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A Bicycling Mystery: Head Injuries Piling Up

Barnes JE. New York Times, 29 Jul 2001. 2001.

In the USA, the rate of cyclist head injuries has risen 10% although helmet use has soared and cycle use has declined.

A case control study of the effectiveness of bicycle safety helmets

Thompson RS, Rivara FP, Thompson DC. New England Journal of Medicine, 1989 v320 n21 p1361-7. 1989.

A case-control study on the effectiveness of bicycle safety helmets in preventing facial injury

Thompson DC, Thompson RS, Rivara FP, Wolf ME. American Journal of Public Health, 1990; 80(12):1471-1474. 1990.

A cost-benefit analysis of BC's bicycle helmet law

Johns R. Velo City Global, Vancouver 2012. 2012.

The relative costs and moral issues of British Columbia's helmet law

A hospital led promotion campaign aimed to increase bicycle helmet wearing among children aged 11-15 living in West Berkshire 1992-98

Lee AJ, Mann NP, Takriti R. Injury Prevention, 2000;6:151-153. 2000.

A prospective analysis of injury severity among helmeted and non helmeted bicyclists involved in collisions with motor vehicles

Spaite DW, Murphy M, Criss EA, Valenzuela TD, Meislin HW. Journal of Trauma, 1991 Nov;31(11):1510-6.. 1991.

A prospective investigation of the impact of alcohol consumption on helmet use, injury severity, medical resource utilization and health care costs in bicycle-related trauma  

Spaite DW, Weist EA, David MD, Valenzuela TD, Judkins D, Meislin HW. Journal of Trauma, 1995;38(2):287-290. 1995.

A rational approach to pedal cyclist head protection

Depreitere B. Catholic University of Leuven. 2004.

Bicycle helmets could not offer sufficient protection to the temporal area against lateral blows. There was no unequivocal beneficial effect of the helmets on the rotational acceleration of the head and on the vibration of the skull base.

Alcohol in fatally injured bicyclists

Li G, Baker SP. Accident Analysis & Prevention, 1994;26(4):543-548. 1994.

Alcohol, bicycling and head and brain injury: a study of impaired cyclists' riding patterns

Crocker P, Zad O, Milling T, Lawson KA. American Journal of Emergency Medicine, 2010;28(1):68-72. 2010.

Alcohol use by cyclists is more strongly associated with head and brain injuries than cycle helmets. (Also subsequent letter by D. Robinson doi:10.1016/j.ajem.2010.02.019)

All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work

Andersen LB, Schnohr P, Schroll M, Hein HO. Arch Intern Med, 2000 Jun 12;160(11):1621-8. 2000.

An expert judgment model applied to estimating the safety effect of a bicycle facility

Leden L, Garder P, Pulkkinen U. Accident Analysis & Prevention, 2000 Jul;32(4):589-99. 2000.

Assessing the actual risks faced by cyclists

Wardlaw MJ. Traffic Engineering + Control, Dec 2002 p352-356. 2002.

Assessment of current bicycle helmets for the potential to cause rotational injury  

StClair VJM, Chinn BP. Transport Research Laboratory, PPR213. 2007.

Attitude and opinion of neurosurgeons concerning protective bicycle-helmet use  

Jung CS, Zweckberger K, Schick U, Unterberg AW. J Neurotrauma, 2010 May;27(5):871-5. 2010.

Australia's helmet law disaster  

Turner L. Institute of Public Affairs, IPA Review 2012(64):28-29. 2012.

Australian per capita cycling participation in 1985/6 and 2011  

Gillham C, Rissel C. World Transport Policy & Practice, 2012(May);18(3):5-10. 2012.

Benefits of shift from car to active transport  

Rabl A, de Nazelle A. Transport Policy. 2011.

Estimates a health gain benefit from exercise (bicycling) at EUR 1310/year, plus a public health gain of EUR 33/year, vs. -EUR 19/year cost to the individual from air pollution, and -EUR 53/year from accidents. For the individual, that would give a benefit to risk ratio in Euros of 1310/(19+53) or about 18:1.

Bicycle helmet efficacy: a meta-analysis

Attewell RG, Glase K, McFadden M. Accident Analysis & Prevention, 2001-05 v33 n3 p345-52. 2001.

Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries (Review)

Macpherson AK, Spinks A. Cochrane Database of Systematic Reviews, 2007 issue 2 Art. No. CD005401. 2007.

Unable to show that reductions in head injuries after helmet laws were result of helmets rather than decline in cycling.

Bicycle helmet legislation: Can we reach a consensus?

Robinson DL. Accident Analysis & Prevention, 2007;39(1):86-93. 2007.

Suggestions for data and methodology to resolve conflict between case-control studies and trends.

Bicycle helmet prevalence two years after the introduction of mandatory use legislation for under 18s in Alberta, Canada

Hagel BE, Rizkallah JW, Lamy A, Belton KL, Jhangri GS, Cherry N, Rowe BH. Injury Prevention, 2006;12:262-265. 2006.

Bicycle helmet usage rates in Victoria, 1990 - 1991

Morgan M, Peberdy J, Rogerson P. Vic Roads, GR91-9 ISBN 073061381X. 1991.

Bicycle helmet use and bicyclists head injuries before and after helmet legislation in Alberta Canada

Karkhaneh M. University of Alberta. 2011.

