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Evaluation of the Costs and Benefits

of

Motorcycle

Helmet Laws

ANDREAS MULLER,

PHD

Abstract: Since 1976, 28 states have repealed or

significantly

amended their motorcycle helmet laws. The change in legislation was not based on an

evalua-tion

of the costs and benefits of such laws. This paper attempts such an assessment by comparing the cost of

motorcycle

helmets with the

medical

costsaverted due to helmet use using data primarily based on

motor-cycle

crashes in Colorado, Oklahoma, and South Da-kota. Nationwide, at least $61 million could be saved

annually

ifall

motorcyclists

were to use helmets.

Hel-metlaw repeals have been observed to lead to a 40 to 50per cent

point reduction

in helmet use. The

associ-Introduction

Motorcycles enjoy increasing popularity in the United States. Between 1967 and 1977 motorcycle registrations

in-creasedby 150 per centfrom about2million vehiclesto over

5 million, with most ofthe increase occurring before 1974.

Withtheincreasing number of motorcyclesonthehighways, thedeath toll has increasedaswell. Between 1967and 1976,

the number ofmotorcycle deathsrosefrom1,971 to3,000,or

5per centannually. ' However, in 1977the number of

motor-cycle fatalities alone increased by 770, or23per cent, from theprevious year.2

AU.S. Department ofTransportation study relates the rise inmotorcycle deathsto therepealofmotorcycle helmet laws inmanystates. Thestudy notes that, in11 stateswhich repealed their helmet laws, fatalities increased during the first half of1977by one-third when comparedwiththesame

period in 1976. In contrast, the number of deaths increased by only 6per cent in 28 states which retained thelaw.3

Watson's, et al, recentexamination of26 states which repealedor weakened theirmotorcycle helmetlaws further

Address reprint requests to Andreas Muller, PhD, Assistant

Professor,Pennsylvania StateUniversity,College ofHuman Devel-opment, University Park, PA 16802. Thispaper, submitted to the

JournalNovember9, 1979,wasrevised and accepted for publication February 11, 1980.

Editor'sNote: See alsorelated editorial, p 573, and article, p.

579, this issue.

ated

additional medical

carecosts

substantially

exceed cost savingsproduced by reduced helmet use. It is es-timated that helmet law repeals may produce annually between

$16

and 18 million of unnecessary medical care

expenditures.

Several alternatives to increase

motorcycle

helmet use are

briefly discussed.

Itis con-cluded that helmet laws are effective in encouraging helmet use among motorcyclists and will prevent un-necessary

medical

expenditures

as well as unneces-sary

pain

and

suffering

among injured motorcyclists. (Am J

Public

Health 70:586-592, 1980.)

indicatesthat the motorcyclistfatality rate increased by 38

per cent over that predicted if laws had remained in effect.4 This finding is alsocorroborated byRobertson's studywhich suggeststhatthemotorcyclefatalityratedropped by30per cent after introduction of helmet laws.5

In 1976, Congress disallowed the withholdingof high-way construction funds from states which did not require

helmet useforpersons over 18 years ofage. Sincethen, 28 states have either repealed or weakened their motorcycle helmet laws.* Recognizing the waning support for helmet

laws, the National Highway Traffic Safety Administration

(NHTSA) commissioned several studies to further explore theeffectivenessofsafetyhelmets and relatedregulation.6-9

Noefforthas beenmade, however, to determinethebenefit

and costof thislegislationtothepublic. The followingpaper presents such an analysis which is primarily based on the

accident experience ofmotorcyclists in Colorado,

Oklaho-ma, and SouthDakota.

