1.1 Universal Motorcycle Helmet Use Laws
Motorcycle helmets are highly effective in protecting motorcycle riders’ heads in crashes. Research indicates that helmets reduce motorcycle rider fatalities by 22 to 42% and brain injuries by 41 to 69% (Coben et al., 2007; Cummings et al., 2006; Deuterman, 2004; Liu et al., 2008; NHTSA, 2003; NHTSA, 2006; NHTSA, 2019). A Cochrane Collaboration review of 61 studies concluded that risk reductions were on the high end of the ranges mentioned above, with higher quality studies indicating that the protective effect of helmets was about a 42% reduction in risk of fatality in a crash and 69% for risk of a head injury in a crash. This review found that there was insufficient evidence to determine the effect on neck or facial injuries, or the effects of types of FMVSS 218 compliant helmets on injury outcomes (Liu et al., 2008). Others have found no evidence that helmets increase the risk of neck injuries (Brewer et al., 2013; NCHRP, 2008, Strategy E1; NHTSA, 2000; Philip et al., 2013; Ulmer & Preusser, 2003).
State universal coverage helmet-use laws are effective at increasing helmet use. In 2018 observed compliant helmet use was 83% across States with universal helmet laws that cover all riders, and 57% across States with no law or partial coverage laws (NCSA, 2019). A systematic review of U.S. motorcycle helmet laws found that States with universal coverage laws: (1) had motorcycle helmet use rates 53 percentage points higher than States with partial coverage or no law; (2) had 29% fewer motorcycle fatalities; and (3) had lower fatality rates per registered motorcycle and per vehicle mile traveled (Guide to Community Preventive Services, 2013).
Nationally in 2018, FMVSS 218 compliant helmet use was 71% (NCSA, 2019). Use of noncompliant helmets increased slightly from 7% in 2017 to 9% in 2018, while helmet non-use decreased slightly from 28% in 2017 to 20% in 2018.
Use: The first universal helmet law was enacted in 1966. Universal laws were in effect in 47 States and the District of Columbia by 1975. After Federal penalties were eliminated in 1975 for States failing to have a universal law, about half the States repealed their laws. Several States have enacted or repealed helmet laws since then. The IIHS (2019) summarizes the helmet law history in each State.
As of 2019 there were 19 States and the District of Columbia that had helmet laws covering all riders (IIHS, 2019). Three States (Illinois, Iowa, and New Hampshire) did not have motorcycle helmet laws. The remaining States had laws covering only riders under a specified age, typically 17 or 20. The motorcycle helmet laws of 30 States and the District of Columbia apply to motorcycles. Seventeen States have motorcycle helmet laws that do not cover certain low-powered cycles, typically those with engine displacements under 50cc or with maximum speeds less than 30 mph.
Effectiveness: Studies of helmet use among motorcyclists indicate that universal helmet use laws are effective in increasing helmet use, which reduces injuries, decreases hospital admissions and treatment costs, and lowers insurance claims. Studies in States that enacted universal helmet laws observed use rates of 90% or higher immediately after the laws became effective, compared to 50% or lower before the laws (Ulmer & Preusser, 2003, Section II). States that repealed universal helmet laws observed the opposite effect, as use rates dropped from above 90% to about 50% (Kyrychenko & McCartt, 2006; Preusser et al., 2000, Section V; Ulmer & Preusser, 2003, Sections IV and V). Injury severity and mortality rates increased in States that repealed universal helmet laws, with post-repeal rates similar to rates in States with partial motorcycle helmet laws (Striker et al., 2016; Wiznia et al., 2016). Carter et al. (2017) evaluated the impact of the repeal of Michigan’s helmet law by comparing motorcyclist fatalities, injuries, and helmet use rates over a period of 12 months before and after the repeal. Among riders involved in crashes, helmet use decreased 24% to 27% after the repeal. The decrease was sharper among alcohol-intoxicated riders, among passengers than operators, and among females than males. A 14% increase was observed in head injury trauma in hospitalized motorcycle riders. There was no change in overall fatality rates in the 12 months before and after the repeal. Reenactment of a universal law in Louisiana (after a cycle of repeals and reenactments since 1968) resulted in increases in helmet use among riders involved in crashes, from 42% before reenactment to 87% following (Gilbert et al., 2008).
The Community Preventive Services Task Force conducted a systematic review of 60 studies (through August 2012) evaluating motorcycle helmet laws in the United States. This review found that universal helmet use laws consistently increased helmet use and decreased injuries and deaths associated with motorcycling. Universal helmet laws are also associated with economic benefits at the societal level due to avoided productivity loss and healthcare costs (Peng et al., 2017). The Task Force concluded that universal coverage laws were substantially more effective than partial coverage laws or no law (Guide to Community Preventive Services, 2013; Peng et al., 2017). The U.S. General Accounting Office (GAO, now the Government Accountability Office) reviewed 46 studies of State helmet laws published before 1990. GAO concluded that motorcycle rider fatality rates were 20 to 40% lower with universal helmet laws (GAO, 1991; Ulmer & Preusser, 2003, Section II). Studies since 1990 confirm these results (Cummings et al., 2006; Houston & Richardson, 2008; Kyrychenko & McCartt, 2006; Morris, 2006; Ulmer & Northrup, 2005; Ulmer & Preusser, 2003, Section II).