Bicycle helmets - a case of risk compensation?  

Fyhri A, Bjørnskau T, Backer-Grøndahl A. Transportation Research Part F, 2012;15(5):612-624. 2012.

Helmet laws disproportionately discourage the safest cyclists, who are not speed-happy and who cycle without much cycling equipment. In this way the overall average risk per cyclist is increased and interventions such as helmet laws have no net benefit.

Bicycle helmets - a review of their effectiveness: a critical review of the literature

Towner E, Dowswell T, Burkes M, Dickinson H, Towner J, Hayes M. Department for Transport, Road Safety Research Report 30. 2002.

Bicycle helmets and accidental asphyxia in childhood

Byard RW, Cala A, Ritchey D, Woodford N.. Medical Journal of Australia, MJA 2011;194(1):49. 2011.

Accidental hanging still occurring due to cycle helmets when worn by children off their bikes.

Bicycle helmets and brain injury

Curnow WJ. Accident Analysis & Prevention, 2007 May;39(3):433-6.. 2007.

Further response on the inadequacy of the Cochrane Review to provide evidence that helmets protect against brain injury.

Bicycle helmets and public health in Australia

Curnow WJ. Health Promotion Journal of Australia, 2008 Apr;19(1):10-15.. 2008.

After helmet legislation was introduced, rates of cycling declined sharply with loss of benefits for health, but the risk of casualty increased. Compulsion to wear a bicycle helmet is detrimental to public health in Australia.

Bicycle helmets: a scientific evaluation

Curnow WJ. Transportation Accident Analysis & Prevention, Nova Science Publishers, Chapter 6. 2008.

A detailed analysis of brain injuries, helmets and legislation

Bicycle helmets: lack of efficacy against brain injury

Curnow WJ. Accident Analysis & Prevention, 2006 Sep;38(5):833-4.. 2006.

Rebuttal of criticism of Curnow's 2005 paper, The Cochrane Collaboration and Bicycle Helmets.

Bicycle injuries and mortality in Victoria, 2001 - 2006  

Sikic M, Kikocka-Walus AA, Gabbe BJ, McDermott FT, Cameron PA. Med J Aust, 2009;190(7):353-356. 2009.

Bicycle injuries: road trauma is not the only concern

Jacobson GA, Blizzard L, Dwyer T. Austr NZ J Public Health, 1998 Jun;22(4):451-5.. 1998.

Bicycle safety helmet legislation and bicycle-related non-fatal injuries in California

Lee BH, Schofer JL, Koppelman FS. Accident Analysis & Prevention, 2005;37:93-102. 2005.

Bicycle-related head injury rate in Canada over the past 10 years  

Middaugh-Bonney T, Pike I, Brussoni M, Piedt S, Macpherson A. Injury Prevention, 2010;16:A228. 2010.

Although bicycle-related injuries are generally declining, this decline is not consistent, nor is it clearly associated with helmet laws.

Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share  

Teschke K, Koehoorn M, Shen H, et al. BMJ. 2015.

The purpose of this study was to calculate exposure-based bicycling hospitalisation rates in Canadian jurisdictions with different helmet legislation and bicycling mode shares, and to examine whether the rates were related to these differences.

Bicyclist injury severities in bicycle/motor vehicle accidents  

Kim JK,Kim S,Ulfarsson GF,Porrello LA. Accident Analysis & Prevention, 2007 Mar;39(2):238-51. 2007.

Bicyclists, helmets and head injuries: a rider-based study of helmet use and effectiveness

Wasserman RC, Waller JA, Monty MJ, Emery AB, Robinson DR. American Journal of Public Health, 1988 Sep;78(9):1220-1. 1988.

Usually cited as a pro-helmet paper, nevertheless helmet wearers were 7 times more likely to have hit their heads than non-wearers.

Changes in head injury with the New Zealand bicycle helmet law

Robinson DL. Accident Analysis & Prevention, 2001 Sep;33(5):687-91. 2001.

The large increase in helmet wearing as a result of the NZ helmet law has not led to any obvious change in head injuries over and above existing trends.

Changes in traffic crash mortality rates attributed to use of alcohol, or lack of a seat belt, air bag, motorcycle helmet or bicycle helmet, United States 1982-2001

Cummings P, Rivara FP, Olson CM, Smith KM. Injury Prevention, 2006;12;148-154. 2006.

Changing gears: bicycling as the panacea for physical inactivity?  

Bauman A, Titze S, Rissel C, Oja P. Br J Sports Med, 2011;45:761-762. 2011.

A summary of the health benefits and risks of cycling. Describes current controversies and evidence challenges for cycling policy and promotion.

Changing pattern of child bicycle injury in the Bay of Plenty, New Zealand

Moyes SA. Journal of Paediatrics and Child Health, 43(2007):486-488. 2007.

Since the New Zealand helmet law was enacted, childrens' injuries from bicycle use have increased but there has been a marked reduction in collisions with motor vehicles. This is the result of a change in the way bicycles are used by children. (This suggests that any reduction in head injuries post-law would be at least in part because children face less serious injuries as they now cycle much less in traffic)

Children and cycle helmets -- the case against

McCarthy M. Child Care Health Dev, 1996 Mar;22(2):105-11. 1996.