The application of cost-benefit analysistopublic health and safety programs encounters formidable problems. The principal benefits of such programs are in terms of lives

saved, injuries prevented, or pain and suffering averted,

*Thestatesare:Alaska, Arizona, Colorado, Connecticut,

Dela-ware, Hawaii, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine,

Maryland, Minnesota, Montana, Nebraska,New Hampshire,New

Mexico, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island,

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while program costs are measured in monetary units. How-ever,cost-benefit analysis requires thatcostand benefits be measured in the same units. Several studies conducted by the federal government'0'" attempted to overcome this problem by equating the value of lives lost with the value of

foregoneearnings. But, as Acton pointsout, this approach is

theoretically unfounded and discriminatory.12 Moreover, many public decision makers and public policy observers

find it objectionable to assign dollar figures to human lives. Due to thesedifficulties, the present cost-benefit

analy-sisisconfined to clearly measurable effects. These are: 1) the cost ofmotorcycle helmets, and 2) the dollar value of the

medicalcare expenses averted due to the use of the safety

device. The limitation of the analysis to these effects will

result inan underestimateofthe monetaryvalue of the gross

benefits and yieldaconservative estimateofthe net benefits. Inaddition, an attemptwillbe made toassess the importance

of effects notmeasured inmonetary terms.

The

Cost

and

Benefit

ofHelmet

Use

In this section the costs of helmets will be compared

with the costsavings generated by the number of head and facial injuries prevented by helmet use. For ease of calcu-lation, costs and benefits are computed on the basis of

100,000motorcycles inagivenyear.

The current retail price for motorcycle helmets ranges

between $11 and $130 depending upon the type of helmet.

Thelower pricerepresentsthe saleprice ofastandard safety helmetmeeting federal standards withoutaface shield which addsbetween$3and$10totheprice.Arepresentative of the Safety Helmet Council of America estimates thecurrent av-erage retailprice ofsafety helmetsat$30.**

Since motorcycle helmet laws require that motorcycle drivers and passengers wearhelmets, the totalexpenditure

on motorcycle helmets has to be adjusted for the average

number of riderspermotorcycle. Roadsidesurveys inSouth Dakota,6 Colorado,7 and Oklahoma8 observed motorcycle

occupancy ratesranging from 1.22 to 1.27ridersper

motor-cycle.Assuming that the helmetpriceaverages$30,that the

averagenumber ofmotorcycleridersis1.25, and theaverage

lifetime of used helmets ranges between 4.1 and 4.9

years,*** the total annual consumer expenditure is esti-mated between$910,194and$766,871 per 100,000

motorcy-cles.

The gross medical care expenditure benefit of helmet

use is determined by three factors: 1) the motorcyclist's probability of being involved in crashes; 2)theeffectiveness of the safevv device; and3) the amount ofmedical care

ex-penditures

tPK

7ries ofdifferent severityclass.

The

MotorcY

Safety

Foundation'3

inconnection with theAmerican

MotfC<ycle

Association'4reported 144,115

ac-cidents nationwide in 1976,representinganannual crash

in-**Personal communication May 10, 1979 with Ivan Wagar,

President of Safety Helmet Council ofAmerica.

***SeeAppendixAfor estimation ofaveragenumber ofhelmet

useyears.

volvementrate of2.9 percent(144,115/4,979,889registered motorcycles x 100). Incomparison, the crash involvement

rateswere somewhat lower in states considered in the

analy-sis. The average crashinvolvementratefor theperiod 1973-77 was 2.1 per cent in Colorado,7 2.3 percentin Kansas,9 and 1.8 per centin South Dakota.'" Similarly, the crash in-volvement rateformotorcycles registered inOklahomawas 1.9percentin 1976 and 2.0percent in1977.''3 16 To derive a

lower bound on the amount ofthe gross benefit, it will be assumed the crash involvementrateis 2per cent.

The effectiveness ofhelmets can be measured by

com-paring therateofinjury for helmeted and non-helmeted

mo-torcyclists involved in crashes. Specifically, if helmets are

effective, the rate and severity of head and facial injury

should be lower for helmet users than for non-users. This

expectation is supported by several studies which indicate

that injuredmotorcyclists who didnot wearhelmets had be-tween two and three times higher rates of head andfacial

injuries thanthose who worehelmets.6-9 Also,theaverage severity of these injurieswasfoundtobesignificantly higher

among injuredmotorcyclists notwearinghelmets.

