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A bicycle helmet is designed to attenuate impacts to the head of a cyclist in falls while minimizing side effects such as interference with peripheral vision.[1] There is an active scientific debate, with no consensus, on whether helmets are useful for general cycling, and on whether any benefits are outweighed by their disadvantages. The debate on whether helmet use should be enforced by law is intense and occasionally bitter, often based not only on differing interpretations of the academic literature, but also on differing assumptions and interests on the two sides.[2][3]

A bicycle helmet.

About helmets

History of designs

"Hairnet" helmet

A cycle helmet should generally be light in weight and provide ample ventilation, because cycling can be an intense aerobic activity which significantly raises body temperature, and the head in particular needs to be able to regulate its temperature. The dominant form of helmet up to the 1970s was the leather "hairnet" style. This offered acceptable protection from scrapes and cuts, but only minimal impact protection, and was mainly used by racing cyclists. More widespread use of helmets began in the U.S. in the 1970s. After many decades, when bicycles were regarded only as children's toys, many American adults took up cycling during and after the bike boom of the 1970s. Two of the first modern bicycle helmets were made by MSR, a manufacturer of mountaineering equipment, and Bell Sports, a manufacturer of helmets for auto racing and motorcycles. These helmets were a spin-off from the development of expanded polystyrene foam liners for motorcycling and motorsport helmets, and had hard polycarbonate plastic shells. The bicycle helmet arm of Bell was split off in 1991 as Bell Sports Inc., having completely overtaken the motorcycle and motor sports helmet business.

The first commercially successful purpose-designed bicycle helmet was the Bell Biker, a polystyrene-lined hard shell released in 1975.[4][5] At the time there was no appropriate standard; the only applicable one, from Snell, would be passed only by a light open-face motorcycle helmet. Over time the design was refined and by 1983 Bell were making the V1-Pro, the first polystyrene helmet intended for racing use. In 1984 Bell produced the Li'l Bell Shell, a no-shell children's helmet. These early helmets had little ventilation.

In 1985, Snell B85 was introduced, the first widely adopted standard for bicycle helmets; this has subsequently been refined into B90 and B95 (see Standards below). At this time helmets were almost all either hard-shell or no-shell (perhaps with a vacuum-formed plastic cover). Ventilation was still minimal due mainly to technical limitations of the foams and shells in use.

A Giro Atmos helmet, showing seamless in-mould microshell construction.

Around 1990 a new construction technique was invented: in-mould microshell. A very thin shell was incorporated during the moulding process. This rapidly became the dominant technology, allowing for larger vents and more complex shapes than hard shells.

Use of hard shells declined rapidly among the general cyclist population during the 1990s, almost disappearing by the end of the decade, but remain popular with BMX riders as well as inline skaters and skateboarders.

The late 1990s and early 2000s saw advances in retention and fitting systems, replacing the old system of varying thickness pads with cradles which adjust quite precisely to the rider's head. This has also resulted in the back of the head being less covered by the helmet; impacts to this region are rare, but it does make a modern bike helmet much less suitable for activities such as unicycling, skateboarding and inline skating, where falling over backward is relatively common. Other helmets will be more suitable for these activities.

Since more advanced helmets began being used in the Tour de France, carbon fiber inserts have started to be used to increase strength and protection of the helmet. The Giro Atmos and Ionos, as well as the Bell Alchera were among the first to use carbon fiber.

Some modern racing bicycle helmets have a long tapering back end for streamlining. This type of helmet is mainly dedicated to time trial racing as they lack significant ventilation, making them uncomfortable for long races.

History of standards

In the United States the Snell Memorial Foundation, an organization initially established to create standards for motorcycle and auto-racing helmets, implemented one of the first standards, since updated. Snell's standard includes testing of random samples.[6] In 1990 the Consumers' Association (UK) market survey showed that around 90 % of helmets on sale were Snell B90 certified. By their 1998 survey the number of Snell certified helmets was around zero.[citation needed] There are two main types of helmet: hard shell and soft/micro shell (no-shell helmets are now rare). Hard shells declined rapidly among the general cyclist population over this period, almost disappearing by the end of the decade, but remained more popular with BMX riders as well as inline skaters and skateboarders.

The American National Standards Institute (ANSI) created a standard called ANSI Z80.4 in 1984. Later, the United States Consumer Product Safety Commission (CPSC) created its own mandatory standard for all bicycle helmets sold in the United States, which took effect in March 1999.[1]

In the European Union (EU) the currently applicable standard is EN 1078:1997.

In the UK the current standard is BS EN 1078:1997, which is identical to the EU standard, and which replaced BS 6863:1989 in 1997.[7]

In Australia and New Zealand, the current legally-required standard is AS/NZS 2063.[8] The performance requirements of this standard are slightly less strict than the Snell B95 standard but incorporate a quality assurance requirement. As a result, the AS/NZS can be argued to be safer.[9] SAI Global (a profit-making arm of the Standards Australia organisation]) runs a marketing program based on the AS/NZS 2063 standard, in which manufacturers pay royalties and fees to affix a "5 ticks" certification trademark sticker on helmets.[10]

The CPSC and EN1078 standards are lower than the Snell B95 (and B90[citation needed]) standard; Snell helmet standards are externally verified, with each helmet traceable by unique serial number. EN 1078 is also externally validated, but lacks Snell's traceability. The most common standard in the US, CPSC, is self-certified by the manufacturers. It is generally true to say that Snell standards are more exacting than other standards, and most helmets on sale these days will not meet them.[citation needed]

Although helmet standards have weakened over time[11] there are no data on which to base an assessment of how this has affected the design goal of mitigating minor injuries. Minor injuries are substantially under-reported, and it is difficult to measure such injuries validly in any large population.[citation needed]

In brief, the primary design goal of a helmet is to decelerate the skull (and by implication, the brain inside it) more gently than would be the case if no helmet were worn. A helmet's ability to manage linear deceleration of the skull could be improved by providing a greater thickness of expanded polystyrene foam and also by making this foam softer, but this would make the entire helmet bulkier, heavier, and hotter to wear.[citation needed] Another concern is that a thicker helmet increases the risk of rotational-type brain injuries (discussed in more detail below). Ultimately, every helmet design represents some sort of compromise.

The trend is toward thinner helmets with many large vents. This trend to lower standards has been noted in some of the studies.[12]

Design intentions and standards

Both are intended to reduce acceleration to the head due to impact, as a stiff liner made of expanded polystyrene is crushed against the head.[13][14]

Standards involve the use of an instrumented headform which is dropped, wearing a helmet, onto various anvils. The speed of impact is designed to simulate the effect of a rider's head falling from approximately usual riding height, without rotational energy and without impact from another vehicle.{http://www.cpsc.gov/businfo/frnotices/fr98/10mr98r.pdf }

Collision energy varies with the square of impact speed. A typical helmet is designed to absorb the energy of a head falling from a bicycle, hence an impact speed of around 12 mph or 20 km/h. This will only reduce the energy of a 30 mph or 50 km/h impact to the equivalent of 27.5 mph or 45 km/h, and even this will be compromised if the helmet fails.[citation needed] As a subsidiary effect, they should also spread point impacts over a wider area of the skull. Hard shell helmets may do this better, but are heavier and less well ventilated. They are more common among stunt riders than road riders or mountain bikers. Additionally, the helmet should reduce superficial injuries to the scalp. Hard shell helmets may also reduce the likelihood of penetrating impacts, although these are very rare.

