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Further information: Bicycle helmet laws by country

  No legal restrictions
  Some local laws apply
  Children only
  Partial rules apply
  Mandatory but no fines apply
  Mandatory

Some countries and lower jurisdictions have enacted laws or regulations which require cyclists to wear a helmet in certain circumstances, typically when riding on the road or a road-related area (such as a bicycle lane or path). In some places this requirement applies only to children under a certain age, while in others it applies to cyclists of all ages.

Research indicates that bicycle helmet laws reduce bicycle fatalities and injuries.[1] Large increases in the rate of helmet wearing usually take place after helmet laws are passed.[2][3] Evidence is mixed as to whether the helmet laws lead to less cycling.[1]

Background

Modern varieties of bicycle helmet first became commercially successful from 1975.[4] Industry helmet standards were developed from the 1970s[5] and are still under development.[6][7] Even before then, there had been calls for riders to wear helmets,[8] based on the assumptions of high risk to cyclists and effectiveness of helmets in preventing serious injury.[8]

The Royal Australasian College of Surgeons campaigned actively to raise public awareness, acceptance and demand,[9] and helmets first became compulsory across Australia from 1990 to 1992.[10][11] In New Zealand, Rebecca Oaten was a prominent champion; after a disastrous head injury to her son in 1986 she traveled the country to push the importance of wearing helmets. For six years she visited an average of four schools a day.[12][13][14][15] Bicycle helmets became compulsory in New Zealand in January 1994.[16] A report from the Australian Department of Transport in 1987 cast doubt on the effectiveness of helmets in real accidents.[17] In 2004 members of the UK Parliament questioned the claims made for helmets in an Early Day Motion.[18]

By 1991, after widespread well-resourced campaigns,[19][20] the use of helmets had attained near-universal support in the United States, becoming what the League of American Wheelmen characterized as a "Mom and apple pie" issue.[21] Some official and professional bodies in the English-speaking world now support compulsory use of helmets.[22][23] A 2009 poll of U.S. adults found that 86% supported helmet laws for children.[24] Support has spread elsewhere; Safe Kids Worldwide, which has received financial support from equipment suppliers including helmet manufacturer Bell Sports, was founded in 1987 and is currently active in a total of 17 countries.[25] Australia, Canada, the Czech Republic, Finland, Iceland, New Zealand, Sweden, and the United States have bicycle helmet laws, in at least one jurisdiction, for either minors only, or for all riders. Spain requires helmets to be worn while cycling along public roads outside population centers, except for riders with a medical exemption or during extremely hot days.[26]

Helmet laws are not universal in the United States; most U.S. states and municipalities have no laws or regulations regarding helmet use. In the U.S.A. 21 states and the District of Columbia have statewide mandatory helmet laws for children.[27] 29 U.S. states have no statewide law, and 13 of these states have no such laws in any lower-level jurisdiction either.[28] The territory of Guam made helmets compulsory for all bicycle riders and passengers on 27 February 2012.[29]

Israel's helmet law was never enforced or obeyed. A long and sophisticated volunteer campaign led to the revocation of the adult element, in order to allow bike-hiring schemes to work.[30][31] An official predicted that this would have disastrous health consequences.[32] Mexico City has repealed its helmet law to allow a bike-sharing scheme to work.[31]

Debate

Main article: Bicycle helmet

Support

The mandatory wearing of helmets is frequently supported by medical organizations and by bodies responsible for road safety.[33]

Effects of head injury

Head injury can result in death or disastrous long-term physical and mental disability. Such injuries have happened to cyclists, and such cases have given powerful stimulus to political activity.[34] A helmet testing specialist states that some of these accidents can generate energy levels beyond those used when certifying competition motor racing helmets.[35] One study which examined post-mortem examinations of the twenty cyclist fatalities in Auckland, New Zealand between 1974 and 1984 found that sixteen died of fatal injury to multiple organ systems, including fourteen with fatal brain injuries; four died solely of brain trauma.[36]

Injury prevention

A 2018 review analysed the results of 21 studies on the effects of bicycle helmet legislation.[1] The meta-analysis results showed that helmet legislation reduced total head injuries by 20%, and serious head injuries by 55%.

