How the RSA backs helmet promotion

monument

RSA’s helmet references requested and released under the Access to Information on the Environment (AIE) regulations, S.I. No. 133 of 2007. This is the research the RSA uses to back its promotion of helmets…

I think I see one or two which have been debunked already. But might as well share before looking into it further. Also my bookmarks both pro and anti helmet are here.

I've also uploaded the following here where you can download it in Word, PDF, or TXT file.

Bibliography
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Borglund, S. J., Hayes, J. S., & Eckes, J. M. (1999). Florida’s bicycle helmet law and a bicycle safety educational program: Did they help? Journal of Emergency Nursing , 25 (6).

Broker, J. P., & Hill, P. F. (2006). Bicycle Accidents : A Biomechanical, Engineering and Legal Perspective. Lawyers and Judges Publishing Company.

Cameron, M., Vulcan, P., Finch, C. F., & Newstead, S. V. (1994). Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia—An evaluation. Accident Analysis & Prevention, , 325-337.

Ching, R. P., Thompson, D. C., Thompson, R. S., Thomas, D. J., Chilcott, W. C., & Rivara, F. P. (29). Damage to bicycle helmets involved with crashes. Accident Analysis & Prevention , 1997 (5), 555-562.

Coppens, N. M., & Mandeville McCabe, B. (1995). Promoting children's use of bicycle helmets. Journal of Pediatric Health Care , 1995 (2), 51-58.
Cummings, P., Rivara, F. P., Thompson, D. C., & Thompson, R. S. (2006).

Misconceptions regarding case-control studies of bicycle helmets and head injury. Accident Analysis & Prevention , 38 (4), 636-643.

Curnow, W. J. (2007). Bicycle helmets and brain injury. Accident Analysis & Prevention , 39 (3), 433-436.

Curnow, W. J. (2006). Bicycle helmets: Lack of efficacy against brain injury. Accident Analysis & Prevention , 2006 (5), 833-834.

Curnow, W. J. (2005). The Cochrane Collaboration and bicycle helmets. Accident Analysis & Prevention , 37 (3).

Currow, W. (2003). The efficacy of bicycle helmets against brain injury. Accident Analysis and Orevention , 35, 287-292.

Doll, L. S., Bonzo, S. E., Mercy, J. A., & Sleet, D. A. (2007). Handbook of Injury and Violence Prevention Handbook. Sringer.

Ekman, R., Schelp, L. W., & Svanstrom, L. (1997). Can a combination of local, regional and national information substantiallyincrease bicycle-helmet wearing and reduce injuries? Experiences from Sweden? Accident Analysis and Prevention , 29, 321-328.

Elvik, R., & Vaa, T. (2010). The Handbook of Road Safety Measures. Elesevier.
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Franklin, J. (2007). CycleCraft. TSO.

Gielen, A. C., Joffe, A., Dannenberg, A. L., Wilson, M. E., Beilenson, P. L., & DeBoer, M. (1994). Psychosocial factors associated with the use of bicycle helmets among children in counties with and without helmet use laws. The Journal of Pediatrics , 124 (2), 204-210.

Hagel, B. E., & Pless, B. (2006). A critical examination of arguments against bicycle helmet use and legislation. Accident Analysis and Preventio , 38 (2), 277-278.

Ho-Yin Lea, B., Schoferb, J. L., & Koppelman, F. S. (2005). Bicycle safety helmet legislation and bicycle-related non-fatal injuries in California. Accident Analysis and Prevention , 37, 93-100.

Hui, S. K., & Yu, T. X. (2002). Modelling of the effectiveness of bicycle helmets under impact. International Journal of Mechanical Sciences , 44 (6), 1081-1100.

Ichikawa, M., & Nakahara, S. (2007). School regulations governing bicycle helmet use and head injuries among Japanese junior high school students. Accident Analysis and Prevention , 39, 469-474.

Kakefudaa, I., Stallonesb, L., & Gibbs, J. (2009). Discrepancy in bicycle helmet use among college students between two bicycle use purposes: Commuting and recreation. Accident Analysis and Prevention , 39, 513-521.

