia a 71 year old man was picked up by the police the day before Christmas in 1992 for not paying a helmet fine and spent two days and two nights in the lock-up. In 2010, Sue Abbott challenged her helmet fines in a District Court on the grounds of 'necessity'. Having read all the material provided by Sue Abbott, the District Court judge told her "...I think I would fall down on your side of the ledger...I frankly don't think there is anything advantageous and there may well be a disadvantage in situations to have a helmet - and it seems to me that it's one of those areas where it ought to be a matter of choice". The offence was found proven but her conviction was quashed. Ms Abbott ended up having her driving licence revoked and some property confiscated for refusal to pay a victims' compensation levy imposed because she took this legal action to challenge her helmet-law fine. Her daughter won a similar case. In April 2013 Ms Abbott was fined again for failing to wear a helmet while cycling across the Sydney Harbour Bridge and has indicated an intention to challenge the fine in court.

Colin Clarke stated in a peer-reviewed paper about cycling helmet laws in New Zealand that "discrimination can occur in accident compensation cases where a cyclist was not wearing a helmet, compared to pedestrians or indeed motor vehicle occupants who received head injuries. The helmet laws result in unfair compensation and a biased legal process".

The Sydney Morning Herald has reported that the number of cyclists who have been fined decreased from more than 13,000 in 2005-06; to 10,807 in 2007-08; and to 8,866 in 2008-2009. The newspaper also reported that in 2005 almost 10,000 cyclists were fined for not wearing a helmet and that the number had dropped to 6,537 in 2010. The chairman of the Pedestrian Council of Australia was quoted as saying that in the past 5 years there have been no fines issued for most bicycle-related offences; that 74% of the fines related to helmets, not riding offences; and that it appeared that the government was going soft on cyclists. An article in The Age quoted the officer in charge of Victoria Police's bicycle unit as saying that cyclists without a helmet were a particular focus, because it is a most fundamental safety rule. The newspaper also reported that Bicycle Victoria supported the increased fines. (Bicycle Victoria is Australia's largest bike riding organisation, with almost 50,000 members; the combined membership of the equivalent organisations in NSW, Queensland and SA is about 10,000.)

In April 2013 the Queensland government announced that exemptions on religious grounds from mandatory bicycle helmet laws would be granted from 2014.

Public attitude to helmets

A 2011 survey of 1000 Australians by the Cycling Promotion Fund found that 515 respondents were not interested in cycling for transport, with 15.7% citing "don't like wearing a helmet" as one of their reasons. This was the 13th most popular response with safety issues ("Unsafe road conditions" "Speed/volume of traffic" and "Don't feel safe riding" the top three responses). 158 people had cycled for transport in the past month.

In 2010, Rissel and Wen conducted a telephone survey of 600 Sydney residents, in which 1 in 5 respondents claimed they would cycle more if they didn't have to wear a helmet. From these details, the researchers concluded that, "...to the extent that Sydney is representative of the rest of Australia, the repeal of mandatory helmet legislation would be likely to substantially increase cycling in Australia." A critique of the study by Olivier et al. was subsequently published. Discussion of the study by one of its authors (Rissel) and by Churches also appeared in the online media and blogosphere respectively.

An April 2012 survey of 1,910 Australian respondents found 94% approved of the government making helmet wearing mandatory while 1% strongly opposed.

An online survey of attitudes to cycling of 1,007 randomly-selected Australian women aged 18 and over was commissioned in February 2013 by the National Heart Foundation of Australia and the Cycling Promotion Fund. In response to the statement "Wearing a helmet ruins a woman's hairstyle", 39% of survey participants agreed, 33% disagreed, 27% responded "neither" and 1% were unsure. In response to the question "What would encourage women to cycle more?", 4% of participants listed "Not having to wear helmets" as a main reason, and 11% listed it as an other reason.

Health implications of bicycle helmets legislation

See also: Health effects of physical exercise

Prior to introducing bicycle helmet legislation in Victoria in 1990, the Government published a Regulatory Impact Statement (RIS). In 2007, Clarke reported that the RIS recognised that there would be some inconvenience to people but that it did not provide any details or discussion about people being discouraged from cycling, nor did it provide details of the potential health loss or environmental loss if people did less exercise or transferred from bicycles to motorised transport. Pless pointed out in 2006 that no study has demonstrated a causal link between mandatory helmet legislation and lower levels of physical fitness at the population level. He stated "We provided some evidence that most cycling is insufficient to enhance fitness, but this and other rebuttals continue to be ignored.

The Bicycle Federation of Australia and the Cycling Promotion Fund reported that "...active transport (cycling and walking) are effective ways of getting adequate physical exercise. Cycling is a convenient, cheap, low impact, environmentally friendly form of transport which, as a daily physical activity, is more likely to be maintained than other leisure-time physical activities" and that "...lack of physical activity is second only to tobacco as the most important health risk in Australia".

A 2008 review by Bill Curnow concluded: “Compulsion to wear a bicycle helmet is detrimental to public health in Australia but, to maintain the status quo, authorities have obfuscated evidence that shows this” and "Cycling declined after the helmet laws by an estimated 40% for children, with loss of the benefits of the exercise for health. As serious casualties declined by less, the risks to cyclists, including death by head injury, increased".

Cycling is one way for people to undertake physical exercise, which tends to improve fitness and have other health benefits. People who exercise regularly tend to live longer than those who do not. The British Medical Association has stated that, compared to cycling, and despite the risk of accidents, "...car travel is more deleterious to health unless the motorist can exercise several times a week by other means that will maintain fitness". Estimated benefit:cost ratios for cycling range from 13:1 to 415:1. The Australian Transport Safety Bureau, an Australian government agency, has indicated that the risks of cycling have to be weighed against the substantial benefits.

For mathematical health-benefit models of mandatory cycling helmet laws, see Health benefits of cycling

See also

• Bicycle helmet laws
• Cycling in Australia
• Bicycle helmets by country

External links

• Bicycle Helmet Research Foundation - Australia
• VicRoads: Wearing a bicycle helmet
• NSW Cycling Research
• Bicycle Network Victoria
• Cycling Resource Centre
• Bicycle Helmet Safety Institute: Research Page
• Mandatory bicycle helmet law in Western Australia