Criticism of current standards

Some helmet liners may be too stiff to be effective. Standards require the use of headforms more rigid than the human head; these are more capable of crushing foam than is the human head.[15]

very little crushing of the liner foam was usually evident... What in fact happens in a real crash impact is that the human head deforms elastically on impact. The standard impact attenuation test making use of a solid headform does not consider the effect of human head deformation with the result that all acceleration attenuation occurs in compression of the liner. Since the solid headform is more capable of crushing helmet padding, manufacturers have had to provide relatively stiff foam in the helmet so that it would pass the impact attenuation test... As the results in Figure 15 illustrate, the child skull is far from being solid and will deform readily on impact. This fact is well known in the medical field and is largely why a child who has had a rather modest impact to the head is usually admitted to hospital for observation. The substantial elastic deformation of the child head that can occur during impact can result in quite extensive diffuse brain damage.[16]

In real accidents, while broken helmets are common, it is extremely unusual to see any helmet that has compressed foam and thus may have performed as intended.

Another source of field experience is our experience with damaged helmets returned to customer service... I collected damaged infant/toddler helmets for several months in 1995. Not only did I not see bottomed out helmets, I didn’t see any helmet showing signs of crushing on the inside.[15]

Fit and care

correctly worn helmet

It is important that a helmet should fit the cyclist properly – in one study of children and adolescents aged 4 to 18 years, 96 %[17] were found to be incorrectly fitted. Efficacy of incorrectly fitted helmets is reckoned to be much lower; one estimate states that risk is increased almost twofold.[18]

Most manufacturers provide a range of sizes ranging from children's to adult with additional variations from small to medium to large. The correct size is important. Some adjustment can usually be made using different thickness foam pads. Helmets are held on the head with nylon straps, which must be adjusted to fit the individual. This can be difficult to achieve, depending on the design. Most helmets will have multiple adjustment points on the strap to allow both strap and helmet to be correctly positioned. Additionally, some helmets have adjustable cradles which fit the helmet to the occipital region of the skull. These provide no protection, only fit, so helmets with this type of adjustment are unsuitable for roller skating, stunts, skateboarding and unicycling. In general, the more skull coverage a helmet provides, the more effectively it can be fitted to the head and hence the better it will remain on the head in an accident.

Newer helmets for toddlers and children feature flat backs that prevent the helmet from tilting too far forward when worn while riding in a trailer or child seat with a headrest. Pinch-proof buckles and light-weighted helmets are also available for small children. Although these features do not increase protection upon impact, they are convenient.

The Snell Memorial Foundation recommends that any helmet that has sustained a substantial blow should be discarded and replaced, including any helmet involved in a crash in which the head has hit a hard surface or in which a fall has resulted in marks on the shell. Because some helmet materials deteriorate with age, the Snell Memorial Foundation recommends that a helmet be replaced at least every 5 years, or sooner if the manufacturer recommends it.[19][20]

History of use

Helmets use varies greatly between populations and between groups. Downhill mountain bikers and amateur sportive cyclists normally wear helmets,[21] and helmet use is enforced in professional cycle sport and in a few legal jurisdictions. Utility cyclists and children are much less likely to wear helmets unless compelled.

Required helmet use in cycling sport

Historically, road cycling regulations set by the sport's ruling body, Union Cycliste Internationale (UCI), did not require helmet use, leaving the matter to individual preferences and local traffic laws. The majority of professional cyclists chose not to wear helmets, citing discomfort and claiming that helmet weight would put them in a disadvantage during uphill sections of the race.

The first serious attempt by the UCI to introduce compulsory helmet use in 1991 was met with strong opposition from the riders.[22] An attempt to enforce the rule at the 1991 Paris–Nice race resulted in a riders' strike, forcing the UCI to abandon the idea.

While voluntary helmet use in professional ranks rose somewhat in the 1990s, the turning point in helmet policy was the March 2003 death of Kazakh Andrei Kivilev. The new rules were introduced on 5 May 2003,[23] with the 2003 Giro d'Italia being the first major race affected. The 2003 rules allowed for discarding the helmets during final climbs of at least 5 kilometres in length;[24] subsequent revisions made helmet use mandatory at all times.

No studies have been published yet into whether injuries to racers have reduced as a result, but modern helmets can help to decrease aerodynamic drag by approximately 2% over a rider with no helmet, giving a competitive edge in a bicycle race.[25]

Cycling risk and head injury

In the USA, two-thirds of cyclists admitted to hospital have a head injury. Ninety per cent of cyclist deaths are caused by collisions with motor vehicles.[26] For cyclists admitted to hospital in Western Australia before the helmet law, about 30% of cyclists and 30% of pedestrians had head injuries. Trends and proportions of cyclists admitted to hospital with head injury were similar for all road users.[27][28][29]

A 2002 study found that, per mile in the United Kingdom, cycling has an overall risk of injury and death similar to walking but higher than driving; it found that in France cycling is safer per hour than motoring.[30] Measured per hour, the risk of driving, cycling and walking are similar.[31][32]

Science: measuring helmet effectiveness

Desirable effects of helmet use

The effects of cycle helmets have been studied mainly through case-control studies and time-trend analyses. Case-control studies usually show a substantial protective effect on head injuries as do most meta-analyses of them. Time-trend analyses usually show less or no protective effect. No randomized controlled trials have been done on the subject.

Time-trend analyses

Time-trend analyses compare changes in helmet use and injury rates in populations over time. This type of study usually shows that as helmet-use increases, head injury rates among cyclists do not fall faster than for road users without helmets such as pedestrians and motorists.[33][34]

Authors do not agree on how studies should be selected for analysis, nor on what summary statistics are most relevant. Potential weaknesses of this type of study include: simultaneous changes in the road environment (e.g. drink-drive campaigns); inaccuracy of exposure estimates (numbers cycling, distance cycled etc.), changes in the definitions of the data collected, failure to analyse control groups, failure to analyse long-term trends, and the ecological fallacy.

Robinson's reviews of cyclists and control groups in jurisdictions where helmet use increased by 40% or more following compulsion conclude that enforced helmet laws discourage cycling but produce no obvious response in percentage of head injuries.[33][34] These studies have been the subject of vigorous debate.[35][36] A review, by Macpherson and Spinks, which included two original papers (neither of which meet the criteria for inclusion in Robinson's review), concluded that "Bicycle helmet legislation appears to be effective in increasing helmet use and decreasing head injury rates in the populations for which it is implemented. However, there are very few high-quality evaluative studies that measure these outcomes, and none that reported data on an (sic) possible declines in bicycle use."[37] Later work by Macpherson's group admitted that this conclusion had been erroneous and that "Although bicycle-related injuries are generally declining, this decline is not consistent, nor is it clearly associated with helmet laws."[38]

One study covering eight million cyclist injuries over 15 years, showed no effect on serious injuries and a small but significant increase in risk of fatality.[39] Although the head injury rate in the US rose in this study by 40 % as helmet use rose from 18 % to 50 %,[39] this is a time-trend analysis with the potential weaknesses mentioned above; the correlation may not be causal. Association with increased risk has been reported in other studies.[40] Different analyses of the same data can produce different results. For example, Scuffham analysed data on the increase of voluntary wearing in New Zealand to 1995; he concluded that, after taking into account long-term trends, helmets had no measurable effect.[41] His subsequent re-analysis without accounting for the long-term trends suggested a small benefit.[42] Scuffham's later cost-benefit analysis of the New Zealand helmet law showed that the cost of helmets outweighed the savings in injuries, even taking the most optimistic estimate of injuries prevented.[43]

