Enforcement and Helmet Use Compliance: An Observation in Selected Areas in Selangor

Enforcement and Helmet Use Compliance: An Observation in Selected Areas in Selangor Rabihah, I., Azli, A. Z., Abdullah, S. & Nurulhana, B. Design and Instrumentation Unit, Road User Behavioral Changes Research Center, Malaysian Institute of Road Safety Research, Kajang, Malaysia Abstract Motorcycle crash fatalities make up approximately 60% of Malaysia s road crash fatalities, even if it is not the most-widely used mode of transportation in Malaysia. One of the most promising personal protective equipment that is available for vulnerable motorcyclists is the crash helmet. An observation was conducted during a festive week during which enforcement activities were more intense as compared to during normal days. The objective of this observation is to study motorcyclists compliance of helmet use during the enforcement period in two selected areas in Selangor, the state with highest number of recorded road crash fatalities in Malaysia. The observation records whether a motorcyclist was using a helmet, type of helmet used, the type of strap and users' characteristics. Appropriate helmet use and appropriate strap style are the criterion in determining proper use of a helmet. 6,422 riders and 1,226 pillions were observed in this study. There is no significant difference in helmet use during the weekend and weekdays as the use rate ranged from 92.1% to 92.5%. Despite the high compliance of helmet use, the rate of proper use was dismal as it only ranged from 43.8% to 46.3%. There is a significant association between proper use and day of observation. Motorcyclists in Semenyih were more likely to wear the helmet properly as compared to those in Sekinchan (OR= 4.46, CI=4.03, 4.95). Low proper use rate indicates the need for improvements in the enforcement activities and that motorcyclists do not understand the philosophy behind helmet use law. Results suggest that Malaysia needs enhancements in the enforcement approaches and also proper advocacy programs to mitigate this situation. 1 Introduction 1.1 Motorcycle Crash Overview The motorcycle s relatively cheap cost and reliability make it one of the preferred modes of transportation in Malaysia. The demand for motorcycles is the second highest after cars, with the registration of motorcycles making up 1

Number of fatalities 4 th International Conference for Road Safety 44.74% of new vehicles registration in 2011 [1]. Although it is the second most popular mode of transportation, motorcycle crashes contribute 60% of road fatalities in Malaysia [2, 3]. Motorcyclist fatalities is not only a problem in Malaysia but also in other Association of South East Asian Nations, ASEAN, where motorcycle accidents contribute to 52% of road fatalities. Cambodia holds the highest number of motorcyclist fatalities per 10,000 registered motorcycles in ASEAN [4] while Malaysia is at the 7th place. Further analysis on motorcyclist fatalities in Malaysia [2] found out that 61% of fatalities occurred in rural areas, 62% on motorways and primary roads, 66% on straight roads, and 93% during clear weather. Researchers also found out that motorcyclist fatalities are at the highest from Saturday to Tuesday, especially on the weekend [5]. 600 500 400 300 200 100 0 409 462 506 335 355 340 268 325 307 334 184 122 Fatalities Hours Figure 1. Number of motorcycle accident fatalities by time of day (2011). Figure 1 illustrates the number of motorcycle accident fatalities by the time of day in Malaysia in 2011. The number of fatalities fluctuates over the hours but are at the highest during 1601 to 2200 hours, which are peak hours [5]. High exposure, high traffic volume and fatigue due to working could be the contributing factors in these crashes. 2

1.2 Injury and Fatality Profile 2.4% 0.4% 0.1% 9.1% 23.7% 60.5% Head Neck Chest Arms Back Hips 0.7% 3.1% Legs Multiple Figure 2. Motorcyclist fatalities by part of body injured. Kulanthayan s study found out that head injury contributes to the majority of motorcyclist fatalities [3], which is consistent with Royal Malaysian Police (RMP) data from 2011 [6] as illustrated in Figure 2. Figure 2 also suggests that multiple injuries is the second most common injury in motorcyclist fatalities. Multiple injuries would also include head injury. However, Yen and team's review of 186 fatality cases found out that chest injury is the second contributor to motorcyclist fatalities after head injuries [5]. Data by WHO shows that head injuries also result in high medical and social costs to survivors, their families and community [7]. 1.3 Helmet Saves Lives The crash helmet is one of the most promising protection methods for motorcyclists. Studies have shown that the use of helmet could reduce injuries risk and severity; and decrease the likelihood of fatality up to 39% [7]. Data reviews from 70 countries found out that for every 10% increase in helmet use rate, 1 life per 1,000,000 inhabitants can be saved per year [8]. However, a helmet is only effective when it is properly secured [9]. Malaysia has enforced Motorcycle (Safety Helmets) Rules since 1973 which states that every person other than a person exempted under rule P.U. (B) 23/1975, who drives or rides on a motorcycle on a road is required to wear a safety helmet which must be fitted and securely fastened in the manner required by the nature and construction of safety helmet [10]. 3

