Bicycle helmet laws

Further information: Bicycle helmet laws by country

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.

Background

Modern varieties of bicycle helmet first became commercially successful from 1975.[1] Industry helmet standards were developed from the 1970s[2] and are still under development.[3][4] Even before then, there had been calls for riders to wear helmets,[5] based on the assumptions of high risk to cyclists and effectiveness of helmets in preventing serious injury.[5]

The Royal Australasian College of Surgeons campaigned actively to raise public awareness, acceptance and demand,[6] and helmets first became compulsory across Australia from 1991 to 1992.[7][8] 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.[9][10][11][12] Bicycle helmets became compulsory in New Zealand in January 1994.[13] A report from the Australian Department of Transport in 1987 cast doubt on the effectiveness of helmets in real accidents.[14] In 2004 members of the UK Parliament questioned the claims made for helmets in an Early Day Motion.[15]

By 1991, after widespread well-resourced campaigns,[16][17] 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.[18] Some official and professional bodies in the English-speaking world now support compulsory use of helmets.[19][20] A 2009 poll of U.S. adults found that 86% supported helmet laws for children.[21] 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.[22] 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.[23]

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.[24] 29 U.S. states have no statewide law, and 13 of these states have no such laws in any lower-level jurisdiction either.[25] The territory of Guam made helmets compulsory for all bicycle riders and passengers on 27 February 2012.[26]

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.[27][28] An official predicted that this would have disastrous health consequences.[29] Mexico City has repealed its helmet law to allow a bike-sharing scheme to work.[28]

The helmet debate

Main article: Bicycle helmet

The debate on helmet laws has been described as "sour and tetchy".[30]

There is no consensus on whether helmets themselves are effective, useful, or worth either promotion or compulsion. Cycling in the Netherlands and in Denmark is perceived as a "normal" activity requiring no special clothing or equipment.[31] Official organizations have supported the use of helmets without calling for laws; the Dutch Institute for Road Safety Research (SWOV) finds contradictory evidence but on balance concludes "that a bicycle helmet is an effective means of protecting cyclists against head and brain injury".[32] Some Dutch cycling experts and planners have opposed the use of helmets, claiming that helmets discourage cycling by making it less convenient, less comfortable, and less fashionable. They also mention the possibility that helmets would "make cycling more dangerous by giving cyclists a false sense of safety and thus encouraging riskier riding behavior."[33]

Support

The mandatory wearing of helmets is frequently supported by medical organizations and by bodies responsible for road safety.[34]

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.[35] A helmet testing specialist states that some of these accidents can generate energy levels beyond those used when certifying competition motor racing helmets.[36] 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.[37]

Injury prevention

The largest metastudy ever conducted on the relationship between bicycle helmets and injuries was published in 2016, comprising a synthesis of 40 separate studies from 11 countries, involving approximately 64,000 injured cyclists.[38] The findings were as follows:


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. "[41][42] 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%.[43] 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"[44]

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.[45]

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.[46]

Case-control studies

Cases of head injury report a lower rate of helmet-wearing than controls who have injured other parts of the body.[47] 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.[48]

Opposition

Bicycling organizations generally oppose laws mandating the wearing of helmets.[49] Civil Liberties Australia published three articles indicating concerns at the consequences of having a mandatory requirement.[50] In Ontario Canada, opposition has been present for many years.[51]

Consequences of bicycle laws

Effects on head injuries or deaths among cyclists

New Zealand: Cyclist (pink) and non-cyclist (blue) head injury rates vs. helmet usage (green)

There is an active debate, with no scientific consensus; the two leading reviews have come to opposite conclusions. Robinson's review of cyclists and control groups in jurisdictions where helmet use increased by 40 % or more following compulsion concluded that "enforced helmet laws discourage cycling but produce no obvious response in percentage of head injuries".[52] This study has been the subject of vigorous debate.[53][54][55] A more recent review, by Macpherson and Spinks, includes two primary papers (neither of which meet the criteria for inclusion in Robinson's review) and concludes 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. However, there are very few high-quality evaluative studies that measure these outcomes, and none that reported data on an (sic) possible declines in bicycle use."[56] Later work by Macpherson's group admitted that this conclusion had been erroneous and that "Although bicycle-related injuries are generally declining, this decline is not consistent, nor is it clearly associated with helmet laws."[57]

Changes in head injury with the New Zealand bicycle helmet law.[58]

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.[59]