Kopjar, B., & Wickizer, T. M. (2000). Age Gradient in the Cost-Effectiveness of Bicycle Helmets. Preventive Medicine , 30 (5), 401-406.

Lajunen, T., & Rasanen, M. (2004). Can social psychological models be used to promote bicycle helmetnext term use among teenagers? A comparison of the Health Belief Model, Theory of Planned Behavior and the Locus of Control. Journal of Safety Research , 115-123.

Lajunen, T., & Rasanen, M. (2001). Why teenagers owning a bicycle do not use their helmets. Journal of Safety Research , 323-332.

Loubeau, P. R. (2000). Exploration of the barriers to bicycle helmet use among 12 and 13 year old children. Accident Analysis and Prevention , 32 (1), 111-115.

Mills, N. J. (2007). Bicycle helmet case study. Polymer Foams Handbook , 329-350.

Mills, N. J., & Gilchrist, A. (2008). Finite-element analysis of bicycle helmet oblique impacts. International Journal of Impact Engineering , 35 (9), 1087-1101.

Mills, N. J., & Gilchrist, A. (2008). Oblique impact testing of bicycle helmets. International Journal of Impact Engineering , 35 (9), 1075-1086.

Ming, J., Gilchick, R. A., & Bender, S. J. (2006). Trends in helmet use and head injuries in San Diego County: The effect of bicycle helmet legislation. Accident Analysis & Prevention , 38 (1), 128-134.

O'Callaghan, F. V., & Nausbaum, S. (2006). Predicting Bicycle Helmet Wearing Intentions and Behavior among Adolescents. Journal of Safety Research , 37 (5), 425-431.

Rezendes, J. L. (2006). Bicycle Helmets: Overcoming Barriers to Use and Increasing Effectiveness. Journal of Pediatric Nursing , 21 (1), 35-44.

Robinson, D. L. (2007). Bicycle helmet legislation: Can we reach a consensus? Accident Analysis and Prevention , 37, 86-93.

Robinson, D. L. (2010). Bicycle helmets benefits might be overestimated. The American Journal of Emergency Medicine , 28 (4), 527-528.

Robinson, D. L. (2001). Changes in head injury with the New Zealand bicycle helmet law. Accident Analysis & Prevention , 33 (5), 687-691.

Rodgers, G. B. (1995). Bicycle Helmet Use Patterns in the USA A Description and Analysis of National Survey Data. Accident Analysis and Prevention , 43-56.

Scuffham, P., Alsop, J., Cryer, C., & Langley, J. D. (2000). Head injuries to bicyclists and the New Zealand bicycle helmet law. Accident Analysis & Prevention , 32 (4), 565-573.

Shafi, S., Gilbert, J. C., Loghmanee, F., Allen, J. E., Caty, M. G., Glick, P. L., et al. (1998). Impact of bicycle helmet safety legislation on children admitted to a regional pediatric trauma center. Journal of Pediatric Surgery , 33 (2), 317-321.

Simms, C., & Woods, D. (2009). Pedestrians and Cyslist Impact: A Biomechanical Perspective. Springer.

Smith, T. A., Tees, D., Thom, D. R., & Hurt Jr., H. H. (1994). Evaluation and replication of impact damage to bicycle helmets. Accident Analysis & Prevention , 26 (6), 795-802.

Thompson, N. J., Sleet, D., & Sacks, J. (2002). Increasing the use of bicycle helmets: lessons from behavioral science. Patient Education and Counseling , 46 (3), 191-197.

Wang, J. T.-J., Li, S.-H., Tsai, S.-D., & Yu, W.-Y. (2009). Characteristics of bicycle-related head injuries among school-aged children in Taipei area. Surgical Neurology , 36-40.

Watts, D., O'Shea, N., Ile, A., Flynn, E., Trask, A., & Kelleher, D. (1997). Effect of a bicycle safety program and free bicycle helmet distribution on the use of bicycle helmets by elementary school children. Journal of Emergency Nursing , 23 (5), 417-419.

