Bicycle helmet usage is rare in societies with large numbers of transportation bicyclists

(See, for example, The City of Cyclists Video)

Copenhagen is known far and wide as the "City of Cyclists". This is due to its longstanding and lively cycling tradition. Cycling is a socially acceptable means of transport and it is not uncommon to see Danish ministers or mayors cycle to work. Bicycle traffic in Copenhagen has grown in recent years. Currently, one out of three Copenhageners cycle to work.

The thing to notice in this video is how few bicyclists are wearing helmets. This is the norm: bicyclists in countries with large numbers of transportation bicyclists (Denmark, Holland, Japan) do not wear bicycle helmets. At the same time, the bicyclist mortality rate in these countries is 6 – 11 times lower than it is in the US.

The #1 reason to oppose a mandatory helmet law is that forced helmet use is foreign to and inhibits the establishment of a transportation bicycling culture like the one enjoyed by Copenhagen.

Helmet Laws divert attention from real safety considerations.

Bicyclists agree that by far the most important safety considerations are:

• Education — of bicyclists and motorists
• Defensive bicycling
• Safe Facilities (bike lanes and bicycle-friendly roadways)
• A properly equipped and functional bicycle

Helmet laws are often touted as a "cheap way" to improve bicyclist safety; however, there is no substitute for spending money on roadway repairs and bicycle lanes, and the best way to avoid a head injury is to not fall on your head in the first place. Education, safe facilities, defensive biking, and educated motorists prevent head injuries, not bicycle helmets!

Helmet Laws are divisive and hurt community spirit.

Transportation bicyclists feel insulted by mandatory helmet laws (MHLs) because such laws suggest that bicyclists are incapable of managing their own personal safety. Furthermore, in a car-oriented city, bicyclists are already a beleaguered minority, and MHLs represent a heavy-handed swipe at them. Far from having the effect of "people getting used to wearing helmets" as helmet law proponents have suggested, the 96-97 Austin MHL was controversial and bitterly divisive for the entire 10 months it was in place. In 1997, underdog city council candidates Bill Spelman and Willy Lewis were elected on the campaign promise that they would repeal the helmet law. Of the minority of bicyclists who supported the helmet law in 1996, most are now either opposed or neutral after witnessing the negative impact it had on the community.

An Adult Helmet Law is a particularly bad fit for Austin (no pun intended)

Austin strives to be a "creative class" city where weirdness is embraced, not criminalized. Repressive personal safety mandates are completely incompatible with attracting creative class types to live and work here in addition to sending the wrong message. The measure of the sophistication of a society is the extent of the freedoms it grants its constituents. Transportation bicycling encourages better land use because bicyclists like to live close to where they work and have shopping nearby. The city has been going to great lengths recently to promote density, mixed-use, and alternative transportation. An all-ages MHL ordinance would take us in exactly the opposite direction by discouraging bicycling.

Helmet Laws are a barrier for beginning transportation bicycling.

A lot of people get into transportation bicycling by making short neighborhood trips to the grocery store or coffee shop. A helmet law can serve as a barrier to these kinds of short rides on quiet neighborhood streets. Rather than risk being stopped by the police, and not wanting to bother with a helmet, potential bicyclists will elect to drive instead, consequently never making the transition to substantive transportation bicycling.

Nationally, increased bicycle helmet use is correlated with an increase in head injuries. [ref]

Claims that "helmets reduce the incidence of serious head injuries by as much as 85%" are almost all based on a series of studies that gathered data from Seattle-area emergency rooms in the late 1980′s and early 1990′s. Even the authors of these studies admit that these studies suffer from serious methodological flaws. For example, the same data can be used to show that "helmets reduce the incidence of leg injuries by as much as 72% [ref]". Most studies like these showing a positive impact of helmet use are hopelessly compromised by confounding variables, such as the fact that helmeted riders tend to be more cautious by nature than riders who refuse to wear a helmet. When writing about the effect of MHLs, many authors fail to take into account reductions in the number of bicyclists and other safety measures implemented at the same time (lower speed limits, etc.). When these factors are taken into account, the safety impact of MHLs is, at best, negligible. [ref]

A far more reasonable way to measure the effectiveness of helmet use is simply to look at the raw numbers on a large scale. By this measure, helmets fair rather poorly. According to an article published in The New York Times July 29, 2001, from 1991 to 2000 — at the same time that voluntary helmet use in the United States went from 18% to 50% — the number of bicyclist head injuries increased by 10%. However, during this period bicycle use actually declined by 21%, so that the effective increase in head injuries was 51% — a strong linear correlation between increased helmet use and increased head injuries.

