Motorcycle Helmet Use and Crash Trends 10 years after Florida s Helmet Law Change in 2000

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1 Motorcycle Helmet Use and Crash Trends 10 years after Florida s Helmet Law Change in 2000 *Chanyoung Lee, Ph.D., PTP Meeta Saxena, E.I.T. Pei-Sung Lin, Ph.D., P.E., PTOE Center for Urban Transportation Research University of South Florida 4202 East Fowler Avenue, CUT100 Tampa, FL Phone: (813) Fax: (813) cylee@cutr.usf.edu Trenda McPherson Traffic Safety Specialist FDOT Traffic Safety Office 605 Suwannee Street, MS 17 Tallahassee, Florida Phone: (850) Fax: (850) Trenda.McPherson@dot.state.fl.us 2011 TRB Annual Meeting Submitted August 1, 2010 Word Count: 4000 words + 12 figures and tables = 7500 words * Corresponding author

2 ABSTRACT There is a growing concern regarding the rapid increase of motorcycle rider fatalities in the U.S. Motorcycle crash fatalities continued their ten year increase, reaching 5,290 in Florida has been above the national averages in the proportion of motorcyclists killed in traffic crashes compared to all traffic fatalities and in the fatality rate per 10,000 registered motorcycles. The helmet law repeal came into effect on July 1, 2000, which allows Florida motorcyclists 21 and older to ride without a helmet as long as they carry at least $10,000 in medical insurance to cover injury costs in the event of a crash. This study analyzed motorcycle crash trends in Florida for ten years before and after the repeal of the motorcycle helmet law in It was found that there has been a sharp increase in motorcycle registrations in the post-law period as well as a notable increase in motorcycle fatalities in Florida. An observational survey was conducted to measure the actual use of helmets by motorcycle riders in Florida. The total number of observed helmeted riders increased from 47 percent in 2002 to 54 percent in The analysis of observed helmet use and fatal motorcycle crash data at the county level shows a statistically significant association. An increase in the appearance of older riders in motorcycle crash data was found ( ), as well as a reduction in the overall average injury severity, despite an increasing number of overall motorcycle crashes in the same time period.

3 Lee et al INTRODUCTION There is a growing concern regarding the rapid increase of motorcycle rider fatalities in the U.S. While national rates for motor vehicle crash fatalities based on VMT (vehicle mile traveled) or licensed driver [1] have been declining over the last 10 years, motorcycle rider fatalities have continued their ten-year increase, reaching 5,290 in Florida has been above the national averages in the proportion of motorcyclists killed in traffic crashes compared to all traffic fatalities and in the fatality rate per 10,000 registered motorcycles. In 2000, Florida became one of six states (along with Arkansas, Kentucky, Louisiana, Texas, and Pennsylvania) that repealed or amended motorcycle helmet use laws since The new helmet law, which came into effect on July 1, 2000, allows Florida motorcyclists 21 and older to ride without a helmet only if they carry at least $10,000 in medical insurance to cover injury costs in the event of a crash [2]. It is often seen that during a motorcycle-involved crash, the motorcycle rider tends to become separated from his/her vehicle, which means the proper use of personal protective gear, such as helmet, would have significant impact on the level of injury from the crash [3]. This study conducted an observational survey of motorcycle riders in Florida to assess the use of motorcycle helmet use 10 years after the helmet law repeal and the analysis of motorcycle crash trends in Florida for ten years before and after the repeal of the motorcycle helmet law. NEW HELMET LAW AND INITIAL BEFORE/AFTER STUDY Effective July 1, 2000, Florida eliminated the legal requirement of mandatory helmet use for motorcycle riders. However, for riders under the age of 21, Florida law continues to require mandatory helmet use. For riders 21 or older, mandatory helmet use is required by those who do not carry at least $10,000 of medical insurance. After this law change in 2000, several studies [3, 4] confirmed that the use of a helmet in Florida was reduced. A study [3] showed a reduction in helmet use in Florida, going from 99.5 percent in 1998 to 52.7 percent in The use of novelty helmets also showed a reduction from 40.2 percent in 1998 to 5.7 percent in The study also showed that there had been an increase in total number of motorcycle injuries and fatal crashes. However, with the exception of fatality rates, crash rates and injury rates per registered motorcycle and per VMT had declined. Another study in 2004 [4] found that motorcyclist fatalities increased by 81 percent in Florida from the before ( ) period to after ( ), compared to a 48 percent national increase. Additionally, there is also an increase in the non-fatal serious injuries which began increasing in the first six months of 2000 and increased by 32 percent in the first year following the law repeal. The same study also confirmed that there was a 40 percent increase in the number of injured motorcyclists who were admitted to hospitals and nearly an 82 percent increase in admissions for head injuries. Initial evaluation efforts showed that after the helmet law was repealed in Florida, the use of helmets declined and motorcycle crashes increased. MOTORCYCLE CRASH TREND Motorcycle registrations have shown an upward trend at both the national and Florida levels. As it can be seen in Figure 1, the number of motorcycle registrations in Florida has increased to nearly 3.5 times the number of registrations in The national motorcycle registration over the same period of time only doubled. During the same time-period between 1991 and 2008, the total numbers of car registrations has only increased by 1.37 times in Florida and 1.2 times at the national level. The