Total numbers of injured cyclists

A motoring breakdown organization has sponsored an initiative by the Bicycle Helmet Initiative Trust which supports legislation, reporting that "in 2009/10 nearly 6,000 young cyclists were admitted to hospitals and of these 40% had suffered head injuries. Around 83% of young cyclists suffering head injuries were not involved in a collision with another vehicle but merely hit their head after falling from the cycle. "[37][38] In North Carolina, where bicycle helmets are compulsory for children, the North Carolina Department of Transportation publish a fact sheet stating that a bicyclist is killed or injured approximately every six hours and that helmets reduce the risk of head injury by as much as 85% and the risk of brain injury by as much as 88%.[39] The National Highway Traffic Safety Administration reports that in 2006, 773 bicyclists were killed in the US. In a speech arguing for helmet legislation in the UK Parliament, an MP said: "In a three-year period from 2003, 17,786 children aged 14 and under were admitted to NHS hospitals in England because of injuries incurred while cycling"[40]

Risks relative to exposure

In the UK, some 8,000 years of average cycling will produce one clinically severe head injury, and 22,000 years one death.[41]

Risks relative to other groups

Ordinary cycling in the UK is not demonstrably more dangerous than walking or driving, and is far safer for other road users.[42]

Case-control studies

Main article: Bicycle helmet § Case-control studies

Cases of head injury report a lower rate of helmet-wearing than controls who have injured other parts of the body.[43] This has been taken as strong evidence that cycle helmets are beneficial in a crash. 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. There are many criticisms of this study.[44]

Opposition

Cycling organizations generally oppose laws mandating the wearing of helmets.[45][46] Civil Liberties Australia published three articles indicating concerns at the consequences of having a mandatory requirement.[47] In Ontario Canada, opposition has been present for many years.[48]

Consequences

Effects on head injuries or deaths among cyclists

A 2018 meta-analysis found that "effect of mandatory bicycle helmet legislation for all cyclists on head injuries is a statistically significant reduction by 20%... Larger effects were found for serious head injury... larger effects were found when legislation applies to all cyclists than when it applies to children only."[1] A 2017 systemic review and meta-analysis concluded, "Bicycle helmet use was associated with reduced odds of head injury, serious head injury, facial injury and fatal head injury. The reduction was greater for serious or fatal head injury."[49] A 2011 Cochrane review, concluded that "helmet legislation appears to be effective in increasing helmet use and reducing head injuries."[50] A 2008 Cochrane 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," but the study noted that very few high-quality studies existed at the time.[51]

A 2019 study found that bicycle helmet laws in Australia led to a substantial decline in bicycle-related fatalities.[52]

A 2006 BMJ study found that enforced helmet laws did not lead to a reduction in head injuries.[53] This study was the subject of vigorous debate.[54][55][56]

Changes in head injury with the New Zealand bicycle helmet law.[57]

The most studied laws are in New Zealand and Australia. A study conducted by the University of New South Wales in 2011 concluded that Mandatory Helmet Laws led to a 29% reduction in cycling related head injuries.[58] A 2002 study of the New Zealand law found that the law had net positive effects on minors, but that the costs outweighed the benefits for adults.[59]

A 2019 systematic review found no evidence in most of the research literature that bicycle helmet led to more risky behavior by bicyclists.[60]

Effects on the amount of cycling

A 2018 meta-analysis concluded that the evidence was mixed as to whether bicycle helmet laws reduced cycling.[1] Regular moderate cycling is extremely beneficial for health,[61][62][63][64][65][66][67][68] thus if mandatory helmet use deters cycling, the health impact could be unintentionally adverse.

A 2018 study found "that “all‐age” bicycle helmet laws significantly increased both adult and youth helmet use by 50%–190% relative to pre‐reform levels, with larger effects for younger adults and less‐educated adults. All‐age helmet laws had modest effects at reducing cycling and increasing in‐home exercise during winter months among adults but did not meaningfully affect weight. Overall, our findings confirm that all‐age helmet laws can be effective at increasing population helmet use without significant unintended adverse health consequences."[3]