Locally, Austin’s juvenile helmet law is correlated with an increase in bicycle-related juvenile head injuries.

The National Highway Traffic Safety Administration (NHTSA) published a five year study profiling the effectiveness of the existing juvenile Austin helmet law using 1995 as a baseline:

Increase in juvenile helmet use: 316%.

Although statistically insignificant, juvenile head injuries did increase an average of 35% over the baseline year before the helmet law was in effect.

The only statistically significant trend associated with Mandatory Helmet Laws is a general decrease in bicycling.

Mandatory helmet laws have been shown to decrease bicycle use by as much as 44% when imposed statewide in Victoria, Australia [ref]. Proponents claim that similar reductions have not been measured in the US — this is not true: hospital data for non-head injuries suggest that youth cycling declined by around 14% across California as a result of a statewide 17 and under MHL [ref]. Many people will simply elect to stop using a bicycle for short transportation trips if burdened with wearing a helmet at all times

Mandatory Helmet Laws create the impression that transportation bicycling is unsafe.

When I encourage people to try using a bicycle for transportation, the #1 reason I get for refusal to do so is "bicycling on the street is not safe". Actually, nothing could be further from the truth. Per hour spent, bicycling is safer than walking and riding in or on a motor vehicle [ref]. Only transit is a safer way to get around on the ground. A helmet law creates the impression that bicycling is much less safe than driving, walking, or even riding a motorcycle, since only bicyclists are required to wear helmets when an MHL is in affect.

The cost of bicyclist head injuries is negligible compared to head injuries due to other causes, particularly motor vehicle accidents.

Source: http://www.cdc.gov/ncipc/tbi/Causes.htm

Per hour, driving is almost twice as deadly as bicycling and at least as likely to cause a serious head injury [ref]. Last year there were over 2.5 million injuries due to motor vehicles, and the direct cost of motor vehicle accidents is over $10 billion per year in Texas alone. If we really want to save lives and money, the key is to get more people out of cars and onto bicycles and transit. This means encouraging, not discouraging bicycling by implementing punitive laws.

The effectiveness of bicycle helmets under any circumstances is severely limited.

By design, bicycle helmets are only effective only at very low speeds (< 14mph). Any deviation from this and a bicycle helmet can actually increase the severity of injury [ref]. For example, an off-center impact on the oblong surface of a helmet or having the air vents catch on something can violently twist the head and neck, leading to a potentially fatal neck injury (pp. 173-174, The Art of Urban Cycling by Robert Hurst). Recent research on brain injury adds further confusion, suggesting that the major causes of permanent intellectual disablement and death may well be torsional forces leading to diffuse axonal injury, a form of injury which helmets cannot mitigate (The efficacy of bicycle helmets against brain injury, Curnow, WJ. 2003. Accident Analysis and Prevention: 2003,35:287-292).

Helmet Laws are only selectively enforced.

The Dallas Helmet Law appears not to be enforced. Here is a photo from a weekly ride in central Dallas.

In many weekends spent in Dallas over the past 6 months, I have yet to see even one transportation bicyclist wearing a helmet. For the roughly one year (1996-1997) that the Austin adult helmet law was in place, 70-80% of all tickets were issued to minorities. No tickets have been issued for the Austin juvenile helmet ordinance since 2002. Prior to this, over 90% of all tickets were issued to minority youths.

Helmet Laws are a completely inappropriate way to encourage helmet use.

Even under the assumption that helmets are extremely effective, coercion is not the way to encourage helmet use. Helmets must be properly fit and correctly worn in order to have any chance of being effective at reducing the severity of injury. According to one study, individuals whose helmets were reported to fit poorly had a 1.96-fold increased risk of head injury compared with those whose helmets fit well (Fit of bicycle safety helmets and risk of head injuries in children. Rivara FP, Astley SJ, Clarren SK, Thompson DC, Thompson RS. Injury Prevention. 1999; 5:194-197). Improperly worn helmets result in all the hazards outlined above with none of the protective benefits. An individual who wears a helmet simply to avoid getting a ticket is not going to suffer the discomfort of a properly worn helmet. The best and only effective/appropriate way to encourage helmet use is through education.