Assuming a high level of benefit from the New Zealand law, the costs still outweighed the benefits.[60] A full analysis of the New Zealand law showed no reduction in head injuries.[61]

Effects on the amount of cycling

Regular moderate cycling is extremely beneficial for health.[62][63][64][65][66][67][68][69]

An analysis of Australian census data before and after the introduction of helmet laws in some states, showed that in states which had helmet laws, the amount of cycling to work had reduced by about one third.[52] Other evidence strongly suggests that promotion or compulsion of helmet use deters cycling.[70][71] 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".[72] 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.[73] Helmet laws seem to offer net health benefit only in dangerous bicycling environments under optimistic assumptions of the efficacy of helmets.[73]

A 2011 review commissioned by the Queensland Government found little evidence to support the claim that mandatory helmet usage discouraged bike riding,.[74] 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.[75][76] In a 2012 study, over 60% of the respondents cited helmet law restrictions as being the main reason stopping them from using the bike sharing system in Brisbane.[77]

Effects on the rate of helmet wearing

Large increases in the rate of helmet wearing are usual after helmet laws.[78] Not all laws have increased helmet use, no such increase was noted among the children covered by the North Carolina bicycle helmet law.[79] In another area, an early rise in helmet use was followed by a fall to below pre-law levels.[80][81] Attitudes to cycling, and the amount of enforcement effort, may both be relevant.[82]