A 2006 BMJ study showed that in states which had helmet laws, the amount of cycling to work had reduced by about one third.[53] Other evidence strongly suggests that promotion or compulsion of helmet use deters cycling.[69][70] It has been suggested that this is irrelevant to health as "any cyclist who wants to exercise but hates helmets enough to quit cycling if a law is passed can turn to a multitude of other activities to stay active".[71] However, relatively few people who bicycle as part of their daily routine, would increase gym visits or take up other exercise activities if, as a result of a mandatory bicycle helmet law, they were discouraged from cycling. For many people, exercise is only sustainable if it is integrated into daily routine such as shopping errands or traveling to and from work.[72] Helmet laws seem to offer net health benefit only in dangerous bicycling environments under optimistic assumptions of the efficacy of helmets.[72]

A 2011 review commissioned by the Queensland Government found little evidence to support the claim that mandatory helmet usage discouraged bike riding.[73] However, the helmet laws are frequently suggested as the main cause of the disappointingly low usage of the bicycle-sharing systems in Melbourne and in Brisbane.[74][75] In a 2012 study, 61% of the respondents identified helmet issues as the main reason preventing them from using the bike sharing system in Brisbane, most of this was the lack of helmet availability, the study revealed a dramatic increase in usage after the council made helmets available with the bicycles.[76]

Effects on the rate of helmet wearing

Large increases in the rate of helmet wearing are usual after helmet laws.[2][3] Not all laws have increased helmet use, no such increase was noted among the children covered by the North Carolina bicycle helmet law.[77] In another area, an early rise in helmet use was followed by a fall to below pre-law levels.[78][79] Attitudes to cycling, and the amount of enforcement effort, may both be relevant.[80]A qualitative systematic review found that perceptions on helmet design, it’s quality and cost , perceived risk and benefits, parental strategies and adoption and enforcement of laws influencing helmet use.[81]