Weiss, J., Okun, M., & Quay, N. (2004). Predicting Bicycle Helmet Stage-Of-Change among Middle School, High School and College Cyclists From Demographic, Cognitive and Motivational Variables. The Journal of Pediatrics , 145 (3), 360-364.

monument

I have not had time to look at everything yet, but:

• Most/all of the case studies are of a limited type
  
• At least five of the references are against bicycle helmet use / promotion.
  
• At least 14 of the references are about bicycle helmet use or increasing bicycle helmet use. None of which direct support for the RSA’s position.
  
• It references CycleCraft, but it's strange how the RSA do not give out the advice CycleCraft says is much more important (ie road positioning, taking the lane where needed etc)

Chips Lovell

monument wrote: »

...but it's strange how the RSA do not give out the advice CycleCraft says is much more important (ie road positioning, taking the lane where needed etc)

I don't think it's that strange actually. From their point of view it's an obvious/non-controversial thing to promote, i.e. most of the general public would row in behind it. It's the kind of thing that people accept without having to think about it. So if you want to be seen to promote safe cycling, then it's a no brainer.

Lumen

Monument, I hesitate to debate with you for fear of drowning under the weight of actual evidence rather than my own uninformed speculation, but...

I thought the basis of the case against helmets was that their marginal effectiveness is outweighed at a population health level by the negative effects of bicycle usage reductions caused by making helmets mandatory.

However, I imagine that the RSA isn't responsible for overall public health, it's responsible for road safety as measured (for example) by KSI stats, so (a) the fewer cyclists on the road the lower the total number of KSI, regardless of the injury rate for those cyclists remaining, and (b) for those accidents which do happen, helmets will general help rather than hinder.

In other words, I can see no reason why the RSA would not promote cycling helmets given its mandate.

Perhaps you should pressure them also to recommend helmets for car occupants and pedestrians, so as to be even handed.

monument

el tonto wrote: »

I don't think it's that strange actually. From their point of view it's an obvious/non-controversial thing to promote, i.e. most of the general public would row in behind it. It's the kind of thing that people accept without having to think about it. So if you want to be seen to promote safe cycling, then it's a no brainer.

Indeed, I don't really find it strange given the set up of agencies like the RSA.

But it's wrong that such agencies are spending public money on what makes them be seen to promote safety rather than promoting actual proven safe cycling methods. And given the RSA's position, further public money is spent by other agencies, departments, local authorities etc which follow the advice. Money which could be spent on cycle training or just providing better advice.

Lumen wrote: »

I thought the basis of the case against helmets was that their marginal effectiveness is outweighed at a population health level by the negative effects of bicycle usage reductions caused by making helmets mandatory.

That's one of the main arguments, but there is more.

The pro helmet research is deeply flawed. The case studies of injuries, for example, do not see a difference between a person taking it easy enough on a street and another person cycling downhill mountain biking off-road (or another racing around the place, in a race or not). The nature of the research is also very limited. There's research attacking this and there's papers devoted to defending the limited nature of the pro-helmet research.

There's also research which points to the idea that drivers pass helmet-wearing cyclists closer and the increased likelihood of different types of injuries because a helmet is being worn.

By promoting helmets (and other gear) you make cycling look more dangerous than it is thus decrease the chances of getting more people cycling. This in turn decreases the positive and more proven effects of safety in numbers. Helmet use is the lowest in counties with the most cyclists and the least serious injury and death per km.

Helmets and gear are a distraction to the real issues of safe cycling. Helmets don't have a chance of helping in the majority of cyclist deaths.

Lumen wrote: »

However, I imagine that the RSA isn't responsible for overall public health, it's responsible for road safety as measured (for example) by KSI stats, so (a) the fewer cyclists on the road the lower the total number of KSI, regardless of the injury rate for those cyclists remaining, and (b) for those accidents which do happen, helmets will general help rather than hinder.

For the reasons above, I'm not sure about that last bit.

The reason the RSA are so important is that nearly everybody follows their advice on helmets -- ie Dublin City Council saying on one of their websites that "Although it is not required by law, the Road Safety Authority recommends that you wear a cycle helmet and hi-viz clothing."

Lumen

monument wrote: »

Helmet use is the lowest in counties with the most cyclists and the least serious injury and death per km.