Cycle helmets give very limited protection and shift the blame onto children if they are injured even though adult motorists are often at fault. 5 times as many child pedetrians die after road crashes than child cyclists.

Collisions involving pedal cyclists on Britain's roads: establishing the causes  

Knowles J, Adams S, Cuerden R, Savill T, Reid S, Tight M. Transport Research Laboratory, PPR445. 2009.

Costs and benefits of bicycling investments in Portland, Oregon

Gotschi Thomas. 2011.

Promoting bicycling has great potential to increase overall physical activity; however, significant uncertainty exists with regard to the amount and effectiveness of investment needed for infrastructure. The objective of this study is to assess how costs of Portland's past and planned investments in bicycling relate to health and other benefits.

Cycle helmet effectiveness in New Zealand

Povey LJ, Frith WJ, Graham PG. Accident Analysis & Prevention, 1999 Nov;31(6):763-70. 1999.

Cycle Helmets

. BMA Board of Science and Education, ISBN 0-7279-1430-8. 1999.

The wearing of helmets by cyclists should not be made compulsory, but the wearing of helmets – preferably to the Snell B95 standard – should be encouraged.

Cycle helmets - time for legislation

Lee AJ, Mann MP. Archives of Disease in Childhood, 2003;88:465-466. 2003.

Cycle helmets and road casualties in the UK

Hewson PJ. Traffic Injury Prevention, 2005;6(2):127-134. 2005.

There is no evidence that cycle helmets reduce the overall cyclist injury burden at the population level in the UK when data on road casualties is examined.

Cycle helmets: the case for and against

Hillman M. Policy Studies Institute, ISBN 0-85374-602-8. 1993.

At best, helmets only marginally reduce a cyclist's chance of being fatally or serious injured. The balance of evidence does not suggest that a helmet law would reduce the level of head injuries. Similarly, encouraging voluntary helmet use is unlikely to reduce the risk of head injury. The primary means of reducing serious head injury is to create an environment in which crashes are less likely to occur.

Cycling and alcohol  

Andersson AL, Bunketorp O. Injury, 2002;33(6):467-471. 2002.

Cycling and children and young people: a review

Gill T. National Children's Bureau. 2005.

"Those ... who cycle should be under no illusion that helmets offer reliable protection in crash situations where our lives may be in danger. Neither should we believe that widespread adoption of helmet wearing would see many fewer cyclists killed or permanently disabled. The evidence so far suggests otherwise."

Cycling injuries in Australia: road safety's blind spot?  

Garrard J, Greaves S, Ellison A. Australasian College of Road Safety, ACRS 2010;21(3):37-43. 2010.

Cycling: your health, the public's health and the planet's health

Bloomfield A. Making Cycling Viable symposium. 2000.

Opinion from neurosurgeon that helmets had made some head injuries worse. Need to reconsider issue as legislation has not delivered benefits predicted.

Deaths of cyclists in London 1985-92: the hazards of road traffic

Gilbert K, McCarthy M. BMJ, BMJ;1994:308(6943):1534-7. 1994.

30% of cyclists' deaths in outer London and 58% in inner London involve heavy good vehicles. Helmets do not address the source of danger in crashes where the injury is severe or fatal. Helmets restrict cyclists rather than motor vehicles.

Do bicycle safety helmets reduce severity of head injury in real crashes?

Dorsch MM, Woodward AJ, Somers RL. Accident Analysis and Prevention, 1987 Jun;19(3):183-90. 1987.

Do cycle helmets prevent serious head injury?

McCarthy M, Illingworth C. BMJ, 1992 v305 p881-3. 1992.

Cycling is safe, green and healthy. The main study supporting cycle helmet use is useless as policy guidance as it compared quite different groups of cyclists. Cycle helmets do not improve safety and place responsibility for injury protection on the victim.

Do cyclists have an exaggerated perception of the effectiveness of cycle helmets and the risks of cycling?  

Burton R. University of the West of England. 2008.

Do enforced bicycle helmet laws improve public health?

Robinson DL. BMJ, 2006;332:722-725. 2006.

There is no clear evidence of benefit from countries that have enforced the wearing of cycle helmets.

Do the health benefits of cycling outweigh the risks?  

de Hartog JJ, Boogaard H, Nijland H, Hoek G. Environmental Health Perspectives, doi: 10.1289/ehp.0901747. 2010.

On average, the estimated health benefits of cycling were substantially larger than the risks relative to car driving for individuals shifting mode of transport. Estimated benefit to risk ratios of 9:1 (in Holland) and 7:1 (in Britain) in terms of years of life gained to lost.

Drivers overtaking bicyclists: Objective data on the effects of riding position, helmet use, vehicle type and apparent gender  

Walker Ian. University of Bath. 2006.

Economic disparity in bicycle helmet use by children six years after the introduction of legislation

Macpherson AK, Macarthur C, To TM, Chipman ML, Wright JG, Parkin PC. Injury Prevention, 2006;12:231-235. 2006.

Effect of legislation on the use of bicycle helmets

LeBlanc JC, Beattie TL, Culligan C. Canadian Medical Association Journal, CMAJ 2002;166(5): p592-5. 2002.

Effectiveness of bicycle helmets in preventing head injury in children: case-control study

Thomas S, Acton CH, Nixon J, Battistutta D, Pitt WR, Clark R. BMJ, 1994;308:173-176. 1994.