The exemption was given to Muslim Hajis, Hajjahs and Lebais, who wear serban (Muslim type of turban) and to motorcyclists of the Sikh persuasion who wear turbans. Hajis and Hajjahs are Muslim men and women who have performed their pilgrimage in Mecca while Lebais are Muslim religious clerics. This exemption is subject to the condition that such classes of persons are wearing the serban or turbans as the case may while driving or riding motorcycles. Violators of this law can be fined up to RM300.00. Apart from the fine, violators may be given an oral caution and advice from a traffic police [9]. Helmet use compliance is affected by enforcement activities [8], and more frequent enforcement activities during the festive seasons are the norm in Malaysia as a method of mitigating road crashes [11]. Accident data by month from years 2007 to 2011 shows that the highest numbers of accidents were recorded during the months with a festive season [6], which were caused by an increased traffic volume and greater exposure. Therefore, a study was conducted to study the helmet use law compliance during a festive season in Selangor, a state which consistently records the highest number of fatalities in Malaysia [6]. 2 Methodologies This study was conducted during the Aidilfitri festive season during which the enforcement level is greater as compared to normal days. A majority of Malaysians celebrate Aidilfitri since Malaysia is a Muslim-majority country. During this festive season, most Muslims visit friends and family members; and leave the cities to return to their hometowns, which increase the risk of being involved in road crashes. The enforcement officers had selected two primary roads; F1 and F5 due to the high occurrence of crashes recorded there to conduct their enforcement activities. Semenyih was chosen to represent the F1 stretch while Sekinchan to represent the F5 stretch. An observational study was conducted on a weekday and a weekend during which observers were stationed in primary and arterial roads of both towns concurrently. Data was recorded at 10 a.m. to 12 a.m. and 4 p.m. to 6 p.m. simultaneously for comparison. These time frames were selected to represent the hours with the least fatalities and the fatal hours with most fatalities, respectively. Data collection could not be performed during the highest fatality hours due to the diminishing daylight. During the observations, observers recorded the volume of motorcycles and helmet compliance by looking at riders and pillions gender, age class, helmet type and strap use. The definitions used in this study are simplified in Figure 3: 4

i. Appropriate helmet: A type of helmet used by motorcyclists (riders and pillions) which is built with a full shell cover to protect the wearer s head against impact, e.g: full-faced helmet and half-faced helmet. ii. Inappropriate helmet: A type of helmet used by motorcyclists (riders and pillions), which is built with a shell cover, but is unable to protect the wearer s head against impact, e.g: turtle helmet. iii. Proper use: The act of helmet use whereby the wearer is using an appropriate helmet WITH the chain-strap properly fastened. iv. Improper use: The other types of helmet use that do not comply with proper uses listed above). For example: a. using an appropriate helmet with loose / untied chin-strap b. using an inappropriate helmet Figure 3. Examples of proper and improper helmet use. Observers underwent training to classify the motorcyclists based on their physical appearances and helmet use. Age class and gender of a motorcyclist would be classed as unknown if observers found that motorcyclist physical appearance inconclusive. Data was recorded using a helmet compliance observation checklist. The recorded data then was analyzed using SPSS 17.0. 5

