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Use of Motorcycle Helmets: Universal Helmet Laws

Task Force Finding

The Community Preventive Services Task Force recommends universal motorcycle helmet laws (laws that apply to all motorcycle operators and passengers) based on strong evidence of effectiveness. Evidence indicates that universal helmet laws increase helmet use; decrease motorcycle-related fatal and non-fatal injuries; and are substantially more effective than no law or than partial motorcycle helmet laws, which apply only to riders who are young, novices, or have medical insurance coverage below certain thresholds.

States in the U.S. that repealed universal helmet laws and replaced them with partial laws or no law consistently experienced substantial:

  • Decreases in helmet use, and
  • Increases in fatal and non-fatal injuries.

States that implemented universal helmet laws in place of partial laws or no law consistently experienced substantial:

  • Increases in helmet use, and
  • Decreases in fatal and non-fatal injuries.

These beneficial effects of universal helmet laws extended to riders of all ages, including younger operators and passengers who would have been covered by partial helmet laws.

Economic evidence shows that universal motorcycle helmet laws produce substantial economic benefits that greatly exceed costs. Most benefits come from averted healthcare and productivity losses.

Read the full Task Force Finding and Rationale Statement for more detailed information on the finding, including implementation issues, potential benefits and harms, and evidence gaps.

Intervention Definition

Motorcycle helmet laws require motorcycle riders to wear a helmet while riding on public roads. In the U.S., these laws are implemented at the state level with varying provisions and fall into two categories:

  • Universal helmet laws apply to all motorcycle operators and passengers.
  • Partial helmet laws apply only to certain motorcycle operators such as those under a certain age (usually 18); novices (most often defined as having less than one year of experience); or those who do not meet the state's requirement for medical insurance coverage. Passengers on motorcycles are not consistently covered under partial helmet laws.

Universal or partial motorcycle helmet laws may contain provisions that:

  • Require use of helmets approved by regulatory agencies (e.g., U.S. Department of Transportation)
  • Cover all motorized cycles (including motorcycles and low-powered cycles such as mopeds or scooters), or cover only those meeting specific criteria (most often defined by engine capacity, horsepower, or ability to exceed certain speeds)
  • Specify penalties for violators (usually monetary fines)

In the U.S., motorcycles account for about 3% of registered vehicles, 0.6% of vehicle miles traveled, and a disproportionate 14% of all road traffic fatalities (DOT, 2013). The Insurance Institute for Highway Safety maintains a current list of states and their helmet laws External Web Site Icon.

About the Systematic Review

This Task Force finding is based on a systematic review of evidence from 71 studies with 78 study arms; 67 study arms evaluated motorcycle helmet laws in the U.S. (search period through August 2012). Comparison of universal and partial helmet law effectiveness came from 48 study arms.

Results

Included studies consistently showed that universal motorcycle helmet laws increase helmet use and decrease motorcycle-related deaths and injuries, and are substantially more effective than no law or partial motorcycle helmet laws.

