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Bicycle helmets in Australia

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

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.

Cycling levels before and after the introduction of mandatory bicycle helmet laws

A 1993 Victorian study by Finch et al. concluded that (after taking weather conditions into account) the helmet legislation had no deleterious effect on adult cycling, but reduced teenage (road) cycling by about 45%. 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."

Studies conducted for the NSW Roads and Traffic Authority indicated that number of child (road) cyclists reduced by about 40% after the helmet law, but that there was no reduction in adult cycling.

A 1995 SA study by Marshall and White found that, after the helmet law, there was no change (p<0.05) in the number of adults or children who cycled at least once a week. Marshall and White also found that prior to the helmet law, cycling to school comprised about 20% of cycling activity in that age group, and that after the helmet law, cycling to school reduced by about 40%, and cycling to/around other venues increased by about the same amount.

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.

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.

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%.

See also: Bicycle_helmet § Rotational_injury

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.

See also: Bicycle_helmet § Meta-analyses

Use of case-control studies

Main article: Bicycle_helmet § 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) analysed sixteen such studies, four from Australia.

All these studies are disputed by Curnow.

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.

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."

See also

Footnotes

  1. 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.
  2. 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

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