Mandatory bicycle helmet laws in the United States

Below is an expanded study researched and written in August 2013 which elaborates on peer-reviewed findings published by World Transport Policy and Practice in January 2015. The data is accurate and can be used by any researcher investigating the efficacy of bicycle helmet laws in the United States.


Abstract: Studies of child and teenage cyclist injury rates in the United States consistently report a downturn since mandatory bicycle helmet laws were introduced in various states and municipalities during the 1990s and progressively since. The downturn is generally attributed to improved safety through mandatory and voluntary wearing of helmets by children and teenagers. To test these conclusions against confounding factors, primarily child cycling participation, this study considers rates of cycling sourced to public and private agencies since 1995 and compares these with injury numbers sourced to the US Consumer Product Safety Commission National Electronic Injury Surveillance System and fatality numbers sourced to the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System. Participation is also compared with cyclist traumatic brain injury and concussion data each year since 1995, and with 2010/2011 cyclist fatalities in all US states with and without child helmet legislation. The study finds that 7-17yo cycling participation in the United States declined 23.1% from a 1995-2003 average of 18,593,000 to a 2004-2012 average of 14,296,889, while 7-17yo cyclist all-body injuries fell 23.7% and concussion injuries fell 2.1%. Multiple sources confirm these results as indicative of US child cycling participation and injury trends, suggesting a failure of bicycle helmet laws to improve public health and cycling safety.


Introduction
Materials and methods
Child cycling participation data
Child cycling injury data
Child cycling head injury data
Child cycling fatality data
Child cycling fatality data in different states
Discussion
Limitations
Conclusion
References
Appendix charts and tables


Note: Cycling participation and updated injury data to 2015 can be viewed here.


Introduction

Previous studies of child cyclist injury rates in the United States have identified a significant decline since the 1990s and have generally attributed this to the introduction of mandatory bicycle helmet laws 1.

Published surveys suggest helmet wearing among 5-15yo cyclists increased from 25% in 1994 to 48% in 2001/2002 2, 27. A 1998 survey published in the Injury Prevention journal 3, 6 put average probability of riders aged less than 16 always or almost always wearing a helmet at 72.3% in helmet law states and 49.6% in states without a helmet law.

Different state and local jurisdictions mandate helmet wearing among <12, <14, <15, <16, <17 and <18 age groups, a small number of municipalities also requiring helmet use by cyclists of all-ages.

Among other sources, this study extracts <17yo cycling data 1995 to 2012 from the US Census Bureau 4 and from the US Consumer Product Safety Commission National Electronic Injury Surveillance System 5.

Analysis results are categorized by states wherein child helmet laws are applied and the study assumes there is more helmet wearing among youth than adults across the United States, either by law, parental coercion or choice.

Child cyclist participation, population, cyclist number, all-body injury, head injury and fatality data from public and private agencies are compared in different age groups and American states to determine whether helmet laws have achieved better health and injury outcomes than in voluntary jurisdictions.

The analysis below also uses 6-17yo, 18-24yo and 6yo+ cycling participation data from the Outdoor Industry Association, as well as all-body and concussion injury data from the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System, to compare recent trends from 2006 to 2015.


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Material and methods

Data for this study are sourced from:


A majority of the source agencies are government and their calculations of relevant data are considered accurate.

All calculations and charts in this study were performed and created within the Microsoft Excel and Apple Numbers spreadsheet applications. All data used is publicly accessible from the internet and all calculations are arithmetic, requiring no skills beyond knowledge of basic spreadsheet functions to verify data.


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Child cycling participation data

According to An Overview of the Bicycle Study 31, a survey by the US Consumer Product Safety Commission estimated that in 1991 there were 66.9 million Americans of all ages who had cycled at least once during the previous year (39.5% in 1-14yo age bracket). An estimated 17.6% of all cyclists wore a helmet all or most of the time in 1991, with another 6% wearing a helmet sometimes (11-14yo age group 11.4%; 1-11yo age group 17.0%).

Georgia was the first American state to introduce mandatory bicycle helmet laws for children aged less than 16 years old in 1993, although child and youth helmet wearing had been mandated by various local municipalities and/or enforced by many parents and schools across the USA in previous years.

According to the National Sporting Goods Administration 8 (NSGA), an estimated 56,308,000 Americans rode bicycles in 1995 at least six times a year. However, participation dropped 17,008,000 or 30.2% by 2012 to 39,300,000. From 2000 to 2011, 7-11yo cycling fell 21% and 12-17yo cycling was down 15% 15.

