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Between 1990 and 1992, Australian states and territories adopted various laws mandating that cyclists wear bicycle helmets while riding.

Because Australian bicycle helmet laws came into effect before such laws were enacted elsewhere, much of the data about mandatory bicycle helmet use comes from Australia. Debate continues, without consensus, about its efficacy.

History

Taking note of studies suggesting that cyclists were more at risk of injury in comparison to motorists using the same roads, the Royal Australasian College of Surgeons (RACS) undertook a seven-year inquiry into the topic. Its final report was issued in 1985.

The Academy's final report concluded that cooperation of states and territories should be sought to review the need for legislation addressing bicycle safety and the introduction of such legislation, if necessary. Subsequently, the Academy undertook a campaign to persuade the public of the need to reduce cycling injuries, especially among child cyclists, with mandatory helmet laws.

Mandatory helmet laws were first introduced in Victoria in July 1990, followed in January 1991 by laws for adult cyclists in New South Wales and all cyclists in Tasmania. In July 1991, News South Wales extended the law's reach child cyclists. In the same month, laws covering all cyclists were adopted in South Australia and in Queensland, where the law was not enforced until 1 January 1993. In January 1992 helmet laws were introduced in the Northern Territory and Western Australia and in July 1992 in the ACT.

Legal requirements

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

In Tasmania, the law only applies on public streets, while in the NT since March 1994 there is an exemption for adults cycling along footpaths or on cycle paths.

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

Surveys of helmet use and cycling participation

Various surveys have been published concerning the use of helmets and participation in cycling both before and after the introduction of helmet laws.

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

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

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

Injury rates in Australian cyclists

Hospital admission data in a 1995 Victorian study by Carr et al. showed that in the 3 after the helmet law, compared to the 3 years before the helmet law, pedestrian head injury hospital admissions dropped by about 20%, cyclist non-head injury admisions dropped by about 25%, cyclist head injury admissions dropped by 40%, and serious and severe cyclist head/brain injury (AIS 3/4) admissions dropped by 60%. After taking into account various factors that could have contributed to the reduction in cyclist head injuries, Carr et al. concluded that "the major part of this reduction is attributable to the introduction of the helmet wearing law" and that "This analysis has confirmed the substantial reductions being made in both number and severity of bicycle injuries since the introduction of the mandatory helmet wearing law".

A 1995 NSW study by Williams showed that between 1990 and 1993, road fatalities excluding cyclists dropped by 24%, and cyclist road fatalities dropped by 60% (from 20 to 8). In 1994 there were 23 cyclist fatalities.

A 1995 SA study by Marshall and White found that, after accounting for exposure and changing hospital admission policy (for concussion injury), comparing the year before the helmet law to the year after the helmet law, the helmet legislation could be linked to a 12% reduction in cyclists injuries that were potentially preventable by the use of a helmet. Comparing the 2 years before and after the helmet law, Marshall and White found that the helmet law was responsible for a 25% decrease in hospital admissions for potentially preventable cyclist head injuries in SA.

In a 1996 analysis of cyclist and pedestrian casualties in Victoria and NSW, all-age cyclist counts in Victoria, and child cyclist counts in NSW, Dorothy Robinson noted similar declining trends for both cyclist and pedestrian head injuries in those states, and concluded that the decreases in hospital admissions were less than the decreases in cycling.

Noting that all road users had 42% fewer deaths from head injury in 1994 than in 1998, pedestrians had 38% fewer, but the reduction in head injury deaths for cyclists was only 30%, Curnow concluded: "Despite a decrease in cycling, deaths to cyclists, even those by head injury, declined by less than other road users. No benefit from the helmet laws is evident." ATSB road fatality data shows that between 1992 and 1994, compared to 1987-1989, the number of pedestrian fatalities fell by 28%, and the number of cyclist fatalities fell by 45%.