Case-control studies

In a case-control study, hospitalised cyclists are divided into those with head injuries (cases) and those without (controls). Many studies of this type have been conducted, and they usually conclude that helmets provide some level of protective effect against head injuries. For example, one recent French study analyzing over 13,000 cyclist casualties during a ten-year period "confirms the protective effect [of helmets] for head and facial injuries," and finds that "the reduction of risk is greater for serious head injuries. The study is inconclusive about the risk for neck injuries."[44] The most widely quoted case-control study, by Thompson, Rivara, and Thompson, reported an 85% reduction in the risk of head injury by using a helmet.[45] It has been suggested that these studies may be fundamentally flawed.[46][47][48][49] [50] [51] Thompson and Thompson have rejected these criticisms.[52]

Meta-analyses

There are several meta-analyses and reviews which synthesize and evaluate the results of multiple case-control studies. A Cochrane review of case-control studies of bicycle helmets by Thompson et al. found that "helmets provide a 63 to 88% reduction in the risk of head, brain and severe brain injury for all ages of bicyclists. Helmets provide equal levels of protection for crashes involving motor vehicles (69%) and crashes from all other causes (68%). Injuries to the upper and mid facial areas are reduced 65%."[53] It has been suggested that this work was misleadingly presented.[54][55]

A meta-analysis of sixteen studies by Attewell et al. reported "conservative risk reduction estimates of at least 45% for head injury, 33% for brain injury, 27% for facial injury and 29% for fatal injury."[56] A 2011 re-analysis of Attewell et al. (2001) by Elvik finds that it was influenced by publication bias and time-trend bias. When "these sources of bias are controlled for, the protective effects attributed to bicycle helmets become smaller than originally estimated." The re-analysis finds that helmets "clearly" reduce the risk of head injury and provide slight protective effects for the face, but apparently not for the neck. Elvik finds that four studies not included in Attewell et al. show "no overall effect of bicycle helmets ... when injuries to head, face or neck are considered as a whole." [57] people sometimes go crazy while using a helmet

Undesirable effects of helmet use

Health benefits of cycling

Studies from China, Denmark, the Netherlands and the United Kingdom show that regular cyclists live longer because the health effects far outweigh the risk of crashes.[58][59][60][61] A reduction in the number of cyclists is likely to harm the health of the population more than any possible protection from injury.[33][34] UK figures show that it takes at least 8000 years of average cycling to produce one clinically severe head injury and 22,000 years for one death.[62] Because cycling is more healthy than dangerous, helmet laws appear to offer net health benefit only in dangerous bicycling environments under optimistic assumptions of the efficacy of helmets.[63]

Concerns have been raised that enforced mandatory bicycle helmet laws might lead to a reduction in the number of cyclists, with worse health as a result.[33][34][63] This suggestion has been criticized.[64] Fewer cyclists might lead to increased risks per cyclist due to the "safety in numbers" effect.[65] According to one source, the probability of an individual cyclist being struck by a motorist declines with the 0.6 power of the number of cyclists on the road.[31] This means that if the number of cyclists on the road doubles, then the average individual cyclist can ride for an additional 50% of the time without increasing the probability of being struck. It is thought that the increased frequency of motorist-cyclist interaction creates more aware motorists.

Most work, and the only studies using concurrent control groups, come from Australia; see Bicycle helmets in Australia for more detail. Cycling in Australia was increasing before the helmet laws were introduced and fell by roughly one-third at that time.[34] As of 2006, there were fewer cycle trips per head than before the laws.[33][34][66] [67]

Australian census data on cycling to work

Some Australian states made bicycle helmets compulsory before the 1991 census, which asked about mode of transport to work on census day. This allowed comparison of states with and without helmet laws. The reduction in commuting by bicycle was about one-third at sites in New South Wales, Melbourne, and Perth.[34] The conclusion that this was due to helmet laws has been criticized.[64] Bicycle hire schemes in Australia have had low usage rates, of the order of one-tenth of schemes in areas without helmet laws, and mandatory helmet legislation was thought to reduce spontaneous use.[68][69]

As of 2010, the number of cyclists in Australia was at an all-time high, and modal share of cycle commuting rose from 1.1% to 1.5% between 2000 and 2009.[70] 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. Any per capita increases from 1985/86 until the introduction of helmet laws were therefore reversed, with a further 24% reduction in the number of cycle trips per person compared to 1985/86 levels.[71]

In the UK between 1994 and 1996, in areas where cyclist counts dropped, wearing rates increased and where the number of cyclists increased, helmet wearing rates fell.[72]

Several mechanisms by which cycle helmet promotion or compulsion may deter cycling have been suggested. Helmets and their promotion may reinforce the misconception that bicycling is more dangerous than traveling by passenger car.[73] Referring to the use of "human skull" images in a campaign,[74] the CTC suggests that "this macabre imagery, with its associations of hospitals and death, is likely to reduce cycle use, thereby undermining efforts to realize the health and other benefits of increased cycling".[75] Bicycle helmets can be an additional expense.

A 2010 telephone survey of 600 residents in Sydney, Australia, found that 22.6% of the respondents said that they would cycle more if they did not have to wear a helmet. The survey's authors conclude: "While a hypothetical situation, if only half of the 22.6% of respondents who said they would cycle more if they did not have to wear a helmet did ride more, Sydney targets for increasing cycling would be achieved by repealing mandatory bicycle helmet legislation."[76]

Papers denying that helmet promotion has a deterrent effect on cycling[37] have tended to ignore evidence to the contrary.[77][78]

Risk compensation

Wearing helmets may make cyclists feel safer and thus take more risks. This effect is known as risk compensation and is consistent with other road safety interventions such as seat belts and anti-lock braking systems.[79][80]

In tests, adults accustomed to wearing helmets cycled faster when wearing a helmet than without, indicating a higher tolerance for risk.[81][82] Tests also show that children go faster and take more risks when wearing safety gear (including helmets),[83] and that parents allow children to be more risky when using safety gear.[84]

Motorists may also alter their behavior toward helmeted cyclists. One small study from England found that vehicles passed a helmeted cyclist with measurably less clearance (8.5 cm) than that given to the same cyclist unhelmeted (out of an average total passing distance of 1.2 to 1.3 metres).[85]

Rodgers re-analysed data which supposedly showed helmets to be effective; he found data errors and methodological weaknesses so serious that in fact the data showed "bicycle-related fatalities are positively and significantly associated with increased helmet use".[39] A range of theories have been proposed to explain why helmet use might indirectly translate into more or worse accidents. In short, the analysis of helmet effectiveness is confounded by changes in human behaviour apparently induced by the presence of protective headgear.

Rotational injury

It has been suggested that the major causes of permanent intellectual disablement and death after head injury may be torsional forces leading to diffuse axonal injury (DAI), a form of injury which usual helmets cannot mitigate and may make worse.[48] Bicycle helmet designs, in particular those which are not full-face helmets, may increase the torsional forces by increasing the distance from the centre of the spine to the outside of the helmet, compared to the distance to the scalp without a helmet: "Bicycle helmet crash simulation experiments carried out as part of this project indicated very high rotational accelerations for a fall over the handlebars at 45 km/h. The rotational accelerations were found to be 30 percent higher than those found in similar tests using a full face polymer motorcycle helmet."[86]

An article in the New Scientist stated:

"The major discovery is that the skull plays an important role in protecting against rotational acceleration," says Phillips. He says almost all head injuries involve not just a direct blow to the skull but also damage to blood vessels caused by the brain rotating within the skull.

