On July 1, 1990, the first statewide law in Australia requiring wearing of an approved safety helmet by all bicyclists became effective in Victoria (1989 population: approximately 4.3 million) (Figure 1). Implementation of the law was preceded by a decade-long campaign to promote helmet use among the estimated 2.2 million persons who ride bicycles; the campaign included educational programs; mass media publicity; financial incentives; and efforts by professional, community, and bicycle groups (1,2). This report assesses helmet law enforcement, helmet use, and injuries related to bicycling in Victoria.

Victoria's comprehensive bicycle-helmet-promotion program included promotion of helmets in the schools through a bicycle-safety education unit, a film on safer riding, and since 1983, a requirement for helmets to be worn for all cycling activities organized by public schools in the state. A mass media publicity campaign emphasizing the seriousness of head injury and the protection provided by helmets was targeted at parents of primary-school-aged children. A helmet-promotion task force was formed that included bicyclists, motorists, police officers, educators, community safety organizations, helmet manufacturers, retailers, and physicians. Government-sponsored bulk purchase and rebate programs enabled purchase and distribution of 188,000 helmets at discount.

The law requires all persons cycling on roads, footpaths, and separate bicycle paths and in public parks to wear a securely fitted, government-approved bicycle helmet; the law also applies to passengers (e.g., children in bicycle child seats). Exemptions are difficult to obtain; fewer than 50 exemptions were granted during the first year. The maximum penalty for an offense -- a $100 fine -- has been invoked rarely; more commonly, a "Bicycle Offence Penalty Notice" of $15 is issued, or a "Bicycle Offence Report" for children (no monetary penalty) is sent to the parents. The number of penalty notices increased from 2836 during July 1989-June 1990 and to 19,229 during July 1990-June 1991, and offense reports increased from 1743 to 5028, respectively.

Overall helmet-wearing rates for cyclists in Victoria were estimated by combining the results of observation surveys in the city of Melbourne and elsewhere in proportion to the population distribution (1). Estimated overall wearing rates for Victoria increased from 31% during 1990 to 75% during 1991. Substantial increases occurred among all age groups, although rates of use were lowest among teenagers (Table 1).

Concurrent with the increase in helmet use, declines have occurred in both the number of compensation claims filed with the Transport Accident Commission (TAC), the sole motor-vehicle insurer in Victoria, for severe bicycle injuries (fatal or resulting in hospitalization) (Figure 2) and the number of cyclists with injuries who were admitted to public hospitals (Figure 3). Based on comparison of claims submitted to the TAC during 1989-1990 and 1990-1991, the number of cyclists killed or hospitalized with head injuries decreased by 51%, and the number with similarly severe injuries other than to the head decreased by 24%; for public hospital admissions (Figure 3), these numbers decreased 37% and 21%, respectively.

Observational surveys of bicycle use in Melbourne indicated a 36% decrease in bicycle use by children in May-June 1991 compared with May-June 1990. The largest decrease (44%) occurred among 12- 17-year-olds, compared with the decrease among 5-11-year-olds (15%).

Reported by: AP Vulcan, MH Cameron, L Heiman, Monash Univ Accident Research Center, Melbourne, Victoria, Australia. Epidemiology Br, Div of Injury Control, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: The findings in this report indicate a substantial increase in helmet-wearing rates after implementation of the law in Victoria, especially among teenagers and adults. The number of offenses issued suggests a moderate level of enforcement. In addition, however, comprehensive efforts to promote helmet use increased the prevalence of helmet wearing among cyclists to 31% from 1989 through 1990 -- before the law was enacted -- and were accompanied by a reduction in head injuries; these efforts fostered support for legislation.

The reduction in number of bicyclists with head injuries following implementation of the law in Victoria may reflect a combination of several factors, including the decline in bicycle use by children; the possibility that, by wearing helmets, cyclists are more likely to be noticed by motorists; the effect of educational efforts and publicity in improving the safety practices of cyclists; and the impact of major initiatives in 1989 and 1990 to reduce motorists' speeding and drinking and driving. The findings in this report suggest a substantial and positive effect of the law on helmet use. Further assessment is needed to identify the most important components of the combined legislative and educational approach and to measure the effectiveness of the program in reducing head injuries.

Attempts to increase bicycle safety-helmet use in the United States include, for example, a communitywide educational program in Seattle that increased helmet use from 5% to 33% during a 3-year period (3). In Howard County, Maryland, a law requiring bicyclists aged less than 16 years to wear a helmet was enacted after the cycling-related deaths of two children; helmet use among children increased from 4% before the law to 47% after implementation (4). However, no U.S. community has employed the approach in Victoria of combining a sustained, comprehensive educational approach with enactment and enforcement of a law.

Although most head injuries resulting from bicycle crashes occur among children, and helmet use reduces the risk for head injury by 85% (5), the prevalence of helmet wearing is low among U.S. children (6). Attributable risk calculations suggest that if all U.S. bicyclists had worn helmets from 1984 through 1988, as many as 2500 deaths and 757,000 head injuries might have been prevented (7). The comprehensive community-based educational program and legislative approach for increasing bicycle-helmet use in Victoria may serve as a model for reducing bicycle-related injuries and deaths in the United States and other countries.

References

1. Vulcan AP, Cameron MH, Heiman L. Evaluation of mandatory bicycle helmet use in Victoria, Australia. In: Proceedings of the 36th Annual Conference of the Association for the Advancement of Automotive Medicine. Chicago: National Center for Statistics and Medicine, 1991.

2. Vulcan P, Cameron MH, Watson WC. Mandatory bicycle helmet use: experience in Victoria, Australia. World J Surg 1992;16:389-97.

3. Rogers LW, Bergman AB, Rivara FP. Promoting bicycle helmets to children: a campaign that worked. Journal of Musculoskeletal Medicine 1991;8:64-77.

4. Cote TR, Sacks JJ, Lambert-Huber DA, et al. Bicycle helmet use among Maryland children: effect of legislation and education. Pediatrics 1992;89:1216-20.

5. Thompson RS, Rivara FP, Thompson DC. A case-control study of the effectiveness of bicycle safety helmets. N Engl J Med 1989;320:1361-7.

6. Weiss BD. Trends in bicycle helmet use by children: 1985 to 1990. Pediatrics 1992;89:78-80.

7. Sacks JJ, Holmgreen P, Smith SM, Sosin DM. Bicycle-associated head injuries and deaths in the United States from 1984 through 1988: how many are preventable? JAMA 1991;266:3016-8.

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