C. State Of Maryland
Jurisdiction: State law.
Effective date: October 1, 1995.
Ages covered: Children under age 16 (one geographic exemption: sections of the boardwalk in Ocean City, MD).
Penalty: Warnings and educational materials only; no fine.
Agency enforcing the law: State, county, city, park police agencies.
Legislative language from both the state and county level is reprinted in Section VIII C.
Impetus For Legislation:
Maryland was the scene for early activity regarding U.S. bicycle helmet use laws. In 1990, Howard County, MD, was one of the first U.S. jurisdictions to mandate use of bicycle helmets by schoolchildren. Soon after the law took effect, the 47 percent bicycle helmet use rate found in that community was “the highest rate of use ever recorded for children in the United States.”vii Other Maryland counties soon followed, and in 1995, Maryland enacted a bicycle helmet use law. (For a brief chronology of events, see Box 2, this section.)
Some believe that the beginnings of the Maryland law can be traced to a bicycling tragedy in Howard County, a suburban/rural county in the Washington, D.C. metropolitan area. According to a case study of the Howard experience (see Box 1 Below), that local ordinance was fueled by the bicycling crash deaths of two students from the same middle school within a nine-month period.viii After the death of one child (who was not helmeted) in January 1989, a teacher instituted a bicycling safety course as an extracurricular activity. The course was well received.
Yet, in October 1989, just two weeks before the course was to be implemented countywide, a second student was killed in a bike crash. Although this child had participated in the bicycle safety activities, he was not wearing a bicycle helmet. Students and teachers at this school, joined by others, worked with the county council to enact the ordinance.
The Howard ordinance caught the attention of the Office of Injury & Disability Prevention (OIDP),1 a part of the state Department of Health and Mental Hygiene (DHMH).2 The staff conducted a pre- and post-evaluation of the Howard County law, where the injury prevention program worked with a CDC-appointed epidemic intelligence service officer. The evaluation included two counties as controls: Baltimore County, with no formal program to encourage bicycle helmet use, and Montgomery County, which at the time was using education to promote bicycle helmet use. The study found a bicycle helmet use rate of 47 percent for children in Howard County, as mentioned below.ix (For a summary of this evaluation, see Box 1.)
Howard County’s ordinance made news and neighboring Montgomery County soon followed Howard County’s lead, adopting a similar law the following year. Both Howard County’s and Montgomery County’s efforts included children’s participation at a variety of levels, including testifying at county hearings. Then, rural Allegany County, inspired by these activities, coordinated a successful effort in 1992 to enact a bicycle helmet use ordinance in that county.
The year after Howard County passed its ordinance, the Maryland Governor’s Bicycle Advisory Committee (BAC) was created. This committee is now called the Governor’s Bicycle and Pedestrian Safety Advisory Committee. According to a DHMH document, “the concept of the Governors’ Bicycle Advisory Committee (BAC) was initiated by members of the bicycling community in Prince George’s County. The legislation to establish the BAC was sponsored by Delegates Pitkin, Rosapepe and Hubbard and Senator Dorman. The purpose of the BAC was to address the needs of bicyclists throughout Maryland and to make Maryland a bicycle friendly state.”x
Therefore, its purpose was not necessarily injury prevention or bicycle safety, but “to promote bicycle-friendly roads, access, and that kind of thing,” according to one committee member. Several observers cited Maryland Delegate Jim Rosapepe, representing the Prince George’s County area, as the legislative leader in committee’s creation.
When the Maryland Department of Health and Mental Hygiene reviewed the proposed legislation to create the committee, the OIDP director recommended that the department support the commission “providing that they put someone from the health department on the committee.” That did occur; the Governor’s appointees to the BAC included not only members of the bicycling community to represent different regions of the state but also representatives from the Maryland State Police and the Maryland Departments of Education, Transportation, Health and Mental Hygiene, and Economic and Employment Development.xi
Several different perspectives emerged regarding the BAC’s decision to pursue a statewide bicycle helmet use law. These perspectives follow:
Though different activists hold a variety of opinions about just how the BAC came to the decision to pursue a statewide bicycle helmet use law, they all agree the BAC did so. There also was a consensus that the state OIDP program’s role was key. As a state highway official put it: “The state Department of Health and Mental Hygiene was instrumental in getting it passed.”
According to a former DHMH employee, bike helmet use legislation had been introduced in 1991 (before BAC involvement), which would have required bicycle helmet use by minors. That legislation did not move forward. Another member believes that bicycle helmet use legislation had been brought up in the legislature for eight to 12 years before it was passed.
Once the BAC decided that a bicycle helmet use law was a priority, members began drafting a model bill and developing necessary supporting materials. With BAC involvement, one observer said, “new life was breathed into it.” While one committee member credited Del. Rosapepe and his staff for research and doing the groundwork for the legislation, others reported that the committee members themselves provided the impetus. The BAC representative from the Department of Health and Mental Hygiene “really picked it up, got Johns Hopkins University involved, got the statistics,” according to another member.
