Background The increased risky use of bicycles in China lead to growing bicycling injuries. We report the incidence of unsafe bicycling behavior and examine incidence differences across type of riders and areas cycled in.

Methods A video-based observational study was conducted to estimate the incidence of five unsafe bicycling behaviors in Changsha, China: not wearing helmets (A), violating traffic lights (B), riding in a direction opposite (C), holding the handlebar with one or no hands (D), and riding in a non-bicycle lane (E). Chi-square tests examined differences in unsafe cycling behavior incidence between shared versus personal bicyclists and across the area cycled in (commercial, university, office, or leisure areas). Logistic regressions quantified the association between unsafe cycling behaviors and both type of riders and areas cycled in.

Results The incidences of A, B, C, D, E were 99.28% (95% CI: 99.14%-99.41%), 19.57% (95% CI: 18.50%-20.64%), 13.73% (95% CI: 13.19%-14.27%), 2.57% (95% CI: 2.32%-2.82%), and 64.06% (95% CI: 63.16%-64.96%), respectively. Compared to personal bicycle riders, shared bicyclists had higher incidence rates of A and C (AOR= 18.97, 2.08) but lower incidence of B (AOR= 0.63) (p<0.05). Across the types of cycling areas, the university, commercial and office area had the highest incidence of A, C and B, respectively (p<0.05).

Conclusion Cyclists using shared and personal bikes were observed behaving in unsafe manners frequently, especially rarely wore helmets.

Learning Outcomes It highlights the unsafe cycling behaviors in urban China, and the high incidence of not wearing helmets are needed to be interpreted.