A 1996 analysis by Bruce Robinson used information on head injuries, recorded for hospital admissions in Western Australia (WA) since 1971, to show the remarkably similar trends for all road users, and noted that a divergence between the injury rates from 1991 was unexplained, suggesting that it might just be random variation. The WA data were later analysed by Hendrie et al., using a statistical model to estimate the effect of the helmet law on cyclist head injuries, after taking the downward trends in both pedestrian and cyclist head injuries into account. The model showed that the divergence was not due to random variation (p<0.001); that before the helmet law the proportion of cyclists with a head injury was on average 6% higher than the proportion of pedestrians with a head injury; and that after the law the proportion of cyclists with a head injury was on average 16% lower than the proportion of pedestrians with a head injury. (This divergence can be seen on the graph, where the green/pedestrian line crosses the black/cyclist line the year before the helmet law is introduced.) With respect to the cost-benefit of the helmet law, Hendrie et al concluded that "In monetary terms, it is unlikely that the helmet wearing legislation would have achieved net savings of any sizeable magnitude." ATSB data shows that in NSW, during the 3 years following legislation 1992-1994, compared to the 3 years prior to legislation of 1988-1990, pedestrian fatalities dropped by 34% (from an average of 185 to 122 per year), cyclist fatalities dropped by 49% (from an average of 24 to 12 per year) and motorcyclists dropped by 49% (an average of 107 to 54). A 1995 NSW RTA analysis reported the total reduction in cyclist casualties since helmet legislation (including the effects of safer roads and reduced cycling) as 33 fewer cyclist deaths and 1040 fewer injuries, a saving of $47,863,820 in casualty costs.

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

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

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

Bambach et al. 2013 provided details for NSW, 2001 to 2009, by comparing wearers and non-wearers, head and other injuries from accidents involving motor vehicles. A noticeable feature in the details was for the ages, 55% of non-wearers were in the 0-19 age group compared with 19% for wearers. Bambach Table 2 shows 267 head injuries for non-wearers and 372 head injuries for wearers. There were 120 non-wearers over the 0.05 BAC limit and 85 wearers. Non-helmeted cyclists were more likely to display imprudent cycling behaviour, including disobeying a traffic control (9.4% compared with 3.3%) and cycling with a BAC greater than 0.05 (7.2% compared with 1.7%) (Table 2). However, non-helmeted cyclists were more likely cycling on the footpath (34.4% compared with 12.9%) and in speed zones of 50 km/h or less (56.9% compared with 50.0%), and less likely cycling on highways or freeways (8.3% compared with 12.6%). Overall, non-helmeted cyclists were more likely to be seriously injured in body regions other than the head (9.5% compared with 7.3%).

In a meta-analysis of published helmet effectiveness studies, Attewell et al. found in 2000 that "...three studies provided neck injury results that were unfavourable to helmets with a summary estimate of 1.36 (95% confidence interval 1.00 to 1.86), but this result may not be applicable to the lighter helmets currently in use", and that compared to helmeted cyclists, unhelmeted cyclists were 2.4 times more likely to sustain a brain injury; 2.5 times more likely to sustain a head injury; and 3.7 times more likely to sustain a fatal injury.

Use of case-control studies

Case-control studies concerning the effectiveness of helmets, including some from Australia, have been cited in a literature review regarding the health outcomes of cycling and bicycle helmets by the Centre for Accident Research & Road Safety — Queensland (CARRS-Q). The Australian Transport Safety Bureau (ATSB) analyzed sixteen such studies, four from Australia.

All these studies are disputed by Curnow and Robinson pointed out that case-control studies in other areas, such as hormone replacement therapy and heart disease, have produced misleading results.

Bicycle usage

Bicycle usage: studies with control groups

The Australian census asks about about method of travel to work on census day. Some states — Victoria, New South Wales and Tasmania — made bicycle helmets compulsory some months before the 1991 census. The trend from 1986-91 in all these states was below that from 1981-86. In SA the law was introduced a month before before the census and there was a greater reduction in cycling to work from the 1991 to the 1996 census than from 1986-91. In WA, the law was introduced on 1 Jan 1992 and enforced from 1 July 1992. In Qld, no provision was made for penalties and the law was widely ignored (about 50% of adults wore helmets) until 1 Jan 1993, when penalties were introduced. The greatest declines in cycling to work in these states were seen from the 1991 to 1996 census. In the Australian Capital Territory, cycling continued to increase despite the helmet law.