A variety of other individuals and groups were cited as playing a role during the pre-introduction phase of the legislation. One advocate believes it was “just a matter of getting a good group of 16-18 people; a lot of medical people, and some police officers, who did it as a personal thing.”
The bicycling community was not united either for or against bicycle helmet use laws, according to one bicycling enthusiast who said: “The bike people were evenly split. When the question was a children-only helmet law, you’d have 65 to 70 percent in favor; when the question was a helmet law for all riders, it went the other way.” According to this observer, two Washington, DC area clubs were supportive. Washington Area Bicyclist Association (WABA) actively supported it and the Potomac Pedalers Touring Club wrote a letter in support. The main Baltimore area biking club did not weigh in because its membership was divided about the bicycle helmet use law.
According to a DHMH document: “In 1993, the BAC assisted in drafting HB 957 which was sponsored by Delegates Pitkin, Conroy, and Hubbard. This legislation would mandate helmet use for all bicyclists and their passengers. Gil Clarke, representing the BAC from the DC Metro Area (also the Executive Director of the League of American Bicyclists) assisted the BAC in drafting HB 957.”xii
The Bicycle Helmet Environment And Existing Efforts:
Bicycle helmet promotion was occurring in a variety of ways in Maryland in advance of the adoption of the state law. Some of this activity appeared to be fueled by the legislature’s consideration of the law. Another factor was a new source of funds supporting a variety of efforts to increase bicycle helmet use and increase bicycle safety.
“During the years while the legislation was being considered there was increased interest in promoting helmet use,” noted a former injury prevention program official. For example, “that’s when Cycle Across Maryland (CAM), a bicycle touring event got interested in giveaways. I don’t think CAM had giveaways before then.”
The CDC grant funded a wide range of activities. One aspect sought to compare school-based bicycle education to community-based bicycle safety/helmet wearing programs in their effectiveness in encouraging children’s bicycle helmet use. A school-based program, “Bicycle Safety Education Program” (BSEP), was developed and pilot-tested, designed as a curriculum enhancement for fourth graders. Mini-grants to conduct community-based bicycle safety/helmet wearing programs were provided to several local health departments, some of which were in counties also implementing the BSEP. Bicycle helmet use was observed in one county that used the BSEP alone; three counties that used the community-based bicycle safety/helmet wearing programs alone; two counties in which both programs were used; and two counties in which neither were used.xiv As part of this program, local health departments distributed small numbers of bicycle helmets on the basis of need.xv
One observer noted: “I don’t think there was a lot going on before BAC and the CDC grant trying to move this law forward.” Also, “before the state law was passed, county laws had an impact as well as the fact that CDC and the state injury prevention program were focusing attention on the issue. I was living in Howard County at the time. I know that the county law made an impact. Local SAFE KIDS coalitions were doing some helmet education, etc. But bike helmet use was not a major focus of the statewide SAFE KIDS coalition. They focused more on child safety seats and buckling up. They did support the legislation.”
Another BAC member remembered there were “a tremendous amount of giveaway programs. A lot of police had helmets in their trunks; groups gave them away by the gross.” According to the state health department’s final report on the CDC program, a total of 9,640 bicycle helmets were distributed through various mechanisms over three years.xvi
“There were bike rodeos. And it’s still happening to a lesser extent,” said one BAC member. “Safety groups were giving them away; you don’t see as much of it now,” although perhaps one reason for that is that “almost every store has a good line of bike helmets, offered alongside the bicycles. I don‘t know” if a giveaway bicycle helmet effort is as productive as it was before.
Additionally, as mentioned earlier, one state activity involved investigating if education programs alone made a difference in bicycle helmet use, through the three-county study (where usage rates in the county with an education program did not increase as much as rates in the county with the bicycle helmet use ordinance).
John Overstreet, who provides bicycle safety presentations to schoolchildren, was cited as doing “a tremendous amount” to promote bicycle helmet use. He educates thousands of children in bicycle safety every year and has been doing so for about 25 years.
“I pass out helmets in my bicycle safety presentation in my classes and have kids do posters or essays to win,” Overstreet said. “I show them hand signals, talk about bike safety,” such as how to identify an unsafe bike, the risks of wrong-way riding, the importance of keeping shoe strings and other hazards from getting caught in the bike. Children at his presentations do not get a bicycle helmet until they go through an education program.
Overstreet gives presentations to up to 6,000 children a year. He volunteers his time with the state reimbursing him only for his travel and for the bicycle helmets. Overstreet’s efforts predate the county and state laws. He took part in the effort to pass the Howard County ordinance.
The Legislative Process:
BAC activity and support alone was not enough for the bill to progress through the legislature. The resources of the BAC and the commitment and organization of its members were identified as one key to success. The BAC “had to walk a fine line, and be advocates, not lobbyists,” according to one BAC member. Another emphasized: “a lot of us (on the BAC) couldn’t lobby because we were state employees.” This section will describe how other players and participants would be vital for the next steps.