3 Results and Discussions A total of 7,648 motorcyclists were observed during the 2 days of data collection. 6,422 of them were riders, and the rest; 1,226, were pillions. 78.9% of observed motorcyclists were male, 17.0% were female while the rest were of unidentified gender. Observed motorcyclists were 95.5% adults, 4.5% children while the rest were of unidentified age class. The observation shows that helmet wearing status was high during enforcement days with the helmet use rate at 92.3%. However, a deeper analysis found out that improper use rate was higher (50.7%) as compared to the proper use rate. 43.2% of motorcyclists fall into the improper use group due to the failure in fastening the strap securely, 25.2% due to the use of inappropriate helmets while the rest (31.5%) was due to inappropriate helmet use and unsecured strap. 3.1 Overall Helmet Use Table 1. Helmet use by motorcyclist type, gender and age class. Variables Wear (%) Not Wear (%) Pearson Chi- Square Motorcyclists Riders 6216 (96.8) 206 (3.2) Pillions 842 (68.7) 384 (31.3) 1142.90* Male 5787 (95.9) 248 (4.1) Gender Female 1228 (94.3) 74 (5.7) 2806.83* Unknown 43 (13.8) 268 (86.2) Adults 6992 (95.8) 309 (4.2) Age class Children 60 (17.6) 281 (82.4) 2796.90* Unknown 6 (100.0) 0 (0.0) *significant at p<0.05 Table 1 shows that the majority of both riders and pillions were wearing a helmet when they were travelling by motorcycle. However, more pillions were observed to not be using a helmet as compared to the riders. This suggests that motorcycle operators are 13.76 times more likely to wear a helmet as compared to pillions (CI=11.45, 16.54). Table 1 illustrates a strong association in helmet use and gender. However, male motorcyclists were 1.41 times more likely to wear a helmet as compared to female motorcyclists (CI=1.08, 1.84). A high percentage of helmet non-users (86.2%) were observed among the motorcyclists with unknown gender. Observers could not conclude those motorcyclists gender due to their physical appearance; for example those who were too slim or too 6

overweight, those who covered their chest areas with a windbreaker and those with androgynous hair styles. In terms of age, helmet use among adults was significantly higher than that of children s. The analysis of odds ratio shows that children were 104.91 times more likely to not wear a helmet as compared to adults when travelling by motorcycle (CI=77.63, 141.18). Table 2. Helmet use by day, hour, location and road type. Variables Wear (%) Not Wear (%) Pearson Chi- Square Day Weekday 3572 (92.5) 289 (7.5) Weekend 3486 (92.1) 301 (7.9) 0.58 Hour a.m. 3131 (93.4) 220 (6.6) p.m. 3927 (91.4) 370 (8.6) 11.065* Location Semenyih 3913 (96.5) 144 (3.5) Sekinchan 3145 (87.6) 446 (12.4) 210.54* Road type Primary 3386 (96.2) 134 (3.8) Arterial 3672 (89.0) 456 (11.0) 139.88* *significant at p<0.05 Table 2 shows that there is no significant association in helmet use during the weekend and weekdays. However, helmet use is significantly associated with time of the day whereby motorcyclists were 1.34 times more likely to wear a helmet during morning trips as compared to during afternoon trips (CI=1.13, 1.59). Strong associations between the factor of location with helmet use; and road type with helmet use are also evident in Table 2. The odds ratio test shows that motorcyclists in Semenyih were 3.85 times more likely to wear a helmet as compared to motorcyclists in Sekinchan (CI=3.18, 4.68). Analysis also shows that motorcyclists on primary roads were more likely to wear a helmet as compared to those on arterial roads (OR=3.14, CI=2.57, 3.83). 7

3.2 Proper Helmet Use 7.7% 50.7% 41.6% proper improper not using Figure 4. Distribution of helmet use. Figure 4 shows that 92.3% of motorcyclists in Semenyih and Sekinchan wore their helmet while riding their motorcycles and only 7.7% of them did not. Despite a high number in helmet use, only 42% of motorcyclists were wearing them properly. Table 3. Proper use by motorcyclist type, gender and age class. Variables Proper (%) Improper (%) Motorcyclists Riders 2778 (44.7) 3438 (55.3) Pillions 402 (47.7) 440 (52.3) Male 2719 (47.0) 3068 (53.0) Gender Female 442 (36.0) 786 (64.0) Unknown 19 (44.2) 24 (55.8) Adults 3153 (45.1) 3839 (54.9) Age class Children 24 (40.0) 36 (60.0) Unknown 3 (50.0) 3 (50.0) *significant at p<0.05 Pearson Chi- Square 2.791 49.449* 0.683 As presented in Table 3, improper use was identified to be greater than proper use in all motorcyclist type, gender and age class, but only statistically significant in terms of gender. Riders and children were observed to be more frequent in improper use as compared to pillions and adults. There is a strong association between gender and proper use in helmet use whereby a majority of motorcyclists in all the three groups of gender did not wear their helmet properly. When comparing between the male with the female, female motorcyclists were 1.58 times more likely not to wear their helmet properly (CI=1.39, 1.80). 8