4 Lee et al sharp increase in Florida motorcycle registrations starts in the year 2000, which coincides with the July 2000 helmet law repeal. A 2004 study [5] suggests that the law change in 2000 must have stimulated interest in motorcycling and resultantly increased the number of motorcycle registrations in Florida. Other states that have repealed the mandatory helmet law have also witnessed increases in motorcycle registrations one year after their helmet law was weakened. Arkansas showed a 47 percent increase in motorcycle registrations after their law change, whereas Louisiana showed a 13 percent increase and Texas showed a 12 percent increase. The extent of such a law induced effect is currently not known [5] Florida - Motorcycle registrations Florida - Car registrations US - Motorcycle registrations US - Car registrations FIGURE 1 Indexed Motorcycle and Car Registration Trends (indexed to 1991 = 1) It is a well-known concern that motorcycle crashes have also increased in the U.S. during the same period (1991 to 2008). According to annual reports [6, 7], the number of motorcycle crashes has increased by 54% in the U.S. between 2001 and 2008, while a higher increase (66.8%) was observed in Florida. Figure 2 shows the percentage of motorcycle crashes compared to all vehicle crashes between 1991 and Florida shows a higher percentage of motorcycle crashes in all vehicle crashes compared to the national trend. This increase is not as sharp as the motorcycle registration increased and is at a reasonably stable rate given the year-round riding conditions in Florida and the appeal to motorcycling tourists from around the nation. 86

5 Lee et al % 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 4.0% 3.5% National Florida 3.6% 3.0% 2.9% 2.8% 2.7% 2.7% 2.5% 2.3% 2.1% 2.1% 2.3% 2.4% 1.9% 1.9% 1.8% 1.8% 2.0% 2.0% 1.7% 1.7% 1.7% 1.2% 1.2% 1.1% 1.1% 1.2% 1.2% 1.3% 1.4% 1.0% 1.0% 1.0% 0.9% 0.9% 0.5% % FIGURE 2 Percentage of Motorcycle Crashes to All Vehicle Crashes Figure 3 shows that Florida has a higher percentage of motorcycle fatalities compared to all traffic fatalities. The Florida trend is very close to the U.S. trend before the year 2000; however, after the helmet law change there has been an increasing gap between the two trends. In 2008, the proportion of motorcycle fatalities compared to all traffic fatalities reached an all time high of 17.8 percent in Florida, compared to the national all time high of 14.2 percent. 20.0% 17.8% 17.1% 18.0% 16.3% 16.0% National Florida 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 6.7% 7.1% 7.4% 8.2% 6.2% 6.4% 5.4% 6.1% 6.0% 5.7% 6.8% 6.9% 6.1% 6.1% 5.7% 5.3% 5.1% 5.0% 5.5% 6.0% 11.9% 12.5% 14.2% 10.7% 12.6% 9.2% 8.7% 10.5% 11.3% 8.7% 9.4% 7.6% 7.6% % FIGURE 3 Percentage of Motorcycle Fatalities to All Vehicle Crash Fatalities ( ) On average, national data on motorcycle crashes shows that 3.9% of crashes involve a motorcycle fatality whereas in Florida, 4.5% are motorcycle fatalities. Figure 4 shows this trend in percentages of motorcycle fatalities in Florida and the US for the last 18 years. It can be seen that prior to the