Bicycle usage: states with and without enforced laws at the 1991 census

Aggregating all data for states with (Vic, Tas and NSW) or that may have had (SA) enforced helmet laws, and those that did not (Qld, WA and ACT) provides a clearer picture for the country as a whole. Both in capital cities and regional areas, cycling continued to increase on average in states without enforced helmet laws at the 1991 census. In contrast, the percentage cycling to work in states with enforced helmet laws decreased. Before helmet legislation in 1986, capital cities had similar numbers (43,218 vs 40,798 in regional/rural areas) cycling to work but much lower percentages (1.14% compared to 3.14%). Capital cities generally have higher traffic levels and the lower percentages cycling to work suggest they were less conducive to cycling than regional areas such as small country towns, with less traffic and shorter distances between home and work. In Vic, NSW, Tas and SA, the fall in non-capital cities was from 2.9% in 1986 to 2.0% in 1991. Excluding the capital cities of Perth and Brisbane, in 1991, in Qld and WA, 3.57% of journeys to work were by bicycle. This fell to 2.45% by the 1996 census when these areas had enforced helmet laws, with continued declines to 1.7% by the 2006 census. Bicycle usage in all capital cites was 1.14% in 1986 when no helmet laws existed. In 1991, it was 0.99% in Victoria, NSW, Tasmania and SA — states that had (or for SA may have had) enforced laws — and 1.57% in Qld, ACT and WA. From 1986-1996, cycling to work in capital cities dropped from 1.14% to 0.89%, (a difference of 0.25 percentage points, but a decrease of 22%). Census data for Adelaide for 1986, 1991 and 1996 have commuter cycling counts on Census day of 8061, 7186 and 4494 respectively and represent a reduction from 1986 to 1996 of 44%. (note, pre law surveys were conducted on 30 June of each census year and post law surveys in early August (slightly warmer conditions and approximately 42 minutes extra daylight).

Opinions on cycling in relation to the helmet laws

A street survey in the Northern Territory found 20% of cyclists had given up because of the law and 42% said they had reduced their cycling. A 1994 evaluation report on the helmet laws by the NSW Roads and Traffic Authority stated:

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

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

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

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

Census data from 2011 showed lower percentages cycling to work than before helmet laws were introduced.

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

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

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

Regular telephone surveys conducted by the South Australian Health Commission reported a decrease in the proportion of people aged 15 years and over who cycled at least once a week from 12% to 10.4%, but no change in the frequency of at least weekly cycling for younger people (61%). However, from 1988 to 1994, cycling to school (which comprises about 20% of trips for children under 15) declined by 38.1%. Reductions in cycling to school were offset largely by an increase from 25% to 34% of children cycling on their "own property" (where mandatory helmet laws do not apply).

Helmets and bike-share schemes

Melbourne inaugurated a bicycle sharing system in 2010. Mandatory helmet laws have been cited as one reason for its low initial usage. Increased access to helmets in local shops saw usage of the bike share scheme almost double in late 2010 to an average of 183 trips a day. The bike share scheme has seen its usage increase in 2011 from a low point of 257 average daily trips in July, to 519 in January 2012. Nonetheless, this is still low by international standards at 0.4 trips per bike per day in July and 0.8 trips per bike per day in January, while 8 to 10 trips per day is usual elsewhere. Some politicians has suggested that the helmet laws should be altered so as to aid bike hire schemes. The Lord Mayor of the City of Sydney, Clover Moore, has indicated that an exemption from compulsory helmet laws will be sought for a future bike hire scheme after a network of inner-city bikes lanes is completed.