Table 1showsthe effect ofhelmetuse ontheseverity of injuryasmeasured by the Overall AbbreviatedInjuryScale

(OAIS).'7Accordingtothisscale, the crash-involved

motor-cyclist is assigned a single scorebasedonthe clinical

judg-mentof theoverall effect ofhis/hermost severeinjuries. The

data clearly show that non-helmet users are morelikely to

sustaininjuries ofhigher severity ranking.Forinstance,

non-helmetedmotorcyclistsare atleasttwoandone-half timesas

likelytosustaincritical and currently untreatable injuriesas arehelmet users (see OAIS classes 5and6).

Adjusting the crash involvementrateby theaverage oc-cupancy rate of motorcycles (1.25), about 2,500

motorcy-clistsareexpectedtohavebeen involved in crashes annual-ly. When this base numberis distributed accordingtoOAIS class(see Table 1), theexpected number ofinjured and unin-jured riders can be determined foreach group of

motorcy-clists. Helmet effectivenesscanthen beexpressedasthe dif-ference between the number of helmetusers andnon-users

for eachseverity class. The results of these calculationsare

presented in Table 2.

Faigin's study of the "SocietalCosts ofMotorVehicle Accidents," is used as the basis for the valuation of bene-fits.'8 Among other cost components, the study estimates medical care expenditures on hospitals, physicians, other

health care providers, andrehabilitation for each injury

se-verity class. These estimatesarepresently the best available

proxy measure for the cost ofhead and facialinjuriesand are

presentedinthe fourth column ofTable 2. The multiplication ofthe cost estimatesbythose in column3,results inan

esti-mateof$1,308,781 for medical care and rehabilitationcosts

averted in 1975 dollars, or $2,094,050 in 1979 prices.t The

tFor the period 1972-77, the average annual inflation for all healthcareexpenditures varied between10and15 percentwith 12.5

percentbeing themeanof the annualaverages.'9Itis assumedthat anannualinflationrateof12.5 percentpersiststhroughout 1975-79,

that is, 1979healthcare pricesexceed 1975prices by60percent. Thus, 1975pricesareinflatedbyafactorof1.6.

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TABLE 1-Distribution of Crash-involved Motorcyclists by Overall Abbreviated Injury Scale and Helmet UseStatus

Helmet Use Yes No OAIS % 0. NoInjury 605 39.59 347 33.62 1. MinorInjury 388 25.39 198 19.18 2. Moderate Injury 307 20.09 223 21.61 3. SevereInjury (not life 148 9.68 145 14.05

threatening)

4. SeriousInjury(lifethreat- 42 2.75 45 4.36 ening, survivalprobable)

5. Critical Injury (survival 15 .98 27 2.62 uncertain)

6. Maximum Injury (currently 23 1.51 47 4.55 untreatable)

TOTAL 1,528 99.99 1,032 99.99

SOURCE: DatawereaggregatedfromDare,etal,7(Table5, p. 13)and fromDorrisandPurswells(Table 47,p.47; Table 23, p. 29).

Note: Result ofKolmogorov-Smimovtest with directionpredicted:X2= 9.5=p<.01 (2 df).

annualgrossbenefit exceeds theannual expenditureon hel-metsbyatleast$1,183,856per100,000motorcycles.

Extrap-olating this figuretoallregistered motorcycles

(approximate-ly 5,150,000),anannual net benefit of$61 milliondue to hel-met usewould be expected nationwide.

Costs

and

Benefits

ofHelmet

Law

Enactment

and

Repeal

The

previous

calculations assess the costs and benefits

of

motorcycle

helmetuse. Incontrast, thecostsand benefits

ofhelmet laws mustbe measuredby the additional (margin-al)costsandbenefits arisingfrom lawenactment orrepeal. The following section willpresent two methods for estimat-ing these effects. The first method estimates the marginal

costsand benefitsas afraction of thenetbenefitdueto

hel-met use(seeTable 2).

