Background Motorcycles' riders have the highest public health burden. Since helmet reduces the risk of death by 42% to 69% it seems that the main contributing factors is improper helmet usage by motorcyclists.

Objective To determine the impact of safe community programme on motorcyclists' death and to the KAP of motorcyclists about helmet usage in WHO Safe Community model in Iran.

Methods At the first step motorcyclists' fatality data of 14 cities were extracted from the data bank in forensic medicine department, hospital records and death registry during 2006–2007. The second step was a cross sectional study on 10% of motorcyclists. Data were collected by interviewing and observing the motorcyclists' knowledge, attitude and behaviour independently. ANOVA method used to testing for comparison of safe community with none safe community.

Results In Khorasan province the highest death rate was reported from the Torbat-e-hydarieh city (None Safe community) and the lowest from Bardscan and kashmar cities (Safe community).Other two provinces (Busher, Fars) showed no differences between the two settings in terms of motorcyclists' death rate. No effect was detected in any of the three provinces on Knowledge, Attitude and practice of motorcyclists towards helmet usage. In spite of owning a helmet by 97% of participants the rate for helmet usage was only 13%. ‘Embarrassing, disturbing, heat generation, sight and hearing blockage were the main excused made by the motorcyclists for not wearing helmet’.

Significance This study stresses on mandatory helmet law enforcement along with public education as the most effective ways to raise helmet usage.