The Legislative Process:
“Lots of different people were involved, the bicycling community, all that,” said one bicycle helmet advocate, “but one of the turning points, to me, was when we involved the person who was hired by the Maryland chapter of the American Academy of Pediatrics (AAP) and the person working for the Epilepsy Association of Maryland.
“Their lobbyists worked toward this goal; their influence with the committees and their work with the legislature was the turning point to get this bill passed. They taught the BAC what they needed to do to get support for the legislation,” such as compiling packages of materials. “The lobbyist for the AAP knew all the people, and who to talk to. She made a lot of difference in it. Without the partners, I think it would have been tough to pass.”
“We didn’t need a big group to move the law forward,” said another activist. We “had a small group that became amateur lobbyists.” This same activist described grass roots activities helpful in getting legislative support, such as a post card campaign. Groups supporting the bicycle helmet use law sent out post cards asking people to contact their legislator in support of the law. Since “bicyclists are organized,” mechanisms were in place to locate bicyclists and urge them to act. “While you’re on this ride, why don’t you sign this letter?” was one example offered.
Additionally, a statewide symposium was held about the law that attracted representatives from many counties, demonstrating broad support for the bill. It was especially important in illustrating that the support wasn’t solely in large urban areas. These types of activities were undertaken, the activist explained, because “politicians had to be assured that they had support for the law.”
The medical community, especially emergency medicine, was very active and persuasive. One BAC member said the effort took off once they “brought the doctors in.” He said emergency medicine professionals “came out real, real high on it.” Confirmed another: “This community was deeply involved in promoting passage.” They were “definitely part of the whole.”
Children who were associated with the Epilepsy Foundation handed out materials to legislative offices, using data and educational materials from the state health department. Insurance companies and retailers who sold bikes and helmets also received credit for their support. One proponent pointed out that the retailers “had discount programs (to lower the cost of the bicycle helmet to the buyer), so it wasn’t just that they would make money from this.”
Outside Groups and Efforts.
Activities inside the State House were joined by efforts outside the state house. The Center for Disease Control (CDC) grant mentioned earlier supported media activities, including a Office of Injury & Disability Prevention/Department of Health and Mental Hygiene (OIDP/DHMH) and Cycle Across Maryland joint media campaign, which began in April 1994. The campaign theme was “Protect Your Melon…Wear Your Helmet…Correctly.” The program distributed sport bottles, buttons, bumper stickers and labels, a guide to bike rodeos, bicycle safety brochures, and bicycles.
The first year’s efforts included ten billboard displays, a news conference announcing the distribution of 3,000 bicycle helmets statewide, and the production and airing of public service announcements (PSAs). These efforts continued into and beyond the year in which the legislature ultimately adopted the state law.
“We talked about what would happen with and without a helmet. We had bumper stickers. We did PSAs. We had a campaign called Protect your Melon campaign. We used a watermelon and put a helmet on it,” said one advocate. The melon was dropped and it didn’t break. The program “talked about how to properly wear a helmet, keep the straps straight, make it as bright as you could,” remembered another activist.
Bicycle helmet use law proponents also approached the legislative hearings strategically, carefully considering who would testify and their messages. Although many members of the BAC did not have direct contact with the legislature because they were state employees and didn’t lobby, some were very involved in setting up the panels of witnesses and providing relevant data to legislators.
A panel of medical people might precede a panel of bicyclists who supported the bill. Using these panels, proponents would have five people at the table testifying at a time, which could quickly convey the breadth of support for the bill. For one “health” panel, the head of the Maryland Institute for Emergency Medical Service Systems brought a broken helmet to the hearing.
A DHMH document reported on the 1994 session: “Favorable testimony was heard from members of both the public and private sector and included the following: members of the BAC, bicycle clubs, the American Academy of Pediatrics - Maryland Chapter, the Epilepsy Foundation, Maryland Institute for Emergency Medical Service Systems, the Montgomery County Police Department and the Johns Hopkins School of Public Health. Supporting testimony was given by DHMH and the Department of Education. The (state) Department of Transportation did not take a position.” Other witnesses included a representative of the Montgomery County Health Department.xix
According to one injury prevention professional, it is also “important to have victims, as much as one hates to do that. But it works; people have to see this (the impact of a traumatic brain injury); it puts a real face on it. It makes a real difference. Legislators do have soft hearts in some cases, when you get children up there who were seriously brain damaged.” One of the witnesses was a child who had had “a fabulous future,” a very bright child who had received a substantial scholarship, but then had suffered a severe brain injury in a bike crash. Before the crash, the child had asked his father for a bicycle helmet and his dad had responded: “I didn’t have one, you don’t need one.” Once injured, the child not only lost the scholarship and was facing a life of vastly diminished potential, but his father eventually abandoned the family, reportedly out of guilt. That testimony was described as extremely moving for everyone at the hearing.
Process - Role of County Laws.