Effectiveness of bicycle safety helmets in preventing head injuries: a case-control study

Thompson DC, Rivara FP, Thompson RS.. JAMA, 1996 Dec 25;276(24):1968-73. 1996.

Effectiveness of bicycle safety helmets in preventing serious facial injury

Thompson DC, Nunn ME, Thompson RS, Rivara FP. JAMA, 1996a;276(24):1974-1975. 1996.

Effet du casque sur les blessures à la tête, à la face et au cou  

Amoros E, Chiron M, Ndiaye A, Laumon B. INRETS, Lyon, Rapport UMRESTTE No0912. 2009.

Effets bénéfiques de l’exercice physique sur la santé   

Vuillemin A. INRETS. 2009.

Epidemiology of bicycle injuries and risk factors for serious injury

Rivara FP, Thompson DC, Thompson RS. Injury Prevention, 1997 3: 110-114. 1997.

Epidemiology of bicycle injury, head injury, and helmet use among children in British Columbia: a five year descriptive study

Linn S, Smith D, Sheps S. Injury Prevention, 1998;4:122-125. 1998.

Evaluating the health benefit of bicycle helmet laws  

de Jong P. Macquarie University NSW. 2009.

Net health costs of helmet laws greatly outweigh the safety benefits.

Evaluation of New Zealand's bicycle helmet law  

Clarke CF. New Zealand Medical Journal, 2012;125(1349). 2012.

A halving of cycle use may have led to around 53 additional premature deaths each year. At the same time cyclist injuries have more than doubled compared to pedestrians.

Evaluation of the bicycle helmet wearing law in Victoria during its first four years

Carr D, Dyte D, Cameron MH. Monash University Accident Research Centre, Report 76. 1995.

Extent and severity of cycle accident casualties

. Scottish Executive Social Research. 2005.

Fewer head and face injuries with helmets, but no effect on injuries serious enough to require hospital admission or other ongoing treatment.

Fahrradunfälle mit und ohne Fahrradhelm

Hausotter W. Versicherungsmedizin, 52:28-32. 2000.

Fatal injuries to bicycle riders in Auckland

Sage MD, Cairns FJ, Koelmeyer TD, Smeeton WMI. NZ Med J, Vol 98, No793, pp1073-1074, 1985. 1985.

"This study indicates that compulsory wearing of suitable safety helmets by cyclists is unlikely to lead to a great reduction in fatal injuries, despite their enthusiastic advocacy". Includes death of helmeted cyclist in simple fall without involvement of motor vehicle."

Finite-element analysis of bicycle helmet oblique impacts

Mills NJ, Gilchrist A. Int Journal of Impact Engineering, 2008;35(9):1087-1101. 2008.

Hats off (or not?) to helmet legislation

Chipman ML. Canadian Medical Association Journal, 2002 Mar 5;166(5):602. 2002.

Although the proportion of cyclists wearing helmets increased in Nova Scotia following helmet legislation and the number of head injuries fell, the main effect of the law was a large decrease in the number of people cycling.

Head injuries and bicycle helmet laws

Robinson DL. Accident Analysis & Prevention, 1996 Jul;28(4):463-75. 1996.

The most notable effect of helmet laws in Australia has been to reduce cycling, and this may have generated a net loss of health benefits to the nation. The risk of dying from head injury per hour is similar for unhelmeted cyclists and motor vehicle occupants, and a helmet law for motorists has the potential to save 17 times as many lives as a cycle helmet law.

Head injuries and helmet laws in Australia and New Zealand

Robinson DL. 2005.

An assessment of the helmet laws. There is little benefit to either cyclists or the community from passing laws forcing cyclists to wear helmets. Rather than encouraging cyclists to wear helmets, the laws appear to have discouraged cycling, resulting in reduced health and fitness, but very little change in the head injury rate. Indeed, risks per cyclist seem to have increased, compared to what would have been expected without the law.

Head injuries to bicyclists and the New Zealand bicycle helmet law

Scuffham P, Alsop J, Cryer C, Langley JD. Accident Analysis and Prevention, 2000 Jul;32(4):565-73. 2000.

Head injuries, heading and the use of headgear in soccer  

Niedfeldt MW. Curr Sports Med Rep, 2011 Nov;10(6):324-9. 2011.

The universal use of soccer helmets may lead to more aggressive heading and head challenges, thus leading to an increased risk of injury.

Heads up - the science of helmets

Walker B. Cycle, Jun/Jul 2005. 2005.

Helmets offer only limited protection in simple low-speed falls with no other vehicle involved. Helmet standards have declined greatly in recent years yet most helmets do not meet the standards to which they are accredited. The courts remain to be convinced that helmets can be relied upon to provide useful protection in most crashes.

Health benefits of cycling: a systematic review  

Oja P., Titze S., Bauman A., de Geus B., Krenn P., Reger‐Nash B. and Kohlberger T. . Wiley Online Library. 2011.

Health on the move 2. Policies for health promoting transport

Mindell JS, Watkins SJ, Cohen JM. Transport & Health Study Group. 2011.

Cycling has great potential to assist public health programmes and reduce road danger. Fair comparison proves that the risks of cycling are within the range to which drivers and pedestrians are exposed. The most careful long-term studies do not reveal evidence of noticeable prevention of serious head injuries with rising helmet use.