Averaged 1995-1998, there were 21.2% fewer cyclists than 2009-2012 (49,576,000 / 39,084,750). Averaged 1995-2001 and 2003-2009, 7-17yo cycling fell 20.1% (9,673,286 / 7,730,571) and 18+ cycling fell 10.7% (4,462,405 / 3,983,405). On average, there were 1,942,715 fewer <17yo cyclists and 479,000 fewer cyclists aged 18+.

Outdoor Industry Association 7 (OIA) data below indicate the 6-17yo proportion of all cyclists on roads and paved surfaces in the US was 45.2% in 2006 (17,401,000 / 38,457,000) and 27.9% in 2015 (10,696,000 / 38,280,000).


Table 1


Youth Participation in Outdoor Activities, Ages 6 to 17


2006Pop %2007Pop %2008Pop %2009Pop %2010Pop %
Bicycling (Road/Paved Surface)17,401,00034.7%14,336,00028.5%13,325,00026.8%13,652,00027.3%12,442,00024.7%
2011Pop %2012Pop %2013Pop %2014Pop %2015Pop %
Bicycling (Road/Paved Surface)12,330,00024.3%12,397,00024.5%12,363,00024.4%11,610,00022.7%10,696,00020.8%


Participation in Outdoor Activities, All Americans Ages 6+


2006Pop %2007Pop %2008Pop %2009Pop %2010Pop %
Bicycling (Road/Paved Surface)38,457,00014.0%38,940,00014.1%38,114,00013.6%40,140,00014.3%39,320,00013.9%
2011Pop %2012Pop %2013Pop %2014Pop %2015Pop %
Bicycling (Road/Paved Surface)40,348,00014.1%39,232,00013.7%40,888,00014.1%39,725,00013.6%38,280,00013.0%


The OIA figures above show the number of 6-17yo Americans cycling on roads and paved surfaces fell by 6,705,000 or 38.5% over the 10 years. America's 6-17yo population increased 0.51% from 2006 to 2015 (49,239,000 > 49,490,821).

All Americans ages 6+ participation was down by 177,000 from 2006 to 2015 which, because of population growth, represents a 1.0% drop in population percentage. America's 6yo+ population increased 6.34% from 2006 to 2015 (274,897,000 > 292,322,017). It is noteworthy that 6+ road cycling participation in 2015 was 2,068,000 fewer than in 2011.

Adult road cycling in the US has increased by slightly more than 6.5 million over the past decade and all the reduction has been among 6-17yo cyclists who are subject to mandatory helmet laws in half the American states (in all states if parent, school and local government coercion is taken into account).

NSGA data below suggest the 7-17yo cycling proportion was 27.4% in 2012 (10,800,000 / 39,400,000).


Chart 1


united states cycling participation


Chart 2


united states cyclist ages


Data from the US National Household Travel Survey 10 below confirm a significant downturn in <30yo and particularly <18yo cycling from 1995 to 2009, with 5-15yo and 16-17yo bicycle trips falling 20.1% and 40.8% respectively.


Table 2


us census cyclist numbers


Census Bureau data show a 16.6% reduction in 7-17yo cycling from 2001 to 2006 (17,008,000 / 14,183,000). The OIA participation surveys tabulated above suggest a 27.9% decline in 6-17yo cycling participation from 2006 to 2015.

Most of the reduction has occurred in the <17yo age group:


Chart 3


us census cycling participation


America's 7-17yo population increased 9.0% from 1995 to 2009 (41,221,000 > 44,924,000).

These results validate findings by Pucher et al 27 of a 33% decline in youth participation per population 2001-2009:


Chart 4


pucher chart for cycling participation


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Child cycling injury data

Data from the Centers for Disease Control and Prevention (CDC) 6 16 show the 1-15yo cyclist age group enjoyed a 19.9% drop in injuries from 2001-2006 (303,852 / 243,439) and a 35.4% drop from 2001-2013 (303,852 / 196,345):


Chart 5


american cycling injuries us child cyclist injuries


The CDC and the OIA provide systemically consistent datasets since 2006 that compare age group injuries with age group participation, demonstrating that 6-17yo cyclist injuries in the US fell 20.1% from 2006 to 2014 - considerably less than the 33.3% reduction in cycling participation within that age group:


Chart 6


us cycling participation and injuries us child cyclist participation us child cyclist injuries