Helmet Laws are becoming less, not more popular.

The test of time has not been kind to bicycle helmet laws, particularly all-ages MHLs. With the exception of Washington State, only one all-ages MHL has been passed in this decade, in Creve Coeur, Missouri [ref]. If one excludes Washington State, only 12 cities and 1 county have all-ages MHLs, and most of these are small. Municipal governments which ignore the hype and take the time to look at the actual data reject even juvenile MHLs [ref]. No state has adopted an all-ages MHL.

Local and state bicycling organizations do not support an all-ages mandatory helmet law for Austin

• The Austin Cycling Association (ACA) does not support the proposed mandatory helmet law.
• The Texas Bicycle Coalition (TBC) does not support the proposed all-ages Austin mandatory helmet law.
• The League of Bicycling Voters was organized to oppose a mandatory bicycle helmet law.

We’re not sure which is more absurd, the ongoing unwarranted belief in the effectiveness of bicycle helmets at preventing injury/death or the exaggerated claims regarding the cost that bicyclist head injuries pose to society

Whenever someone states that "helmets reduce the incidence of serious head injuries by 85%" or something similar, they are basing this claim on a series of studies that gathered data from Seattle-area emergency rooms in the late 1980′s and early 1990′s. Even the authors of these studies now acknowledge that these studies suffer from serious methodological flaws. The same data, for example, can be used to "show" that bicycle helmets significantly reduce the risk of leg injuries, too. All such studies are hopelessly compromised by confounding variables, hidden factors which affect the outcome, such as the fact that helmeted riders tend to be more cautious by nature than riders who refuse to wear a helmet, hence will be less likely to have an accident in the first place.

There is no statistically significant evidence suggesting that increased helmet use decreases the rate of bicyclist injuries/fatalities. On the contrary, in the US, increased helmet use is actually correlated with an increase in head injuries! According to an article published in the New York Times July 29, 2001, from 1991 to 2000, at the same time that voluntary helmet use in the United States went from 18% to 50%, the number of bicyclist head injuries increased by 10%. However, during this period bicycle use actually declined by 21%, so that the effective increase in head injuries was 51% — a strong linear correlation between increased helmet use and increased head injuries.

G.B. Rogers [Rodgers, G.B., Reducing bicycle accidents: a reevaluation of the impacts of the CPSC bicycle standard and helmet use, Journal of Products Liability, 11, pp. 307-317, 1988]
studied over 8 million cases of injury and death to cyclists over 15 years in the USA.
He concluded as follows: "There is no evidence that hard shell helmets have reduced
the head injury and fatality rates. The most surprising finding is that
the bicycle-related fatality rate is positively and significantly correlated
with increased helmet use."

When one combines this with the fact that the entirely unhelmeted bicyclists in Holland, Denmark, and Japan have per capita (or per billion km. traveled) fatality rates that are 6-12 times lower than bicyclists in the
US, the evidence is rather clear: bicycle helmets play at best a negligible
role in increasing bicyclist safety, and compelling evidence exists that
they might actually reduce safety.

Additional statistics and other useful information can be found here:

http://www.cyclehelmets.org/mf.html?1052

http://www.vehicularcyclist.com

http://en.wikipedia.org/wiki/Bicycle_helmet

The email below, reprinted verbatim, was sent to city council and city officials on or about August 10, 2006 by one Patrick J. Crocker, D.O., director for the Brackenridge Hospital Department of Emergency Medicine. Crocker’s message is confused and confusing in many different ways, but what I particularly like about it is that it neatly illustrates the canonical statistical flaw that all helmet law proponents make. Case control studies demonstrating that helmets decrease the severity of head injuries and fatalities fail to take into account a number of factors, most importantly fundamental differences between those bicyclists who elect to wear a helmet and those who don’t [ref].
This is why the same studies that show that bicycle helmets are 85% effective at preventing head injuries also show that bicycle helmets are (using the example of the most frequently cited study) 72% effective at preventing leg injuries. Whenever such data is correctly analyzed, the advantages of helmet use disappear.
Moreover, population studies uniformly show no statistically significant reduction in either severe head injuries or fatalities when bicycle helmets are used. One large scale study of over 8 million bicyclists in the USA indicates that wearing a bicycle helmet actually increases the risk of fatality (see http://lobv.org/statistics.html).

But back to Crocker’s letter. The red text and superscripts have been added in order to facilitate the subsequent discussion.