Large roadside surveysofmotorcyclists insevenstates

have found voluntary helmet use to range between 37 per cent and 64 per cent with a mean helmet use of 51 per

cent.7 152024 Incontrast, helmetuse exceeded 90per cent

in similarsurveys which hadbeen conducted theyearprior

to helmet law repeal (Utah 92percent; South Dakota99.5

TABLE 2-Expected Number ofCrash-Involved Motorcyclists per 100,000 Motorcycles byInjurySeverityClass, Helmet UseStatus, RelatedMedical Care & Rehabilitation Costs, and Medical Care Costs Averted

Helmet Use Medical Medical

Care Cost per Person Care Costs in1975($) Averted Yes No Difference (4) (5)=(3)x(4) OAIS (1) (2) (3)=(2)-(1) $ $ 0. NoInjury 989.8 840.5 -149.3 0 0 1. Minor Injury 634.8 479.5 -155.3 100 -15,530 2. ModerateInjury 502.3 540.3 38.0 615 23,370 3. SevereInjury 242.0 351.3 109.3 1,620 177,066 4. SeriousInjury 68.8 109.0 40.2 7,450 299,490 5. Critical Injury 24.5 65.5 41.0 17,345 711,145 6. MaximumInjury 37.8 113.8 76.0 1,490* 113,240 TOTAL 2,500 2,499.9 1975 ($) 1,308,781 1979($) 2,094,050 Gross Annual Benefit: $2,094,050

Gross Annual Cost: High $ 910,194 Low $ 766,871 Annual Net Benefit: Low $1,183,856

High $1,327,179

*Includes$925 (discountedat7%)saved on postponed funeral expenses.

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TABLE 3-Distribution of Crash-involved Motorcyclists by Overall Abbreviated Injury Scale and Helmet Law Repeal Status

HelmetLawRepealStatus

Pre-RepealYear Post-RepealYear

OAIS %

0. No Injury 340 32.47 449 33.04 1. Minor Injury 267 25.50 261 19.21 2. Moderate Injury 203 19.39 309 22.74 3. Severe Injury (not life threatening) 128 12.23 172 12.66

4. Serious Injury(life threatening, 70 6.69 93 6.84 survival probable)

5. Critical Injury (survival uncertain) 14 1.34 37 2.72

6. Maximum Injury (currently untreatable) 25 2.39 38 2.80 TOTAL 1,047 100.01 1,359 100.01

SOURCE: Datawereaggregatedfrom:Dareetal,7(Table 4, p. 12), and fromStruckman-Johnson6(Table 48, Vol.I,

p. 68andTable 1 in Appendices, p. N1).

Note: Result of Kolmogorov-Smirnov test with direction predicted:x2= 9.36=p<.01 (2 df).

per cent and Colorado99.4 per cent). These figuressuggest

that 40 to 50 per cent of all motorcyclists would not wear

helmets voluntarily,butare induced by helmet laws to do so.

Assuming that 50per centof all motorcyclists wear helmets

voluntarilyand helmet lawenactment will extend helmet use to 95 per cent, helmet law enactment could save annually

between$532,735and$597,231 onmedicalcareand rehabili-tation expenditures per 100,000 motorcycles. Conversely,

the repeal of the helmet law will result inanetloss ofequal

size.

The effect of motorcycle helmet law repeal can also be

measuredby comparingpre-and post-repealdata on the

in-jury severity ofcrash-involved motorcyclists. Table 3 pre-sents such a comparison which is based on motorcyclists' OAIS scores.Toincrease the number of observations in the

most serious injury classes (OAIS classes 4, 5, and 6), data forColorado7 and SouthDakota6 wereaggregated.