Chart 7


us cyclist injuries us child cyclist participation us child cyclist injuries


Chart 8


us cyclist injury numbers us child cyclist participation us child cyclist injuries


The 6-17yo injuries are mostly responsible for total all-age injury rates rising per cyclist from 2006 to 2011 when age group injury rates per million cyclists are adjusted for participation in each age group:


Chart 9


us cyclist injury per million us child cyclist injury age brackets us child cyclist injuries


From the chart above, 6-17yo injuries increased 6.9% from an average 15,678 per million cyclists in 2006-2009 to 16,755 in 2010-2014. 18-24yo injuries decreased 6.4% from an average 16,395 per million cyclists in 2006-2009 to 15,340 in 2010-2014, while injuries among all ages 6+ increased 2.4% from an average 11,636 per million cyclists in 2006-2009 to 11,913 in 2010-2016.

Injuries can also be considered per million population rather than per million cyclists:


Chart 10


us cyclist injuries in age brackets us child cyclist injury age brackets us child cyclist injuries


From the chart above, 6-17yo injuries decreased 9.7% from an average 4,566 per million population in 2006-2009 to 4,124 in 2010-2014. 18-24yo injuries increased 11.8% from an average 1,752 per million population in 2006-2009 to 1,958 in 2010-2014, while injuries among all ages 6+ increased 1.5% from an average 1,626 per million population in 2006-2009 to 1,650 in 2010-2016.

NSGA data for 2012 suggest cyclist numbers aged 7-17 fell 37.9% from 2006, similar to the OIA estimate of a 38.5% reduction among 6-17yo from 2006 to 2015 (Table 1 and Charts 1, 2 and 3). Data for ages 6-17 and for 6+ allow a comparison of 6-17yo and 18yo+ injury rates per million cyclists from 2006 to 2014:


Chart 11


us all age cyclist injuries us child cyclist injury age brackets us child cyclist injuries


From the chart above, 6-17yo injuries increased 6.9% from an average 15,678 per million cyclists in 2006-2009 to 16,755 in 2010-2014. 18yo+ injuries increased 4.9% from an average 9,313 per million cyclists in 2006-2009 to 9,772 in 2010-2014. 6-17yo injuries per million cyclists have decreased since their peak in 2011 and 18+ injuries per million cyclists have decreased since their peak in 2012.

US Census Bureau data for 7-17yo cycling participation can be compared annually with total 7-17yo cyclist injury data from the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS):


Chart 12


us child cycling us child cyclist injury age brackets us child cyclist injury age brackets us child cyclist injury age brackets us child cyclist injury age brackets


From the chart above, 7-17yo cycling participation in the US declined from a 1995-2003 average of 18,593,000 to a 2004-2012 average of 14,296,889, or 23.1%. At the same time, 7-17yo cyclist all-body injuries in the US declined from a 1995-2003 average of 291,970 to a 2004-2012 average of 222,869, or 23.7%.

America's 7-17yo population increased 10.31% from 1995 to 2012 (41,221,000 > 45,472,409).

Alternatively, more recent comparative data can be sourced to the Outdoor Industry Association surveys 2006-2015 and the US Consumer Product Safety Commission National Electronic Injury Surveillance System:


Chart 13


us cyclist concussions us child cyclist injury age brackets us child cyclist injury age brackets


From the chart above, 6-17yo total injuries decreased 15.5% from an average 236,354 per annum in 2006-2010 to 199,651 in 2011-2015. However, 6-17yo cycling participation decreased 16.5% from an average 14,231,200 per annum in 2006-2010 to 11,879,200 in 2011-2015.

America's 6-17yo population increased 0.51% from 2006 to 2015 (49,239,000 > 49,490,821).

The data above can be compared with annual total injuries suffered by cyclists aged 18+ from 2006 to 2015:


Chart 14


us cyclist concussions us child cyclist injury age brackets us child cyclist injury age brackets


From the chart above, 18yo+ total injuries increased 22.3% from an average 231,234 per annum in 2006-2010 to 282,814 in 2011-2015. 18yo+ cycling participation increased 12.3% from an average 24,763,000 per annum in 2006-2010 to 27,815,400 in 2011-2015.

America's 18yo+ population increased 7.61% from 2006 to 2015 (225,658,000 > 242,831,196).