Right, but who cares about death per km? Isn't it more reasonable for the RSA to care about deaths per year, since death is bad?

monument wrote: »

The reason the RSA are so important is that nearly everybody follows their advice on helmets -- ie Dublin City Council saying on one of their websites that "Although it is not required by law, the Road Safety Authority recommends that you wear a cycle helmet and hi-viz clothing."

Steady on. When you say nearly everybody I assume you mean "of the organisations who dispense unsolicited advice", not "of the cycling population".

Similarly, "nearly everybody" recommends men drink less than 21 units of alcohol per week, but such is the level of drinking in the general population that I've been accused of lying by a GP during a insurance medical when I claimed to drink less than that amount.

niceonetom

Lumen wrote: »

Steady on. When you say nearly everybody I assume you mean "of the organisations who dispense unsolicited advice", not "of the cycling population".

Similarly, "nearly everybody" recommends men drink less than 21 units of alcohol per week, but such is the level of drinking in the general population that I've been accused of lying by a GP during a insurance medical when I claimed to drink less than that amount.

I think the point is that the opinions of the RSA (and other such bodies in different H&S areas) are taken seriously by legislators and could end up bring it from advice to mandatory practice.

It is a worry that they might a adopt a staunchly pro-helmet-and-high-viz stance simply because it makes them look like they're taking cyclist safety seriously, and then that opinion gets taken as incontrovertible and uncontroversial by some politician on the look out for bandwagons to commandeer. It's a disturbingly short hop from reactionary opining to law in this country (see: head shops), so it is wise to keep an eye on those dispensing "unsolicited advice" just in case someone starts taking them seriously.

Chips Lovell

monument wrote: »

By promoting helmets (and other gear) you make cycling look more dangerous than it is thus decrease the chances of getting more people cycling. This in turn decreases the positive and more proven effects of safety in numbers. Helmet use is the lowest in counties with the most cyclists and the least serious injury and death per km.

I think this is a key point and it's something I have a big problem with, the notion that you have go out dressed like you're working on an oil rig in order not to get killed on the road.

I've no issue with people choosing to wear helmets or high-viz or whatever, but I'm uncomfortable with being fed the notion that someone is being irresponsible if they don't. Cycling is pretty safe as activities go and I think this kind of stuff puts people off.

Unfortunately though, I don't think we've got the critical mass of cyclists for organisations like the RSA to really give cycling policy some thought. I think it would be far more productive to highlight issues like interacting with HGVs and road positioning. Poking them in this fashion could help, but I suspect they may only really change if they have a big enough consituency of cyclists on their hands.

P.S. Wasn't the RSA responsible for that leaflet with the motor tax renewal forms? That was a step in the right direction.

el tonto

el tonto wrote: »

P.S. Wasn't the RSA responsible for that leaflet with the motor tax renewal forms? That was a step in the right direction.

Not sure if they were involved but at a conference last month on cycling I was at it was the Dept. of Transport guy telling us of the idea. Came away with the strong impression that they were heavily involved with getting this done, but I don't know who came up with the initial idea.

tomasrojo

Quite a lot of those references are very sceptical of the merits of helmets.

Curnow really doesn't have a lot of time for them. He makes a good case for the current design of helmets being flawed, because they aim to reduce linear acceleration of the head, but most of the really bad damage is done by rotational acceleration of the brain, which they do nothing to address.

tomasrojo

I'm surprised that Thompson, Rivara and Thompson (1989) doesn't appear in that list. It's entirely to their credit that it doesn't, as it's statistical bull****. Still probably the most quoted paper about helmets and safety (source of "bicycle helmets prevent 88% of head injuries").

monument

niceonetom wrote: »

I think the point is that the opinions of the RSA (and other such bodies in different H&S areas) are taken seriously by legislators and could end up bring it from advice to mandatory practice....

Thanks, yes, that's more like what I was meaning to say -- was should have been heading out the door at the time of writing that last post. Should have said everybody in officialdom or those who oversee safety.

el tonto wrote: »

Unfortunately though, I don't think we've got the critical mass of cyclists for organisations like the RSA to really give cycling policy some thought. I think it would be far more productive to highlight issues like interacting with HGVs and road positioning. Poking them in this fashion could help, but I suspect they may only really change if they have a big enough consituency of cyclists on their hands.