Many proponents believed that the existence of the three county bicycle helmet use ordinances was key. “The fact that these three jurisdictions passed the law really influenced the state,” said one bicycle helmet advocate. The local laws helped. It would be hard for legislators from those areas to vote against what was clearly supported locally,” said another proponent who worked with the legislature to pass the law. One activist who worked on passage of both a county and the state law added: “I think it helps, it builds credibility. The state doesn’t like to be the first in doing something. It certainly had to help at the state level that we had the law (at the county level).”
Process - Motorcycle Helmets.
One complication to the legislative process was the state’s recent enactment of an all-rider motorcycle helmet use law, which had some extremely vocal opponents and was subject to a repeal effort around the time that the bicycle helmet use law was being considered. “At that time there was an awfully big fuss to repeal the motorcycle helmet law, so we were in a context where it was not just bicycling and bicycling safety that was going on,” said one bicyclist. The motorcycle helmet effort was receiving “a fair amount of press, and there had been at least three years of major effort on each side of it (the motorcycle helmet use law). We were coming in on the end of it.”
When the BAC “decided to go for” the bicycle helmet use law, as one BAC member remembered, “they got into motorcycle helmets, seat belts. Some of the same people who were testifying for (bicycle) helmets on kids were against motorcycle helmets. We had to stop using the word bike, needed to use bicycle” because of the confusion with motorcycles. Bicycle helmet advocates had to factor in these political considerations in their strategies, in developing materials, and when discussing the issue with legislators.
Arguments in Favor of the Bill.
A constellation of arguments were cited as being persuasive to legislators:
Additionally, during consideration of the bill, the tragic death of a child in Baltimore who wasn’t wearing a bicycle helmet helped to convince some legislators.
When asked about the importance of statistical information in moving the bill forward, one expert said, “It’s the advocacy groups and the partners that get it passed. The data – you need it but it wouldn’t have carried it, in and of itself.”
One argument that “we were told to say” was that in moving forward on this issue, Maryland would be one of the leaders in the country but “how much of an influence that truly has, I don’t know,” said one skeptical activist.
Opponents and Arguments Against the Bill.
One BAC member advised: “Make sure you deal with your opposition. The legislature does not want to make one group happy by angering another.” One key factor was assuring that “the cycling community for the most part was in agreement” or at least not uniformly opposed. “As long as we didn’t go after adults, cycling enthusiasts didn’t have a problem with it. They had rules requiring helmet use (in their clubs) but they didn’t want the state telling them they needed it.” Therefore, “there was very little opposition by the time we passed it. No one came and said this is a bad idea, don’t do it.”
However, another advocate remembered a variety of legislative opponents, such as the legislator who commented that a group of nurses supporting the bicycle helmet use law were “like Hitler,” or the chair of a committee that was one of “the stumbling blocks.” As one advocate put it: “Injury prevention programs had a difficult time getting out of his committee.”
But this was a concern that was easy to address because bicycle helmet use law promoters had already recognized and moved to meet this need. “We had a mechanism to deal with low-income communities. We had a giveaway program, a subsidy program, educational materials, and data. It was multifaceted; everybody was working together to make this happen. We had to write up and give to the legislators our plan to show that we will deal with children in low income areas, that we had money dedicated for this, had discount programs, etc.,” to assure the legislators that if the law was passed, “we would get helmets out to the community,” said a former injury prevention program official.
Although some had hoped to get the support of educators, “we couldn’t get school groups behind this. They thought they would be the ones who would have to enforce it. There was resistance to kids bringing bikes to school, so then schools would have to deal with storage, theft, etc.,” said another BAC member.
Bicycle helmet use law activists described the legislative experience as routine or expected. A list of “building blocks” was developed to describe the key steps and strategies needed (See Box 4 below).
MD Box 4
Phase-In To Implementation:
The Maryland bicycle helmet use law was signed into law in May 1995 and became effective in October 1995. “There was a lot of activity (to promote bicycle helmet use) once the law passed,” according to several bicycle helmet use proponents. The state highway administration used National Highway Traffic Safety Administration (NHTSA) 402 highway safety grant funds “to purchase helmets which they gave away or gave to people to give away several years ago,” said one BAC member. “They may still be doing it for all I know.”
Activities funded under the CDC grant included the display of 10 billboards throughout the state with language publicizing the bicycle helmet use law, supported by corporate sponsors (First National Bank of Maryland and Value Food Markets). The “Protect Your Melon” message appeared on a Greenspring Dairy milk carton.
The state received federal preventive block grant funds, which it sent to local communities to fund injury prevention programs; these activities can include bike helmet promotions.
One BAC member remembered “a lot of different individual efforts. Cycle Across Maryland
Law enforcement officers preferred to use a positive approach, so some officers distributed McDonalds’ certificates for free food items to children who were wearing bicycle helmets.
Some of these efforts are still continuing, such as safety fairs that include bicycle helmet fittings, giveaways, and coupon programs. The federal funds are still being distributed to local jurisdictions by the state, according to an injury prevention expert. For example, one police officer said: “Personally, I’ve given out many helmets. Last Sunday we did a bike rodeo and gave out 25 or 30 helmets. I never give out helmets without educating and fitting the helmet. We do an educational thing before we give out the helmets.”