Department of Transportation National Highway Traffic Safety Administration (NHTSA) 20 data for 2011 show <=20yo cyclists had an injury rate of 194.4 per million population compared to a 21yo+ injury rate of 141.9 per million:


Table 3 - United States per capita cyclist injury and fatality rates and state fatality breakdown, 2011


cycling in different us states


US population <=15yo was 21% and cyclists <=15yo represented 18.75% of all cyclist injuries. Cyclists <=15yo had an injury rate of 137.7 per million population compared to a 16yo+ injury rate of 158.4 per million population.

In this NHTSA data for 2011, there were less than 500 injuries among the <5yo age group but these are included in the comparison with <=15yo population of 20,162,000. Excluding that age group entirely, 5-15yo had an injury rate of 199.1 per million population compared to a 16yo> injury rate of 158.4 per million population.

Census Bureau data 15 show 17,008,000 cyclists aged 7-17 in 2001 and 13,196,000 in 2009. CDC data 6 show 259,193 injuries for 7-17yo cyclists in 2001 and 215,947 in 2009. Participation fell 22.4% and injuries fell 16.7%.

NSGA data show 2012 participation among 7-17yo cyclists at 10,800,000, down 36.5% on 2001 participation data from the Census Bureau. Injury data for 2012 are not available but CDC data show 214,333 for 7-17yo in 2011, down 17.3% from 2001. The participation level fell at more than twice the rate of all-body injury reduction, with a crude rate of 1,524 per 100,000 participants in 2001 and 1,985 in 2011/12.

Census Bureau data show 21,996,000 cyclists aged 18yo+ in 2001 and 24,942,000 in 2009. CDC data show 192,712 all-body injuries for 18yo+ cyclists in 2001 and 247,359 in 2009. Participation rose 13.4% and injuries rose 28.4%.

NSGA data show 2012 participation at 24,640,000 cyclists aged 18+, up 12% on 2001 participation data from the Census Bureau. Injury data for 2012 are not available but CDC data show 268,459 for 18yo+ in 2011, up 39.3% from 2001. The all-body injury level increased at more than three times the rate of participation, with a crude rate of 876 per 100,000 participants in 2001 and 1,090 in 2011/12.


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Child cycling head injury data

Compared annually with the 7-17yo decline in cycling participation of 23.1%, NEISS data for 7-17yo cyclists show that 7-17yo cyclist concussion injuries in the US dropped from a 1995-2003 average of 6,555 to a 2004-2012 average of 6,420, down 2.1%:


Chart 15


us cyclist concussions us child cyclist injury age brackets us child cyclist injury age brackets us child cyclist injury age brackets us child cyclist injury age brackets


Alternatively, more recent comparative data can be sourced to the Outdoor Industry Association surveys 2006-2015 and the US Consumer Product Safety Commission National Electronic Injury Surveillance System:


Chart 16


us cyclist concussions us child cyclist injury age brackets us child cyclist injury age brackets


From the chart above, 6-17yo concussions decreased 10.7% from an average 6,781 per annum in 2006-2010 to 6,056 in 2011-2015. However, 6-17yo cycling participation decreased 16.5% from an average 14,231,200 per annum in 2006-2010 to 11,879,200 in 2011-2015.

In 2015, 6-17yo cyclist concussions were for the first time in 20 years fewer than recorded in 1995 (5,341 > 4,985), although best estimates show participation dropped 53.4% between those two years (22,948,000 for 7-17yo in 1995 v 10,696,000 for 6-17yo in 2015, so demographics are not identical).

The data above can be compared with annual concussions suffered by cyclists aged 18+ from 2006 to 2015:


Chart 17


us cyclist concussions us child cyclist injury age brackets us child cyclist injury age brackets


From the chart above, 18yo+ concussions increased 45.7% from an average 5,167 per annum in 2006-2010 to 7,527 in 2011-2015. 18yo+ cycling participation increased 12.3% from an average 24,763,000 per annum in 2006-2010 to 27,815,400 in 2011-2015.


Surveillance for Traumatic Brain Injury Related Death - United States, 1997-2007 17 shows that, on average, head trauma deaths fell less for cyclists than for vehicle occupants:


Table 4


us cyclist brain injury


Traumatic Brain Injury 18 suggests riders aged 5-19 represented 49.2% of total pedal cyclist traumatic brain injury hospitalisations from 2002-2006 (750 / 1,524) and cyclists aged 5-14 represented 33% (507 / 1,524):


Table 5


us cyclist traumatic brain injury


Comparative NEISS data 19 show average 5yo+ cyclist injuries 2005-2012 were 6.2% less than 1996-2003 (487,924 / 520,306). Average total injuries aged 5-15yo in 2005-2012 were 29.3% less than 1996-2003 (227,440 / 321,793) and concussions in this age group were 14.8% less (6,204 / 7,279):


Chart 18


cyclist concussion in different us states us child cyclist injury age brackets


Average 16yo+ injuries 2005-2012 were 31.2% more than 1996-2003 (260,484 / 198,513) and concussions in this age group were 87.6% more (6,717 / 3,580). Concussions altogether represented an average 1.2% of average 5yo+ injuries (5,935 / 503,418) from 1996 to 2012. Average annual 5yo+ injuries fell 32,382 from 1996-2003 to 2005-2012 while concussions fell 1,075.