Heat transfer variations of bicycle helmets

Bruhwiler PA, Buyan M, Huber R, Bogerd CP, Sznitman J, Graf SF, Rosgen T. J Sports Sci, 2006 Sep;24(9):999-1011. 2006.

Lack of systematic understanding of the principles behind bicycle helmet ventilation, which varies considerably between helmets.

Helmet laws and health

Robinson DL, Acton CH. Injury Prevention, 1998;4:170-172. 1998.

Complementary articles, for and against the effectiveness of helmets.

Helmet laws: creating consensus out of controversy and contradictions

Robinson DL. Velo City 2007. 2007.

Helmet legislation and admissions to hospital for cycling related head injuries in Canadian provinces and territories: interrupted time series analysis  

Dennis J, Ramsay T, Turgeon AF, Zarychanski R. British Medical Journal, BMJ 2013;346:f2674. 2013.

Helmet protection from head injuries among recreational bicyclists

Wasserman RC, Buccini RV. American Journal of Sports Medicine, 1990 Jan-Feb;18(1):96-7. 1990.

Helmet use and bicycle-related trauma in patients presenting to an acute hospital in Singapore  

Heng KWJ, Lee AH, Zhu S, Tham KY, Seow E. Singapore Medical Journal, 2006;47(5):367-372. 2006.

Helmet use in BIXI cyclists in Toronto, Canada: an observational study  

Bonyun M, Camden A, Macarthur C, Howard A. BMJ Open, 2012 Jun 18;2(3). pii: e001049. 2012.

Helmets for preventing head and facial injuries in bicyclists (Cochrane Review)

Thompson DC, Rivara FP, Thompson RS.. Cochrane Database Syst Rev, issue 4, 2002. 2002.

Impact of bicycle helmet safety legislation on children admitted to a regional trauma center

Shafi S, Gilbert JC, Loghmanee F, Allen JE, Caty MG, Glick PL, Carden S, Azizhan RG. J Paediatric Surgery, 1998 Feb;33(2):317-21. 1998.

Impact of Mandatory Helmet Legislation on Bicycle-Related Head Injuries in Children: A Population-Based Study

Macpherson AK, To TM, Macarthur C, Chipman ML, Wright JG, Parkin PC. Pediatrics, 2002; 110(5):e60. 2002.

Influence of exercise, walking, cycling and overall nonexercise physical activity on mortality in Chinese women

Matthews CE, Jurj AL, Shu Xo, Li HL, Yang G, Li Q, Cao YT, Zheng W. American Journal of Epidemiology, 2007 165(12):1343-1350. 2007.

Injuries resulting from bicycle collisions  

Frank E, Frankel P, Mullins RJ, Taylor N. Academic Emergency Medicine, 1995;2(3):200-203. 1995.

Injuries to pedal cyclists on New Zealand roads, 1988 - 2007  

Tin Tin S, Woodward A, Ameratunga S. BMC Public Health, 2010, 10:655. 2010.

Since the helmet law, the number of cyclists admitted to hospital has increased notwithstanding a large fall in cycle use. There has particularly been an increase in off-road casualties.

Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers

Maimaris C, Summers CL, Browning C, Palmer CR. BMJ, 1994 Jun 11;308(6943):1537-40. 1994.

Injury rates from walking, gardening, weightlifting, outdoor bicycling and aerobics

Powell KE. Medicine & Science in Sports and Exercise, 1998;30:1246-1249. 1998.

Fewer people reported injuries from cycling than any of the other activities.

Intended and unintended consequences of youth bicycle helmet laws  

Carpenter CS,Stehr MF. Journal of Law and Economics, Vol 54 No2 May 2011. 2011.

In America, 650,000 fewer children ride bikes each year after helmet laws go into effect. Study has its weaknesses.

Intensity versus duration of cycling, impact on all-cause and coronary heart disease mortality: the Copenhagen City Heart Study  

Schnohr P, Marott JL, Jensen JS, Jensen GB. Eur J Prev Cardiol, 2012 Feb;19(1):73-80. 2012.

Relative intensity of cycling, and not the duration of cycling, is of more importance in relation to all-cause and coronary heart disease mortality. Adults should prefer brisk cycling to slow.

Investigating population level trends in head injuries amongst child cyclists in the UK

Hewson PJ. Accident Analysis & Prevention, 2005;37(5):807-815. 2005.

Head injuries are declining for child cyclists and pedestrians, but this is not related to helmet wearing data.

Legislation for the compulsory wearing of cycle helmets

BMA. BMA. 2004.

Making cycle helmets compulsory: ethical arguments for legislation

Sheikh A, Cook A, Ashcroft R. J R Soc Med, J R Soc Med 2004;97:262-265. 2004.

Making Vision Zero real: Preventing pedestrian accidents and making them less severe

Erke A, Elvik R. TOI, Norwegian Centre for Transport Research, Report 889/2007. 2007.

There is evidence of increased accident risk per cycling-km for cyclists wearing a helmet. Meta analyses of helmet benefit are very likely affected by publication bias and methodological flaws. Increasing the amount of cycling would decrease accident risk.