Enforcement, fines and legal aspects of compulsory helmet use

In Victoria more than 19,000 fines for not wearing a helmet were issued in the first 12 months of their helmet law. Before the law was enforced in Queensland, bicycle travel represented about 2.3% of total vehicle kilometres; after the helmet law was enforced in 1993, bicycle offence notices increased to 7.9% of traffic offence notices, implying that per kilometre, bicycle offence notices were about four times higher than all other traffic offences put together - speeding, drink-driving, not wearing seatbelts, careless driving or riding, etc. In 2005 almost 10,000 cyclists in NSW were fined for not wearing a helmet. The figure had dropped to 6,537 in 2010.

The Sydney Morning Herald has reported that the number of cyclists who have been fined decreased from more than 13,000 in 2005-06; to 10,807 in 2007-08; and to 8,866 in 2008-2009. The chairman of the Pedestrian Council of Australia was quoted as saying that in the past 5 years there have been no fines issued for most bicycle-related offences; that 74% of the fines related to helmets, not riding offences; and that it appeared that the government was going soft on cyclists. An article in The Age quoted the officer in charge of Victoria Police's bicycle unit as saying that cyclists without a helmet were a particular focus, because it is a most fundamental safety rule. The newspaper also reported that Bicycle Victoria, a cycling advocacy group, supported the increased fines.

Public attitude to helmets

In 1989, an officially-commissioned survey showed that public support for mandatory helmet laws was 92% for children and 83% for all riders. A 1995 study by Williams reported that prior to the legislation in NSW, compulsory helmet wearing had an approval rating of over 70%, rising to 92% in 1994.

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

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

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

See also

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

Footnotes

1. Walker reported: “As it turns out, the first survey was conducted in overcast conditions in Sydney and, in some areas, was interrupted by rain whereas the second survey was conducted in sunny conditions.”
2. Hynd et al. noted that Robinson's definition of head injuries is "very vague and not useful for this type of study", and that it is important that injury severity is considered in such analyses. Hagel noted that the correlation coefficient corresponding to one of the figures in Robinson's 2006 article suggested that much of the variation in the percentage of head injuries is explained by helmet use. Hagel also noted that much of Robinson's data is based on time series or ecological designs without any concurrent comparison groups, and that such studies are considered to provide weak evidence. Hagel then noted that time series or ecological studies are subject to confounding/bias, and that unlike case-control studies, confounding variables in ecological studies cannot be measured, so cannot be adjusted for.
3. Attewell et al. (2000) concluded: "This formal summarisation of studies of individual cyclists in various settings has confirmed the clear benefits of helmets in terms of injury risk. The upper bounds of the 95% confidence intervals provide conservative risk reduction estimates of at least 45% for head injury, 33% for brain injury, 27% for facial injury and 29% for fatal injury."