Concussions represented an average 1.04% of total cyclist injuries in 1996-2003 (5,430 / 520,306) and 1.32% in 2005-2012 (6,461 / 487,924). The number of 16yo+ concussions rose 29.5% averaged 2006-2008 to 2009-2011, compared to 17.4% growth in 16yo+ cycling participation.

If concussions are indicative of head injury, this data suggests the reduction in total injuries was caused by reduced 5-15yo cycling participation rather than reduced head injuries.


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Child cycling fatality data

Census Bureau data 15 show 18,089,000 cyclists aged 7-17yo in 1999 and 13,196,000 in 2009. CDC data 6 show 172 fatalities for 7-17yo cyclists in 2001 and 69 in 2009. Participation fell 27% and fatalities fell 59.9%.

NSGA data show 7-17yo participation at 10,800,000 in 2012, down 40.3% from the Census Bureau’s 1999 estimate. Fatality records for 2012 are unavailable but CDC data show 67 fatalities for 7-17yo in 2010, down 61% from 2001.

Census Bureau data show 24,316,000 cyclists aged 18yo+ in 1999 and 24,942,000 in 2009. CDC data show 425 fatalities for 18yo+ cyclists in 1999 and 451 in 2009. Participation increased 2.6% and fatalities increased 6.1%.

NSGA data show 18yo+ participation at 24,640,000 in 2012, up 1.3% on 1999 participation data from the Census Bureau. Fatality data for 2012 are not available but CDC data show 478 for 18yo+ in 2010, up 12.5% from 1999.

NHTSA Traffic Safety Facts 21 shows that pedal cyclist fatalities worsened as a proportion of all traffic deaths in the US from 2002 to 2011:


Table 6


american cycling fatalities


Out of 51 jurisdiction in the NHTSA dataset for 2011, 23 or 45.1% had some form of helmet law for child cyclists, some up to 17yo.

NHTSA Traffic Safety Facts 2011 allows comparison of cyclist and other road user death and injury rates from 2002 to 2011:


Table 7


american road user fatalities


Table 8


US road user fatalities


Police reported injuries are always less than hospitalised injuries but the NHTSA data suggest US cyclist death and injury trends are worse than for most other road users with the exception of motorcyclists.


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Child cycling fatality data in different states


Table 9


cycling safety in different states Table 10 Table 10 Table 10 Table 3 Table 3 Table 9 Table 9 Table 9 Chart 47 Chart 47 Chart 47 Chart 46 Chart 46 Chart 45 Chart 45


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Discussion

Multiple data sources have been used to compare child, teenage and adult cyclist participation, all-body injuries, head injuries and fatalities from 1995 to 2012, during which time various American states introduced child helmet laws for different age groups less than 18, concluding with 22 states and districts enacting such legislation.

Nationwide, 51.1% of Americans aged 17 and less lived in bike helmet jurisdictions in 2012 (37,457,154 / 36,270,934).

Census Bureau data show 7-17yo cycling across the US was 22,948,000 in 1995 and reliable NSGA survey data show numbers had dropped to 10,800,000 in 2012. This is a 52.9% reduction or 12,148,000 fewer cyclists aged 7-17, impacting regular recreational exercise among American youth with future public health implications.

Participation surveys by the OIA show 6-17yo cyclist numbers fell 28.8% from 2006 to 2012 and survey data compiled by the NSGA suggest the reduction was 37.9% by 2012.

In response to such significant falls in child and teenage cycling participation, and with about 60% of 5-15yo cyclists wearing helmets that are claimed to reduce head injury risk by up to 85% 23, a commensurate reduction in accidents and injured cyclists should be expected at hospital emergency departments.