See also

References

  1. ↑ "Bell Helmets - Bell Timeline". Bell. Archived from the original on 2009-12-28. Retrieved 2015-08-04.
  2. ↑ ,"Bicycle Helmet Standards." Bicycle Helmet Safety Institute. February 26, 2009, accessed February 12, 2011.
  3. ↑ "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
  4. ↑ Mandatory standard—Bicycle helmets. Product Safety Australia. http://www.productsafety.gov.au/content/index.phtml/itemId/974624 Accessed 26 February 2011
  5. 1 2 Richard Ballantine (1972). Richard's Bicycle Book. Ballantine Press. ISBN 1-56458-484-4.
  6. ↑ "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: 379–383. doi:10.1007/BF02104435. 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
  7. ↑ Bicycle Helmet Research Foundation. "Helmet Laws: What has been their effect. Australia." Retrieved 2011-01-31.
  8. ↑ Curnow, Bill. "A Brief History of the Bicycle Helmets Law in Australia". Retrieved 2011-01-31.
  9. ↑ Kennett, Jonathan (2004). Ride: The Story of Cycling in New Zealand. Wellington: Kennett Brothers. p. 216. ISBN 0-9583490-7-X.
  10. ↑ "Editorial: Use your head; stick a helmet on it". The Marlborough Express. 14 July 2010. Retrieved 20 September 2011.
  11. ↑ Duff, Michelle (17 August 2010). "Aaron's tragedy spurred Helmet Lady's crusade". Manawatu Standard. Retrieved 20 September 2011.
  12. ↑ Mullins, Justin. "Hard-Headed Choice", New Scientist, 22 July 2000. Retrieved 2010-08-29.
  13. ↑ Gillham, Chris. "Mandatory bicycle helmet laws in New Zealand". cycle-helmets.com. Retrieved 3 February 2012.
  14. ↑ 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)
  15. ↑ http://www.parliament.uk/edm/2003-04/764
  16. ↑ 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."
  17. ↑ 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
  18. ↑ "LAB Helmet Law Position". League of American Wheelmen. May 1991. Retrieved 2011-03-01. ...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...
  19. ↑ "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 2011-02-16.
  20. ↑ "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." , "Helmet Laws for Bicycle Riders." Bicycle Helmet Safety Institute. January 5, 2011, accessed on February 20, 2011
  21. ↑ 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. Vol. 6 Issue 4 June 17, 2009
  22. ↑ 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
  23. ↑ "Real Decreto 1428/2003, de 21 de noviembre, por el que se aprueba el Reglamento General de Circulación." (PDF). 2003-12-23.
  24. ↑ "Helmet Laws for Bicycle Riders".
  25. ↑ Helmet Laws for Bicycle Riders Bicycle Helmet Safety Institute 5 January 2011. http://www.bhsi.org/mandator.htm
  26. ↑ 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 accessed 3 March 2012
  27. ↑ 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
  28. 1 2 European Cyclist's Federation. Examples of successful campaigns. http://www.ecf.com/3677_1 downloaded 10 May 2010
  29. ↑ "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
  30. ↑ Department of Transport (UK) 2002. Road safety research report. Bicycle helmets: review of effectiveness (No.30). Elizabeth Towner, Therese Dowswell, Matthew Burkes, Heather Dickinson, John Towner, Michael Hayes. November 2002. "In terms of tone, the bicycle helmet debate can best be described as sour and tetchy. Neither side seems willing to concede that there can be alternative points of view." [www.cycle-helmets.com/uk_2002_towner.pdf Section 7: Opinion Pieces.
  31. ↑ "Cycle helmet promotion: a dangerous distraction" (DOC). Cyclists' Touring Club (CTC). Archived from the original on 28 September 2007. Retrieved 2007-08-24.
  32. ↑ "SWOV Fact sheet: Bicycle helmets" (PDF). NL Institute for Road Safety Research (SWOV). October 2009. Retrieved 2011-02-27.
  33. ↑ Pucher and Buehler (2007-11-12). "Making Cycling Irresistible: Lessons from the Netherlands, Denmark, and Germany" (PDF).
  34. ↑ 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 Accessed 28 February 2011
  35. ↑ "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
  36. ↑ Walker, B. "Helmet standards and capabilities". Bicycle Helmet Research Foundation. Retrieved 2011-02-27.
  37. ↑ Sage M, Cairns F, Koelmeyer T, Smeeton W (1985-12-25). "Fatal injuries to bicycle riders in Auckland". The New Zealand Medical Journal. 98: 1073–4.
  38. ↑ Olivier J, Creighton P (2016-07-22). "Bicycle injuries and helmet use: a systematic review and meta-analysis". International Journal of Epidemiology.
  39. ↑ Olivier J, Creighton P. "Bicycle injuries and helmet use: a systematic review and meta-analysis (Abstract)". Oxford Journals: International Journal of Epidemiology. Retrieved 2016-10-04.
  40. ↑ Julie Power. "Bike helmet review throws cold water on sceptics". Sydney Morning Herald. Retrieved 2016-10-04.
  41. ↑ 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.
  42. ↑ Motoring organisation backs cycle helmet compulsion. Carlton Reid. 27 February 2011. http://www.bikebiz.com/news/read/motoring-organisation-backs-cycle-helmet-compulsion
  43. ↑ 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
  44. ↑ Mr Peter Bone, MP for Wellingborough, Hansard Volume No. 464 Part No. 142. House of Commons Debates 16 October 2007.
  45. ↑ Wardlaw MJ (2000). "Three lessons for a better cycling future". BMJ. 321 (7276): 1582–5. doi:10.1136/bmj.321.7276.1582. PMC 1119262Freely accessible. PMID 11124188.