Mandatory helmet legislation and children's exposure to cycling

Macpherson AK, Parkin PC, To TM. Injury Prevention, Inj Prev 2001;7:228-230. 2001.

Mind your head - the data and debate on bicycle helmet effectiveness

Cook A. Significance, Dec 2004;1;4:162-3. 2004.

Motorcycle and bicycle protective helmets: requirements resulting from a post crash study and experimental research

Corner JP, Whitney CW, O'Rourke N, Morgan De. Federal Office of Road Safety, Report CR55. 1987.

New Zealand bicycle helmet law - do the costs outweigh the benefits?

Taylor M, Scuffham P. Injury Prevention, 2002;8:317-320. 2002.

No clear evidence from countries that have enforced the wearing of helmets

Robinson DL. BMJ, 2006;332:722-725. 2006.

There is no clear evidence of benefit from countries that have enforced the wearing of cycle helmets.

Oblique impact testing of bicycle helmets

Mills NJ, Gilchrist A. Int Journal of Impact Engineering, 2008;35(9):1075-1086. 2008.

On your head be it: helmets

Davis R. Death on the Streets chapter 11, ISBN 0-948135-46-8. 1992.

No conclusive benefit from helmets, but they do deflect attention away from dangerous driving.

Pedal cycle accidents in Great Britain

Downing CS. Ways to Safer Cycling conference. 1985.

Cycle helmets have potential to reduce cyclist casualties by less than 1%, compared with 27% for developments in training and engineering.

Pedalling health - health benefits of a modal transport shift  

Roberts I, Owen H, Lumb P, MacDougall C. 1996.

Australian assessment of health benefits of cycling. A commitment to cycling will result in a far healthier community.

Pedestrian risk decrease with pedestrian flow. A case study based on data from signalised intersections in Hamilton, Ontario

Leden L. Accident Analysis & Prevention, 2002;34:457#64. 2002.

Promoting safe cycling and helmet use

Curran ALM. British Medical Association. 2008.

Revised 2010

Promoting safe walking and cycling to improve public health: lessons from the Netherlands and Germany  

Pucher J, Dijkstra L. American Journal of Public Health, 2003;93(9):1509-1516. 2003.

Protection afforded by cycle helmets

Keatinge R, Parry R. BMJ, 1994;309:1441 (26 Nov). 1994.

Protection afforded by cycle helmets

McDermott FT, Lane JC. British Medical Journal, BMJ 1994;309:877. 1994.

Protective effect of different types of bicycle helmets  

Hansen KS, Engesaeter LB, Viste A. Traffic Inj Prev, 2003;4(4):285-290. 2003.

Public Bicycle Share Programs and Head Injuries  

Graves Janessa M., Pless Barry, Moore Lynne, Nathens Avery B., Hunte Garth, Rivara Frederick P.. American Journal of Public Health. 2014.

American Journal of Public Health 104, e106_e111

Public health benefits of strategies to reduce greenhouse-gas emissions: overview and implications for policy makers  

Haines A, McMichael AJ, Smith KR, Roberts I, Woodcock J, Markandva A, Armstrong BG et al. The Lancet, 2009; 374(9707):2104-2114. 2009.

Active travel (cycling and walking)in London gives an increase of 5496 life-years per million of population, against a loss of 418 due to injuries, a ratio of 13:1. Or 15:1 using disability adjusted data.

Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport  

Woodcock J, Edwards P, Tonne C, Armstrong BG, Ashiru O, Banister D, Beevers S, Chalabi Z, et al. The Lancet, 2009;374(9705):1930-1943. 2009.

Publication bias and time-trend bias in meta-analysis of bicycle helmet efficacy: A re-analysis of Attewell, Glase and McFadden, 2001

Elvik R. Accident Analysis & Prevention, 2011;43(3):1245-1251. 2011.

Attewell et al influenced by publication and time-trend biases. When controlled for, the protective effects of helmets are smaller. Adding new studies, no overall benefit of helmets found.

Publication bias in meta-analysis. Prevention, assessment and adjustments

Rothstein H, Sutton AJ, Borenstein M. John Wiley & Sons. 2005.

Quantifying the risk of head injury to child cyclists in England: an analysis of hospital admissions data

Franklin J, Chapman G. BHRF. 2005.

Reducing bicycle accidents: a re-evaluation of the impacts of the CPSC bicycle standard and helmet use

Rodgers GB. Journal of Products Liability, 1988 ,11:307-317. 1988.

The largest ever cycling casualty study involving over 8 million cases of injury and death to cyclists in the USA over 15 years. It concluded that there was no evidence that hard shell helmets had reduced the head injury and fatality rates. Moreover, there was a significant positive correlation between fatalities and helmet use (i.e. helmeted riders were more likely to be killed).

Ride your bike: healthy policy for Australians

Rissel C. Health Promotion Journal of Australia, 2003;14(3):151-153. 2003.

Emphasis on helmets has deterred many people from achieving the health benefits of cycling.

Risk compensation and bicycle helmets  

Phillips RO, Fyhri A, Sagberg F. Risk Analysis, 2011; Mar 18. 2011.

Field study, the findings of which are consistent with the notion that those who use helmets routinely perceive reduced risk when wearing a helmet, and compensate by cycling faster.

Risk compensation behavior in children - myth or reality?