In mechanical terms, the head is an elliptical spheroid with a single universal joint, the neck. It is therefore almost impossible to hit it without causing it to rotate. The head tries to dampen these forces using a combination of built-in defences: the scalp, the hard skull and the cerebrospinal fluid beneath it. During an impact, the scalp acts as rotational shock absorber by both compressing and sliding over the skull. This absorbs energy from the impact.[87]

Full-face and slip-plane helmet designs
A carbon full-face bicycle helmet.

A 1991 study by Hodgson, in which bicycle helmets were tested for ease of skidding, found that adding facial protection to a standard bicycle helmet (making the helmet a full-face helmet) brought the benefit of reduced twisting forces on the brain. A full face helmet design was also found to reduce the cervical-spine injury index. It also assisted in keeping the helmet in place during the crash tests and in protecting the face. It reduced "neck injury by reducing the facial-pavement friction and subsequent twisting, bending, and compression; and brain injury by reducing sudden rotational movements during facial impact, and lowering linear head accelerations by absorbing energy by deformation in the event impact occurs on the guard."[88]

A bicycle helmet with its own synthetic "scalp" has been designed with the aim of mitigating rotational injury.[89] This is one of several slip-plane-type designs that are intended to reduce rotational acceleration on the brain during an oblique impact.[90] Although many bicycle helmets are designed with rounded, smooth shells that slide easily along pavement, adding a slip plane to such an already-good design may be valuable in situations where the helmet impacts obliquely against a high-friction surface.[91] The concept of slip planes is not new, but the implementation in production bicycle helmets is.[91]

Accidental hanging by helmet straps

There are cases of young children playing (on or near bunk beds, trees, clothes lines, play equipment etc.) suffering death or severe brain damage as a result of hanging by the straps of their bicycle helmets.[92][93][94][95][96][97][98][99][100][101][102][103] As a result, European Standard EN 1080 was developed, which uses a weak retention system designed to open under load.[104] Such helmets are not intended for use anywhere motor vehicles are present.[105] To avoid serious accidents, parents and carers should take care to ensure that children do not wear bicycle helmets during unsupervised play, or when using climbing equipment.[106]

Opinions for and against the compulsion or strong promotion of helmets

Supporters

Significant helmet promotion preceded epidemiological studies evaluating the effectiveness of bicycle helmets in bicycle crashes.[107][108] Received opinion in some English-speaking countries is that bicycle helmets are useful and that every cyclist should wear one; helmets had become a ‘ "Mom and apple pie" issue’ in the United States by 1991 according to the League of American Bicyclists.[109]

A number of cycling advocacy organizations support helmet use. The League of American Bicyclists "has encouraged the wearing of helmets via its publications and its education program for many years. Since 1991 the League has required participants in League-sponsored events to wear helmets."[110] Cycling Advocates' Network (CAN), a nationwide New Zealand cycling advocacy group, "fully supports the use of helmets when undertaking recreational cycling in difficult terrain or high-speed competitive racing."[111]

Numerous health and medical groups, such as the World Health Organization,[112] Centers for Disease Control and Prevention,[113] and American Academy of Pediatrics[114] recommend wearing helmets.

Some medical groups support helmet laws, as well. These include the British Medical Association,[115][116] American Medical Association,[117] and American College of Emergency Physicians.[118]

Groups in other sectors also advocate helmet use or laws. For instance, safety groups Safe Kids USA[119] and the National Safety Council[120] urge helmet wearing. Temple University's Public Health Law Research program classifies bicycle helmets laws as an "effective" public health intervention, based on a review of scholarly research.[121]

U.S.-based cycling activist John Forester suggests that helmet wearing could prevent 300 deaths a year in the US out of a total of 1530 preventable deaths, behind Effective Cycling at 500 but ahead of all other interventions.[122]

Opponents

Robinson reviewed data from jurisdictions where helmet use increased following legislation, and concluded that helmet use did not demonstrably reduce cyclists' head injuries.[33][34] Mayer Hillman, a transport and road safety analyst from the UK, does not support the use of helmets, reasoning that they are of very limited value in the event of a collision with a car, that risk compensation negates their protective effect and because he feels their promotion implicitly shifts responsibility of care to the cyclist.[123][124] He also cautions against placing the recommendations of surgeons above other expert opinion in the debate, comparing it to drawing conclusions on whether it is worthwhile to buy lottery tickets by sampling only a group of prizewinners.[125] The prominent UK-based cycling activist John Franklin is skeptical of the merits of helmets, regarding proactive measures including bike maintenance and riding skills as being more important.[126] Cyclists' representative groups complain that focus on helmets diverts attention from other issues which are much more important for improving bicycle safety, such as road danger reduction, training, roadcraft, and bicycle maintenance.[127][128] Of 28 publicly funded cycle safety interventions listed in a report in 2002, 24 were helmet promotions. [citation needed]

In 1998 the European Cyclists' Federation adopted a position paper rejecting compulsory helmet laws as being likely to have greater negative rather than positive health effects.[127] The UK's largest cyclists' organisation, the CTC, believes that the "overall health effects of compulsory helmets are negative."[129] The British National Children's Bureau has said "The 2004 BMA statement announcing its decision to support compulsory cycle helmets shows how the uncritical use of accident statistics can lead to poor conclusions."[130] The same report estimated that, at most, universal helmet use would save the lives of three children aged 0 to 15 each year. That figure "assumes universal and correct use of helmets, it assumes that risk compensation does not occur and it assumes that no children die as a result of strangulation or other injuries caused by helmet use. These assumptions are most unlikely to be correct in the real world." The Dutch Fietsersbond summarized existing evidence and concluded that a compulsory helmet law (for utility cyclists) would have a negative impact on population health."Helmet laws save a few brains, but destroy a lot of hearts". No advice was given for specific situations (sports, MTB use, etc). http://www.fietsersbond.nl/nieuws/fietsersbond-onderzoekt-helpt-de-helm

Legislation and culture

See also: Bicycle helmets by country

The following countries have mandatory helmet laws, in at least one jurisdiction, for either minors only, or for all riders: Australia, Canada, Czech Republic, Finland, Iceland, New Zealand, Sweden, and the United States. Spain requires helmets on interurban routes.[131] In the U.S. 21 states have state-wide mandatory helmet laws for minors of varying ages, and 37 states have mandatory helmet laws for varying age groups in varying jurisdictions.[132] Nearly 9 in 10 American adults support helmet laws for children.[133] Israel's helmet law was never enforced or obeyed, and the adult element has been revoked; Mexico City has repealed its helmet law.[134]

Although the link is not causal, it is observed that the countries with the best cycle safety records (Denmark and the Netherlands) have among the lowest levels of helmet use.[135] Their bicycle safety record is generally attributed to public awareness and understanding of cyclists, safety in numbers, education, and cycling infrastructure. A study of cycling in major streets of Boston, Paris and Amsterdam illustrates the variation in cycling culture: Boston had far higher rates of helmet-wearing (32% of cyclists, versus 2.4% in Paris and 0.1% in Amsterdam), Amsterdam had far more cyclists (242 passing bicycles per hour, versus 74 in Paris and 55 in Boston).[136] Cycle helmet wearing rates in the Netherlands and Denmark are very low.[124][137][138] An Australian journalist writes: "Rarities in Amsterdam seem to be stretch-fabric-clad cyclists and fat cyclists. Helmets are non-existent, and when people asked me where I was from, they would grimace and mutter: "Ah, yes, helmet laws." These had gained international notoriety on a par with our deadly sea animals. Despite the lack of helmets, cycling in the Netherlands is safer than in any other country, and the Dutch have one-third the number of cycling fatalities (per 100,000 people) that Australia has."[139] The UK's CTC say that cycling in the Netherlands and Denmark is perceived as a "normal" activity requiring no special clothing or equipment.[140] Pucher and Buehler state: "The Dutch cycling experts and planners interviewed for this paper adamantly opposed the use of helmets, claiming that helmets discourage cycling by making it less convenient, less comfortable, and less fashionable. They also mention the possibility that helmets would make cycling more dangerous by giving cyclists a false sense of safety and thus encouraging riskier riding behavior."[141]

