 |
||||||||||||||||||||||||
Policy as a powerful
tool for changing health behavior
Last month, I was in Barcelona for a conference. I noticed that everyone on a motorcycle wore a helmet. In stark contrast, practically no one on a bicycle wore a helmet. Spain has a universal helmet use law for two-wheeled motorized vehicles. Everyone, regardless of age, must wear a helmet when riding a motorcycle or moped. A study conducted in Spain a few years after the law was passed showed that deaths among motorcycle riders, especially those involving traumatic brain injuries, dropped substantially. For bicyclists, however, Spain does not have helmet use policies. And by my observations, helmet use among people on bikes is nearly nonexistent. So, how about in the United States? We have laws requiring motorcycle helmet use, but the specifics of these laws vary from state to state. As the laws vary, so does helmet use. In states requiring all motorcyclists to wear a helmet, nearly 100% do. Conversely, in states in which helmet use is optional or required only of minors, use is much lower. States enacting universal helmet use laws have seen impressive decreases in motorcycle deaths and serious head injuries. As expected, states that have repealed universal helmet use laws have seen a rise in motorcycle-related brain injuries and deaths. The laws for bicycle helmet use across the United States are as variable as the laws for motorcyclists, even though legislation has been recommended by CDC as a means to increase helmet use. In public health, the focus is often on sharing information about risks and encouraging healthier alternatives. That’s enough to get some people to make healthy choices. But others need more of a “push.” We cannot underestimate the power of policy as impetus for change, especially when paired with programs to educate and raise awareness. Where else might we explore the use of policies that require healthy behaviors or prohibit unhealthy ones? We welcome your ideas. Posted by: Ileana Arias, Tuesday, July 29, 03:30 pm ETT
A State Senator in Oregon floated an idea to pass a law requiring helmet use for all ages of bicycle drivers and was shouted down by bicyclists saying that bicyclists in Europe do not wear helmets and their death and injury rate per trip is much lower than in the United States. I have looked for studies confirming or refuting this and have not found anything. Do you have any such information? If we are going to pass mandatory helmet laws, we need data showing the difference between European and US bicyclist death and injury rates and the reasons for the differences. Can you help? Posted by: Joanne Fairchild, RN, Thursday, August 07, 2008 5:31 PM ETT Dear Ms. Fairchild, The available research indicates that bicycle helmets work to prevent injury, and laws that require helmet use work to prevent injury. Helmets have been shown by numerous studies to prevent serious injury and death among bicyclists. This point has been consistently shown in several countries, including Australia, New Zealand, Canada, and the UK. In particular, helmets have been proven to reduce various forms of head injury, which is the biggest threat to bicyclists, including head, brain, facial, and "fatal" head injuries of all types (Odds ratios of 0.40, 0.42, 0.53, and 0.27 respectively) These results are summarized in an article by R.G. Attewell et al, "Bicycle helmet efficacy: a meta analysis," Accident Analysis and Prevention, (33) (2001) p. 345-352. Although helmets have been scientifically proven to be effective, helmet use depends as much or more on legislative efforts as it does on education efforts. Helmet usage is quite low in countries that do not have mandatory helmet laws, with one study citing helmet usage levels at below 10% in such countries. (Weiss, "Cycle related head injuries", Clinics in Sports Med, 1994) Legislation aimed at mandating bicycle helmet usage has been shown to both increase helmet use, as well as lead to a subsequent decrease in bicycling deaths and injuries. Such results are well outlined in a meta-analysis which included five studies on this topic: Macpherson A, Spinks A. "Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries." Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005401.DOI:10.1002/14651858.CD005401.pub2. Bicycle helmets also make sense from an economic perspective. The National Safety Council estimated that the comprehensive cost of each person killed in a traffic crash to be nearly 4 million dollars. Multiplying this number by the 784 bicyclists killed in the year 2005 totals more then $3 billion. In addition, the average cost of a non-fatal injury event to bicyclists was $52,900, which when multiplied by the 45,000 reported injury bike crashes in 2005 totals nearly $2.4 billion. These results are outlined at the website "bicycling info.org", and can be accessed at this link: http://www.bicyclinginfo.org/faqs/answer.cfm?id=42. Helmet use could put a significant dent in these societal costs. Still, bicycle helmet use is not the only factor which determines the risk of injury to a bicyclist, and it is these other factors which are likely to be playing a role in the lower risk of injury among bicyclists in Europe. The lower bicycling injury rates per trip in these countries may be attributable to a number of other factors related to the built environment, such as well marked bicycle paths, lower average traffic volumes, different intersection types (such as roundabouts), increased use of devices to make the biker more visible, and intersection signals designed for bicyclists. In addition, more people bicycle and this familiarity with bicycling is important too. In sum, helmets themselves are an excellent tool for reducing risk of injury in bicyclists, regardless of locale, and use can be raised though a combination of legislative and educational efforts. I hope this information is helpful. Sincerely, Posted by: Ileana Arias, Tuesday, September 09, 2008 7:29 PM ETT
|
|
|||||||||||||||||||||||
Page last modified: September 22, 2008