Table 4. Proper use by day, time, location and road type. Variables Proper (%) Improper (%) Day Weekday 1566 (43.8) 2006 (56.2) Weekend 1614 (46.3) 1872 (53.7) Hour a.m. 1321 (42.2) 1810 (57.8) p.m. 1859 (47.3) 2068 (52.7) Location Semenyih 2373 (60.6) 1540 (39.4) Sekinchan 807 (25.7) 2338 (74.3) Road type Primary 1983 (58.6) 1403 (41.4) Arterial 1197 (32.6) 2475 (67.4) *significant at p<0.05 Pearson Chi- Square 4.31* 18.65* 862.029* 479.81* Table 4 shows that the time of travelling is significantly associated with the proper use of the helmet in both days and hours. Proper use was observed to be 1.10 times higher during the weekend as compared to during the weekdays (CI=1.01, 1.21) while more improper use was recorded in the morning as compared to afternoon (OR=1.23, CI=1.12, 1.35). Motorcyclists in Sekinchan were identified to be 4.46 times more likely not to use the helmet properly as compared to motorcyclists in Semenyih (CI=4.04, 4.95) while a significant majority of motorcyclists in Semenyih (60.6%) wore their helmet properly. Road type is also strongly associated with the proper helmet use as illustrated in Table 4. Motorcyclists on arterial roads were more likely not to wear their helmet properly as compared to motorcyclists on main roads (OR=2.92, CI=2.65, 3.22) who were observed to use their helmet properly (58.6%). 4 Discussions While a high helmet use was rate recorded, a high improper use rate was also recorded. This shows that the current enforcement approach could not ensure motorcyclists compliance with the law of using a helmet and fastening the strap securely. Compared to the use of a fitted helmet, the problem with the failure of securely fastening the strap is more prominent. This situation could explain the high count of head injuries recorded even when most motorcyclists are using a helmet [12]. 9

4.1 Motorcyclist characteristics More riders were observed to wear a helmet as compared to pillions, but there was no significant difference in term of the proper use. The study also shows that more male motorcyclists were using a helmet as compared to female motorcyclists and more male motorcyclists were wearing it properly. This result contradicts the other studies [3, 13, 14] which found out that proper use is significantly higher among female motorcyclists as compared to their male counterparts. While adults showed a higher helmet use rate, there is no significant difference found in the rate of proper use. This result is consistent with WHO and Kulanthayan's findings [14] that children are less likely to wear a helmet and tend to put on adult helmets, which do not fit them [15]. The higher rate of helmet use among adults could be attributed to their lower risk taking behavior [5] since they have more responsibilities as compared to children. However, they could still lack the initiative to wear the helmet properly. 4.2 Time Days in a week do not make any difference on helmet use rate among motorcyclists, but proper use is significantly higher during the weekend. This condition could be contributed by the perception that enforcement activities are more likely to take place during the weekend. Weekend is also a time for long distance travelling, with the distance travelled also influencing the proper use [3]. Despite the high helmet use rate in the morning, the helmets were less likely to be worn properly. Hurriedness for business or school is the possible influencing factor. 4.3 Location 60.6% of proper helmet use in Semenyih was recorded in this study while a study by Azzuhana during the 2012 Chinese New Year resulted in 83.17% [11]. However, a comparison could not be made since the definition for proper use was not clearly stated in that study. Higher rates in both helmet use and proper use in Semenyih and primary roads indicate that the prediction of enforcement activities influences motorcyclist s helmet use behaviour. This result corroborates other studies performed on the location factor [2, 3, 11,13], and crash records [6, 12]. Another factor could also be Sekinchan s more rural location as compared to Semenyih. It is the norm in rural areas in Malaysia for the traffic police to be more lenient with traffic offenders, and they are more likely to let the offenders off with a warning than with a traffic fine, as highlighted by [3]. 10