The effectofthehelmetlawrepealisashiftintheinjury severity distribution toward a smaller proportion of minor injuries and somewhat largerproportion of life-threatening and fatal

injuries,#t

particularly those of injury severity classes5and 6. This result isexpected if helmetsare more

effective in reducingsevere injuries than inreducing minor injuries, and ifhelmet usedeclines inresponse totherepeal

TABLE 4-Effect of Helmet Law Repeal on Medical Care and Rehabilitation Expenditures (Based on Experience in Two States) per 100,000 Motorcycles

NumberofInjured Medical Care

Cost per Person MedicalCare

in 1975($) ExpensesAverted Pre Post Difference (4) (5) =(3) x(4)

(1) (2) (3) $ $ 0. NoInjury 811.8 826 -14.2 0 0 1. Minor Injury 637.5 480.3 157.2 100 15,720 2. Moderate Injury 484.8 568.5 -83.7 615 -51,475 3. SevereInjury 305.8 316.5 -10.7 1,620 -17,334 4. SeriousInjury 167.3 171 -3.7 7,450 -27,565 5. CriticalInjury 33.5 68 -34.5 17,345 -598,403 6. Maximum Injury 59.8 70 -10.2 1,490* -15,198 (currently untreatable) TOTAL 2,500.5 2,500.3 1975 ($) -694,255 1979($) -1,110,808 Gross Annual Cost: $1,110,808

AnnualCostSavings: High $466,019

Low Low $392,638

Low Annual Net Loss: $644,789

High Annual Net Loss: $718,170

SOURCE:seeTable 3

*Includes$925(discounted at 7%) saved on postponed funeral expenses.

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of helmetlaws. In fact, helmet use in the aggregate sample was 94 per cent in the pre-repeal year and 42.8 per cent in the post-repeal year, representing a decline of 51.2 percentage

points.

The effect of helmet law repeal on medical care and re-habilitation expenditures is presented in Table 4. In the stan-dard population, helmet law repeal contributed to an esti-mated$694,255 (1975 dollars) of additional expenditures, or

$1,110,808 in 1979 prices. Most of the additional costs are

incurred by motorcyclists who sustained critical injuries

(OAIS class5). The additional expenditures are partially off-set by a decline in helmet use among motorcyclists. Since helmet use declined by 51.2 per cent in the aggregate sample, it is expected that between $392,638 and $466,019 would be

savedon helmets, resulting in an annual net loss ranging be-tween

$644,789

and$718,170per

100,000

motorcycles. When

these figures are extrapolated to all states which repealed

theirhelmet laws, it can be estimated that helmet law repeals

annuallycontribute$16.1 million to$18.0 million of

addition-al medical care and rehabilitation expenditures in 1979

prices.

Examination

of

Assumptions

The cost-benefit analysis presented in Table 2 assumes

that the difference in injuryseverity between helmeted and

unhelmeted motorcyclistsis due entirely to the effectiveness

ofhelmets. Itis conceivable, however, thatpart orall of the difference is duetoconfounding factors. Forinstance, if

hel-meted motorcyclists travel at lower speeds than

non-hel-meted motorcyclists, then they would be less likely to

sus-taininjuriesas severe astheirunprotectedcounterparts; the

evidence is inconclusive onthispoint.

Data on South Dakota6motorcyclists suggest that prior to the accident helmet users were somewhat less likely to

exceed the speed limit thanwere non-users. Amonghelmet users, 10 per cent exceeded the legal speed limit by six or more miles perhour, while for non-users the figure was 14 per cent. Similar datacompiled in the Colorado study 25 in-dicate that 1.6 per centofhelmet users and4.1 per cent of

non-users exceeded 60 miles per hour before the crash. However, the same study also shows that nearly an equal

proportion of motorcyclists in either group traveled more

than45mph before the accident occurred;23 per cent among

helmet users and 22 per cent among non-users. Similarly, datacollected on injured Kansas motorcyclists do not sug-gest thatthe estimated pre-crash speedwassignificantly dif-ferent betweenthe two groupsofmotorcyclists.24

When the injury severity of helmeted and unhelmeted

riderswascompared for specific body regionswhich should not benefit from helmet use (i.e., chest, abdomen, pelvis, andextremities), helmetedmotorcyclists were found to have a somewhat lower mean injury severity score than unhel-meted motorcyclists. However, the difference between the mean scoresbasedonthe mostsevere injury sustained was notstatistically significant. Itappears therefore, that the

dif-ference between the two groupsofmotorcyclists shown in Table 1 reflects helmet effectiveness rather than

self-selec-tion. This conclusion is also supported by the finding that

amongOklahoma and South Dakota motorcyclists only 9.9

per centof theinjured helmetuserssustained head and facial injuries while28.5 per centof theinjurednon-usersreceived

these typesofinjuries.