Repealing Universal Helmet Laws
  • States that changed from universal helmet laws to partial laws or no laws experienced decreases in helmet use and increases in motorcycle-related deaths and injuries.
    • Helmet use: median decrease of 41 percentage points (interquartile interval [IQI]: ‑48 to ‑31 percentage points; 21 study arms)
    • Total number of deaths: median increase of 42% (IQI: 26% to 67%; 20 study arms)
      • Deaths related to head injuries: 6% and 65% increase (2 study arms)
    • Fatality rates:
      • Per registered motorcycle: median increase of 34% (IQI: 9% to 42%; 18 study arms)
      • Per vehicle mile traveled: median increase of 23% (range: 14% to 38%, 3 study arms)
      • Per crash: median increase of 23% (IQI: 1% to 36%, 12 study arms)
    • Total number of non-fatal injuries: median increase of 41% (IQI: 19% to 61%, 10 study arms)
      • Non-fatal head injuries: median increase of 74% (range: 53% to 83%; 4 study arms)
Implementing Universal Helmet Laws
  • States that changed from partial helmet laws or no law to universal helmet laws consistently saw increases in helmet use and decreases in motorcycle-related deaths and injuries.
    • Helmet use: median increase of 54 percentage points (IQI: 43 to 74 percentage points; 16 study arms)
    • Total number of deaths: median decrease of 31% (IQI: ‑43% to ‑23%; 14 study arms)
      • Deaths related to head injuries: median decrease of 50% (IQI: ‑55% to ‑38%, 9 study arms)
    • Fatality rates:
      • Per registered motorcycle: median decrease of 34% (IQI: ‑47% to ‑23%; 12 study arms)
      • Per vehicle mile traveled: 43% decrease (1 study arm)
      • Per crash: median decrease of 17% (range: ‑27% to ‑8%, 5 study arms)
    • Total number of non-fatal injuries: median decrease of 31% (IQI: ‑37% to ‑14%, 9 study arms)
      • Non-fatal head injuries: median decrease of 51% (IQI: ‑56% to ‑40%; 10 study arms)
Comparison of Helmet Laws across U.S. States
  • When compared with states that had partial laws or no law, states with universal helmet laws had higher rates of helmet use and lower rates of motorcycle-related deaths and injuries.
    • Helmet use: median of 53 percentage points higher (IQI: 51 to 60 percentage points; 6 study arms)
    • Total number of deaths: median of 24% fewer (IQI: ‑29% to ‑22%; 7 study arms)
      • Deaths related to head injuries: 47% fewer (1 study arm)
    • Fatality rates:
      • Per registered motorcycle: median of 12% lower (IQI: ‑19% to ‑8%; 7 study arms)
      • Per vehicle mile traveled: median of 27% lower (range: ‑32% to ‑22%; 2 study arms)
      • Per crash: 14% lower (1 study arm)
    • Total number of non-fatal injuries: 24% fewer (1 study arm)
      • Non-fatal head injuries: median of 33% fewer (range: ‑44% to ‑12%; 3 study arms)
  • When compared with states that had no law, states with partial helmet laws had slightly higher rates of helmet use and lower rates of motorcycle-related deaths and injuries.
    • Helmet use: median of 5 percentage points higher (range: 0 to 19 percentage points; 4 study arms)
    • Fatality rates:
      • Per registered motorcycle: 10% lower and 43% higher (2 study arms)
      • Per vehicle mile traveled: 8% fewer (1 study arm)
    • Non-fatal head injuries: 15% fewer (1 study arm)

Youth

All partial helmet laws in the United States include young riders, so helmet use among youth might be expected to be the same in states with partial and universal helmet laws. Evidence from fifteen included study arms (12 from U.S., 3 from other countries) showed, however, that universal helmet laws were much more effective than partial laws in increasing helmet use and reducing deaths and head injuries among these younger riders.

Repealing Universal Helmet Laws
  • States that changed from universal helmet laws to partial helmet laws saw the following changes:
    • Helmet use: median of 17 percentage point decrease (IQI: ‑19 to 3 percentage points, 5 study arms)
    • Total number of deaths: median of 125% increase (Range: 116% to 189%, 3 study arms)
    • Deaths per 1,000 crashes decreased by 48% (1 study arm)
Implementing Universal Helmet Laws
  • States that changed from partial helmet laws or no law to universal helmet laws saw the following changes:
    • Helmet use: 31 percentage point increase (1 study arm)
    • Total number of deaths: 48% decrease (1 study arm)
    • Non-fatal head injuries: median of 27% decrease (range: ‑60% to ‑19%, 3 study arms)
Comparison of Helmet Laws across U.S. States
  • When compared with states that had partial laws or no law, states with universal helmet laws had the following:
    • Helmet use rates that were a median of 41 percentage points higher (range: 31 to 59 percentage points, 2 study arms with 4 effect estimates)
    • Total number of deaths that was 31% fewer (1 study arm)
    • Total number of non-fatal injuries that was 8% higher (1 study arm)
    • Non-fatal head injuries that was 12% fewer (1 study arm)
  • When compared with states that had no law, states with partial helmet laws had the following:
    • Helmet use rates that were a median of 10 percentage points higher (range: 5 to 17 percentage points, 3 study arms)
    • Total number of deaths that were not changed -1% and 0.1%, (2 study arms)
    • Deaths per 10,000 registered motorcycles that was not changed (0%, 1 study arm)

