Motor Vehicle Injury Motorcycle Helmets: Universal Helmet Laws
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends universal motorcycle helmet laws that apply to all motorcycle operators and passengers.
Evidence shows universal helmet laws increase helmet use; decrease motorcycle-related deaths and injuries; and are substantially more effective than no law or partial motorcycle helmet laws. Partial helmet laws apply only to riders who are young, novices, or have medical insurance coverage below certain thresholds.
Evidence shows the economic benefits of universal motorcycle helmet laws greatly exceed costs. Most benefits come from avoided healthcare and productivity losses.
The full CPSTF Finding and Rationale Statement and supporting documents for Motor Vehicle-Related Injury Prevention: Use of Motorcycle Helmets, Universal Helmet Laws are available in The Community Guide Collection on CDC Stacks.
Intervention
Motorcycle helmet laws require motorcycle riders to wear a helmet when riding on public roads. In the United States these laws are implemented at the state level and fall into two categories:
- Universal helmet laws apply to all motorcycle operators and passengers.
- Partial helmet laws apply only to some motorcycle operators, such as those under a certain age (usually 18); novices (most often defined as having less than 1 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 and 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)
About The Systematic Review
This CPSTF 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 United States (search period through August 2012). Comparison of universal and partial helmet law effectiveness came from 48 study arms.
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 mostly male (median: 91%).
- Outside the United States, motorcyclists were slightly younger (mean age of 38.3 years) with fewer males (median: 67%).
Summary of Results
The systematic review included evidence from 71 studies with 78 study arms. Of these, 67 study arms evaluated motorcycle helmet laws in the United States.
- 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.
- These outcomes apply to riders of all ages, including younger operators and passengers who would have been covered by partial helmet laws.
Repealing Universal Helmet Laws
States that replaced universal helmet laws with 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 (21 study arms)
- Total number of deaths: median increase of 42% (20 study arms)
- Death rates:
- Per registered motorcycle: median increase of 34% (18 study arms)
- Per vehicle mile traveled: median increase of 23% (3 study arms)
- Per crash: median increase of 21% (12 study arms)
- Total number of non-fatal injuries: median increase of 41% (10 study arms)
Implementing Universal Helmet Laws
States that replaced partial helmet laws or no law with 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 (16 study arms)
- Total number of deaths: median decrease of 31% (14 study arms)
- Death rates:
- Per registered motorcycle: median decrease of 34% (12 study arms)
- Per vehicle mile traveled: 43% decrease (1 study arm)
- Per crash: median decrease of 17% (5 study arms)
- Total number of non-fatal injuries: median decrease of 31% (9 study arms)
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 15 included study arms (12 from the U.S.) 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.
Summary of Economic Evidence
The economic review included 22 studies, of which 21 were 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.
Evidence shows the economic benefits of universal motorcycle helmet laws greatly exceed costs. Most benefits come from avoided healthcare costs and productivity losses.
- Reported intervention costs included only the price of motorcycle helmets, which ranged from $1.3 million to $4.5 million per 100,000 motorcyclists per year.
- Economic benefits:
- The main economic benefits came from avoided healthcare costs and productivity losses.
- Twelve benefit-only studies reported increased economic benefits after implementing universal helmet laws. 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 repeal of universal helmet laws. 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.
- Cost benefit comparisons
- Cost benefit analyses in all three studies found that economic benefits greatly exceeded 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.
Applicability
The available evidence indicates that universal helmet laws are effective in a range of contexts and populations, including:
- U.S. and non-U.S. settings
- Urban and rural areas
- Motorcyclists of all ages
- Males and females
- Motorcycle riders and passengers
Evidence Gaps
- What is the role of enforcement in helmet law effectiveness?
- What is the impact of use of unapproved helmets on helmet law effectiveness?
- What is the effectiveness of universal helmet laws in rural areas?
- What is the impact of universal helmet laws on riders of low-powered motorized cycles (e.g., scooters, mopeds)? Currently, some states cover all types of low-powered cycles, while other states cover motorized cycles above certain thresholds, such as those designed to go over 30 mph.
Implementation Considerations and Resources
- Universal helmet laws, in addition to being more effective than partial laws, are easier to enforce. They apply to all motorcycle riders and passengers rather than some motorcyclists and don’t depend on factors that are difficult or impossible to determine visually, such as age, experience, or medical insurance coverage.
- Some motorcyclists use helmets not approved by the U.S. Department of Transportation (DOT), even though these unapproved 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.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.