USA report

[Steady rider]

New study questions helmet law benefits in America
Gillham C, Rissel C, Children’s cycling participation, injuries, fatalities and helmet legislation in the United States, World Transport Policy and Practice Volume 21.1 January 2015, http://www.eco-logica.co.uk/pdf/wtpp21.1.pdf

World Transport Policy and Practice has published a peer-reviewed study by Australian researchers who found declining child cyclist injury levels in the US are probably due to corresponding reductions in child cycling participation in that country, with concussion levels not falling despite the introduction of child helmet laws in almost half the American states.
The research also found no difference in fatality levels among US states with or without helmet laws, suggesting the legislation may have contributed to reduced child cycling participation but with no safety improvements at a population level.
The significant reduction in regular recreational cycling among children since the 1990s is a likely long-term contributor to America's obesity crisis and mirrors trends in Australia.
The study was conducted by independent Perth research journalist Chris Gillham and Professor Chris Rissel from the School of Public Health at the University of Sydney.
Their paper analysed publicly accessible data from government authorities including the US Census Bureau report on Participation in Selected Sports Activities, the US Consumer Product Safety Commission National Electronic Injury Surveillance System, and the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System.

Study findings
Out of 51 jurisdictions in the NHTSA Fatality Analysis dataset for 2011, there are 23 jurisdictions (45.1%) with some form of helmet law for child cyclists including some for children up to 17 years. The first child helmet law was introduced in California in 1987, with most other states enacting the law in the mid to late 1990s.
The estimated number of children aged 7-17yo in the US who cycled in the previous 12 months plunged from 22,948,000 in 1995 to 10,800,000 in 2012, despite Census data showing the 5-17yo population increased by 9.6% during those years.
Regression analysis shows 557,371 fewer children cycling each year from 1995 to 2012.
Cycling participation among 7-17yo children in the US declined 23.1% from a 1995-2003 average of 18,593,000 to a 2004-2012 average of 14,296,889. Over the same time period, 7-17yo cyclist all-body injuries in the US dropped from a 1995-2003 average of 291,970 to a 2004-2012 average of 222,869, a 23.7% decline.
Regression analysis shows 6,796 fewer injuries each year from 1995 to 2012. However, concussion injuries among 7-17 year old cyclists declined from a 1995-2003 average of 6,555 to a 2004-2012 average of 6,420, a drop of just 2.1%. There was a statistical association between all body injuries and cycling participation but not between concussion injuries and cycling participation.

Pedestrian comparison
All age pedestrian fatalities in bike helmet law states and non-helmet law states declined significantly from 1998 to 2011 and were strongly correlated, whereas all age cycling fatalities declined significantly in non-helmet law states but not in helmet law states, with a non-significant moderate correlation between the helmet and non-helmet law states.
Among children aged less than 17 years, fatalities declined significantly in both helmet and non-helmet law states, with a very high and statistically significant correlation indicating no differences in fatalities between the helmet and non-helmet law states.
If concussion injuries are taken as a proxy for impact to the head and potential head injury, the data suggest that the significant increase in child and teenage mandatory/voluntary helmet wearing since 1995 has not made a meaningful contribution to young cyclist head injuries in the US, consistent with 2013 Canadian data which showed no influence on head injuries resulting from helmet legislation.

Associated research
In December 2013 and while the study was under peer review, the final report of the OECD International Transport Forum Working Group on Cycling Safety 1 recommended member countries consider that although bicycle helmet laws may reduce head injury risk, they also increase crash risk and discourage cycling participation with possibly negative health and safety consequences.
A study by Markowitz and Chatterji published by Health Economics in January 2015 2 similarly found bicycle helmet laws are associated with decreased cyclist non-head injuries and increased head injuries in other wheeled sports, supporting the evidence of youth cycling discouragement and implying unintended consequences of the laws that should be considered by policymakers.
Since the end year of the Gillham/Rissel study, bicycle sales in the US remained weak in 2013 at 16.2 million compared to a 1995-2012 average of 17.6 million per year 3 and the American Bicyclist Study (ABS 4) found that from 2011 to 2012, about 3 million Americans aged 17 and younger dropped out of cycling participation.
Describing the trend as urgent and negative, the ABS predicted that if current trends continue there will only be an estimated six to seven million Americans aged 17 or younger who cycle six or more days per year by 2034.