Study Characteristics

  • Included studies evaluated helmet laws in the United States (67 study arms), Australia (1 study arm), Italy (4 study arms), New Zealand (2 study arms), Spain (2 study arms), and Taiwan (2 study arms).
  • In the United States, motorcyclists had a mean age of 36.5 years and were predominantly male (median: 91%).
  • Outside the United States, motorcyclists were slightly younger (mean age of 33.8 years) with fewer males (median: 67%).

Applicability

The available evidence indicates that universal helmet laws are effective in a range of contexts and populations, including the following:

  • U.S. and non-U.S. settings
  • Urban and rural areas
  • Motorcyclists of all ages
  • Males and females
  • Motorcycle riders and passengers

Economic Evidence

The economic review included 22 studies, with 21 studies from the U.S. (search period through June 2013). Three studies reported program costs, 18 detailed economic benefits, three included cost-benefit analyses, and one featured cost-effectiveness. Monetary values are reported in 2012 U.S. dollars.

Economic evidence shows that universal motorcycle helmet laws produce substantial economic benefits that greatly exceed costs. Most benefits come from averted healthcare costs and productivity losses.

  • Reported intervention costs included only the price of motorcycle helmets, which ranged from $1.3-$4.5 million per 100,000 motorcyclists per year.
  • Economic benefits:
    • The main economic benefits came from averted healthcare costs and productivity losses.
      • Twelve benefit-only studies reported increased economic benefits after universal helmet law implementation. Four of the studies were directly comparable and reported benefits ranging from $29.3 million to $96.1 million per 100,000 registered motorcycles per year.
      • Five benefit-only studies reported higher healthcare costs after universal helmet law repeal. Three of the studies were directly comparable and reported increased costs ranging from $1.8 million to $27.2 million per 100,000 registered motorcycles per year.
      • There was no statistically significant difference between average treatment cost for a head injury for riders in universal law states versus partial or no law states.
  • Cost-benefit comparisons
    • Cost-benefit analyses in all three studies found that the economic benefits greatly exceeded the intervention costs. Benefit-to-cost ratios ranged from 2:1 to 20:1 and net savings ranged from $2.7 million to $86.9 million per 100,000 motorcyclists per year.
    • Cost-benefit ratios varied based on what types of benefits were considered, with studies considering a more complete set of benefits producing higher benefit-to-cost ratios. Benefit estimates included one or more of the following outcomes:
      • Healthcare costs avoided
      • Work productivity losses avoided
      • Non-monetary benefits such as the value of time spent with family or friends

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

  • Universal helmet laws, in addition to being more effective than partial laws, are easier to enforce because they apply to all motorcycle riders and passengers rather than some motorcyclists based on factors that difficult to determine in passing such as age, experience, or medical insurance coverage.
  • Some motorcyclists use helmets unapproved by the U.S. Department of Transportation (DOT), even though these helmets might not provide adequate protection from head injuries. Some states require the use of DOT-approved helmets. Training traffic law enforcement officers in these states to recognize unapproved helmets, and thereby enforce existing laws, may improve helmet law effectiveness.

References

DOT. Traffic Safety Facts 2011 Data. (Report No. DOT HS 811 765). 2013 Washington, DC: National Highway Traffic Safety Administration. Available at URL: http://www-nrd.nhtsa.dot.gov/Pubs/811765.pdf.

Supporting Materials

Publication Status

Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe External Web Site Icon to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.

Promotional Materials

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    Developed by The Community Guide in collaboration with CDC's Division of Unintentional Injury Prevention

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Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation:
Guide to Community Preventive Services. Use of motorcycle helmets: universal helmet laws. www.thecommunityguide.org/mvoi/motorcyclehelmets/helmetlaws.html. Last updated: MM/DD/YYYY.

Review completed: August 2013 (effectiveness review), October 2013 (economic review)