Law Effectiveness - Including Arguments and Issues

This section addresses the Effectiveness of All-rider Helmet Requirements.  All-rider helmet requirements (universal helmet laws) are enacted as a method to increase the percent of riders who wear helmets.

The complicated part with the use of the term “effectiveness” is that effectiveness is defined in multiple ways.  The clearest and simplest definition is in answering the question: “Do all-rider motorcycle helmet use requirements increase the percentage of riders who wear helmets?”  If the answer is “yes” then helmet requirements can be labeled as effective. Answering this question does not require complicated research designs.  Simply counting the number of riders observed on the road wearing or not wearing a helmet before and after the enactment or before and after repeal of an all-rider requirement, will provide the answer.

The research listed in this section indicates that in states where all-rider requirements (universal helmet laws) have been partially or entirely repealed, the rate of helmet use drops significantly. When all-rider use requirements are in effect, nearly ever rider wears some kind of helmet.  When all-rider requirements are repealed and replaced with a partial law requiring only some riders to wear a helmet, helmet use drops to approximately 50% or lower.  Additionally, it has been found that partial laws are not effective in that many of those who are required to wear a helmet under the requirements of a partial law do not comply.

The much more complicated definition of “effectiveness” relates not just to helmet use rates, but to the impact of all-rider helmet requirements on motorcyclist-related deaths, injuries and costs.  This definition of helmet reuirement effectiveness uses the same impacts used to identify the effectiveness of helmets.  It is the second step of a “two-step” definition.  Helmets use reduces risk of death and injury and reduces medical costs.  All-rider helmet use requirements  increase use, therefore an all-rider helmet requirement is effective in reducing the risk of death and injury and serves to reduce medical costs.

Most of the research reported here is of this second type, i.e. the impact of all-rider helmet requirements on motorcyclist death and injury and costs to society.

A few of the reports, while scholarly in nature and well referenced, lean more toward arguments for all-rider helmet laws or discussions of the issues associated with all-rider laws, rather than evaluations of the impacts of such laws.  We have done our best to separate those, have posted them at the beginning of this section but have decided include them here because they provide excellent summaries of other research and are often a good source for references to original research.

The “Impact of Repeal” section is an additional source of information regarding the impact of all-rider helmet requirements.

Please scroll down for the Motorcycle Helmet Law Effectiveness Research Studies.

All-rider Helmet Laws - Arguments and Issues Research Studies

2016 – “The Case of the Missing Motorcycle Helmet Mandates: Why has a Universal Motorcycle Helmet Law Not Been Passed in the U.S. Even with Strong Scientific Evidence that Supports such a Measure?”

The purpose of this report is to examine the main reasons for why universal motorcycle helmet mandates have not yet been passed in the U.S.  This report concludes that the values and objectives of motorcyclist associations, and the mobilized coalition that has resulted, are the main obstacles preventing the passing universal helmet laws. The report begins by presenting scientific evidence demonstrating that helmet mandates are (1) effective in reducing the risk of fatality and injury, and (2) tangibly increase helmet use.  Includes more than 65 references.

2016 – “Federally Mandating Motorcycle Helmets in the United States”

Although statewide universal motorcycle helmet laws effectively increase helmet use, most state helmet laws do not require every motorcycle rider to wear a helmet.  The authors propose and outline the solution of implementing a federal motorcycle helmet law, while addressing potential counterarguments. According to the authors helmet use fits squarely within the purview of the federal government for public health and economic reasons. Forty-four references.

2015 – “Preventing Head Trauma and Saving Lives: Universal Helmet Law in Texas”

The authors of this report state “it is important to recognize during the policy making process for motorcycle helmets, a public health problem is being addressed.”  The report provides a brief background and addresses social, economic, ethical and political factors related to an all-rider helmet law.

