MV PICCS Intervention: Bicycle Helmet Laws for Children

Overview

Bicycle helmet laws mandate that children use helmets while they are riding bicycles to reduce the likelihood of head trauma, including traumatic brain injury (TBI), and related consequences.1 One of the interventions in MV PICCS is for states to have bicycle helmet laws that require all children under 16 years of age to wear helmets when they are riding bicycles.

Effectiveness and use

Bicycle helmets are effective in reducing head injuries, such as TBI, and fatalities.123 A meta-analysis of 55 studies from 1989–2017 estimated that the use of bicycle helmets reduces injuries to the face, TBI, and fatal head injuries for cyclists of all ages.2 While helmets are known to protect against injury, they have not been universally adopted. In a 2012 survey of U.S. households, only 42% of parents whose youngest child rode a bicycle in the past 30 days reported that the child always wore a helmet while riding a bike during that time.4

Several studies, including systematic reviews, have found that legislation might be effective at increasing helmet use.56 A Cochrane systematic review of studies through 2010 found that legislation likely increased helmet use.6 A more recent study analyzed Youth Risk Behavior Survey data from 1991 to 2013 from five jurisdictions, four with helmet laws adopted during the time period and one that did not adopt such a law during the time period. The study found that bicycle helmet use significantly increased among students in jurisdictions with the laws; these increases remained 10 years after implementation.7

Two reviews have examined the effect of bicycle helmet legislation on injuries.68 The most recent, a meta-analysis of studies through 2018, found that mandatory bicycle helmet legislation for children decreased head injuries and fatalities.8 The meta-analysis also found larger effects for children with all-ages legislation compared to legislation mandating helmets only for children.8 Another study of U.S. injury data from 1991–2008 from the National Electronic Injury Surveillance System found that helmet laws were associated with a reduction in bicycle-related head injuries.9 However, the study also found that helmet laws were associated with a decrease in non-head bicycle-related injuries and an increase in injuries from other wheeled sports such as skateboarding, which the authors suggest could indicate changes from bicycling to other wheeled sports because of the legislation.9

The effectiveness of bicycle helmet laws will be influenced by their implementation. Publicity and educational campaigns can enhance the impact of the laws, and law enforcement can reinforce the legislation through positive interactions about helmet safety and by providing positive incentives for helmet use or free or discounted helmets.1

State legislation

You can visit the bicycle helmet use laws by state web page on the Insurance Institute for Highway Safety's website for up-to-date information on bicycle helmet laws for children, requirements, and laws by state.1011 The Governors Highway Safety Association also maintains information about bicycle helmet laws on their state laws by issue – bicyclists and pedestrians web page.12

Costs and time to implement

Helmets meeting safety requirements can be purchased for less than $20.1 A bicycle helmet should be replaced whenever it has been involved in a crash or is damaged or the foam has become brittle.1 Some states make free or discounted helmets available to some children or parents.1 Communication and outreach to parents and other groups like schools will be needed to support a helmet law.1 To view materials that can be used to educate parents, children, and others about bicycle helmet use, please visit the helmet safety webpage on the CDC website13 and the bicycle safety webpage on the NHTSA website.14

Bicycle helmet laws can be implemented once legislation is enacted, with local ordinances taking less time to pass than statewide legislation.1 It will take longer to make custom communications, train law enforcement officers, or start a helmet distribution program.1

Other issues and resources

As mentioned above, concerns have been raised over whether laws requiring helmet use have the unintended effect of discouraging bicycling,89 but evidence has been mixed.8 In a 2012 survey of U.S. households, children in states with a helmet law were not less likely to ride a bicycle and were significantly more likely to wear a helmet when they did ride than in those in states without a law.4

You can read NHTSA's Countermeasures that Work: A Highway Safety Countermeasure Guide for State Highway Safety Offices to learn more about the topics above or other issues related to bicycle helmet laws for children.1

You can read the RAND Corporation's final reports for MV PICCS 1.0/2.0 and MV PICCS 3.0 for more information about how effectiveness and costs were incorporated into the MV PICCS tool for this intervention.

History

The modern bicycle helmet was introduced in 1975,15 and states and cities began passing bicycle helmet legislation in the late 1980s.16 California (1987) and New York (1989) were the first states to implement such legislation, mandating helmet use for bicycle passengers age five and younger.16 New Jersey was the first state to require helmet use for children while they are riding bicycles. The law was passed in 1992 and covered riders and passengers under the age of 14.17 As of January 2022, 21 states and the District of Columbia, as well as over 201 municipalities and counties, had bicycle helmet laws.16 State laws range from covering bicyclists age 11 or younger to covering bicyclists age 17 or younger.10 See above for current legislation.