References

1. Curnow, W. J. "Bicycle Helmets: A Scientific Evaluation" in Anton De Smet (2008). Transportation Accident Analysis and Prevention (PDF). Commack, N.Y: Nova Science Publishers. ISBN 1-60456-288-9.
2. ^ "Brief History of Helmet Law in Australia". Cyclists' Rights Action Group (CRAG). Retrieved 26 March 2013.
3. King, M. and Fraine, G. (1993). Bicycle helmet legislation and enforcement in Queensland 1991-1993: Effects on helmet wearing and crashes. Road User Behaviour Section, Road Transport and Safety Division, Queensland Transport.
4. http://www.ntc.gov.au/filemedia/Reports/ARRFeb12.pdf
5. Australian Government: Trade Practices (Consumer Product Safety Standard) (Bicycle Helmets) Regulations 2001
6. Bicycle Helmet Research Foundation (BHRF). "Helmet laws: what has been their effect?". Retrieved 15 March 2013.
7. Calligeros, Marissa (23 April 2013). "Bike helmet laws will change to allow religious exemptions". The Brisbane Times. Retrieved 23 April 2013.
8. Clarke, Colin (2007). "The case against bicycle helmets and legislation" (PDF). Velo-city (cycling conference), Munich 2007. Retrieved 9 March 2013.
9. Finch CF (1993). Bicycle use and helmet wearing rates in Melbourne, 1987 to 1992: The influence of the helmet wearing law. MUARC Report No. 45 (PDF). Monash University, Victoria, Australia.: Monash University Accident Research Centre (MUARC). ISBN 0-7326-0045-6. Retrieved 1 March 2013. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
10. ^ Robinson, DL (1996). "Head injuries and bicycle helmet laws" (PDF). Accident Analysis & Prevention. 28 (4): 463–475. doi:10.1016/0001-4575(96)00016-4. PMID 8870773. Retrieved 28 February 2013. {{cite journal}}: Unknown parameter |month= ignored (help)
11. ^ Walker, MB (1990). Law compliance and helmet use among cyclists in New South Wales. Consultant Report 6/90 (PDF). Rosebery, NSW,Australia.: Road Safety Bureau, NSW Roads and Traffic Authority. ISBN 0-7305-3652-1.
12. ^ Walker, MB (1991). Law compliance and helmet use among cyclists in New South Wales, April 1991. Consultant Report 1/91 (PDF). Rosebery, NSW, Australia.: Road Safety Bureau, NSW Roads and Traffic Authority. ISBN 0-7305-3668-8.
13. Walker, MB (1992). Law compliance among cyclists in New South Wales, April 1992: A third survey (PDF). Rosebery, NSW, Australia.: Network Efficiency Branch, NSW Roads and Traffic Authority. ISBN 0-7305-9100-X.
14. ^ Smith NC (1993). An observational survey of law compliance and helmet wearing by bicyclists in New South Wales -1993 (PDF). Rosebery, NSW, Australia.: Transport and Network Development Branch, NSW Roads and Traffic Authority. ISBN 0-7305-9110-7. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
15. Walker, M. Bicycling in Sydney: law compliance and attitudes to road safety. in Velo Australis. 1996. Fremantle.
16. ^ Marshall J (1994). Evaluation of the compulsory helmet wearing legislation for bicyclists in South Australia. Office of Road Safety Report Series 8/94 (PDF). Office of Road Safety, South Australian Department of Transport. ISBN 0-7308-0075-X. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
17. Evaluation of the bicycle helmet law in Victoria during its first four years; Carr D, Skalova M, Cameron M.; Monash University Accident Research Centre, 1995.
18. ^ Williams, Meredyth-Ann (1995). Evaluation of the NSW introduction of compulsory bicycle helmet legislation. Research Note 17/94 (PDF). NSW Roads and Traffic Authority (RTA). ISBN 0-7305-3844-3. {{cite book}}: Unknown parameter |month= ignored (help)
19. Road Traffic Accidents in NSW-1994
20. ^ Curnow, WJ (2005). "The Cochrane Collaboration and bicycle helmets". Accident Analysis and Prevention. 37 (3): 569–573. doi:10.1016/j.aap.2005.01.009. PMID 15784212. {{cite journal}}: Unknown parameter |month= ignored (help)
21. ^ Road Fatalities Australia: Statistical Summary 2002; Safety Transport Statistics Unit, Australian Transport Safety Bureau, 2003