2013 – “Repeal of Michigan’s Universal Helmet Law: The Cost of Freedom”

Published in Thomas M. Cooley Law Review this article traces the repeal of Michigan’s all-rider helmet law, reviews the evidence related to the effectiveness of all-rider laws, and concludes “The (partial helmet) law will be detrimental to riders and citizens who will be responsible for the costs associated with accidents. At a minimum, the solutions proposed in this article will place some of the costs on the motorcyclists who choose to ride without a helmet. But reenacting a universal helmet law is the most beneficial solution for Michigan.”

2013 – “Mandating the Use of Motorcycle Helmets: What are the Issues?”

An easy to read seven page articles which provides a summary of the issues and argues from the point of view of medical professionals.  The authors argue that surgeons need to play a role in public policy decisions that relate to health care, including the debate over helmet laws. The authors noted that in any contract between medicine and society, physicians should provide expert advice to society on matters of health and public safety.

2009 – “Motorcycle Helmets and Rider Safety: A Legislative Crisis”

Abstract. The authors examine state motorcycle helmet laws in the United States, demonstrate their effectiveness, and tell how opponents have challenged their implementation leading to weakening or repeal.

2008 – “Motorcycle Helmet Laws: The Facts, What Can be Done to Jump-Start Helmet Use, and Ways to Cap the Damages”

Written by neurosurgeon and attorney, Melissa Neiman, we consider this extensively referenced report one of the best for providing background and coverage of the issues related to motorcycle helmet use and the impact of all-rider helmet laws.

2007 – “Paternalism and its Discontents: Motorcycle Helmet Laws, Libertarian Values, and Public Health”

During the past 3 decades, federal government efforts to push states toward enactment of universal helmet laws have faltered, and motorcyclists’ advocacy groups have been successful at repealing state helmet laws. This history raises questions about the possibilities for articulating an ethics of public health that would call upon government to protect citizens from their own choices that result in needless morbidity and suffering. We think this is an excellent article - only 10 pages.

Motorcycle Helmet Law Effectiveness Research Studies

2017 – Universal Motorcycle Helmet Laws to Reduce Injuries: A Community Guide Systemic Review

A total of 60 U.S. Studies qualified for inclusion in the review. Databases relevant to health or transportation were search from database inception to August 2012.  Analysis of the data was completed in 2014. The research concluded universal helmet laws are effective in increasing motorcycle helmet use and reducing deaths and injuries.  Repealing universal helmet laws decreased helmet use and increased deaths and injuries.

2017 – “The Effects of Motorcycle Helmet Legislation on Craniomaxillofacial Injuries”

Benefits of helmet use in motorcycle trauma patients are well documented. In 2012, Michigan repealed its universal motorcycle helmet law in favor of a partial helmet law. The authors describe the early clinical effects on facial injuries throughout Michigan. Compared with helmeted trauma patients, unhelmeted patients were nearly twice as likely to sustain craniomaxillofacial injuries including fractures and soft-tissue injuries.

2017 – “Long-Term Effect of Universal Helmet Law Changes on Motorcyclist Fatal Crashes”

In this study, the authors have attempted to explore the long-term impacts of repeal and reinstatement of Universal Helmet Laws (UHL) by using 13 to 16 years of data. The results showed that the UHL repeal still had significant negative effects on motorcyclist fatal crash counts even 7 to 12 years after the repeal of the law.

2016 – “Motorcycle Helmet Effectiveness in Reducing Head, Face and Brain Injuries by State and Helmet Law”

In this research medical outcomes were compared between partial and universal helmet law settings. Medical charges and rates of head, facial, and brain injuries among motorcyclists were lower in universal law states.

2015 – “Impact of North Carolina’s Motorcycle Helmet Law on Hospital Admissions and Charges for Care of Traumatic Brain Injuries”

Hospital admissions of North Carolina motorcyclists with traumatic brain injuries (TBIs) and associated hospital charges in 2011 were extracted from the North Carolina Hospital Discharge Data system. The authors estimated hospital admissions and charges for the same year under the counterfactual condition of North Carolina without a  universal motorcycle helmet law by using various substitutes (Florida, Pennsylvania, and South Carolina residents treated in North Carolina). The authors conclude “North Carolina’s universal motorcycle helmet law generates health and economic benefits for the state and its taxpayers.”