See also

Further reading

References

  1. ^ a b c d e Hoye, Alena (2018). "Recommend or mandate? A systematic review and meta-analysis of the effects of mandatory bicycle helmet legislation". Accident Analysis & Prevention. 120: 239–249. doi:10.1016/j.aap.2018.08.001. ISSN 1879-2057. PMID 30173006. S2CID 52166465.
  2. ^ a b "a positive effect of bicycle helmet laws for increasing helmet use..." Macpherson, A; Spinks, A. (2008). "Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries". Cochrane Database of Systematic Reviews. 3 (3): 5401. doi:10.1002/14651858.CD005401.pub3. PMC 6823199. PMID 18646128.
  3. ^ a b c Carpenter, Christopher S.; Warman, Casey (18 November 2018). "What do Bicycle Helmet Laws Do? Evidence from Canada". Economic Inquiry. 57 (2): 832–854. doi:10.1111/ecin.12739. ISSN 0095-2583. S2CID 158976350.
  4. ^ "Bell Helmets - Bell Timeline". Bell. Archived from the original on 28 December 2009. Retrieved 4 August 2015.
  5. ^ http://www.bhsi.org/standard.htm ,"Bicycle Helmet Standards." Bicycle Helmet Safety Institute. February 26, 2009, accessed February 12, 2011.
  6. ^ "The standard, known as 2063:2008, is designed to force manufacturers to improve the safety of helmets in three ways. It requires them to use a softer polystyrene in the shell providing more cushioning for the brain, to use straps that will stretch sufficiently in an accident to allow the helmet to come off a rider's head, after absorbing the initial impact and to ensure sun visors do not twist a cyclist's head excessively when hitting the road." New bike helmet standards send retailers into a spin. Matthew Moore URBAN AFFAIRS EDITOR Sydney Morning Herald 19 November 2010 http://www.smh.com.au/lifestyle/wellbeing/new-bike-helmet-standards-send-retailers-into-a-spin-20101118-17zeq.html Accessed 26 February 2011
  7. ^ Mandatory standard—Bicycle helmets. Product Safety Australia. [1] Accessed 26 February 2011
  8. ^ a b Richard Ballantine (1972). Richard's Bicycle Book. Ballantine Press. ISBN 978-1-56458-484-7.
  9. ^ McDermott, F. T (1992). "World Progress In Surgery. Helmet efficacy in the prevention of bicyclist head injuries: Royal australasian college of surgeons initiatives in the introduction of compulsory safety helmet wearing in Victoria, Australia". World Journal of Surgery. 16 (3): 379–383. doi:10.1007/BF02104435. PMID 1589969. S2CID 28307555. The results of a comparative study of the injury profiles of Victorian motorcyclist and bicyclist casualties were used by the Royal Australasian College of Surgeons in initiating a state-wide campaign to promote the wearing of approved safety helmets by Victorian bicyclists and to obtain the necessary legislation whereby such wearing would become compulsory
  10. ^ Bicycle Helmet Research Foundation. "Helmet Laws: What has been their effect. Australia." Retrieved 2011-01-31.
  11. ^ Curnow, Bill. "A Brief History of the Bicycle Helmets Law in Australia". Retrieved 2011-01-31.
  12. ^ Kennett, Jonathan (2004). Ride: The Story of Cycling in New Zealand. Wellington: Kennett Brothers. p. 216. ISBN 978-0-9583490-7-9.
  13. ^ "Editorial: Use your head; stick a helmet on it". The Marlborough Express. 14 July 2010. Retrieved 20 September 2011.
  14. ^ Duff, Michelle (17 August 2010). "Aaron's tragedy spurred Helmet Lady's crusade". Manawatu Standard. Retrieved 20 September 2011.
  15. ^ Mullins, Justin. "Hard-Headed Choice", New Scientist, 22 July 2000. Retrieved 2010-08-29.
  16. ^ Gillham, Chris. "Mandatory bicycle helmet laws in New Zealand". cycle-helmets.com. Retrieved 3 February 2012.
  17. ^ 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 helments: 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) [2]
  18. ^ "CYCLE HELMETS - Early Day Motions - UK Parliament".
  19. ^ Bicycle Helmet Use by Children. Evaluation of a Community-wide Helmet Campaign. Carolyn G. DiGuiseppi, MD, MPH; Frederick P. Rivara, MD, MPH; Thomas D. Koepsell, MD, MPH; Lincoln Polissar, PhD. Journal of the American Medical Association 1989 vol. 262 pages 2256-2261 http://jama.ama-assn.org/content/262/16/2256.full.pdf "METHODS Bicycle Helmet Campaign The campaign's three goals, developed in response to a 1987 survey of schoolchildren and their parents, were to increase parental awareness of the need for helmets, to promote use by children, and to reduce financial barriers to their purchase. Activities were coordinated by a full-time health educator. Initial activities were begun during the summer of 1986, and increased progressively each year. The number of activities and materials provided, the amount of media exposure, and the intensity of the campaign were substantially greater in 1988 than in previous years. To increase parental awareness, professionally produced public service announcements were shown on television 50 times per quarter and during every third Seattle Mariners baseball game and aired regularly on local radio stations. Two press conferences, three local television programs, and 30 print articles featured