One community, however, that apparently is not involved in promoting or implementing the laws is the education community. Given that it is a state law, one volunteer “tried to get the school board to pass a rule to require helmet use when riding on school property and riding to school” but was not successful. A former BAC member noted, “You still don’t see pressure from schools to wear a helmet.” However, the final report on the CDC three-year grant activities reported an enthusiastic response from a number of school districts for the “Bicycle Safety Education Program” (BSEP), curriculum enhancement.xxi
As part of the CDC three-year grant, the BAC, in cooperation with the Office of Injury and Disability Prevention (OIDP), mailed the BSEP to every Maryland public and private school as well as to all preschools that offered Kindergarten-level classes.xxii
Under the Maryland law, police officers are not able to cite a child who is not wearing a bicycle helmet while bicycling. The law allows them to issue a warning and provide educational material. One law enforcement official explained that the law was “not written for enforcement but as an educational law. The law is intended to educate children and parents that you’re supposed to be wearing helmets. If a child takes home a warning, it may bring attention to the parents” about the need for the child to wear a bicycle helmet.
Just as the legislature found it difficult to accept the image of officers giving tickets to children, law enforcement officers don’t think the general public would accept strong enforcement of the law. This same officer believes: “the perception would be the problem here in Maryland. I don’t think the public would appreciate officers giving children tickets. If it was an all-rider law, then it may be acceptable to issue tickets and we would see more enforcement.”
One police officer said: “As far as enforcement of the bicycle helmet law, I don’t think we’ve been really strictly enforcing the helmet law. Usually I threaten, but more of what we do is educate. I’ve probably educated hundreds of kids and given out thousands of helmets, thanks to SAFE KIDS.”
One observer believes that some opportunities to encourage enforcement of the new statute were missed. “After the law was passed, the health department disappeared” from participating in the law’s implementation. “They were helpful in getting it passed, but not in implementing it. And police have so many other issues to deal with,” and thus little enforcement occurred.
Few police departments appear to be making enforcement a high priority. One state safety official added: “I’m not aware off-hand of any police departments that are really enforcing this.”
Others say that it’s more a matter of different jurisdictions’ approaches to enforcing the state law. For example, “the Montgomery County National Capitol Park Police unit has a very active program. They get (the bicycle helmet use rate) up” on park property, according to one knowledgeable observer.
The National Capitol Park Police in Prince George’s County have a volunteer program and one volunteer “did a wonderful video for kids; it was articulate, concise, easy for kids to understand the proper use of helmet and why. I know there are strong programs for the Park Service, but beyond that in individual counties, I can’t tell you. I know some officers who are very vigilant” about enforcing the law.
Some bicycle divisions in some police departments “take it on. And if a child is injured or killed, that particular law enforcement agency gets inundated by parents, and then they do something.” However, implementing the bicycle helmet use law “is not up high on the priority list of police chiefs because they can’t enforce it.”
Whether warnings, educational materials or citations are the tools used, some bicycle helmet use law supporters believe more enforcement of the law should occur. In the words of one activist: “Enforcement of the law is probably lacking. I’ve never heard of anybody being stopped. I don’t know what education is being done that the law even exists. My suspicion is, if anything, they’ll stop someone and say you should have a helmet on. I’ve never really seen them go out of their way to stand at a street corner and hand out education materials. If something needs more looking at, it’s enforcement of these laws. If there was a presence where you started getting verbiage on the news, ‘did you hear about the cop that stopped that cyclist on the path?’ maybe you’d start seeing better behavior overall, not just helmets.”
The “educational materials about bicycle helmet use” that officers are to provide to offenders received different reviews. After passage of the law, sources of educational materials included NHTSA products distributed by the Maryland Department of Transportation and SAFE KIDS coalitions, and other materials used by the Maryland Department of Health and Mental Hygiene. “When we did that first big blitz, we gave materials to CAM, SAFE KIDS had materials, the health department gave grants,” said one BAC member. “We had T-shirts and involved the bicycling clubs.”
The state transportation department has distributed bicycle safety materials since before the passage of the bill. The bicycle safety packets that the department has “distributed in the thousands” includes “three NHTSA brochures that have been reproduced, on the benefits of helmet use, information on how to properly fit a helmet, and tips for safe cycling for children,” according to a state transportation official.
Those brochures go out in the bicycle safety packet (which now also includes pedestrian information), which is distributed “to schools, police departments, service groups, churches, whoever requests it.“ However, the office distributes materials only by request. Additionally, “each county has a transportation safety coordinator; 23 counties plus Baltimore. Those people work with police departments, schools,” informing them about the law, available materials, and other issues, “so I'm sure the word has gone out. We get a lot of calls from police departments requesting information.” Law enforcement agencies “are also conducting safety rodeos for the kids.”
According to a state injury prevention activist, “the educational material varies from department to department, from officer to officer.”
The bicycle helmet use law and its enforcement is not specifically targeted when state police officers are trained; it is covered in general training as part of motor vehicle laws.