Furthermore, the calculations presented in Table 2

as-sumedthathelmetusersandnon-usershad thesame proba-bility ofbeing involved in accidents. It is plausible, however,

thathelmet wearerstendtobea morecautious (safety-mind-ed)groupofmotorcyclistsandarelesslikelytogetinvolved in accidents.Datafromtwostudies wouldsupportthis

prop-osition. In Colorado, the estimated crash involvementrate

for helmetedmotorcyclists was 1.5per cent, while that for unhelmetedriderswas3.2 per cent. InSouthDakota, similar calculations indicate that the crash involvementrates were

1.5 per cent and2.2 per cent, respectively.

Extending helmet use to a group of motorcyclists at

higher risk for accidents will increase thegrossbenefits due

to helmet use and the marginal benefits of law enactment.

Forinstance, if non-users aretwice aslikely tobeinvolved incrashes as helmetusers, and eachgroup isofequal size,

thentwo-thirds ofthe totalgross benefit dueto helmet use

should be produced by the high risk group. If so, the net

benefit due to helmet use and the marginal netbenefit esti-mated onthebasis of Table 2would betoo conservative.

Onthe otherhand, theanalysis ofpre- andpost-repeal data (see Table 4) controls for the different crash in-volvement rates and the different injury severity, because thecomparison includeshelmetusersandnon-users atboth times. Therefore, itis interestingto note thatthe estimated annualnetloss duetohelmet law

repeal

($645,000-$718,000

per 100,000motorcycles)isroughly comparablewith the

es-timate using the first method ($606,000-$680,000) which is based onTable 2. Moreover, theanalyses presented in

Ta-bles 2 and 4 were repeated usingdata onthe most severe

injury sustained (AIS) for Colorado, South Dakota, and

Kansas. The estimated gross annual benefit of helmet use

was8.6 per centlower than that showninTable2while the

grossannualcostduetohelmet lawrepeal was1.2 percent

higher than that reported in Table 4. However, caution is warranted whenextrapolating thefindingsof thisstudysince theaccidentexperienceinfourstatesmaynotbetruly

repre-sentative of the nation.

Discussion

The previous analyses suggest that motorcycle helmet

usecontributestosociety's welfare withoutconsideringthe valueofpain orlives lost. Nevertheless, thereareother ef-fectsorpossibleeffectsthatshould beconsidered before

set-ting public policy.

Although the cost of lawenforcement activities is

un-known, it isnotexpectedto consume alarge amountof

po-liceresources. Helmetuse was over90 per cent among

mo-torcyclists in states mandating helmet use, suggesting that

the cost directly attributable to helmet law enforcement shouldbe very small.

Ithasbeenalleged that theuseofhelmetswillincrease

the rate of neck injuries and interfere with hearing and

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evidence26 and a report by the Department of

Transporta-tion2O (DOT) make it clear that this allegation is unfounded.

Since helmets reduce the sound of safety signals and the noise of the motorcycle by asimilar degree, the motorcyclist

is at no greater disadvantage than the unhelmeted rider to hear safety signals. Althoughhelmet use slightly reduces the

field of vision (by 3 per cent), the horizontal field of view

exceedsthe2100standard set by federal legislation (FMVSS No. 218).

It is undeniable that discomfort and inconvenience are connected with the use of motorcycle helmets. In a study of Illinois motorcyclists27, 45 per cent mentioned discomfort andinconvenience as reasons for not wearing helmets, while 5 per cent ofthe respondents mentioned comfort such as

protection from cold air draft as a reason for wearing the

safety device. Discomfort and inconvenience also influence

use of safety equipment byindustrial workers, but this does not preventmandating their use.