See also

References

  1. ^ a b Consumer Product Safety Commission. "Safety Standard for Bicycle Helmets" (PDF). Final Rule 16 CFR Part 1203. Archived from the original (PDF) on 24 September 2006. Retrieved 2006. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  2. ^ Department of Transport (UK) 2002. Road safety research report. Bicycle helmets: review of effectiveness (No.30). Elizabeth Towner, Therese Dowswell, Matthew Burkes, Heather Dickinson, John Towner, Michael Hayes. November 2002. "In terms of tone, the bicycle helmet debate can best be described as sour and tetchy. Neither side seems willing to concede that there can be alternative points of view." Section 7: Opinion Pieces. http://www.dft.gov.uk/rmd/project.asp?intProjectID=10083
  3. ^ Horton D. Fear of Cycling. pp 133-154 in Rosen P, Cox P, Horton D (eds.) Cycling and Society. Ashgate Publishing, Aldershot, UK, 2007. "The 2004 Parliamentary Bill was unanimously opposed by the cycling establishment, with every major cycling organisation and magazine rejecting helmet compulsion".
  4. ^ "America on the move-Bicycle helmet". National Museum of American History. Retrieved 18 March 2012.
  5. ^ Herlihy, David V. (2004). Bicycle: the history. New Haven: Yale University Press. p. 368. ISBN 978-0-300-12047-9.
  6. ^ http://www.smf.org/standards/b/b95std.html Snell 1995 Bicycle Helmet Standard. 1998 revision and amendments
  7. ^ "BS EN 1078:1997: Helmets for pedal cyclists and for users of skateboards and roller skates". BSi.
  8. ^ http://www.comlaw.gov.au/comlaw/legislation/legislativeinstrumentcompilation1.nsf/current/bytitle/FB65E9F8184B5CB4CA257513007DC08A?OpenDocument&mostrecent=1
  9. ^ http://www.infrastructure.gov.au/roads/safety/publications/2004/Bic_Crash_6.aspx
  10. ^ http://infostore.saiglobal.com/store/Details.aspx?docn=AS0733789315AT
  11. ^ Brian Walker (June/July 2005). "Heads Up" (PDF). Cycle (magazine of CTC): 42–45. {{cite journal}}: Check date values in: |date= (help)
  12. ^ e. g. Vulcan, A.P., Cameron, M.H. & Watson, W.L., "Mandatory Bicycle Helmet Use: Experience in Victoria, Australia", World Journal of Surgery, Vol.16, No.3, (May/June 1992), pp. 389–397.
  13. ^ Brian Walker, of helmet-testing lab Head Protection Evaluations. Heads Up. Cycle magazine, June/July 2005, pages 42-45:"Cycle helmets protect the head by reducing the rate at which the skull and brain would be accelerated or decelerated by an impact."
  14. ^ Jim G Sundahl, Senior Engineer, Bell Sports. 19 January 1998. Letter to the U. S. Consumer Product Safety Commission, c/o Scott Heh, Project Manager Directorate for Engineering Sciences Washington, D. C, 20207 [1] accessed 18 February 2008. (Errors as in original.) "any number of liner materials could absorb energy better than contemporary helmet liners but in fact produce a very poor helmet, A couple of good energy managers are soft lead sheet and modeling clay. impacting either of these produces negligible rebound velocity. In other words, they absorb .virtually ail of the impact energy. None of us are advocating these materials for helmet liners because energy absorption is not very important for helmets. I think that any discussion of helmet test criteria that includes the word "energy’ is suspect and might be misleading. Acceleration management is what helmets are about. All helmet standards measure acceleration and enforce a pass/fail criteria that includes a maximum acceleration rate..." [sic]
  15. ^ a b Jim G Sundahl, Senior Engineer, Bell Sports. 19 January 1998. Letter to the U. S. Consumer Product Safety Commission, c/o Scott Heh, Project Manager Directorate for Engineering Sciences Washington, D. C, 20207 [2] accessed 18 February 2008.
  16. ^ DEPARTMENT OF TRANSPORT, FEDERAL OFFICE OF ROAD SAFETY. Report No. CR 55 Date May, 1987 Pages 160 f xi ISBN 0-642-51043-1 ISSN CR = 0810-770 Title: MOTORCYCLE AND BICYCLE PROTECTIVE HELMETS: REQUIREMENTS RESULTING FROM A POST CRASH STUDY AND EXPERIMENTAL RESEARCH. Authors: J.P. Corner, C.W. Whitney, N. O'Rourke, D.E. Morgan CR 55: Motorcycle and bicycle protective helmets requirements resulting from a post crash study and experimental research (1987) [3]
  17. ^ Parkinson GW, Hike KE (2003). "Bicycle helmet assessment during well visits reveals severe shortcomings in condition and fit". Pediatrics. 112 (2): 320–3. doi:10.1542/peds.112.2.320. PMID 12897281. {{cite journal}}: Unknown parameter |month= ignored (help)
  18. ^ Rivara, F. P; Astley, S. J; Clarren, S. K; Thompson, D. C; Thompson, R. S (1999). "Fit of bicycle safety helmets and risk of head injuries in children". Injury Prevention. 5 (3): 194–7. doi:10.1136/ip.5.3.194. PMC 1730523. PMID 10518266.
  19. ^ "Policy Statement: Bicycle Helmets". American Academy of Pediatrics. Retrieved 5 August 2009.
  20. ^ "Helmet FAQ". Snell Memorial Foundation. Retrieved 8 April 2011.
  21. ^ FUBICY, Fédération francaise des Usagers de la Bicyclette. Our helmet main page, english version. the ratio of cyclists wearing a helmet is close to 90% among sportive cyclists (86 to 94%), whereas this ratio is only 7% among urban cyclists or non-sportive leisure cyclists
  22. ^ Death of cyclist Andrei Kivilev: declaration by the International Cycling Union
  23. ^ "Mandatory wear of helmets for the elite category" (Press release). Union Cycliste Internationale. 2 May 2003. Retrieved 1 May 2008.
  24. ^ "Article 1.3.031" (PDF). Union Cycliste Internationale. 2 May 2003. Retrieved 1 May 2008.
  25. ^ "Aerodynamics and Bicycling" (website). Aerodynamics. 2010. Retrieved 1 September 2010.
  26. ^ Thompson, Diane C; Rivara, Fred; Thompson, Robert (1999). Rivara, Fred (ed.). "Cochrane Database of Systematic Reviews". doi:10.1002/14651858.CD001855. {{cite journal}}: |chapter= ignored (help); Cite journal requires |journal= (help).
  27. ^ Robinson, B. (1996). Is There Any Reliable Evidence That Australian Helmet Legislation Works?, Proceedings of Velo Australis, Fremantle, Australia, October 30.
  28. ^ [Hendrie, D., M. Legge, D. Rosman, and C. Kirov. 1999. An economic evaluation of the mandatory bicycle helmet legislation in Western Australia, Road Accident Prevention Unit.]
  29. ^ Head Injuries and Helmet Laws in Australia and New Zealand. D L Robinson
  30. ^ An introduction to the objective risk assessment of cycling Bicycle Helmet Research Foundation
  31. ^ a b Assessing the actual risks faced by cyclists Traffic Engineering & Control 2002. by Malcolm Wardlaw
  32. ^ INFORMED SOURCES October 2000. Risk, perception and the cold numbers See table, Fatalities per billion passenger
  33. ^ a b c d e f Robinson, D (1996). "Head injuries and bicycle helmet laws". Accident Analysis & Prevention. 28 (4): 463–475. doi:10.1016/0001-4575(96)00016-4. PMID 8870773.
  34. ^ a b c d e f g h Robinson, D L (2006). "No clear evidence from countries that have enforced the wearing of helmets". BMJ. 332 (7543): 722–725. doi:10.1136/bmj.332.7543.722-a. PMC 1410838. PMID 16565131.
  35. ^ Rapid Responses to D L Robinson