the campaign. Bicycle shops in King County were given 8000 bicycle hang tags in 1987 through 1988, which reminded parents to purchase helmets. Some 50 000 informational pamphlets were provided to physicians and health departments in 1987 and 1988 for distribution to patients, and mailings were sent to all 6500 members of the Washington State Medical Association in 1988. During 1987 through 1988, the Coalition also participated in numerous community events and made presentations to Parent-Teacher Associations and youth group leaders. To promote helmet use, a bicycle safety program was implemented in Seattle public elementary schools in 1988. Posters featuring a group of freestyle cyclists popular with youngsters were distributed to all elementary schools. More than 50 000 stickers promoting helmets were distributed to schools and youth groups and at bicycling events. Incentives were provided to children who wore helmets at various bicycling events in 1988, which included 2000 free McDonald's french fry coupons and 564 free Seattle Mariners baseball tickets. Helmet cost was addressed by the distribution of more than 100 000 discount coupons (lowering the cost of helmets to about $25) through physicians' offices, schools, youth groups, and community events during 1988. Thirteen hundred helmets were sold at cost through the Parent-Teacher Associations in 1987 and 1988, and another 1300 were donated in 1988 to youth groups serving low-income children."
  20. ^ Bicycle Helmet Campaign Guide. A guide to community bicycle helmet campaigns. Original author: John Williams Then of Bikecentennial/Adventure Cycling, now with Tracy-Williams Consulting Original publisher: North Carolina DOT Bicycle Program, 1991 Updated by: Bicycle Helmet Safety Institute, 2002 (This copy current on August 27, 2006). http://bhsi.org/manual.htm accessed 28th Feb 2011
  21. ^ "LAB Helmet Law Position". League of American Wheelmen. May 1991. Archived from the original on 5 April 2008. 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...
  22. ^ "The National Highway Traffic Safety Administration supports the enactment of bicycle helmet use laws. Bicycle helmets offer bicyclists the best protection from head injuries resulting from bicycle crashes, and bicycle helmet laws have proved effective in increasing bicycle helmet use.""Bicycle Helmet Use Laws" (PDF). National Highway Traffic Safety Administration. Retrieved 16 February 2011.
  23. ^ "Many riders and parents do not know that they need a helmet, and the laws educate as much as they force compliance. We also believe that most riders regard helmets as a fashion item rather than as a safety appliance, and like any other fashion this one may wane. Since bicycles on a public road are vehicles, we believe that the operator has the rights and obligations of vehicle users in our ever-more-populated and outrageously unsafe road environment, so requiring a bicycle helmet is as reasonable as requiring a helmet on a motorcycle rider or requiring seatbelt usage in cars." [3], "Helmet Laws for Bicycle Riders." Bicycle Helmet Safety Institute. January 5, 2011, accessed on February 20, 2011
  24. ^ C.S. Mott Children’s Hospital, the University of Michigan Department of Pediatrics and Communicable Diseases, and the University of Michigan Child Health Evaluation and Research (CHEAR) Unit. National Poll on Children’s Health. Bicycle helmet laws for kids effective but not yet the norm. Archived 20 July 2011 at the Wayback Machine Vol. 6 Issue 4 June 17, 2009
  25. ^ Mitch Stoller, President & CEO. Safe Kids Worldwide. Annual Report July 2007-June 2008. http://www.safekids.org/assets/docs/who-we-are/finance/skw-annual-report-2009.pdf
  26. ^ "Real Decreto 1428/2003, de 21 de noviembre, por el que se aprueba el Reglamento General de Circulación" (PDF). 23 December 2003.
  27. ^ "Helmet Laws for Bicycle Riders".
  28. ^ Helmet Laws for Bicycle Riders Bicycle Helmet Safety Institute 5 January 2011. http://www.bhsi.org/mandator.htm
  29. ^ Bicycle Safety Act of 2012. Office of the Governor of Guam 29 February 2012. http://202.128.4.46/Public_Laws_31st/P.L.%2031-189%20-%20Bill%20No.%20362-31%28LS%29.pdf Archived 6 October 2014 at the Wayback Machine accessed 3 March 2012
  30. ^ How did we revise the compulsory helmet law in Israel? 31-Aug-2011 Eran Shchori, bike2work project manager and "public policy" team member, Israel Bicycle Association ('Israel Bishvil Ofanaim') http://www.sustainability.org.il/home/bike-news/How-did-we-revise-the-compulsory-helmet-law-in-Israel
  31. ^ a b European Cyclist's Federation. Examples of successful campaigns. "European Cyclists Federation - We care for biking, cycle touring, and bicycle policy, cycle tourism, Bike and train, Fahrrad, Radfahrer, vélo and cycliste". Archived from the original on 22 June 2011. Retrieved 8 January 2011. downloaded 10 May 2010