6 Lee et al law change, Florida motorcycle fatalities as a fraction of total motorcycle crashes was very close to national trend; however, during the post law change period (2000 to 2008) there is a nearly one percent increase in the percentage of fatality-related motorcycle crashes in Florida. This suggests that the post-law-change period witnessed a higher percentage of motorcycle-related fatalities among all motorcycle-related crashes. 7% 6% 5% 4% 3% National Florida 3.94% 3.85% 3.84% 3.03% 3.34% 3.52% 3.26% 3.24% 3.22% 3.37% 3.32% 3.42% 3.24% 3.99% 3.73% 4.85% 4.79% 5.09% 4.14% 4.16% 4.25% 4.40% 4.29% 5.50% 5.65% 5.85% 6.12% 5.98% 4.65% 4.73% 4.56% 4.77% 4.30% 5.53% 4.75% 2% 3% 1% 108 0% FIGURE 4 Percentage of Motorcycle Fatalities to All Motorcycle Crashes ( ) Overall, Florida motorcycle crash trends were quite similar to the national averages prior to the helmet law change in With a sharp increase in motorcycle registrations during the post-law period, there has been an increase in fatalities and injuries related to motorcycle crashes in Florida. It is especially notable that the percentage of motorcycle fatalities to all vehicle crash fatalities and the percentage of motorcycle fatalities to all motorcycle crashes in Florida increased significantly compared to the national average during the same period. OBSERVATIONAL SURVEY To measure the actual use of motorcycle helmets in Florida, an observational survey was conducted within 15 sampled counties. In the months of May and June 2010, one-hour field observations were conducted at 540 sites and at least one motorcycle was observed at 92.4 percent of these sites. Based on the sampling guidelines [8], 27 observation sites were selected for each county and the top five counties with highest number of motorcycle crashes were double-sampled. Sampling To establish a statistically valid sampling process, NHTSA guidelines for state observational surveys of safety belt and motorcycle helmet use [8] were adopted and a data collection plan, meeting the 5 percent relative error precision requirement, was developed. The purpose of the sampling plan was to determine the counties to be surveyed, the number of observational sites in each county, the specific location of these sites, and the days and times for data collection. The final multi-stage

7 Lee et al stratified sampling design was approved by NHTSA and the FDOT project manager before implementation. After evaluating motorcycle registration and crash data by county, the sampling counties were selected and specific intersections within the counties were chosen based on the functional classification of roadways. The survey instrument from the previous observational study [3] was revised and the following information was collected through observational survey. Trike and Moped/ Scooter option was introduced as a motorcycle type category. 137 Rider Headgear Motorcycle Type Gender TABLE 1 Observational Survey Form Operator ; Passenger No Helmet ; Full Face Helmet ; Open Face Helmet ; Motor Cross Helmet ; Novelty Helmet ; Moped / Scooter ; Decorative Helmet ; Carrying but not wearing Helmet ; Unknown type of helmet Sports Bike ; Cruiser ; Touring Bike ; Standard Bike ; On Road Off Road Bike ; Trike ; Moped /Scooter; Other / Custom ; Unknown type of bike Male ; Female Safety Gear Data collection Eye Protection; Jacket; Long Pants; Shoes; Gloves; Head lights On A total of 7,305 motorcyclists in Florida were observed, which included 6,594 motorcycle operators and 711 passengers. Most observations occurred during the midday and peak PM hours. Also, 68.5 percent of all observations occurred on urban principal arterials percent of observations were done on sunny days and 24.8% were done on partly cloudy days. Table 2 summarizes the sampled counties and observations. County TABLE 2 Motorcycle Helmet-use Survey Sample Observations by County Population (2008) Motorcycle Registration (2008) Motorcycle injury and fatality (2008) Drivers Observed (2010) Passengers Observed (2010) Total Observed (2010) Double sampled Broward 1,758,494 43, Hillsborough 1,200,541 32, Dade 2,477,289 55, Orange 1,114,979 31, Volusia 510,750 40, Single sampled Alachua 252,388 10, Brevard 556,213 28,