  36. ^ Hagel, B.; MacPherson, A; Rivara, FP; Pless, B (2006). "Arguments against helmet legislation are flawed". BMJ. 332 (7543): 725–726. doi:10.1136/bmj.332.7543.725. PMC 1410864. PMID 16565133. Robinson's opposition to helmet laws is contrary to published evidence on the effectiveness of bicycle helmets... Similarly, six studies have examined the relation between helmet laws and head injuries, and all found a reduction in head injuries after legislation was enacted... her figures also show that helmet laws are successful in increasing helmet use and seem to be associated with a decrease in the percentage of head injuries. The effect of helmet use is most evident in her fig 2, where the increase in the percentage of cyclists wearing helmets corresponds with a decrease in the percentage of head injuries... All of her data are based on time series or ecological designs, without any concurrent comparison groups. Such studies are considered to provide weak evidence. With ecological studies, investigators cannot determine whether all cyclists sustaining head injuries were wearing helmets. Confounding variables may also influence both the exposure and outcome variables in the context of a time series or ecological study.
  37. ^ a b Macpherson A, Spinks A. (2007). Spinks, Anneliese (ed.). "Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries". Cochrane Database of Systematic Reviews (2): CD005401. doi:10.1002/14651858.CD005401.pub2.
  38. ^ Middaugh-Bonney, T.; Pike, I.; Brussoni, M.; Piedt, S.; MacPherson, A. (2011). "Bicycle-related head injury rate in Canada over the past 10 years". Injury Prevention. 16: A228. doi:10.1136/ip.2010.029215.813.
  39. ^ a b c Rodgers GB (1988). "Reducing Bicycle Accidents: A Reevaluation of the Impacts of the CPSC Bicycle Standard and Helmet Use". Journal of Products Liability. 11: 307–317.
  40. ^ Spaite D. W., Murphy M., Criss E. A., Valenzuela T. D., Meislin H. W. (1991). "A prospective analysis of injury severity among helmeted and non helmeted bicyclists involved in collisions with motor vehicles". Journal of Trauma. 31 (11): 1510–6. doi:10.1097/00005373-199111000-00008. PMID 1942172. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  41. ^ Scuffham PA, Langley JD (1997). "Trends in cycle injury in New Zealand under voluntary helmet use". Accident Analysis and Prevention. 29 (1): 1–9.
  42. ^ Scuffham P, Alsop J, Cryer C, Langley JD (2000). "Head injuries to bicyclists and the New Zealand bicycle helmet law". Accident Analysis and Prevention. 32 (4): 565–73. doi:10.1016/S0001-4575(99)00081-0. PMID 10868759. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  43. ^ Taylor M, Scuffham P (2002). "New Zealand bicycle helmet law-do the costs outweigh the benefits?". Injury Prevention. 8 (4): 317–320. doi:10.1136/ip.8.4.317. PMC 1756574. PMID 12460970.
  44. ^ Amoros, E.; Chiron, M.; Martin, J.-L.; Thelot, B.; Laumon, B. (2011). "Bicycle helmet wearing and the risk of head, face, and neck injury: a French case–control study based on a road trauma registry". Injury Prevention. 18 (1): 27–32. doi:10.1136/ip.2011.031815. PMID 21606469.
  45. ^ Thompson RS, Rivara FP, Thompson DC (1989). "A case-control study of the effectiveness of bicycle safety helmets". N. Engl. J. Med. 320 (21): 1361–7. doi:10.1056/NEJM198905253202101. PMID 2716781. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  46. ^ "Commentary: A case-control study of the effectiveness of bicycle safety helmets". Bicycle Helmet Research Foundation. Archived from the original on 28 September 2007. Retrieved 25 August 2007. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  47. ^ Robinson, D. L. (2007). "Bicycle helmet legislation: can we reach a consensus?". Accid Anal Prev. 39 (1): 86–93. doi:10.1016/j.aap.2006.06.007. PMID 16919590.
  48. ^ a b Curnow, W. J. (2003). "The efficacy of bicycle helmets against brain injury". Acc Anal Prevent. 35 (2): 287–292. doi:10.1016/S0001-4575(02)00012-X.
  49. ^ "Commentary: Why it is wrong to claim that cycle helmets prevent 85% of head injuries and 88% of brain injuries". Bicycle Helmet Research Foundation. Retrieved 11 February 2012.
  50. ^ Curnow W. J. (2005). "The Cochrane collaboration and bicycle helmets". Acc Anal Prevent. 37 (3): 569–573. doi:10.1016/j.aap.2005.01.009.
  51. ^ Keatinge, Richard (14 May 2006). "Objective observation of helmet use is essential". British Medical Journal. Retrieved 17 February 2012. For example, in one case-control study based in Seattle, 7% of the cyclists with head injuries reported wearing helmets, as compared with 24% of the emergency room controls and 23% of community cyclists who had had an accident. However, less than 6% of cyclists on the Seattle streets at the time were actually observed to wear helmets. Either helmets are a serious cause of accidents, or self-reports of helmet use are not valid.
  52. ^ Keatinge, Richard (14 May 2006). "Re: Objective observation of helmet use is essential". British Medical Journal. 332 (7543): 722–5. doi:10.1136/bmj.332.7543.722-a. PMC 1410838. PMID 16565131. Retrieved 17 February 2012. If you truly wish to move the science forward in this area, we respectfully request that you all take some formal courses in the use of Epidemiological methods, non-experimental design and biostatistics. After that you should review the whole body of peer-reviewed published information with an open mind and see where your review leads you. We predict it will lead you to the conclusion that we have reached, that cycle helmets prevent head and brain injuries and increased wearing rates result in decreased head and brain injuries in cyclists. {{cite journal}}: More than one of |author= and |last= specified (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  53. ^ "Helmets for preventing head and facial injuries in bicyclists"
  54. ^ Robinson, D. L. 2007. Bicycle helmet legislation: can we reach a consensus? Accid Anal Prev 39: 86-93. http://www.sciencedirect.com/science/article/pii/S0001457506001126 "What the authors describe as a 69% reduction in head injuries actually means that in crashes severe enough for 90% of non-helmet wearers to be head injured, so would 73.6% of helmet wearers."
  55. ^ European Cyclists' Federation Fact Sheet. Helmet Laws/Case Study: Australia.
  56. ^ "Bicycle helmets and injury prevention: A formal review" Retrieved 2012-02-11
  57. ^ Elvik R (2001). "Publication bias and time-trend bias in meta-analysis of bicycle helmet efficacy: A re-analysis of Attewell, Glase and McFadden" (PDF). Accident Analysis & Prevention. 43 (3): 1245–1251. doi:10.1016/j.aap.2011.01.007.
  58. ^ Andersen, LB; Schnohr, P; Schroll, M; Hein, HO (2000). "All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work". Archives of Internal Medicine. 160 (11): 1621–8. doi:10.1001/archinte.160.11.1621. PMID 10847255.
  59. ^ Johan De Hartog, J; Boogaard, H; Nijland, H; Hoek, G (2010). "Do the Health Benefits of Cycling Outweigh the Risks?". Environmental health perspectives. 118 (8): 1109–16. doi:10.1289/ehp.0901747. PMC 2920084. PMID 20587380.
  60. ^ Influence of Exercise, Walking, Cycling, and Overall Nonexercise Physical Activity on Mortality in Chinese Women American Journal of Epidemiology 2007
  61. ^ Cycling: Towards health and safety. British Medical Association 1992. by Mayer Hillman. ISBN 0-19-286151-4