One state police officer was apparently unaware of the educational materials distributed. “We’re supposed to hand out educational material with the warning; but I have been on the job 16 years and have yet to see the educational materials.” The statute calls for educational materials but “doesn’t explain what type, who is supposed to supply it.” However, since much of the enforcement by the state police takes place on Interstate highways where children will not be bicycling, the officer acknowledged that the experience of state police might be less relevant than that of local police departments.
Although some bicycle helmet proponents were dissatisfied with the low level of enforcement of the law, they believed it did not outweigh the law’s positive benefits. “The biggest thing (about having the law) was that the parents could tell kids, ‘hey, you have to do it because it’s the law.’ It assists the parents.”
One bicycle helmet advocate believes the educational approach and availability of free or subsidized bicycle helmets should mitigate officers’ concerns about issuing warnings. “If we are buying helmets, and the police are helping to fit the helmet on the child, how could the parent be mad?”
Effectiveness Of The Law:
The state law did not define effectiveness, nor require the tracking of the law’s implementation or other aspects of the law. The final report on the CDC project included some statistics on bicycle-related head injuries in 1994 and 1995, but did not have 1996 data. The report provided data from the Maryland Department of Transportation on bicyclist fatalities (See Table 1, below.) The report states: “It is interesting to note that the apparent decline of fatalities in Maryland generally corresponds with the peak of program activities.”xxiv
MD Table 1
A Montgomery County safety expert used anecdotal information to point out that of the three biking fatalities in the county in 1998 and 1999, all three were adolescents and none was wearing a bicycle helmet. Efforts to acquire additional data, however, were unsuccessful. State officials stated that the health department does not currently measure bicycle helmet use nor track bicycle-related head and brain injuries. The state’s motor vehicle crash statistics do not capture information on helmets on bicyclists in their reports. No expert questioned could provide statewide statistics or studies in these areas and most were unaware of the report done for the CDC cited in this profile.
According to a state transportation official: “I’m not aware anyone has done a formal survey, either of helmet use or reduction of injuries. I know the health department has discussed it, but I’m not aware that they have ever done a formal survey. I’m not aware of any other source of information.” A member of BAC said: “I’m not aware of any evaluation or implementation that’s going on around the state. I’d be interested if you were finding any.”
A state injury prevention program employee says that the state does “collect some statistics” and “we also rely on CDC and NHTSA information. Our office does not collect information on helmets . . . we only have one epidemiologist” who relies on NHTSA data on bicycle helmets.
One injury prevention expert says that proving that a bicycle helmet use law is decreasing head injuries is a difficult challenge because “usually head injuries are a relatively small number. If kids fall and hit their heads and they’re fine, you don’t hear anything about it, you can’t get a hold of those statistics. Even if a child has a minor injury with a helmet, you don’t hear about it. We don’t collect doctor visits or (emergency) ER visits. A person has to be injured enough so that they are admitted to the hospital. We use helmet use as a proxy for it, because of the Washington state study,” referring to the 1989 report by Thompson and Rivara that found bicycle helmets reduce the risk of head injury from a bicycle crash by 85 percent.xxv
Another expert concurs that Maryland experiences “fortunately a tremendously low number of bicycle fatalities” annually, increasing the difficulty of measuring before-and-after changes to bicycle crash deaths due to the law.
Another offered this opinion: “As I look around the neighborhood, more and more kids are wearing them, so it is getting out, I think that parents are getting the message that kids should wear them. It’s more acceptable, there’s more understanding, more peer support.”
One bicyclist considered effectiveness in terms of the number of bicycle helmets that are sold: “I think that sales were pretty good.” The message about the law “must have been through the vendors and got to the parents.”
The same activist, self-described as “not a real proponent of the law originally,” added: “It’s very clear to me that it’s very effective. I think it’s highly successful with children. I see a lot of helmet use and it’s rare for me to see a child without a helmet now. Something did happen. I see helmets on kids in rural areas where I least expect it; helmets on kids using training wheels, when they’re just going up and down the driveway. I’m always impressed when I see it and glad that it happened. There was an impact. I think it's promising.” Several observers also pointedly noted with frustration that frequently they observed “a child in a helmet biking with an adult who is not wearing a helmet”.
One state official believes: “My personal opinion is no, the law is not effective. It’s like bicycle safety courses: people interested in going to those are interested in safety to begin with. The people who are not safe riders are not going to be going to safety courses. I think people who want to wear helmets will do so whether there is a law or not. I don’t think anybody’s wearing it because of the law.”
The reason he believes that the law is not effective is that it “has no teeth; by that I mean no ticket, just the educational materials.” This official believes the law “had a minor impact on bicycling children,” based on “over-the-dashboard” surveys, but the impact was not greater because, citing an often-raised argument, “most police we have spoken to don’t want to get involved in giving a ticket to a child.”