P.S. Wasn't the RSA responsible for that leaflet with the motor tax renewal forms? That was a step in the right direction.

Dónal wrote: »

Not sure if they were involved but at a conference last month on cycling I was at it was the Dept. of Transport guy telling us of the idea. Came away with the strong impression that they were heavily involved with getting this done, but I don't know who came up with the initial idea.

It was indeed the Department of Transport... all the 'Smarter Travel' branded things are from the National Sustainable Transport Office from within the department.

Versions for the leaflet for cyclists, HGV drivers and bus drivers are here. The one for cyclists is good. The priority of the list seems good. It says that helmets are recommended, but at least it's way down the list. Road positing is mentioned twice within the first few points.

The HGV and cyclist video is ok, produced by the RSA and the Smarter Travel office (not clear who's idea it was), but the helmets and high vis can easily distract from the main message of HGV blind spots. And yes it is a direct copy of a UK video.

The best cycling advice I've seen (besides CycleCraft and advice on here too) is a leaflet from the Galway Cycle Campaign which is a bit like a condensed version of CycleCraft (funding support from Galway City Council and Smarter Travel, with assistance from CycleCraft author John Franklin).

tomasrojo

That Galway Cycling Campaign leaflet was excellent. I wish that was what the RSA was promoting.

I emailed the RSA a while ago to ask them to alter one of their online safety checklists, asking them to put working brakes ahead of helmets and hi-viz in one of their safety checklists. They said they'd think about, but in terms that suggested they weren't going to change the checklist. They really think wearing hi-viz in conditions of good visibility is vitally important, I got the impression.

Slideshowbob

If you aint wearing a helmet are you thereby going to take more care?

If you do are you saying I am safe Mr Driver and tend to be more blaise?

galwaycyclist

<delurks>

The motor tax leaflets came from the Smarter Travel office. The HGV video came from the Smarter Travel office but used an RSA budget that was still sitting around.

One of the problems with an entity like the RSA is that once it exists it is very hard for other "official" bodies to be seen to do anything that diverges from their guidance. The same problem is about to arise with the National Transport Authority who are a rebranded DTO and appear to be determined to roll out previous DTO idiocy nationwide.

http://www.galwayindependent.com/local-news/local-news/cyclists-slam-city-design-plans/

With regards to the Galway Cycling Campaign cycling skills leaflets - thse are now being franchised out nationally - there is now a version with the DCC logo and another print run is being organised for Waterford.

Regards

- Reneables cloaking device

tomasrojo

Thanks, @galwaycyclist. Any chance it'll be available by download? I have occasionally given people a PDF scan I have of it (I hope that's ok), but it would be better if I could direct them to a website.

tomasrojo

galwaycyclist wrote: »

<delurks>
The same problem is about to arise with the National Transport Authority who are a rebranded DTO and appear to be determined to roll out previous DTO idiocy nationwide.

http://www.galwayindependent.com/local-news/local-news/cyclists-slam-city-design-plans/

It's very vexing to see the Galway City Transportation Unit use an opinion poll to say that more people will cycle if an off-road solution is provided. People always say in surveys that they would cycle if there were more segregated cycle lanes, but the provision of more cycle lanes never results in more cyclists. So it's the usual thing of people saying what they think the surveyor wants to hear.

So people who actually cycle are inconvenienced and novices are put in danger in deference to a bunch of people who made a casual assertion in an opinion poll.

monument

From Acquired Brain Injury Ireland...

Note that the 80% figure seems to be from research Thompson, Rivara and Thompson in 1989, the source mentioned below seems to be a secondary one. Maybe it's telling that even the RSA do not quote these?

Cyclist Reminded to Mind their Head

ABI Ireland reminds cyclists during National Bike Week
of importance of wearing helmets

9th June 2010: National Bike Week takes place from the 13th of June to the 20th of June and Acquired Brain Injury Ireland (ABI Ireland) is urging all cyclists to Mind their Head by wearing a helmet.