2013 – “Use of Motorcycle Helmets: Universal Helmet Laws: Summary Evidence Table – Effectiveness Evidence”

This is a table describing each of the separate research studies examined by the Community Preventive Services Task Force.  Each of the 71 studies with 78 study arms are described including authors, year published, intervention characteristics, population characteristics, outcome and summary. This is the “Cliff Notes” for reviewing 71 different research reports examining the effectiveness of all-rider helmet laws.

2013 – “Use of Motorcycle Helmets: Laws Mandating Use – Risk of Bias Assessment”

This is a table associated with the Community Preventive Services Task Force extensive review of the literature.  It presents an assessment of the risk of bias for the 60 United States based helmet law assessment studies included in the review.

2013 – “Use of Motorcycle Helmets, Universal Helmet Laws: Finding and Recommendation”

This is the finding and recommendation of an extensive review of the literature conducted by the Community Preventive Services Task Force. The Task Force recommendation is based on strong evidence of effectiveness from 71 studies with 78 study arms; 67 study arms evaluated motorcycle helmet laws in the U.S. (search period through August 2012). Comparison of universal and partial helmet law effectiveness came from 48 study arms. Evidence from included studies indicated that universal motorcycle helmet laws resulted in more helmet use and fewer fatal and non-fatal injuries than either partial laws or no law.

2012 – “Motorcycle Helmet Use and Legislation: A Systematic Review of the Literature”

This is a review the literature on motorcycle helmet use and helmet laws as they pertain to injury prevention. The authors conclude the evidence for the protective effects of motorcycle helmets is very strong. There is convincing evidence that motorcycle helmet use reduces both traumatic brain injuries and death after collisions. A preponderance of evidence also suggests that universal helmet laws are very effective in reducing fatalities and injuries associated with motorcycle collisions, although a couple of studies dispute the effect of helmet legislation.

2012 – “Helmeted vs Nonhelmeted: A Retrospective Review of Outcomes From 2-Wheeled Vehicle Accidents at a Level 1 Trauma Center”

This research addresses the impact of Florida’s helmet law repeal.  In this study, the authors analyzed all 2-wheeled vehicle accidents evaluated at a level 1 trauma center over a 5-year period, comparing all outcomes, costs, and insurance status for helmeted and nonhelmeted riders. The findings suggest that the age and insurance exemption of the law should be revoked and a universal helmet law be reinstated in the state of Florida. Motorcycle helmets significantly reduce overall morbidity and mortality, improve discharge outcome, and are cost-effective in healthcare savings.

2011 – “Intracranial Injury and Mortality Associated with Motorcycle-Related Hospitalizations: Differences in Incidence and Costs on the Basis of Universal Helmet Use Legislation in the United States”

This is a thesis paper with a title that describes the purpose.  The author’s conclusion is the incidence of intracranial injury as a result of motorcycle-related crashes is higher, in states without a universal motorcycle helmet use law.

2010 – “Youth Motorcycle-Related Brain Injury by State Helmet Law Type: United States, 2005-2007”

The results of this study highlight and quantify the head-injury risks of different partial-age helmet laws for young riders and offers caution for the many states that have or are considering replacement of universal all-age laws with age specific laws. States with youth-specific laws had an increased risk of traumatic brain injury (TBI) that required hospitalization, serious and severe TBI, TBI-related disability, and in-hospital death among the youth they are supposed to protect. The only method known to keep motorcycle-helmet use high among youth is to adopt or maintain universal helmet laws.