One injury prevention expert also has doubts about the bill’s impact. “In jurisdictions that care about it, like Howard County and Montgomery County, I’m sure helmet use has increased. But we’re looking at two jurisdictions where – with their socioeconomic demographics, the educational level of their population – with an educational program we would probably have gotten about 50 percent compliance already (without a law). An awareness campaign has gotten them where they are.” However, as the three-county Maryland study mentioned earlier found, bike helmet educational efforts were much less effective in increasing use than an ordinance.xxvi
Factors other than the bicycle helmet use law were mentioned as contributing to increased bicycle helmet use, complicating efforts to isolate the law’s impact on bicycle helmet use. Influences mentioned included a national effort to link bike sales with bicycle helmet sales and design changes to bicycle helmets that made them “a little cooler so public resistance (to wearing bicycle helmets) went down.”
Another activist noted: “Between the time since before these laws started to get passed and now, ten years later, you see a change in behavior. You see helmets on kids in articles, on TV, sold in stores, easy to find, many adults find them. Not as many kids are wearing them as you’d like, but it’s much more acceptable than it was. I think the law is a marker for bigger awareness. It’s hard to tell if it came from SAFE KIDS or CDC putting an effort out there, but more attention does seem to be paid to it. People are realizing it is politically incorrect to show a person on a bicycle without a helmet on. That’s a change that we’ve seen in the last ten years.”
These changes, which may be partly due to the law, raise the challenge of how to identify the impact of the law on increases in bicycle helmet use versus increases due to other reasons such as a change in acceptability and culture. Another potential indication of a law’s effectiveness may be an indirect one: if its approach is expanded or adopted in other areas. Recently, the Maryland legislature extended the helmet use requirement to children using scooters and in-line roller skates. Some bicycle helmet use law proponents cited this step as proof of the law’s effectiveness and the growing acceptability of using bicycle helmets.
The state, according to a BAC member, “just passed a scooter/rollerblade helmet bill which will go into effect next October for those 16 and under. Scooters weren’t even in when we were working on the helmet law. Had bicyclists not had (the bicycle helmet use law), rollerbladers wouldn’t have gotten it.” In the words of another activist: “The bike helmet law made it possible this year to pass scooter helmets and in-line skating helmets.”
Several activists, in general agreement that the law is effective (but not without flaws), also expressed concern that acceptance of bicycle helmet use in childhood does not necessarily translate into bicycle helmet use as a teen or adult. “I hear kids saying, boy when my head gets hard enough I won’t have to wear the helmet,” said one. After noting the generally high use of bicycle helmets by children, another activist said: “How that translates to teenagers, teens probably still don’t think that’s a good idea.”
However, one long-time bicycling activist’s “hope is that, with the kids who are born now, it will be in their peer pressure groups to wear a helmet. The highest usage right now is in the age group of around seventh grade, whereas mom and dad behind them are not wearing their helmets. It just took the right time, like seat belts. Compliance for seat belts is up to 80 percent. When it first started, it was 10, 12 percent. Everybody under 25 years old today grew up wearing seat belts and that generation will have higher use of seat belts.”
A variety of observers expressed interest in evaluations of the bicycle helmet use law and more information about the impact of bicycle helmet use on head and brain injuries, the bicycle helmet use rate and other related factors. However, existing evaluations, other than the report compiled for CDC, could not be located.
That report’s comments on evaluating its program included: “The question of how to evaluate the program cannot be separated from resource issues. The Bicycle Injury Prevention Program’s principal evaluation focus was observation of helmet wearing . . . Systematic qualitative follow-up should be strongly recommended and/or mandated in future Cooperative Agreement activities.”
The report also stated: “Any project is only as strong as its weakest or least controllable links. Although collaboration with agencies and organizations must incorporate a significant element of organizational trust, critical tasks should be directly overseen by personnel from the lead agency (in this case, Office of Injury & Disability Prevention/Department of Health and Mental Hygiene. This does not always ensure quality, but enhances its likelihood.”xxvii
In addition, the report indicated: “The principal legacy of the program is Maryland’s bicycle helmet law. The interest in bicycle safety and helmet wearing programs which both preceded the program and that which was generated as a result of CDC funding in this area fostered an atmosphere which was conducive to the passage of legislation in this area. CDC funding and the associated technical assistance also enhanced OIDP’s knowledge base and its ability to provide technical assistance to state and local officials.”xxviii
A common reaction, when asked for evidence demonstrating the impact of the state-level bicycle helmet use law, was to refer to the 1992 study that compared bicycle helmet use in Howard County to that in two counties without an ordinance.xxix The implication was that adequate proof had been put forward to support the state law through that three-county comparison. No new information (from either the national level such as NHTSA or from other jurisdictions) has emerged to contradict support for bicycle helmet use and use laws. (One state employee said: “There was an underlying assumption that it (requiring bicycle helmet use) is a good thing.”) With no indications to the contrary, bicycle helmet use law supporters did not focus on using their limited resources to evaluate the state law.
But, when asked, most activists agreed that there “should have been a better plan for evaluating the law.” One BAC member said: “There was discussion about it but I don’t think it went anywhere. The biggest talk was to come back later and see if there was interest in having the adult law passed.”
