Bicycle Helmet Laws for Children
The purpose of bicycle helmet laws for children is to increase bicycle helmet use, thereby reducing the number of severe and fatal head injuries to children involved in bicycle crashes. A substantial amount of research has examined the efficacy of helmets for minimizing head injuries for bicyclists, and these studies have generally concluded that helmets are important for reducing head injuries. However, research has not reliably shown that legislation and enforcement of helmet laws consistently and equitably lead to increased helmet use.
Legislation effectiveness is enhanced when combined with supportive publicity and education campaigns or programs. See, for example, Rivara et al. (1998), Kanny et al. (2001), Rodgers (2002), and Sandt et al. (2015). The practical effect of bicycle helmet laws is to encourage parents to require their children to use helmets (and educate parents to serve as role models to wear a helmet).
Inequitable enforcement and ticketing must be avoided if helmet laws are enacted. Law enforcement and other safety officials can reinforce the need to wear a helmet through positive interactions, free, or discounted helmet distribution programs (combined with proper helmet fitting), or other positive incentives for helmet use. Publicizing helmet laws and child/parent education on helmet fitting and the importance of wearing a helmet every ride may enhance effectiveness. Educational programs have been shown to increase knowledge about proper use of helmets.
Mandatory bicycle helmet laws for children are in place in 21 States and the District of Columbia (IIHS, 2022). All of these mandatory bicycle helmet laws cover child bicyclists younger than 18.
Two systematic reviews found that legislation may be effective at increasing helmet use (Karkhaneh et al., 2006; Macpherson & Spinks, 2008). Two of three controlled studies reported reductions in head or traumatic brain injury following legislation (Macpherson & Spinks, 2008). The degree of improvement varied but there was a lack of evidence to determine whether enforcement, supporting publicity, and helmet distribution efforts explain some of the variation (Karkhaneh et al., 2006; Macpherson & Spinks, 2008). There was a non-significant trend toward a greater overall increase in helmet use in communities with laws covering all cyclists compared to those covering only children, and effects were larger among children (Karkhaneh et al., 2006). Dennis et al. (2010) also found self-reported helmet use was highest in a province with a law covering all ages, next highest in a province with a law covering children up to 18, and lowest in a province with no law. However, in a study comparing 10 years of injury data from the Trauma Registry database in localities with and without helmet laws for children, Williams et al. (2018) found no change in helmet use after new legislation but did note that communities with helmet laws had higher rates of helmet use among young bicyclists, though those communities generally also had higher incomes.
A survey of adults across the United States conducted by the CDC found that children who lived in States with child helmet legislation were more likely to wear a helmet (51% of respondents reported that their child always wears a helmet, and 21% self-reported their child never wears a helmet) than those in States that did not have a child helmet law (40% always and 35% never) (Jewett et al., 2016). In addition, the strongest predictor of child helmet use was adult helmet use. Parents who reported always wearing helmets were 40% more likely to report that their youngest child always wore a helmet than parents who did not always wear helmets.
The effectiveness of helmet legislation in reducing head injuries is challenging to assess because of the difficulty of controlling for other safety measures that may differ across jurisdictions, and for exposure to crashes of different severities across people in case control studies. Two studies from Canada have found somewhat mixed results. Karkhaneh et al. (2013) found that legislation targeting those under 18 had a beneficial effect on child, adolescent, and adult bicyclists hospitalized for head injury in the province of Alberta, Canada. Helmet use increased from 75% to 92% among children, from 30% to 63% among adolescents, and from 52% to 55% among adults (Karkhaneh et al., 2011). A national study compared trends in provinces with and without legislation. Despite lower injury rates in provinces with helmet laws than in those without, the effect could not be solely attributed to the introduction of the laws (Dennis et al., 2013). However, the study also found that one province that implemented a law covering all ages, not just children, did have a significantly lower injury rate trend for the period covered by the law.
A helmet law should be supported with appropriate communications and outreach to parents, children, schools, pediatric health care providers, and law enforcement. NHTSA has a wide range of material that can be used to educate and promote the use of a helmet every ride, demonstrate helmet effectiveness, and educate and demonstrate how to properly fit a helmet.
Time to Implement:
A bicycle helmet law can be implemented as soon as the appropriate legislation is enacted. Enacting local ordinances may take less time than enacting statewide legislation. To develop custom communications and outreach, train law enforcement officers on implementing the law, or start a helmet distribution or subsidy program in support of the law may require a medium-to longer-term effort.
- Inequitable enforcement: It is important to consider equity implications of the enforcement of helmet laws and existing disparities in helmet use by youth cyclists of lower socioeconomic status. In one study, which was limited to one urban elementary school, lack of access to bicycle helmets was the most cited barrier to helmet use (Pierce et al., 2014). As mentioned above, community-based interventions such as helmet promotion accompanied by free helmets have proven effective at increasing helmet use (Owen et al., 2011).