22. ^ Hendrie D, Legge M, Rosman D, Kirov C. Road Accident Prevention Research Unit, Department of Public Health, The University of Western Australia (1999). An economic evaluation of the mandatory bicycle helmet legislation in Western Australia (PDF). Proceedings, Conference on Road Safety, Insurance Commission of Western Australia.{{cite book}}: CS1 maint: multiple names: authors list (link)
23. ^ Is There Any Reliable Evidence That Australian Helmet Legislation Works? Bruce Robinson, Bicycle Federation of Australia. Proceedings of Velo Australis, a conference held in Fremantle, Australia, 30 October 1996. http://www.bhsi.org/veloaust.htm
24. 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.
25. D Hynd (2009). The potential for cycle helmets to prevent injury — A review of the evidence (Report PPR446). Transport Research Laboratory, UK. ISBN 978-1-84608-939-8. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
26. Hagel, B (2006). "Arguments against helmet legislation are flawed". British Medical Journal. 332 (7543): 725–726. doi:10.1136/bmj.332.7543.725. PMC 1410864. Retrieved 19 March 2013. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: PMC format (link)
27. Evaluation of the bicycle helmet law in Victoria during its first four years; Carr D, Skalova M, Cameron M.; Monash University Accident Research Centre, 1995.
28. Robinson, D L (20052). "Safety in Numbers in Australia: more walkers and bicyclists, safer walking and bicycling". Health Promotion Journal of Australia. 16: 47–51. {{cite journal}}: Check date values in: |year= (help)CS1 maint: year (link)
29. Walter, SR (2011). "The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia". Accident Analysis & Prevention. 43 (6): 2064–2071. doi:10.1016/j.aap.2011.05.029. ISSN 0001-4575. PMID 21819836. Retrieved 24 February 2013. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
30. Rissel, C (2012). "The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia: A rejoinder". Accident Analysis & Prevention. 45: 107–109. doi:10.1016/j.aap.2011.11.017. ISSN 0001-4575. PMID 22269491. Retrieved 24 February 2013. {{cite journal}}: Unknown parameter |month= ignored (help)
31. Walter, SR (2013). "The impact of compulsory helmet legislation on cyclist head injuries in New South Wales, Australia: A response". Accident Analysis & Prevention. 52: 204–209. doi:10.1016/j.aap.2012.11.028. ISSN 0001-4575. PMID 23339779. Retrieved 24 February 2013. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
32. Olivier, J (2013). "Long term bicycle related head injury trends for New South Wales, Australia following mandatory helmet legislation". Accident Analysis & Prevention. 50: 1128–1134. doi:10.1016/j.aap.2012.09.003. PMID 23026203. Retrieved 25 February 2013. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
33. Jake Olivier; Scott Walter; Raphael Grzebieta (3 October 2012). "Bike helmet critics not using their heads". The Age. Retrieved 9 April 2013.
34. Bambach, M; Mitchell RJ, Grzebieta RH, Olivier J (April 2013). "The effectiveness of helmets in bicycle collisions with motor vehicles: A case-control study.". Accid Anas and Prev. 53: 78–88. doi:10.1016/j.aap.2013.01.005. PMID 23377086.
35. ^ Attewell, R. (2000). Bicycle Helmets and Injury Prevention: A formal review (PDF). Canberra, Australia: Australian Transport Safety Bureau. ISBN 0 642 25514 8. Retrieved 24 February 2013. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
36. Haworth N (2010). Bicycle Helmet Research (CARRS-Q Monograph 5) (PDF). Centre for Accident Research & Road Safety — Queensland (CARRS-Q), Queensland University of Technology (QUT). ISBN 978-0-9751-5968-2. Retrieved 31 March 2013. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
37. Robinson, DL (2007). "Bicycle helmet legislation: Can we reach a consensus?". Accident Analysis & Prevention. 39 (1): 86–93. doi:10.1016/j.aap.2006.06.007. PMID 16919590. Retrieved 1 March 2013. {{cite journal}}: Unknown parameter |month= ignored (help)