Pless IB, Magdalinos H, Hagel B. Arch Pediatr Adolesc Med, 2006;160(6):610-614. 2006.

Risk compensation in children's activities: A pilot study

Mok D, Gore G, Hagel B, Mok E, Magdalinos H, Pless IB. Paediatr Child Health, 2004;9(5):327-330. 2004.

First empirical evidence of risk compensation when cycling. Injured children who had worn helmets rode faster and suffered more damage to their bikes.

Risk compensation theory should be subject to systematic reviews of the scientific evidence  

Thompson DC, Thompson RS, Rivara FP. Injury Prevention, 2002;8:e1-e1. 2002.

Part of debate between authors pro- and against the theory of risk compensation.

Risk compensation: a male phenomenon? Results from a controlled intervention trial promoting helmet use among cyclists  

Messiah A, Constant A, Contrand B, Felonneau ML, Lagarde E. American Journal of Public Health, May 2012;102(S2):S204-S206. 2012.

Safety in numbers in Australia: more walkers and bicyclists, safer walking and bicycling

Robinson DL. Health Promotion Journal of Australia, 2005;16:47-51. 2005.

Following the introduction of compulsory helmets for cyclists, there was a 30% reduction in cycling and it was associated with a higher risk of death or serious injury per cyclist, outweighing any benefits of increased helmet wearing.

Safety in numbers: more walkers and bicyclists, safer walking and bicycling

Jacobsen PL. Injury Prevention, 2003;9:205-209. 2003.

Seasonal variation in hospital admission for road traffic injuries in England: analysis of hospital statistics

Gill M, Goldacre M. Injury Prevention, 2009;15:374-78. 2009.

Serious injury due to land transport accidents, Australia, 2003-04

Berry JG, Harrison JE. Australian Institute of Health and Welfare, Inj Res & Stat Series No.38. 2007.

Helmeted cyclists have about the same percentage of head injuries (27.4%) as unhelmeted car occupants and pedestrians (28.5%). Wearing a helmet seems to have no discernible impact on the risk of head injury.

Sikre skoleveje: En undersogelse af borns trafiksikkerhed og transportvaner

Jensen SU, Hummer CH. Danmarks Transport Forskning, Rapport 3, 2002. 2002.

Helmet promotion may be responsible for a generation opting for driving instead of cycling.

Some statistical aspects of road safety research

Smeed RJ. J R Stat Soc A, 1949:1-34. 1949.

Specific patterns of bicycle accident injuries - An analysis of correlation between level of head trauma and trauma mechanism

Möllman FT, Rieger B, Wassmann H. DGNC Köln. 2004.

No significant difference concerning the level of head-trauma due to bicycle accident between cyclists wearing a helmet and others.

Surveillance for Traumatic Brain Injury Related Deaths: United States, 1997- 2007  

Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, Guzman BR, Hemphill JD. Centers for Disease Control and Prevention, May 6, 2011 / 60(SS05);1-32. 2011.

Systematic reviews and meta-analysis  

Littell JH, Corcoran J, Pillai V. Oxford University Press, ISBN13: 9780195326543. 2008.

The Cochrane Collaboration and bicycle helmets

Curnow WJ. Accident Analysis & Prevention, 2005;37(3):569-573. 2005.

Review takes no account of scientific knowledge of types and mechanisms of brain injury and is not a reliable guide to the efficacy of helmets and to interventions concerning their use.

The effect of bicycle helmet legislation on bicycling fatalities  

Grant D, Rutner SM. Journal of Public Policy, 2004;23(23). 2004.

Fatalities reduce 15% in the long term, but this can't be only because of legislation. Nationally a 12% reduction in fatalities was associated with a 21% reduction in bicycle use.

The effectiveness of bicycle helmets: a study of 1710 casualties

McDermott FT, Lane JC, Brazenore GA, Debney EA. Journal of Trauma, 1993; 34(6):834-845. 1993.

The effects of bicycle helmet legislation on cycling-related injury: the ratio of head to arm injuries over time  

Voukelatos A, Rissel C. Australasian College of Road Safety, ACRS 2010;21(3):50-55. 2010.

Helmets were not the main reason for the drop in head injuries in Australia since helmet laws were introduced. General improvement in road safety from random breath testing and other measures were probably the cause.

The effects of bicycling helmets in preventing significant bicycle-related injuries in children

Finvers KA, Strother RT, Mohtadi N. Clinical Journal of Sports Medicine, 1996 Apr;6(2):102-7. 1996.

The effects of provincial bicycle helmet legislation on helmet use and bicycle ridership in Canada

Dennis J, Potter B, Ramsay T, Zarychanski R. Injury Prevention, 2010;16:219-24. 2010.

The effects of wearing protective helmets on attentional processes in young cricketers

Neave N, Emmett J, Moss M, Scholey A, Wesnes K. Northumbria University, Cognitive Science Unit. 2004.

The wearing of cricket helmets slows reaction time due to heating the brain

The efficacy of bicycle helmets against brain injury

Curnow WJ. Accident Analysis and Prevention, 2003,35:287-292. 2003.

The meta-analysis of case-control studies does not provide scientific evidence that such helmets reduce serious injury to the brain as it does not distinguish injuries caused through fracture of the skull and by angular acceleration.

The health impact of mandatory bicycle helmet laws  

de Jong P. Risk Analysis. 2012.