8 Percent Observed Lee et al Collier 332,854 10, Duval 904,971 29, Lee 623,725 23, Leon 274, Palm Beach 1,294,654 30, Pasco 438,668 19, Pinellas 938,461 35, Polk 585,733 19, Total 13,264, ,200 6, Results As shown in Figure 5, observational surveys conducted in 1993 and 1998 showed that 99.5 percent of all motorcyclists in Florida wore helmets. While the observed helmet use in Florida was reduced to 52.7 percent in 2002 survey (after the helmet law repeal). According to the observational survey in 2010, 55.3 percent of motorcycle riders in Florida wore helmets. Figure 5 illustrates the observed use of helmet in Florida. 84.5% DOT Approved Helmet Novelty Helmet No Helmet 59.3% 40.2% 47.0% 47.3% 53.9% 44.7% 15.0% 0.5% 0.5% 5.7% 1.4% Figure 5 Observed Motorcycle Helmet Use: Florida, 2010, 2002, 1998, 1993 The survey shows that 87 percent of riders were male and 13 percent of riders were female. There was no significant difference in the use of motorcycle helmet by gender. 56 percent of female operators wore a helmet and 54 percent of male operators wore a helmet. Also, it was reported that 57 percent of operators wore a helmet while 49 percent of passengers wore a helmet. Table 3 shows the observed use of helmet by motorcycle type. Open face helmets were a observed slightly more often than full face helmets, but there is no major difference on helmet type among different motorcycles. As for no helmet riders which includes novelty helmet, decorative, and carrying but not wearing, about one fifth (21.9 percent) of riders wore some sort of decorative headgear such as bandanas, hats, or some other head covering in place of helmets. Among the bike types observed, about half of the observed riders were riding a cruiser (47.7

9 Lee et al percent). A sports bike (18.1 percent) and touring bike (15.4 percent) were the next most commonly observed bike types in Florida. TABLE 3 Helmet Use by Motorcycle Type, 2010 Observational Survey With Helmet Without Helmet Carrying Grand Row Labels Motor Open No Full Face Novelty Decorative but not Total cross Face Helmet wearing Cruiser Moped/ Scooter On/Off Road Sport Bike Standard Touring Trike Grand Total *6910 * incomplete observations including unknown were removed. Table 4 shows the comparison of helmet use by different bike types from 2002 and 2010 survey. The use of a DOT approved helmet increased in almost all type of motorcycles and the use of a novelty helmet was further reduced compared to 2002 survey. There was no major change in the percentage of observed motorcycle types in Florida between the two survey cycles. It is notable that eight percent of the observations were scooters or mopeds (two-wheel motorcycle-type motor vehicles with usually 50 cc or less gas engines). These riders showed the highest rate of not wearing helmet. TABLE 4 Comparison of observed bike type and helmet use in 2002 and 2010 survey 2002 Survey 2010 Survey DOT DOT No Novelty Bike Type No Novelty approved approved Helmet Helmet Helmet Helmet helmet helmet Bike Type Cruiser (50.4%) Moped / Scooter On/Off Road (0.7%) Sport Bike (18.5%) Standard (9.6%) Touring (18.4%) Trike 28.6% 63.5% 8.0% N/A 56.5% 39.1% 4.3% 79.7% 19.7% 0.6% 54.2% 43.0% 2.7% 54.4% 38.3% 7.3% N/A ( ): Proportion to total observation Cruiser (49.0%) Moped / Scooter (8.2%) On/Off Road (0.7%) Sport Bike (18.7%) Standard (6.4%) Touring (15.4%) Trike (1.5%) Helmet Use Change 45.1% 53.1% 1.7% +16.5% 38.8% 59.4% 1.8% N/A 74.5% 25.5% 0.0% +18% 76.1% 23.9% 0.0% -3.6% 68.8% 29.2% 2.0% +14.6% 57.6% 40.6% 1.8% +3.2% 56.7% 39.4% 3.8% N/A