Some States have helmet laws that mandate use for young riders. Helmet use is generally low in these States (GAO, 1991; Olsen et al., 2016), and these partial coverage laws do not translate into meaningful reductions in young rider fatality rates (Brooks et al., 2010; Houston, 2007). Additionally, Weiss et al. (2010) compared the risk of traumatic brain injury among youth in States with limited-age helmet laws and States with universal helmet laws. They found a 37% increase in risk of traumatic brain injury requiring hospitalization for youth in States with partial coverage helmet laws compared to States with universal helmet laws. A recent study of emergency department and inpatient records in 11 States (5 with universal helmet laws and 6 with partial helmet laws) reported increases of 2 percentage points in traumatic brain injuries in States with partial helmet laws compared to States with universal helmet laws (Olsen et al., 2016). Injuries to the head and neck areas were found to be lower and injuries to extremities higher in States with universal coverage helmet laws. Overall, the study concluded that helmet use was associated with reduced risk of head, facial, and traumatic brain injury, as well as motorcycle-crash related fatalities. However, this risk reduction was less pronounced in States with universal helmet laws than States with partial helmet laws. Another study reported a reduction in fatality rates among all ages for partial coverage laws compared to no law, but the effect was much smaller (7% to 8%) than that for universal coverage (22% to 33%) (Houston & Richardson, 2008). Moreover, when Florida eliminated the requirement that all motorcycle riders 21 and older wear helmets, there was an 81% increase in motorcyclist fatalities (Ulmer & Northrup, 2005). Fatalities even increased among riders under 21 who were still covered by the helmet law.
Hospital admissions and treatment costs have also increased following repeal of universal helmet laws (Derrick & Faucher, 2009; GAO, 1991; Peng et al., 2017). Almost half of all motorcyclists admitted to hospitals lacked sufficient health care insurance or were covered by government services, so the public ultimately shares many costs, as well as a greater long-term burden of care (Derrick & Faucher, 2009; GAO, 1991; NHTSA, 2019). In addition, an analysis of insurance claims data found that when Michigan’s helmet law was amended from a universal coverage law to a partial coverage law (effective since April 2012), claims increased by more than 22% compared with control States (HLDI, 2013). Medical costs related to motorcycle crashes are typically higher in States with partial helmet laws. Olsen et al. (2016) reported that median medical costs were 37% lower for emergency department visits and 21% lower for in-patient hospital charges in States with universal helmet laws. The Community Preventive Services Task Force found in their systematic review of 22 studies that universal coverage motorcycle helmet laws resulted in significant economic benefits (Guide to Community Preventive Services, 2013; Community Preventive Services Task Force, 2017; Peng et al., 2017). These studies show that universal coverage laws provide greater safety and cost benefits than laws that cover only a specific age group or riders having a certain amount of insurance.
Costs: Once legislation requiring universal helmet use has been enacted, implementation costs are minimal. The inevitable controversy surrounding the legislation will help to publicize the new law extensively. Motorcycle helmet laws can be enforced during regular traffic patrol operations because helmet use is easily observed.
Time to implement: Although a universal helmet use law can be implemented as soon as the law is enacted, enacting such a law is a complex and time-consuming process, and may require the involvement of a “champion.”
- Opposition to motorcycle helmet laws: Any effort to enact a universal helmet law can expect immediate, well-coordinated, and highly political opposition (NHTSA, 2003). Helmet law opponents claim that helmet laws impinge on individual rights. They also claim that helmets interfere with motorcycle riders’ vision or hearing, though research shows that these effects are minimal (NHTSA, 1996). See Jones and Bayer (2007) for a history of opposition to helmet laws in the United States. Derrick and Faucher (2009) also discuss national policy, organized opposition, and helmet law changes over four decades.
- Noncompliant helmets: Some riders in States with universal helmet laws wear helmets that do not comply with FMVSS 218 (NCSA, 2019). See the discussion in Appendix A5, Section 1.3.
- Compliance Benefits from Enacting Other Safety Laws: Helmet law compliance has been shown to benefit from the enactment and enforcement of other motorcycle safety laws. In 2007 existing motorcycle safety laws in Puerto Rico were augmented to reduce the legal BAC limit to .02 g/dL, and require motorcycle riders to wear protective safety apparel, along with other requirements. One benefit of the amended law was that the use of DOT-compliant motorcycle helmets increased, even though helmet laws already existed (Fell et al., 2017). From 2006 to 2007 Puerto Rico riders’ use of DOT-compliant motorcycle helmets rose from 39.4% to 56.4% and continued to increase to greater than 70% three years later. Observed DOT-compliant helmet use reached 86%, 4 years after the 2007 Puerto Rico law change.