In jurisdictions where cycling is safe, a helmet law is likely to have a large unintended negative health impact. In jurisdictions where cycling is relatively unsafe, helmets will do little to make it safer and a helmet law, under relatively extreme assumptions, may make a small positive contribution to net societal health. The model serves to focus the mandatory bicycle helmet law debate on overall health.

The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study  

Rojas-Rueda D, de Nazelle A, Tainio M, Nieuwenhuijsen MJ. British Medical Journal, BMJ 2011; 343:d4521 . 2011.

The health benefits of cycling exceed the risks by 77:1, even in a busy city where few people wear helmets.

The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales

Walter SR, Olivier J, Churches T, Grzebieta R.. Accident Analysis & Prevention, 2011 Nov;43(6):2064-71. 2011.

This study claims to be the last word in showing that helmet laws are beneficial.

The impact of compulsory cycle helmet legislation on cyclist head injuries in New South Wales, Australia: A rejoinder  

Rissel C. Accident Analysis & Prevention, 2012;45:107-109. 2012.

This paper challenges Walter, Olivier, Churches and Grzebieta, 2011 detailing many shortcomings that are said to make its conclusions invalid.

The incidence of injuries traveling to and from school by travel mode  

Schofield GM,Gianotti S,Badland HM,Hinckson EA. Preventive Medicine, 2008 Jan;46(1):74-76. 2008.

School-related travel, including cycling, is a relatively safe activity contributing to a minority of all injuries sustained by youth.

The possible effect on frequency of cycling if mandatory bicycle helmet legislation was repealed in Sydney, Australia: a cross sectional survey  

Rissel C, Wen LM. Health Promotion Journal of Australia, 2011; 22: 178-83. 2011.

The potential for cycle helmets to prevent injury - a review of the evidence

Hynd D, Cuerden R, Reid S, Adams S. Transport Research Laboratory, PPR446. 2009.

Despite attempts to manipulate the results, one of the largest reviews of the evidence has not been able to find any reliable evidence that helmets have benefited cyclists

The risk compensation theory and bicycle helmets  

Adams J, Hillman M. Injury Prevention, 2002;8:e1-e1. 2002.

Part of debate between authors pro- and against the theory of risk compensation.

The role of alcohol in non-fatal bicycle injuries  

Olkkonen S, Honkanen R. Accident Analysis & Prevention, 1990;22(1):89-96. 1990.

Three lessons for a better cycling future

Wardlaw MJ. BMJ, 2000-12-23/30 n321 p1582-5. 2000.

Cycling has a fine safety record; driving does not. The statistical wrangle over cycle helmets is a side issue; helmet promotion engenders the impression that cycling has become much more hazardous than driving, which deters cycling and increases risk for those who continue to cycle.

Travel to work in Australian capital cities, 1976-2006: an analysis of census data  

Mees P, Sorupia E, Stone J. GAMUT - Australian Centre for the Governance and Management of Urban Transport. 2007.

Trends in cycle injury in New Zealand under voluntary helmet use

Scuffham PA, Langley JD. Accident Analysis and Prevention, 1997 Jan;29(1):1-9. 1997.

In the 12 months prior to the introduction of a helmet law, helmet wearing in New Zealand rose to 84% for primary school children, 62% for secondary school children and 39% for adults. However, there was no evidence that increased helmet use had resulted in fewer serious head injuries.

Trends in head injury mortality among 0 - 14 year olds in Scotland (1986-95)

Williamson LM, Morrison A, Stone DH. J Epidemiol Community Health, 2002;56;285-288. 2002.

Trends in helmet use and head injuries in San Diego County: The effect of bicycle helmet legislation

Ming J, Gilchick RA, Bender SJ. Accident Analysis & Prevention, 2006;38(1):128-134. 2006.

No significant reduction in serious head injury over study period. Serious head injuries rose as helmet use grew fastest. Although one of the most popular areas for cycling in the USA, the incidence of serious head injury was low.

Trends in pediatric and adult bicycling deaths before and after passage of a bicycle helmet law

Wesson D, Stephens D, Lam K, Parsons D, Spence L, Parkin P. Pediatrics, 2008;122:605-610. 2008.

Trends in serious head injuries among cyclists in England: analysis of routinely collected data

Cook A, Sheikh A. BMJ, 2000;321:1055. 2000.

Trends in serious head injuries among English cyclists and pedestrians

Cook A, Sheikh A. Injury Prevention, 2003;9:266-267. 2003.

Understanding children's injury-risk behavior: Wearing safety gear can lead to increased risk taking

Morrongiello BA, Walpole B, Lasenby J. Accident Analysis & Prevention, 2007 May;39(3):618-23. 2007.

Children went more quickly and behaved more recklessly when wearing safety gear (including helmets) than when not wearing gear providing evidence of risk compensation.

Use of alcohol as a risk factor for bicycling injury  

Li G, Baker SP, Smialek JE,Soderstrom CA. JAMA, 2001;285(7):893-896. 2001.

Where have all the bicycles gone? Are bicycle sales in Australia translated into health-enhancing levels of bicycle usage?  

Bauman A, Merom D, Rissel C. Prev Med, 2012 Feb;54(2):145-7. 2012.

There are many more bikes being sold in Australia than are being used.