Bike helmet legislation could make cycling safer

Legislation that requires people to wear bicycle helmets appears to increase use and decreases injury rates, according to the results of a Cochrane Review.

Cycling is a popular pastime and a mode of transport for children, but it also leads to many injuries that are frequently sufficiently severe to require hospitalisation. This is a global problem, and particularly effects low-income countries where the proportion of cycle-users is high.

Between 35% and 40% of children who are taken to hospital after a cycling incident have head injuries. A previous Cochrane Review identified that bicycle helmets can reduce head injury by up to 88% and facial injury by 65% in all ages (*see note 1). Despite considerable evidence that helmets make you safer, many people still do not use them.

Some countries have tried introducing legislation to increase use. In Australia, for example, cyclists of all ages must wear a helmet. Similar legislation exists in most provinces of Canada, but it only applies to children and adolescents.

A pair of Cochrane researchers therefore set out to see whether there was evidence that introducing legislation did indeed reduce injuries, and whether it introduced any unintended consequences.

They found five studies that met their inclusion criteria. In each case the studies looked at situations where legislation had only covered children.

There was a clear indication that areas that introduced helmet legislation saw a decrease in head injury associated with increased use of helmets.

"What is not clear, however, is whether the legislation caused fewer children to go out on their bikes. It may be that the reductions in injuries were a result of children using bikes less, however, there have been no high quality studies that have tested this scenario," says lead author Anneliese Spinks, who works in the School of Medicine at Griffith University, Queensland, Australia.

"Legislation on its own will probably have little effect unless it is enforced, and we still need to determine the relationship between police enforcement of laws, helmet use and cycling rates," says Spinks.