Itis commonly believed that the constraint of personal

freedom is the mostimportantcostborneby motorcyclists. This is a major ethicaland legal issue whose ramifications cannot be dealt with in this brief discussion. It is worth pointing out, however, that in the opinion polls that have

addressed this issue,2830 the majority of all respondents and the majority of motorcyclists interviewed have favored

enactmentof helmet laws.

Public policy makers may also wishto consider means

other than laws to increase the use ofmotorcycle helmets

among motorcyclists. Public information campaigns would eliminate law enforcementcosts aswellastherestriction of individual freedom felt bysomemotorcyclists. Thisassumes

thatmotorcyclists could be persuaded to usethe safety

de-vice, but similar efforts geared toward encouraging safety beltusehavebeen foundtobe failures and wastefulofpublic resources.31'32

Subsidization would shiftpart orall of thecost of

hel-mets frommotorcyclists to the general public by providing federal money to motorcyclists purchasing helmets. This policy removes financial barriers and possibly encourages

helmet use among motorcyclists who believe helmets

con-tributetotheirsafety. However, subsidies wouldnotmotivate motorcyclists whoperceivedthemselvesasunlikelytohave

an accidentto usehelmets;norwouldtheymotivate helmet

use among motorcyclists who valued the convenience

re-latedtohelmetnon-use morethan thebenefits relatedto

hel-met use. In a surveyof Illinois' motorcyclists,33 only21per centof the respondents who didnot own helmets indicated excessive cost as a reason. Therefore, subsidization of

hel-metpurchase isnotexpected toincrease helmet use signifi-cantly among motorcyclists. Moreover, the policy would mainly benefit motorcyclists who otherwise would volun-tarily purchase helmets.

Motorcycle helmet userscouldbe charged lower

insur-ance premia than unhelmeted motorcyclists. This policy would provide incentives for unhelmeted motorcyclists to

purchase and wearthe safety device. However, differential insurancepremiawould encourage themotorcyclisttoclaim helmet useinordertoreduce his insurance payments when infacthelmets are notused. Withoutadditional

administra-tivecontrols, this option would invite insurance fraud. Motorcyclists who fail to wear helmets and sustain head

injuries could be denied compensation for injury and dam-ages. It is difficult, however, forcourts to determine on a

case-by-case basis in which circumstances compensation would be denied, since head injuries are alsosustained when helmets are worn. Thus, liability could have financially

ruinousconsequences for some motorcyclists and appears to be anunduly harshpunishment for injured motorcyclists.

Eventhough motorcycle helmet lawsare not apanacea forreducing injuries and human suffering relatedto motor-cycle use, they seem to be an effective public health policy

whichincreases society's welfare. Repeal of helmet laws or failure to enact them appear to be policies that waste scarce resources and contribute to additional pain and suffering among motorcyclists.

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22. National Center for Statistics and Analysis, NHTSA:

Motor-cycle Accident Cause Factors and Identification of Counter Measures-Summary Status Report. Washington, DC: DOT HS-501160, 1979.

23. Ellinger M: Illinois Motorcycle Helmet UsageStudy. Illinois

Di-vision of Traffic Safety, 1976.

24. Lummis ML and Tucker GL: Impact of the Repeal of the

Kan-sas Mandatory Motorcycle Helmet Law, Final Report. Springfield, VA: NTIS, DOT HS-804018, 1979.

25. Dare CE, OwensTC and KraneS: Impactof Motorcycle Hel-met Usage in Colorado. Springfield, VA: NTIS, DOT HS-803680, 1978.

26. Balcerak JC: Moped, minibike and motorcycle accidents. NY

State J Med78:631, 1978.

27. Hemmerling PM: Knowledge and attitudes aspredictors of

mo-torcycle safety helmet usage: A regression analysis. Carbon-dale,IL:M.S. Thesis, Dept. of HealthEducation,Southern Illi-nois University, 1975.

28. Commonwealth of Pennsylvania: Analysis of the Mandatory Motorcycle HelmetIssue. Harisburg, PA: Governor's Traffic

Safety Council, 1977.

29. Sund KR: A study of attitude and knowledgeaspertains to

mo-torcycle helmets in mandatory and non-mandatory helmetuse

states.'Carbondale, IL: M.S. Thesis, Dept. of Health Educa-tion, Southern Illinois University, 1976.