10 Lee et al Cross-tabulation analysis of motorcycle type by gender and occupant type show that male riders were more often observed on cruisers (47.4 percent), sport bikes (19.5 percent), and touring bikes (14.8 percent), while female riders were more often observed on cruisers (51.1 percent) and touring bikes (18.6 percent). The majority of passengers were observed on cruisers (51.5 percent) and touring bikes (23.8 percent). As can be seen in Table 5, it was observed that about 9.5 percent of motorcycle riders do not wear any sort of eye protection whether they were helmeted or not. Florida law requires all motorcycle riders to wear eye protection. Table 5 Use of Helmet vs. Eye Protection (Observed Total: 6943*) With Helmet With Eye Protection 48.6% ( 3,371 ) Without Eye Protection 5.4% ( 373 ) * incomplete observations including unknown were removed Without helmet 42.0% ( 2,915 ) 4.1% ( 284 ) Figure 6 shows that there was no major difference in the use of personal protective gears by Florida riders between survey cycles. Due to Florida weather, a jacket and gloves are not commonly used compared to other types of gear. FIGURE 6 Observed Motorcycle Personal Protective Gear & Helmet Use in Florida 120% 100% 80% 93% 93% 95% 97% 93% 95% 90% 86% 82% 1998 study 2002 study 2010 study 77% 75% 73% 60% 40% 20% 9% 11% 10% 24% 20% 16% % Riding with lights on Wearing eye protection Wearing shoes Wearing long pants Wearing jacket or long sleeved shirt OBSERVED HELMET USE VS. FATAL MOTORCYCLE CRASH Wearing gloves It is noted that observed helmet use is quite different from county to county in Florida. Considering that the adopted sampling scheme in this study had a 5 percent error rate, the difference in the rate of observed helmet use is still significant. Figure 7 shows the observed helmet use in sampled counties. In general, the observed DOT approved helmet use rate is lower than 1998 (Prior to helmet law change) but helmet use rate has been increased in most counties compared to the 2002 study.

11 Lee et al % Helmet % (1998) Helmet % (2002) Helmet % (2010) 85% 78% 79% 80% 77% 72% 67% 68% 70% 67% 67% 65% 64% 62% 62% 59% 58% 60% 57% 54% 55% 53% 55% 56% 56% 51% 52% 52% 49% 50% 50% 46% 47% 48% 47% 44% 45% 42% 41% 39% 40% 30% 20% 10% 0% FIGURE 7 Observed DOT-Approved Helmet Use by County for 1998, 2002 and 2010 The observed helmet use rate was compared to the rate of fatal crashes per 10,000 registered vehicle years at the county level, but it did not show any statistical association. However, as can be seen in Figure 8, it seems that the proportion of fatal motorcycle crashes to the total number of motorcycles and observed helmet use at the county level are correlated. The Pearson correlation is equal to (P-Value = 0.008). For example, Palm Beach (Observed Helmet Use: 47%) and Lee (Observed Helmet Use: 45%) counties show almost ten times higher fatal motorcycle crash rates as compared to Alachua (Observed Helmet Use: 65%) and Leon (Observed Helmet Use: 81%) counties, which have a relatively higher observed helmet use. Further statistical analysis of motorcycle crash data showed that crash injury severity is strongly associated with crash year, rider age, county, and alcohol use, while it does not show a correlation with lighting condition, weather, and road surface type and condition.

12 Fatal MC Crashes / All MC Crashes (%) by County Lee et al Observed Helmet Use (%) by County Figure 8 Observed Helmet Use vs. Percentage of Motorcycle Fatalities to All Motorcycle Crashes by County Figure 9 shows the increased appearance of older riders in motorcycle crash data between 2002 and It seems that the older riders are more vulnerable to severe injury during motorcycle crashes. Overall, average injury severity in motorcycle crashes was reduced over the last three years while the number of motorcycle crashes was still increased during the same period FIGURE 9 Trend of Crash by Age and Average Injury Severity by Age RECENT MOTORCYCLE SAFETY PROMOTION EFFORTS IN FLORIDA The Florida Department of Highway Safety and Motor Vehicles (FHSMV) has designed Florida Rider Training Program (FRTP) courses which use the curriculum developed by the Motorcycle Safety Foundation (MSF) to provide training for riding motorcycles. These courses are geared