  62. ^ . doi:10.1136/bmj.321.7276.1582. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  63. ^ a b . doi:10.1111/j.1539-6924.2011.01785.x. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  64. ^ a b Hagel, B.; MacPherson, A; Rivara, FP; Pless, B (2006). "Arguments against helmet legislation are flawed". BMJ. 332 (7543): 725–726. doi:10.1136/bmj.332.7543.725. PMC 1410864. PMID 16565133. Confounding variables may also influence both the exposure and outcome variables in the context of a time series or ecological study. For example, a fall in the number of bicyclists in the 1990s may simply reflect an increase in in-line skating or other recreational activities... Without evidence that those who allegedly stopped cycling rode enough to confer a heart health benefit or that they did not take up another healthy activity in its place, Robinson cannot conclude that decreases in cycling are harmful to health and her argument crumbles.
  65. ^ Jacobsen PL (2003). "Safety in numbers: more walkers and bicyclists, safer walking and bicycling". Injury Prevention. 9: 205–209. doi:10.1136/ip.9.3.205. PMC 1731007. PMID 12966006.
  66. ^ Changes in cycle use in Australia. Bicycle Helmet Research Foundation
  67. ^ ABS census data
  68. ^ Fishman, Elliot (2012-11). "Barriers and facilitators to public bicycle scheme use: A qualitative approach". Transportation Research Part F: Traffic Psychology and Behaviour. 15 (6): 686–698. doi:10.1016/j.trf.2012.08.002. ISSN 1369-8478. Retrieved 2012-09-19. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  69. ^ Share bike schemes need to lose the lids. Michael O'Reilly. The Age, Australia. Sept 20th 2012. [4] accessed 21st Sept 2012
  70. ^ http://www.austroads.com.au/abc/images/pdf/Australian_National_Cycling_Strategy_2011-16.pdf Australian Bicycle Council. "National Cycling Strategy 2011-2016"
  71. ^ Australian cyclist numbers and population
  72. ^ "In order to investigate whether there was any connection between helmet wearing and local levels of cycling, the 1996 helmet wearing data for each place surveyed were compared with the proportions cycling to work, recorded by the 1991 Census. The comparison is shown in Figure 4 and shows a negative regression (p<0.01). This means that in those areas where cycling to work accounts for a high proportion of all journeys to work, helmet wearing levels tend to be low, and are high in areas where the proportions cycling to work are low. This suggests that, if in the future cycling levels increase the helmet wearing levels may decrease. In order to test this, the changes in helmet wearing rates between 1994 and 1996 were compared with the changes in the number of cyclists observed (Figure 5). The regression line (p=0.049) on Figure 5 shows that, as expected, where cyclist counts dropped, wearing rates increased and where the number of cyclists increased, helmet wearing rates fell... Eleven Local Authorities reported that they had held short cycle helmet campaigns, when activities were focused solely on the promotion of helmets. The changes in wearing rates between 1994 and 1996 in these regions were compared with those who had not held such a campaign (Table 16). A significantly greater increase in helmet wearing was found among those who had held a short, focused campaign than those who had not (p<0.001). However, the overall numbers of cyclists observed in areas which had held such a campaign fell significantly by 2.8%, versus a 4.9% increase in the other areas (p<0.001)." K Bryan-Brown and S Taylor 1997. TRANSPORT RESEARCH LABORATORY. Cycle helmet wearing in 1996. Prepared for Road Safety Division, Department of the Environment, Transport and the Regions. DETR customer: D O’Reilly. ISSN 0968-4107. [5]
  73. ^ [6] Estimates of Fatal Risk
  74. ^ "THINK! Cycle safety". Homepage. Department of Transport. Archived from the original on 30 June 2007. Retrieved 24 August 2007. (note images removed summer 2009)
  75. ^ "New government helmet promotion could sound the death knell for the future of cycling". Cycling North Wales. Archived from the original on 28 September 2007. Retrieved 24 August 2007.
  76. ^ Chris Rissel and Li Ming Wen. The possible effect on frequency of cycling if mandatory bicycle helmet legislation was repealed in Sydney, Australia: a cross sectional survey Health Promotion Journal of Australia 2011; 22: 178-83 http://www.healthpromotion.org.au/journal/journal-downloads/article/hpja/35-hpja-vol-22-no-3-december-2011/426
  77. ^ [7] Published evidence supportive of helmet effectiveness: Meta Analyses
  78. ^ [8] Macpherson A, Spinks A (a review)
  79. ^ Risk. John Adams, 1995, Routledge, ISBN 1-85728-068-7 (Authoritative reference on risk compensation theory.)
  80. ^ Death on the Streets: Cars and the mythology of road safety, Davis, 1993, ISBN 0-948135-46-8
  81. ^ Phillips, RO; Fyhri, A; Sagberg, F (2011). "Risk Compensation and Bicycle Helmets". Risk analysis : an official publication of the Society for Risk Analysis. 31 (8): 1187–95. doi:10.1111/j.1539-6924.2011.01589.x. PMID 21418079.
  82. ^ Helmets Make You Bicycle Faster. Marcel Goverde. Department of Integrative Biology, Section of Conservation Biology, University of Basel, Basel, Switzerland. Annals of Improbable Research. September–October 2009 pages 6-9.
  83. ^ Morrongiello, BA; Walpole, B; Lasenby, J (2007). "Understanding children's injury-risk behavior: wearing safety gear can lead to increased risk taking". Accident; analysis and prevention. 39 (3): 618–23. doi:10.1016/j.aap.2006.10.006. PMID 17112456.
  84. ^ Morrongiello, BA; Major, K (2002). "Influence of safety gear on parental perceptions of injury risk and tolerance for children's risk taking". Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 8 (1): 27–31. PMC 1730819. PMID 11928969.
  85. ^ Walker, Ian (2007). "Drivers overtaking bicyclists: Objective data on the effects of riding position, helmet use, vehicle type and apparent gender" (PDF). Accident Analysis & Prevention. 39 (2): 417–425. doi:10.1016/j.aap.2006.08.010.
  86. ^ DEPARTMENT OF TRANSPORT, FEDERAL OFFICE OF ROAD SAFETY. Report No. CR 55 Date May, 1987 Pages 160 f xi ISBN 0-642-51043-1 ISSN CR = 0810-770 Title: MOTORCYCLE AND BICYCLE PROTECTIVE HELMETS: REQUIREMENTS RESULTING FROM A POST CRASH STUDY AND EXPERIMENTAL RESEARCH. Authors: J.P. Corner, C.W. Whitney, N. O'Rourke, D.E. Morgan CR 55: Motorcycle and bicycle protective helmets requirements resulting from a post crash study and experimental research (1987) [9]
  87. ^ Graham-Rowe, Duncan (13 February 2001). "Soft hat". New Scientist. Archived from the original on 3 May 2008. Retrieved 1 May 2008. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  88. ^ Skid Tests on a Select Group of Bicycle Helmets to Determine Their Head-Neck Protective Characteristics. Voigt R. Hodgson, Ph.D., Director, Gurdjian-Lissner Biomechanics Laboratory, Department of Neurosurgery, Wayne State University, Detroit, Michigan. [10]
  89. ^ The bicycle helmet with its own synthetic scalp. Environmental Transport Association. Tuesday, 16 February 2010 [11]
  90. ^ Bicycle Helmets for the 2010 Season. Bicycle Helmet Safety Institute, Arlington, Virginia. [12]