30. Tatum DK: Nevada'sMotorcycle Helmet and Accident Analy-sis. Carson City, NV: Nevada Office of TrafficSafety, 1978. 31. Robertson LS, et al: Acontrolled study of the effect of

televi-sion messagesonsafetybeltuse. AmJPublic Health 64:1071-1080, 1974.

32. Insurance Institute for Highway Safety: Safety Belt Use: A Fact Sheet,Washington, DC: 1978.

33. Allegrante JP:Explaining safety helmet use by motorcycle oper-ators using a behavioral intention model. Urbana, IL: Ph.D. Thesis, Dept. of Health and Safety Education, University of Illi-nois, 1979.

ACKNOWLEDGMENTS

Theresearch on this paper began during the author's post-doc-toralfellowship at the Johns Hopkins University, School of Public Health. The careful andconsiderate guidance of David S. Salkever will not beforgotten. I would also like to acknowledge the help of representatives of the Safety Helmet Council of America, the Mo-torcycle Safety Foundation, and the Motorcycle Industry Council. However, the responsibility for use and interpretation of the infor-mation provided rests with the author.

Appendix A-Estimation

oftheTotal and Average

Number of

Helmet Use

Years

The total number ofyears of helmet use can be

esti-mated by multiplication ofthree factors: (1) the number of motorcycles inuse per year; (2)theaveragenumber of per-sons riding a motorcycle (occupancy rate); (3) helmet use

observed among motorcyclists. Dividing the product by (4) the number ofhelmets being replaced annually, yields the average number ofyears ofhelmet use.

(I) Number ofMotorcycles in Use: According to the MotorcycleIndustryCouncil, 1' 7,925,600motorcycleswere

operatedin 1977. Themajority of motorcycles (5,144,129 or 64.9 percent) were registered for use on public highways, while the remainder (2,781,471 or 35.1 percent) were used

"off-road." In 1977, 3,133,090 motorcycles wereregistered instates whicheithernever had helmet laws or had repealed

theirlaws recently. Off-road motorcycles areexcludedfrom

such regulation.

(2) Average Occupancy Rate of On-Road and Off-Road

Motorcycles: Roadsidesurveysreportedaverageoccupancy rates ranging between 1.22 and 1.27 persons per

motor-cycle.6-8 Although the occupancy rate of off-road

motor-cycles is unknown, the design of such motorcycles would suggest thatonly oneperson will use the motorcycle. Thus,

the average occupancy of on-road andoff-roadmotorcycles,

is assumed to be 1.25 and 1, respectively.

(3) Helmet Use: Helmet use issubstantially different in

stateswith andwithout helmet laws. Voluntary helmetuseis

assumedto range between40 percent and 50 percent, while helmet use in states with helmet laws is expected to range

between 90percent and 100 percent.

(4) Annual Replacement of Helmets: Currently, about

1.2million motorcycles helmets aresold

annually.itf

Using the previous data,the total and average number ofyearsof helmet use can be estimated (see Table A-1).

4t1

Personal communication May 10, 1979 withIvan Wagar, President ofSafety Helmet Council of America.

TABLE A-1-Calculation of Total and Average Number of Helmet Use Years

Helmet UseYears Helmet Use Motorcycle No. ofMotor- Average PerCent

Status cycles in Use (1977) OccupancyRate HelmetUse High Low On-road 5,144,129

States with law 2,011,039 1.25 90-100 2,513,799 2,262,419 Stateswithoutlaw* 3,133,090 1.25 40-50 1,958,181 1,566,545 Off-road 2,781,471 1.0 40-50 1,390,736 1,112,588 TOTAL 7,925,600 Totalhelmet use years: 5,862,716 4,941,552 Annual replacement: 1,200,000 1,200,000 Average # of use years: 4.89 4.12 *Alaska, Arizona,California,Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana,Iowa,Kansas, Louisiana,Maine,Maryland,Minnesota, Montana,

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