Barbara O’Connell, CEO of Acquired Brain Injury Ireland said: “National Bike Week is a fantastic initiative that encourages people to get outside and have some fun. However, at ABI Ireland we see first hand the devastation that is caused by road accidents and simple falls.”

She continued, “Cycling without a helmet is extremely dangerous and all cyclists need to be aware of the risks. Wearing a helmet is the most effective way of reducing head injuries during bicycle collisions. The chances of serious head trauma and lifelong disabilities can be reduced by between 65% - 88% (1) when a helmet is worn during a bicycle collision.”

It is estimated that more than 10,000 people are impacted by ABI in Ireland every year.

Founded in 2000, Acquired Brain Injury Ireland, formerly The Peter Bradley Foundation, is the Irish national organisation which provides support and services for people with an acquired brain injury (ABI). This reminder is part of the Acquired Brain Injury Ireland’s Mind Your Head campaign, which seeks to raise awareness of the serious consequences of not wearing protective headgear in various every day situations such as cycling, working or playing sports.

National Bike Week runs from 13th – 20th June. It comprises a series of nationwide events organised by cycling groups, communities and local authorities supported by the Department of Transport.

1 ‘Helmets for Preventing Head and Facial Injuries in Bicyclists (Cochrane Review)” DC Thompson et al, Issue 1, 2003

monument

Also on the RSA references: I have not finished looking at them, but so-far this is what I've found:

There are 44 in total.

At least 14 of these are about bicycle helmet use or increasing bicycle helmet use, ie these are about helmet promotion rather than how effective helmets are. Many are only about helmet use for children, which there is a larger case for helmet use given less developed skulls.

A number seem to be secondly sources, and this is besides the reviews of primary sources.

At least five are anti-helmet use, and only or two others try to counter these.

tomasrojo

monument wrote: »

From Acquired Brain Injury Ireland...

Note that the 80% figure seems to be from research Thompson, Rivara and Thompson in 1989, the source mentioned below seems to be a secondary one. Maybe it's telling that even the RSA do not quote these?

Yes, the high number is from Thompson, Rivara and Thompson (1989). The Cochrane Review kindly allowed them to sum up the state of helmet research, so they pretty much just reviewed their own research and research that quoted them, and left out all the whole-population research that didn't show what they wanted to show.

The 85/88% figures in that 1989 paper are clearly impossible. The fact that ABI keep using that figure is a sign that, on this issue, they are just propagandists and uninterested in the truth of the matter.

(http://www.chapmancentral.co.uk/wiki/Thompson,_Rivara_and_Thompson_%281989%29#The_85.25_.2F_88.25_figures)

It makes me doubt them as an organisation, which is a pity, as they may do excellent rehabilitation work, which should probably be their focus, instead of hysterical hand-wringing and shroud-waving.

Incidentally, when are they going to start their promised campaigns to fight head injuries in rugby and other sports? They've said that they were just starting with cycling. Never seem to move on though.

tomasrojo

Now I think of it, in all their press releases and articles, ABI always put cycling first in their list of activities that cause head injuries. In fact, it is not more productive of serious head injuries than most common activities, including walking. It certainly does not produce anything like the number of concussions that, say, rugby does.

This really is a case of no-one being more blind that he who will not see.

tomasrojo

monument wrote: »

Also on the RSA references: I have not finished looking at them, but so-far this is what I've found:

There are 44 in total.

At least 14 of these are about bicycle helmet use or increasing bicycle helmet use, ie these are about helmet promotion rather than how effective helmets are. Many are only about helmet use for children, which there is a larger case for helmet use given less developed skulls.

A number seem to be secondly sources, and this is besides the reviews of primary sources.

At least five are anti-helmet use, and only or two others try to counter these.

My impression from what you've said is that the RSA hasn't really read these. They've just produced a list of the most commonly cited papers. After that, they went with "common sense", which is that

1. Cycling is very dangerous
2. Helmets make it all better

They're probably just following what's going on in health and safety circles in the UK and USA, which is to promote helmets at all times.

I mean, how many times have we read somebody assert that it has been proven that helmets save lives, when I can't find any proof anywhere. It certainly isn't in any of the papers listed by the RSA.