Another said: “I would like to see us do some important things that no one is doing; we’re not doing enough evaluation and review . . . We need to have a better sense” of how programs and policies are working. “How do we know it’s good? We need better data than we have right now on a lot of this stuff.” Policy discussions about bicycling in the state are “getting way too much into ‘gotta change the state highway administration, gotta change this attitude, gotta change that.’ It would be interesting to evaluate the law in Maryland” because it would help to shape such discussions.
One state employee said: “There was some consideration by the health department at some time (to conduct an evaluation), but nothing state-wide as part of the law. Once the law was passed, no one really owned the law to be responsible for its implementation.” A former state employee attributed this lack of involvement to the loss of grant funds.
An employee of the state injury prevention program agrees that evaluation would “rightly belong in our portfolio to be the custodian, and to evaluate. But with the constraints of the department, we are limited to educational and advocacy efforts, we must prioritize our needs.” The program faces both financial and staff constraints. “We have a small office of three full-time state employees and some part-time interns from the University of Maryland (U-MD).”
With those limited resources, “what the office does is to continue pushing helmets through county injury coordinators in the counties. We do lots of education for the public when we have the opportunity to do so, when we see a unique opportunity to do so. We also testify in the legislature when such bills come up.” For example, the office testified about the bill to require helmet use for scooters and in-line skates.
“We work mainly through the injury prevention coordinators. There are 24 of them, one in each county plus Baltimore city. We give them information on bike helmets, we also sponsor mini-grants whereby counties apply competitively for small amount of state public health money. For those that succeed, we give them $2,000-$4,000. Almost every year, somebody does something on bicycle helmets. Those are our foot soldiers in Maryland with the public. Working with the injury prevention coordinators and then testifying in the legislature, those are the two main ways that we use to advocate for helmets.”
To evaluate the bicycle helmet use law, the state injury prevention staff would need “mostly financial resources and staff; if we have the money and personnel I can see us conducting such a study,” the employee said. One observer stated: “People in the state injury prevention office only work on projects on which they are grant funded. It doesn’t matter what other issues need to be dealt with, if their staff isn’t funded to work on the issue, it doesn’t happen.”
Another injury prevention expert said conducting an evaluation would be challenging. “I think you’d have to fund an observation study; I don’t know how easy that is to do now. You’d almost have to do an observation study, stop somebody and ask, ‘why did you wear a helmet?’ ‘Did you know this was a law?’ ‘Did your mother make you wear it?’ Maybe do a focus group.”
A state transportation department employee said: “Off the top of my head, I’d say there would have to be some interest in doing it by the people running the departments. There’s not a whole lot of interest in doing it . . . Nobody’s enforcing the law. As much safety information as we’ve sent out, people ought to know they need to wear a helmet, but people aren’t wearing them. If there had been interest, I think we would have done it by now.”
Observers had a variety of comments on how to more effectively support bicycle helmet use in Maryland, as well as on broader bicycle safety and bicycling issues.
On the need for follow-through and evaluation:
On the penalties and enforcement:
Discussion of enforcement was not limited to the lack of penalties in the bicycle helmet use law:
Non-legislative issues were raised that respondents felt were as important to bicycle safety as the state law and its implementation. When the goal is solely increasing bicycle helmet use, other problems may emerge as a result of that single focus. For example, several observers were concerned about bicyclist visibility and even helmet color. Echoing comments made repeatedly, one BAC member said: “I’ve had people complain to me that all the helmets sold today are black. We should make it illegal to have black helmets. We should make helmets visible. It’s good that helmets are getting more and more comfortable. Comfort and style have historically been too much overlooked because of safety. Safety doesn’t sell.”
One bicycling activist, though a supporter of the bicycle helmet use law, believes that bicycle helmet use needs to be considered in a broader context of safety. “We have to be careful not to be putting too much emphasis on helmets when we talk safety, when it may be civil engineering that needs to be safer . . . potholes and barriers won’t get addressed.”
A long-time bicyclist and safety advocate sees a new and improved focus on safety and bicycling which will change the issues addressed: “A new breed is coming in (to the transportation and highway safety community) -- now more committed. It used to be that the bicycle was thought of as a toy, it shouldn’t be on the street. Our aim all along was to make the bike part of the transportation system,” which is now beginning to happen. In the past, “We did it as a civilian-type thing,” relying on a cadre of volunteers. “Only now it’s moving into a professional direction, being taken to a professional level.” It’s “tough to get things moving” when relying only on volunteers. Sometimes it is easier to get things done when efforts are supported by professionals, whose job it is to represent bicycling, and by volunteers.
1The office that oversees injury prevention programs within the Maryland Department of Health & Mental Hygiene had different names during the period covered in this report. For consistency, it will be referred to throughout this report by its current title: The Office of Injury & Disability Prevention, or OIDP.
3The office that oversees injury prevention programs within the Maryland Department of Health & Mental Hygiene had different names over the time period covered in this report. For Consistency, it will be referred to throughout this report by its current title – the Office of Injury & Disability Prevention, or OIDP.