5 Conclusions The rate of helmet use was high in both observed towns, which was in the range of between 87.6% to 95.6%. Semenyih registered significantly better percentages in terms of helmet use and its proper use than Sekinchan. Despite the high number in helmet use, the study shows that the percentage of proper helmet use was as low as 45.1%, even during active enforcement activity periods A high rate of helmet use could be an indication of good enforcement activities. However, a low proper use rate indicates that the current enforcement approaches need to be reviewed. This result also suggests that motorcyclists do not understand the philosophy behind the helmet use law [11]. Therefore, besides improving the enforcement, proper advocacy programs are also needed to mitigate this situation. References 1. JPJ. (2012). Jumlah Pendaftaran Motosikal Mengikut Tahun. Retrieved December 3, 2012, from http://www.jpj.gov.my/web/guest/statistikpendaftaran-motosikal 2. Abdul Manan, M., & Varhelyi, A. (2012). Motorcycle Fatalities in Malaysia. IATSS Research 36, 30-39. 3. Kulanthayan, S., Radin Umar, R., Ahmad Hariza, H., & Mohd Nasir, M. (2001). Modeling of Compliance Behavior of Motorcylists to Proper Usage of Safety Helmet in Malaysia. Journal of Crash Prevention and Injury Control Vol 2 (3), 239-246. 4. Bachani, A., Tran, N., Sann, S., Ballesteros, M., Gnim, C., Ou, A., et al. (2012). Helmet Use Among Motorcyclists in Cambodia: A Surveyof Use, Knowledge, Attitudes, and Practices. Traffic Injury Prevention, 13:sup1, 31-36. 5. Yen, P., Radin Umar, R., Azhar, A., Harwant, S., Shahrom, A., Abdul Halim, M., et al. (1999). Fatal Injuries in Malaysian Motorcyclist. International Medical Research Journal 3 (2), 115-119. 6. PDRM. (2012). Laporan Perangkaan Kemalangan Jalan Raya Malaysia 2011. Kuala Lumpur: Cawangan Trafik, Bukit Aman. 7. WHO. (2006). Module 1: Why are Helmets Needed?. Retrieved December 3, 2012, from http://whqlibdoc.who.int/publications/2006/9241562994_chap1_eng.p df 8. Abbas, A., Hefny, A., & Abu-Zidan, F. (2011). Does Wearing Helmets Reduce Motorcycle-Related Death? A Global Evaluation. Accident Analysis and Prevention. 11

9. Radin Umar, R., Kulanthayan, S., Law, T., Ahmad, H., Musa, A., & Mohd, N. (2005). Helmet Initiative Programs in Malaysia. Pertanika Journal Science & Technology Supplement 13 (1), 13(1), 29-40. 10. WHO. (2010). Helmet Legislation. Retrieved November 11, 2012, from http://www.who.int/violence_injury_prevention/road_safety_status/20 09/laws/helmet_malaysia.pdf 11. Azzuhana, R.,Norfaizah, M.K., Nusayba, M.J., Rohayu, S. & Jamilah, M.M. (in press). Effectiveness of OPS Chinese New Year 2012 on Helmet Use of Malaysian Motorcyclists: A Case Study in Selected Districts in Selangor. Kuala Lumpur: MIROS. 12. Talib, R., Mohd Faizar, M., Sutiman, K., & Ramlan, K. (2003). Kemalangan Jalan Raya: Analisa Data Membabitkan Pengguna Motosikal. Jurnal Teknologi. 38 (B), 1-14. 13. Ambak, K., Hashim, H., Yusoff, I., & David, B. (2010). An Evaluation on the Compliance to Safety Helmet Usage among Motorcyclist in Batu Pahat, Johor. International Journal of Integrated Engineering (Issue on Civil and Environmental Engineering), 45-51. 14. Kulanthayan, S., Radin Umar, R., Ahmad Hariza, H., Mohd Nasir, M., & Harwant, S. (2000). Compliance of Proper Safety Helmet Usage in Motorcyclist. Medical Journal Malaysia Vol 55 No 1, 40-44. 15. WHO. (2004). Road Safety - Helmet: Facts. Retrieved November 13, 2012, from http://www.who.int/violence_injury_prevention/publications/road_tra ffic/world_report/helmets_en.pdf 12