2009 – “Public Policies and Motorcycle Safety”

State-level longitudinal data from 1990 to 2005 are analyzed to determine how various alcohol and traffic policies impact motorcycle safety and whether there are differential effects by type of injury. The results consistently show that universal helmet laws have the most significant effect on both non-fatal and fatal injuries.

2009 – “Impact of Motorcycle Helmets and State Laws on Society’s Burden: A National Study”

Abstract.  This large database study clearly shows that helmets provide protection for motorcycle riders from mortality and other injuries. Head injury is also less severe. Health care resource utilization, measured by intensive care unit (ICU) and hospital stays, is also diminished. Because more non-helmeted riders do not have health insurance, helmets therefore reduce societal costs of injuries suffered by motorcycle riders. Because helmet use is greater when laws dictate their use, such laws benefit the individual by reducing mortality and society by reducing costs.

2008 – “Evaluation of the Reinstatement of the Helmet Law in Louisiana”

Louisiana has enacted and repealed motorcycle helmet laws many times. In 1999, the State amended that law to require helmet use only by motorcyclists under 18 and riders over 18 who did not have a minimum of $10,000 in medical insurance coverage. In 2004, Louisiana reinstated its universal helmet law that required all motorcyclists, riders and passengers, to wear helmets all the time. This study examined rates of motorcycle helmet usage, fatalities, and injuries - pre-reinstatement compared to post-reinstatement.

2008 – “An Analysis of Motorcycle Helmet Use in Fatal Crashes”

This report examined the helmet use of motorcycle riders 21 and older involved in fatal crashes. Factors that were found to be the most highly correlated with a motorcycle rider’s helmet use include the following: the existence of a universal helmet law, the motorcycle rider’s age and blood alcohol concentration, the engine size of the motorcycle, and whether the crash occurred at night or during the day. The odds that a motorcycle rider in a single-vehicle crash wore a helmet were 72 percent less in States without a universal helmet law, compared to States with a universal helmet law.

2007 – “Characteristics of Motorcycle-related Hospitalizations: Comparing States with Different Helmet Laws”

This study compares U.S. motorcycle-related hospitalizations across states with differing helmet laws. Results revealed that motorcyclists hospitalized from states without universal helmet laws are more likely to die during the hospitalization, sustain severe traumatic brain injury, be discharged to long-term care facilities, and lack private health insurance. This study further illustrates and substantiates the increased burden of hospitalization and long-term care seen in states that lack universal motorcycle helmet use laws.

2006 – “The Effectiveness of Motorcycle Helmets and Mandatory Helmet Laws”

Louisiana crash data are used to assess the effectiveness of motorcycle helmets in crashes and the effectiveness of mandatory helmet laws. The Louisiana crash data which are unique in that the motorcycle helmet law was changed several times, in 1968, 1976, 1982, 1999 and 2004, show that helmets significantly reduce the risk of fatal and severe injury in crashes. Louisiana data also show that mandatory motorcycle helmet laws are effective in significantly reducing fatalities and severe injuries in motorcycle crashes.

2001 – “Helmet Laws and Motorcycle Rider Death Rates”

This study investigated motorcycle rider death rates between states with full motorcycle helmet laws and those without.  After controlling for other factors that affect motorcycle rider fatalities (most notably population density and temperature), death rates in states with full helmet laws were shown to be lower on average than deaths rates in states without full helmet laws.  This study is important in that it addresses the problem with the use of “raw data” to support the claim that rider death rates are significantly lower in states without full motorcycle helmet laws.

1991 – “Motorcycle Helmet Laws Save Lives and Reduce Costs to Society”

This is a Government Accountability Office (GOA) report which evaluates studies on motorcycle helmet laws. The report summarizes a review of the literature on (1) the effectiveness of helmets in preventing deaths and serious injuries, (2) the effect of helmet laws on helmet use and fatality rates, and (3) the costs that society incurs when motorcyclists who do not wear helmets are involved in accidents. The GOA recommends Congress consider encouraging states to enact or keep in place universal helmet laws.