Australian context
The US findings were similar to Australian mandatory helmet results, with published research showing cycling levels well below population growth since 1985 but no commensurate reduction in overall injuries.
For example, the West Australian cyclist hospital admission average in 1985 and 1986 was 641.5 per year. In 20011/12 and 2012/13, the average was 1,136.5 per year, a 77.2% increase in injuries. In pre-law 1988-91, there were an average 177 cyclist head injuries hospitalised each year. In 2012/13 it was 286, a 61.6% increase.
Austroads published its implementation report for the National Cycling Strategy in July, confirming a 1.2% reduction in cycling by Australians from 2011 to 2013. That equates to several hundred thousand fewer cyclists on Australian roads and suggests an abject failure of the strategy so far.
The strategy avoids a significant barrier to Australian cycling participation which is bicycle helmet legislation. The US findings add to evidence that although the law discourages many children from healthy recreational cycling it does not reduce the crash and overall injury risk for those wearing helmets, and probably exacerbates it.
With consistent evidence that mandatory bike helmet laws are discouraging healthy cycling but not improving the safety risk for those who do ride, Australian authorities should at least consider the examples of Israel which repealed its adult helmet law in 2011 and the US city of Dallas which in June repealed its 1996 adult law to encourage public use of their bike-share programs.
It seems that without any evidence of clear public health benefits and likely negative consequences, child helmet laws may be a policy failure in the US and in Australia.

1) http://www.keepeek.com/Digital-Asset-Ma ... 5-en#page1
2) http://www.cycle-helmets.com/markowitz- ... juries.pdf
3) http://nbda.com/articles/industry-overv ... 3-pg34.htm
4) http://theamericanbicycliststudy.blogspot.com.au/

Further information: http://www.cycle-helmets.com/us_helmets.html

[Vorpal]

To be honest, although it is interesting, I don't think it adds much to what we already know. There is a significant gap, in that the report does not ay all consider how other differences in legislation between the states may affect fatality rates.

[661-Pete]

One thing that really impressed upon us, on our trip to the USA last autumn, was how few cyclists we saw on the roads. Apart from the occasional intrepid tourist with heavily-laden panniers, possibly doing the coast-to-coast or some such mega-trip, the only other place where we saw cyclists in significant numbers on the road, was Washington DC (where, as you might expect, it's often quicker to get around by bike than by car).

And we weren't driving on the freeways (dual carriageways) all the time. About half of the mileage we covered was on ordinary single-carriageway roads, equivalent to our A and B roads - and in largely rural areas. You might have expected to see some cyclists on such roads - whether training, leisure cycling, or merely getting from A to B - as you would see in the UK. But there weren't .

Is this down to h*lmet law? The four states we visited were Maryland, Virginia, West Virginia and (briefly) Pennsylvania. I don't know what the compulsion laws are in those states, I didn't think to ask. But I think there's general apathy about cycling and far too much of the "cycling is too dangerous" mantra...

[Vorpal]

One thing that really impressed upon us, on our trip to the USA last autumn, was how few cyclists we saw on the roads. Apart from the occasional intrepid tourist with heavily-laden panniers, possibly doing the coast-to-coast or some such mega-trip, the only other place where we saw cyclists in significant numbers on the road, was Washington DC (where, as you might expect, it's often quicker to get around by bike than by car).

And we weren't driving on the freeways (dual carriageways) all the time. About half of the mileage we covered was on ordinary single-carriageway roads, equivalent to our A and B roads - and in largely rural areas. You might have expected to see some cyclists on such roads - whether training, leisure cycling, or merely getting from A to B - as you would see in the UK. But there weren't .

Is this down to h*lmet law? The four states we visited were Maryland, Virginia, West Virginia and (briefly) Pennsylvania. I don't know what the compulsion laws are in those states, I didn't think to ask. But I think there's general apathy about cycling and far too much of the "cycling is too dangerous" mantra...

As far as I know, the helmet laws in the USA only apply to children (mostly under 16, but I expect it differs between states), and not all states have helmet laws.

However, I can say that outside of leisure cyclists, the vast majority of cyclists are in the cities. Even keen cyclists consider it impractical to commute between towns in many places; it could be 25 miles. The other thing is that A and B road equivalents are often not the nicest places to cycle. Except on long-distance rides, I mostly used the equivalent of the back lanes; the roads that went from farm to farm, or meandered along a river, the roads that skirt the transition from city to rural, passing through quiet, semi-residential areas.

Basically if a road had a numebr designation (county highway 72 or some such) or was a trunk road (some states letter these, instead of numbering them), there was probably a more pleasant ride to be had elsewhere.

[Steady rider]

I was cycling from Chicago to Winnipeg (part of the way) in about 2007, arrived in Madison, loads of cyclists.
http://policy.rutgers.edu/faculty/puche ... il2011.pdf has some indication for Maryland, Virginia, West Virgini, low rates.

With the 52 states, 310 million population, it will not be easy comparing data in some cases, a bit like comparing 52 countries with 6 million population each or some way towards that effect or comparing parts in the UK. In parts of the USA I found cycling quite good, west coast, northern part of New York state.

[Lance Dopestrong]

Not very authoritative. Words like "probably" and "suggests" pop up uncomfortably frequently when the terms "because" and "has proven to be because" would actually tell us something substantive.

A vague peer review of studies originally based on vague conclusions is hardly advancing our knowledge.