  32. ^ "Health Ministry chief statistician Dr. Gary Ginsberg predicted that if the current law is changed, the impact on adult urban bicyclists would be disastrous. He told the Knesset Economics Committee recently that by 2014, there would be 18 more deaths, more than 2,000 more hospitalizations, 6,334 more emergency room visits, 19,383 more ambulatory visits to general practitioners, 297 additional rehabilitation efforts and 36 lifelong disabilities if the bill becomes law. The cost in medical expenses is estimated at NIS 210 million." Volunteer organization fights to save bicycle helmet law. By JUDY SIEGEL-ITZKOVICH. 03/03/2011 03:27 Jerusalem Post http://www.jpost.com/NationalNews/Article.aspx?id=210572
  33. ^ Promoting safe cycling. Part 6. Legislative and non-legislative interventions. British Medical Association 17 February 2010 http://www.bma.org.uk/wa/health_promotion_ethics/transport/promotingsafecycling.jsp?page=6[permanent dead link‍] Accessed 28 February 2011
  34. ^ "Tragically, (the proposer) has first hand experience of the effect a life changing head injury has on a young person. However, other than his son, no figures have been presented for cyclists who have been so badly injured and have required such a level of support. Such an event could happen tomorrow but statistically, this economic argument is weak." States of Jersey. COMPULSORY WEARING OF CYCLE HELMETS (P.4/2010): COMMENTS. Presented to the States on 8 March 2010 by the Minister for Transport and Technical Services. http://www.statesassembly.gov.je/documents/propositions/9473-42368-832010.pdf Archived 22 July 2011 at the Wayback Machine
  35. ^ Walker, B. "Helmet standards and capabilities". Bicycle Helmet Research Foundation. Retrieved 27 February 2011.
  36. ^ Sage M, Cairns F, Koelmeyer T, Smeeton W (25 December 1985). "Fatal injuries to bicycle riders in Auckland". The New Zealand Medical Journal. 98 (793): 1073–4. PMID 3865089.
  37. ^ Compulsory cycle helmets UK initiative. David Williams. GEM Motoring Assist. http://www.motoringassist.com/blog/2011/02/24/compulsory-cycle-helmets-uk-initiative/ Accessed 27 February 2011.
  38. ^ Motoring organisation backs cycle helmet compulsion. Carlton Reid. 27 February 2011. http://www.bikebiz.com/news/read/motoring-organisation-backs-cycle-helmet-compulsion Archived 8 July 2011 at the Wayback Machine
  39. ^ North Carolina Department of Transportation FACT SHEET: Bicycle Helmet Safety." NCDOT, Division of Bicycle and Pedestrian Transportation Safety & Education.http://www.ncdot.gov/bikeped/download/bikeped_safety_factsheethelmet.pdf accessed on February 20, 2011
  40. ^ Mr Peter Bone, MP for Wellingborough, Hansard Volume No. 464 Part No. 142. House of Commons Debates 16 October 2007. [4]
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  42. ^ M. Wardlaw (December 2002). "Assessing the actual risks faced by cyclists" (PDF). Traffic Engineering & Control. 43: 352–356.
  43. ^ Thompson, DC; Rivara, FP; Thompson, R. (1999). "Helmets for preventing head and facial injuries in bicyclists". Cochrane Database of Systematic Reviews. 4 (2): CD001855. doi:10.1002/14651858.CD001855. PMC 7025438. PMID 10796827.
  44. ^ "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.
  45. ^ 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".
  46. ^ Pucher and Buehler (12 November 2007). "Making Cycling Irresistible: Lessons from the Netherlands, Denmark, and Germany" (PDF). Archived from the original (PDF) on 17 November 2014. {{cite journal}}: Cite journal requires |journal= (help)
  47. ^ http://www.cla.asn.au/Article/081125BikesHelmetPolicy.pdf [bare URL PDF]
  48. ^ "Home". vehicularcyclist.com.
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  52. ^ Grzebieta, Raphael; Boufous, Sofiane; Olivier, Jake (2019). "The impact of bicycle helmet legislation on cycling fatalities in Australia". International Journal of Epidemiology. 48 (4): 1197–1203. doi:10.1093/ije/dyz003. PMID 30726918.
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  54. ^ http://www.bmj.com/cgi/eletters/332/7543/722-a Rapid Responses to D L Robinson
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  56. ^ http://www.bmj.com/cgi/eletters/332/7543/725 Rapid Responses to Brent Hagel, Alison Macpherson, Frederick P Rivara, and Barry Pless
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  80. ^ "The rise in the use of helmets per region or state varied somewhat, depending on factors such as the original level of helmet use, the area’s socio-economic background, and the amount of supporting publicity and enforcement (with penalties/rewards).""SWOV Fact sheet: Bicycle helmets" (PDF). NL Institute for Road Safety Research (SWOV). October 2009. Retrieved 27 February 2011.
  81. ^ Panigrahi, Sucharita; Parveen, Samina; Kshatri, Jaya Singh; Pati, Sanghamitra; Bhaumik, Soumyadeep (September 2022). "Facilitators and barriers to bicycle helmet use: A qualitative evidence synthesis". Journal of Family Medicine and Primary Care. 11 (9): 5211–5225. doi:10.4103/jfmpc.jfmpc_2464_21. ISSN 2249-4863.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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