  91. ^ a b Sliding Resistance of Bicycle Helmets. Bicycle Helmet Safety Institute, Arlington, Virginia. [13]
  92. ^ Valerie Zehl. After son's accident, family learns to find joy. Press and Sun-Bulletin, Greater Binghamton, New York. 28 January 2008. "Her 15-year-old son, Eddie Holewa, is a quadriplegic. But it wasn't always so. When Eddie was small, he was an effervescent, agile little boy -- but that was before the accident. He was 5 then, and still wearing his bicycle helmet when he started playing on a jungle gym. In a freak accident, his helmet somehow caught on the monkey bars, strangling him and cutting off oxygen to his brain. By the time Kayla Picciano, his now-18-year-old sister, found him, the damage couldn't be undone. His family has the advantage of around-the-clock care, including time at school, which wards off the emotional and physical exhaustion common to special-needs providers. To see Eddie is to understand the severity of his disability -- but to see him smile when his mom teases him is to understand there's still somebody alive and well inside his body. "He's a person," says Elizabeth Scott of Afton, one of his aides. "We can get him to laugh, and he cries at certain movies.""
  93. ^ U. S. Consumer Product Safety Commission. Wear Bike Helmets On Bicycles - Not On Playgrounds. CPSC Document #5121.
  94. ^ Child deaths from helmet use
  95. ^ "Ambulance staff cleared over toddler's death". ABC News (Australia). 7 May 2004. Retrieved 1 May 2008.
  96. ^ Sam Riches, Police Reporter (5 April 2007). "Helmet strangles boy, 3". The Advertiser. Adelaide, South Australia. Helmet strangles boy, 3. Sam Riches, police reporter. April 5, 2007, Adelaide Now. A three-year-old boy died this afternoon after being strangled by the strap of a bike helmet. It is believed the boy tried to climb through a window while wearing the helmet and became wedged between the house wall and the window. [14] accessdate=2009-11-28
  97. ^ "Boy accidentally hangs himself in clothes line". The Herald Sun. 5 July 2009. Retrieved 5 July 2009. A six-year-old Tasmanian boy has accidentally hanged himself after getting entangled in a clothes line while jumping on a trampoline. Police said the boy was using a trampoline placed under a clothes line in the backyard of his New Norfolk home, north west of Hobart, about 11.30am today. As he jumped, the strap of his bicycle helmet got caught on the nylon rope of the clothes line and tightened around his neck. The clothes line appeared to have swung away from the trampoline, leaving the boy suspended and unable to free himself, police said. Attempts to resuscitate him were unsuccessful and he died at the scene.
  98. ^ The deceased had previously been riding a bicycle and was found by his mother hanging by the strap of his helmet which was jammed between the wall and the top bunk of a bunk bed. Fatal Facts. National Coroners Information System. Victorian Institute of Forensic Medicine. Edition 11, Nov 2006, VIC.2003.427 page 14. [15] accessdate=2009-11-28. Boy, 6, strangled in freak trampoline accident. LES KENNEDY, Sydney Morning Herald. July 5, 2009. A SIX-YEAR-OLD Tasmanian boy accidentally hanged himself after getting entangled in a clothes line while jumping on a backyard trampoline yesterday. [16] accessdate=2009-11-28
  99. ^ On February 4, 1999 a Pennsylvania child was asphyxiated while wearing a bicycle helmet and playing on playground equipment. Evidently he was caught between two overlapping horizontal platforms when his helmet would not fit through the gap between them where his body had already gone. [17] accessdate=2009-11-28
  100. ^ http://www.barnehage.no/no/Nyheter/2010/April/--Sykkelhjelm-arsak-til-dodsulykke/ Google translation: Cycle helmet cause of fatal accident... The three-year-old girl who died in Albatross kindergartens in the Kongsberg Friday, was wearing a helmet that hung onto a tree.
  101. ^ Tragic Accident Claims Young Boy's Life. Posted: Nov 10, 2010 5:28 AM GST Updated: Nov 10, 2010 6:42 PM GST "Asher Meyers... died accidentally last weekend after playing on his backyard swingset. He was wearing a bike helmet that somehow got caught." fox12idaho.com accessed 11 November 2010 [18]
  102. ^ Mit Kopfschutz aufs Klettergerüst, Kinder stranguliert Fahrrad-Helm als Todesfalle. "Rechtsmediziner fordern nun Helm-Verbotsschilder auf Spielplätzen." (With head protection on gym equipment, children strangled. Bicycle helmets as a cause of death. "Forensic scientists are now calling for helmet-ban signs on playgrounds." One of the children who died was aged 8, the other aged 4.) 22 November 2011 Medical Tribune Medizin Medien Austria, http://www.medical-tribune.at/dynasite.cfm?dsmid=93096&dspaid=709167, quoting Verena Kuntz et al., Rechtsmedizin 2008; 18: 103 – 106.
  103. ^ The Associated Press (28 September 2012). "Helmet strap strangled boy on zip line near Redmond, investigators say". The Olympian. Retrieved 1 October 2012. Investigators have determined that a bicycle helmet's strap strangled a 12-year-old boy while he was riding a zip line installed at his home outside Redmond. The King County Sheriff's office says Friday that Jackson Roos died when a safety line caught the back of his helmet and pulled it up. It caused the helmet strap to tighten around his neck and cut off his air supply. Detectives say the accident could not have been predicted. Roos' mother thought he was riding his bike around their home Wednesday when she went to look for him. She found him hanging from the zip line.
  104. ^ Bicycle Helmets: Review Of Effectiveness, E Towner, T Dowswell, M Burkes, H Dickinson, J and M Hayes, UK Department for Transport, Nov 2002 [19]
  105. ^ EN 1080/A2 Impact protection helmets for young children, European Committee for Standardization, 2005 (first published 1997) [20]
  106. ^ http://www.productsafety.gov.au/content/index.phtml/itemId/982119 Use bicycle helmets for cycling only. Product Safety Australia. Accessed 14th Sept 2010.
  107. ^ "Injury-Control Recommendations: Bicycle Helmets". Centers for Disease control and Prevention. 17 February 1995. Archived from the original on 27 September 2007. Retrieved 27 July 2007.
  108. ^ Richard Ballantine (1972). Richard's Bicycle Book. Ballantine Press. ISBN 1-56458-484-4.
  109. ^ "LAB Helmet Law Position". League of American Bicyclists. 1991. Retrieved 1 March 2011. ...events have overtaken the League's initiatives on the helmet issue. Strong lobbying groups, including the American Academy of Pediatrics and the Safe Kids Coalition, have been promoting bills requiring children to wear helmets when riding as passengers on bicycles, and setting standards for child carriers. The child carrier industry has also played a part in drafting these bills. ...helmet laws may be unstoppable; helmets have become a "Mom and apple pie" issue, due to widespread publicity in the media... {{cite web}}: Unknown parameter |month= ignored (help)
  110. ^ "Helmet Use when Cycling" Retrieved 2012-02-08
  111. ^ "CAN and Cycle Helmet Legislation" Retrieved 2012-02-05.
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