38. ^ Bicycle Helmet Research Foundation (BHRF). "Changes in cycle use in Australia".
39. Travel to work in Australian capital cities, 1976-2006: an analysis of census data. Paul Mees, Eden Sorupia & John Stone, December 2007 http://www.abp.unimelb.edu.au/files/miabp/2GAMUT2007_DEC_02.pdf
40. Robinson, Dorothy L. "Cycle Helmet Laws — Facts, Figures and Consequences". Paper presented at Velo Australis, the International Bicycle Conference, Freemantle, Western Australia, 1996. Retrieved 25 March 2013.
41. Harland, John C. (2007). "Cycling cultures and the mismeasurement of cycling" (PDF). The BikeShed at CERES (community cycling group). Retrieved 9 April 2013.
42. "2101.0 - Census of Population and Housing, 1991". Abs.gov.au. 28 October 2008. Retrieved 4 June 2013.
43. "2011 Census Community Profiles: Australia". Censusdata.abs.gov.au. Retrieved 4 June 2013.
44. Cameron, MH (1994). "Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia--an evaluation". Accident Analysis & Prevention. 6 (3): 325–337. PMID 8011045. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
45. Robinson, DL. "Head Injuries and Helmet Laws in Australia and New Zealand". Bicycle Helmet Research Foundation. Retrieved 28 February 2013.
46. Ian Ker, 2011. Empty Cells, Damned Half-Truths and Pseudo-Statistics:The Lot(tery) of the Bicycle Planner. Paper presented at the PATREC Planning and Transport Research Centre Forum, 13 September 2011.
47. Mega Projects in Transport and Development: Background in Australian Case Studies, Perth Urban Railway; Imran Muhammad, Nicholas Low &. Leigh Glover; August 2006
48. accessed 4 January 2012
49. Lucas, Clay (29 November 2010). "Helmet law hurting shared bike scheme". Sydney Morning Herald. Retrieved 10 April 2013.
50. "Cyclists fined during anti-helmet protest". ABC News. 24 July 2010. Retrieved 10 April 2013.
51. Moore, Tony (8 Augus 2011). "CityCycle won't follow Melbourne's $5 helmet lead". Brisbane Times. Retrieved 10 April 2013. {{cite news}}: Check date values in: |date= (help)
52. Bike share scheme starts to gain traction The Age http://www.theage.com.au/victoria/bike-share-scheme-starts-to-gain-traction-20120209-1rwsx.html
53. Bicycle Helmet Research Foundation (BHRF). "A Tale of Two Cities". Retrieved 15 March 2013.
54. The Role of Smart Bike-sharing Systems in Urban Mobility. Peter MIDGLEY. JOURNEYS. May 2009. http://www.scribd.com/doc/63059837/IS02-p23-Bike-Sharing
55. Zaw, Yolanda (4 June 2012). "City plans bike-hire scheme". The West Australian. Retrieved 10 April 2013.
56. Zaw, Yolanda (11 May 11, 2012). "Fremantle in call for no helmets trial". The West Australian. Retrieved 10 April 2013. {{cite news}}: Check date values in: |date= (help)
57. Saulwick, Jacob (5-Mar-2012). "Bike hire plans hinge on helmets". Sydney Morning Herald. Retrieved 1 March 2013. {{cite news}}: Check date values in: |date= (help)
58. Cameron M (1992). Evaluation of the Bicycle Helmet Wearing Law in Victoria During its First 12 Months (MUARC Report No. 32). Monash University Accident Research Centre. Retrieved 22 March 2013. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
59. Cyclists 'getting an easy ride' SMH http://www.smh.com.au/nsw/cyclists-getting-an-easy-ride-20101208-18px7.html
60. Smith, Alexandra (9 December 2010). "Fine For Riding Without Helmet, Light / Running Red Light In NSW". Smh.com.au. Retrieved 4 June 2013.
61. Lucas, Clay. "New Cycling Fines In Melbourne Leaves Riders Reeling | Trams". Theage.com.au. Retrieved 4 June 2013.
62. AGB McNair Survey Community Attitude November 1989
63. Riding a Bike for Transport 2011 Survey Findings
64. Essential Vision. "Essential Report 30 April 2012" (PDF). Retrieved 27 February 2013.
65. "Women and Cycling Survey 2013" (PDF). National Heart Foundation of Australia and the Cycling Promotion Fund. 2013. Retrieved 26 March 2013.

External links

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

• Use dmy dates from January 2012
• Cycling in Australia
• Cycling safety
• Australian law
• Bicycle law