  46. ↑ M. Wardlaw (December 2002). "Assessing the actual risks faced by cyclists" (PDF). Traffic Engineering & Control. 43: 352–356.
  47. ↑ 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. PMID 10796827.
  48. ↑ "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 2007-08-25.
  49. ↑ 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".
  50. ↑ http://www.cla.asn.au/Article/081125BikesHelmetPolicy.pdf
  51. ↑ http://www.vehicularcyclist.com/
  52. 1 2 Robinson DL (2006-03-25). "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 1410838Freely accessible. PMID 16565131. Retrieved 2007-08-30.
  53. ↑ Rapid Responses to D L Robinson
  54. ↑ BMJ 2006;332:725-726, doi:10.1136/bmj.332.7543.725 PMID 16565133 Arguments against helmet legislation are flawed. Hagel B, Macpherson A, Rivara FP, Pless B.
  55. ↑ Rapid Responses to Brent Hagel, Alison Macpherson, Frederick P Rivara, and Barry Pless
  56. ↑ 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
  57. ↑ Middaugh-Bonney, T.; Pike, I.; Brussoni, M.; Piedt, S.; MacPherson, A. (2011). "Bicycle-related head injury rate in Canada over the past 10 years". Injury Prevention. 16: A228. doi:10.1136/ip.2010.029215.813.
  58. ↑ Robinson, D.L. (2001). "Changes in head injury with the New Zealand bicycle helmet law". Accident Analysis and Prevention. 33: 687–697. doi:10.1016/s0001-4575(00)00073-7.
  59. ↑ bv.com.au
  60. ↑ Taylor M, Scuffham P (2002). "New Zealand bicycle helmet law – do the costs outweigh the benefits?" (PDF). Injury Prevention. 8: 317–320. doi:10.1136/ip.8.4.317. PMC 1756574Freely accessible. PMID 12460970. Retrieved 2011-02-26.
  61. ↑ Robinson, D. "COSTS AND BENEFITS OF THE NZ HELMET LAWS" (PDF). Retrieved 2011-02-26.
  62. ↑ Rutter H. Valuing the Mortality Benefits of Regular Cycling. In Lind G. CBA of cycling. Nordic Council of Ministers, Copenhagen 2005 http://www.thepep.org/ClearingHouse/docfiles/CBA%20on%20cycling%20nordic%20council%20report%202005.pdf
  63. ↑ Hillman, M (1993). "Cycling and the promotion of health". Policy Studies. 14: 49–58. doi:10.1080/01442879308423639.
  64. ↑ Morris, J N; Clayton, D G; Everitt, M G; Semmence, A M; Burgess, E H. (1990). "Exercise in leisure time: coronary attack and death rates". British Heart Journal. 63: 325–334. doi:10.1136/hrt.63.6.325.
  65. ↑ Paffenbarger, RS Jr; Hyde, RT; Wing, AL; Hsieh, CC. (1986). "Physical activity, all-cause mortality and longevity of college alumni". New England Journal of Medicine. 314 (10): 605–613. doi:10.1056/nejm198603063141003.
  66. ↑ Tuxworth, W; Nevill, AM; White, C; Jenkins, C. (1986). "Health, fitness, physical activity and morbidity of middle aged male factory workers". British Journal of Industrial Medicine. 43 (11): 733–753. doi:10.1136/oem.43.11.733.
  67. ↑ Martin, CK; Church, TS; Thompson, AM; Earnest, CP; Blair, SN. (2009). "Exercise Dose and Quality of Life. A Randomized Controlled Trial". Arch Intern Med. 169 (3): 269–278. doi:10.1001/archinternmed.2008.545.
  68. ↑ Matthews CE; Jurj AL; Shu Xo; Li HL; Yang G; Li Q; Cao YT; Zheng W (2007). "Influence of exercise, walking, cycling and overall nonexercise physical activity on mortality in Chinese women". American Journal of Epidemiology. 165 (12): 1343–1350. doi:10.1093/aje/kwm088. PMID 17478434.
  69. ↑ Andersen, LB; Schnohr, P; Schroll, M; Hein, HO. (Jun 2000). "All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work". Arch Intern Med. 160 (11): 1621–8. doi:10.1001/archinte.160.11.1621. PMID 10847255.
  70. ↑ Wardlaw, MJ (2000-12-23). "Three lessons for a better cycling future". British Medical Journal. British Medical Association. pp. BMJ 2000;321:1582. Retrieved 2011-02-26.
  71. ↑ Chris Gillham. Bike numbers in Western Australia: government surveys. http://www.cycle-helmets.com/bicycle_numbers.html
  72. ↑ Do helmet laws cost society more than they are worth? Bicycle Helmet Safety Institute 2009. http://www.bhsi.org/dejong.htm Accessed 27 February 2011.
  73. 1 2 De Jong, Piet, The Health Impact of Mandatory Bicycle Helmet Laws (February 24, 2010). Available at SSRN: http://ssrn.com/abstract=1368064
  74. ↑ Center for Accident research and bike safety Bike Helmet Research
  75. ↑ http://www.theage.com.au/victoria/helmet-law-hurting-shared-bike-scheme-20101128-18cf2.html
  76. ↑ http://www.freestylecyclists.org/study-confirms-helmet-laws-killing-australian-bike-share/
  77. ↑ "Barriers and facilitators to public bicycle scheme use: A qualitative approach". Transportation Research Part F: Traffic Psychology and Behaviour. 15: 686–698. doi:10.1016/j.trf.2012.08.002.
  78. ↑ "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: 5401. doi:10.1002/14651858.CD005401.pub3.
  79. ↑ "Helmet Laws for Bicycle Riders". Bicycle Helmet Safety Institute. 2011-01-05. Retrieved 2011-02-16.
  80. ↑ Macpherson AK, Macarthur C, To TM, Chipman ML, Wright JG, Parkin PC (2006). "Economic disparity in bicycle helmet use by children six years after the introduction of legislation". Injury Prevention. 12: 231–235. doi:10.1136/ip.2005.011379.
  81. ↑ Bicycle Helmet Research Foundation. Economic disparity in bicycle helmet use by children six years after the introduction of legislation. http://www.cyclehelmets.org/1178.html
  82. ↑ "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 2011-02-27.
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