13 Lee et al towards teaching motorcyclists the knowledge, skills, and attitude necessary for safe motorcycle riding. The Florida Motorcycle Safety Education Course was initially developed in 1988 and was voluntary for individuals 21 and over, but as of July 1, 2008, the Florida Legislature has mandated this course for all riders seeking a new motorcycle endorsement. In addition to this law change, several motorcycle safety campaigns have been developed to address the issue of impaired driving and distracted driving. Campaigns such as the Look Twice, Save a Life campaign and the Ride Proud, Dress Loud campaign have been developed to help motorcycle riders and other vehicle riders be aware of motorcycle safety. In 2008, the Motorcycle Strategic Safety Plan (MSSP) was developed by forming a Florida Motorcycle Safety Coalition, which is geared towards addressing specific issues of motorcycle safety through statewide implementation of safety strategies and the RideSmartFlorida.com website was launched as part of their efforts. The website is a complete resource for motorcycle riders, trainers, sponsors, local governments, law enforcement agencies, emergency services, and anyone who is interested in improving motorcycle safety throughout Florida. By analyzing 2009 Florida crashes from the latest Traffic Crash Statistics Report, preliminary results show a 24.4 percent reduction in motorcyclerelated fatalities in 2009 and a 13.6 percent reduction in overall motorcycle-related crashes compared to previous year. CONCLUSIONS This study conducted an analysis of motorcycle crash data for 10 years before and after the new Florida helmet law in Motorcycle crash trends in Florida were compared to national averages in various aspects. It is important to note that motorcycle registrations have sharply increased since Florida motorcycle crash trends were quite similar to the national averages prior to the helmet law change in There has been an increase in fatalities and injuries related to motorcycle crashes at both the national and Florida levels. However, it is notable that the percentage of motorcycle fatalities to all vehicle crash fatalities and the percentage of motorcycle fatalities to all motorcycle crashes in Florida increased significantly compared to national averages during the same period. An observational survey was conducted in May/June 2010 to evaluate the actual use of motorcycle helmets in 15 different counties. A total of 7,305 motorcyclists were observed, including 6,594 motorcycle operators and 711 passengers. The survey showed that 55.3 percent of motorcycle riders in Florida wore helmets, which is a slight increase compared to 52.7 percent in the 2002 survey. The use of DOT approved helmets was increased for almost all types of motorcycles and the use of novelty helmets was reduced compared to 2002 survey. The observed DOT approved helmet use rate is different based on the type of motorcycle; Sport bike riders (76.1%) wore helmets the most while Cruiser riders (45.1%) and Moped/Scooter riders (38.8%) wore helmets much less. While there is no major change in the percentage of observed motorcycle types and the overall use of personal protective gear in the Florida rider population between two survey cycles, it was observed that nearly 9.5 percent of motorcycle riders do not wear any sort of eye protection whether they were helmeted or not. Florida law requires all motorcycle riders to wear eye protection. According to the survey, observed helmet use is quite different from county to county in Florida. A statistical analysis showed that the proportion of fatal motorcycle crashes to the total number of motorcycles and observed helmet use at the county level are correlated. The Pearson correlation is equal to (P-Value = 0.008), which means certain counties in Florida can be more vulnerable to fatal crashes due to the low rate of helmet use. An ANOVA test also confirmed

14 Lee et al that county is a significant variable for crash injury severity as well as crash year, rider age, and alcohol use. While a further in-depth study can be recommended to establish a causal relationship between increased fatal motorcycle crashes in Florida and helmet law changes, this study presented a clear trend of motorcycle crashes in Florida 10 years before and after the helmet law change and the use of helmets among motorcycle riders without the mandatory helmet law. Lastly, it is notable that the state of Florida has recently made rigorous efforts to address the increased motorcycle crashes in Florida including a recent law change that mandates basic rider training for all new motorcyclists in order to obtain their motorcycle riding endorsement. Preliminary analysis results of the 2009 Florida crashes from the latest Traffic Crash Statistics Report shows a 24.4 percent reduction in motorcycle-related fatalities and a 13.6 percent reduction in overall motorcycle-related crashes.

15 Lee et al REFERENCES 1. National Highway Traffic Safety Administration. Fatal Accident Reporting System. Available at: Accessed: July 25, Florida Department of Transportation. Motorcycle Safety. Available at: Accessed: July25, Patricia, T., and C. Hagelin., Motorcycle Helmet Use and Trends Before and After Florida's Helmet Law Change in In Transportation Research Record: Journal of the Transportation Research Board, No.1922, Transportation Research Board of the National Academics, Washington, D.C., 2008, pp Muller A., Florida s Motorcycle Helmet Law Repeal and Fatality Rates. Am J Public Health. 2004; 94: Kanitpong, K., B. Nuttapong. and T. Yordphol, Helmet Use and Effectiveness in Reducing the Severity of Head Injuries in Thailand. In Transportation Research Record: Journal of the Transportation Research Board, No.2048, Transportation Research Board of the National Academics, Washington, D.C., 2008, pp Traffic crash statistics reports Available at: Accessed: July 25, National Highway Traffic Safety Administration. Traffic Safety Facts, 2008 Data: Motorcycles. Washington, DC: Department of Transportation; DOT publication HS Guidelines for State Observational Surveys of Safety Belt and Motorcycle Helmet Use. Federal Register, Vol. 57, June 29, 1992.

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