Improper motorcycle helmet use in provincial areas of a developing country

Abstract

Motorcycle helmet wearing rates remain low in smaller cities in developing countries. We therefore examined the knowledge, attitudes, and behavior of motorcyclists towards helmet use in two mid-sized cities in China. The methods included roadside observation and interview. Observational sites were randomly selected from main roads and secondary streets; all motorcycles passing by were observed. Riders near the sites were opportunistically approached and asked about knowledge of and perceptions about helmet use. Altogether, 75,949 drivers and 17,230 passengers were observed. A large proportion of both drivers and passengers (34% and 71%, respectively) did not wear a helmet, or did not have their helmet fastened (34% and 14%). Proper helmet usage rates were lower among male drivers, younger people, on secondary streets, and during the evenings and weekends. The majority of the 2325 drivers interviewed (90%) acknowledged the benefits of helmet wearing, but 72% reported that helmets are not always comfortable, and only 20% said they would wear a helmet for preventive purposes. Furthermore, many felt that police enforcement was not strict (62%). These results suggest that educational programs about helmet use in provincial China should emphasize the risks of improper use. Strict enforcement, especially on secondary roads and during non-peak hours, could also improve helmet usage.

Introduction

Motorcycle injuries continue to be a considerable public health problem in many developing countries (Conrad et al., 1996, Odero et al., 1997). In China, the proportion of all traffic fatalities sustained by motorcyclists increased significantly from 7.5% in 1987 to 18.9% in 2001 (Wang, 1997, Zhang et al., 2004). The problem appears to be more serious in smaller cities and provincial areas where motorcycle use is higher (Zhang et al., 2004).

The safety benefits of protective helmets have been well documented with use associated with a 72% decreased risk of head injury in a motor vehicle crash (Branas and Knudson, 2001, Keng, 2005, Liu et al., 2004, Servadei et al., 2003). However, helmet wearing rates remain low in developing countries (Odelowo, 1994). A lack of helmet use has been reported by 31% of motorcyclists in Thailand, 46% in Malaysia, and 45% in Indonesia (Conrad et al., 1996, Kulanthayan et al., 2000, Pitaktong et al., 2004). Moreover, many riders in these countries may not wear a helmet properly. In Los Angeles, only 5% of helmets came off during a crash, whereas in Thailand, nearly one-fourth of helmets came off (Ouellet and Kasantikul, 2006). The problem was particularly serious on secondary roads; for instance, the odds of helmet use were 80% lower on small roads compared to highways in Greece (Skalkidou et al., 1999). These low helmet wearing and high improper helmet wearing rates could partially explain why 90% of motorcycle fatalities are seen in developing countries (Peden et al., 2002).

Evidence-based traffic-related injury prevention interventions for developing countries are a public health priority (Forjuoh, 2003, Mohan, 2004). It is therefore important to identify factors associated with the overall use and proper use of motorcycle helmets in provincial areas in developing countries in order to prevent and control motorcycle injuries more effectively. Hence, the purpose of this study was to examine the attitudes, knowledge, and behavior of motorcyclists in relation to helmet non-use in two middle-sized cities in the southern part of China. By identifying the gaps between knowledge and behavior associated with proper helmet usage, this study can provide evidence-based recommendations for the design of more effective educational programs about helmet wearing as well as enforcement of helmet legislation in provincial areas in developing countries.