Although <18yo cyclist injuries decreased in number, they increased 44.9% from 12,755 per million cyclists aged 6-17yo in 2006 to 18,515 per million in 2011. These results should be considered in the context of US population growth among children and teenagers. The 0-17yo population increased 7.5% from 68,560,913 in 1995 to 73,728,088 in 2012.

In non-helmet law states, the population of 0-17yo increased 9.7% from 33,061,027 in 1995 to 36,270,934 in 2012. In helmet law states, the population of 0-17yo increased 5.5% from 35,493,663 in 1995 to 37,457,154 in 2012.

The proportionally larger youth population growth in non-law states should result in proportionally greater numbers of participants and injuries, but it does not. The confounding factor of cycling participation masks assumptions drawn from total injury numbers.

Census Bureau and NEISS injury data show a 23.1% decline in 7-17yo cycling participation averaged 1995-2003 to 2004-2012, a 23.7% reduction in all-body injuries and a 2.1% reduction in concussion injuries. Analysis of 5-15yo cyclist fatalities through FARS shows a lower rate per million population in non-helmet law states than in helmet law states.

Among 0-16yo cyclists and averaged 1994-2002 to 2003-2011, fatalities fell 55.2% in states without child helmet laws and 50.0% in states with such laws. Fatality numbers in most states are small and volatile but in 2010 the rate per million was less in non-law states than in helmet law states, while in 2011 the rate was higher.

Analysis of all 1,740 bicyclists aged 0-16 years in FARS 9 who died or suffered an incapacitating injury from a motor vehicle collision between January 1999 and December 2009 allows a per million population comparison between states with child helmet laws and those without. Averaged, there were 2.4 fatalities/incapacitating injuries per million in helmet law states and 2.6 per million in states without. From 1999 to 2011, there were an average 2.2 per million in helmet law states and 2.4 per million in states without. The per million population rate of <=16yo death and serious injury decline from 1999 to 2011 was lower in states with child helmet laws (average 2.9 in 1999-2004 to 1.5 in 2006-2011) than in states without (average 3.2 in 1999-2004 to 1.4 in 2006-2011):


Chart 19


cyclist and car injuries in america


Chart 20


child cyclist and car injuries in america


There is no significant difference in child cyclist fatality rates per million population in states that enforce mandatory child helmet legislation. Various US local municipalities have enforced helmet laws for different ages, primarily children, regardless of state legislation and it is likely that voluntary helmet wearing also increased in states without helmet laws through parental or school coercion.

If concussion is considered indicative of head injury frequency, US Government data suggest the significant increase in child and teenage mandatory/voluntary helmet wearing since 1995 has failed to reduce injuries per cyclist, including head injuries, despite a substantial decline in recreational cycling exercise among American youth.

Census Bureau, NSGA, OIA and NEISS data allow a direct comparison of US cycling participation rates and different injuries including head, lower and upper body within matched 7-17 and 18+ age brackets, and suggest head and consussion rates have had the greatest increase from 1997 to 2012 relative to increased participation among adults and reduced participation among children.

Click here for a pop-up window with Figures 17-44 showing total US cyclist participation and head, concussion, face, upper arm, lower arm, neck, upper trunk, hand, elbow, shoulder, lower leg, upper leg, toe and foot injury trends among child and adult cyclists from 1995 to 2012.

Click here for a pop-up analysis of a September 2015 Journal of the American Medical Association research letter detailing adult cycling injuries and hospital admissions in America from 1998 to 2013.


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Limitations

This study is limited in scope by different age group parameters defined in the source datasets published by public and private agencies, at times requiring comparison between slightly different age groups (e.g. 6-17yo and 7-17yo).

No attempt has been made to adjust state data according to different variables such as speed limits, drink driving laws and driver age limitations in the 51 state jurisdictions. These confounding factors are numerous and all have a debatable influence on child cyclist injury and fatality rates.

Raw participation and fatality data are compared between 29 states without helmet laws and 22 states/districts with helmet laws, each with unique and countervailing variables such as population, demographics, wealth, infrastructure and geography that create an unbiased average.

US Census Bureau data on cycling participation since 1995 is only available to 2009. This study uses survey findings from the Outdoor Industry Association for 2010 and 2011, and from the National Sporting Goods Association for 2012.

Census Bureau/NSGA data from 1995 to 2009 and NSGA data for 2012 are for cyclist ages 7-17 but the OIA data from 2006 to 2012 are for cyclist ages 6-17. This inflates 2010 and 2011 child cyclist participation data relative to other years.

A comparison of participation surveys from the three sources in overlapping years from 2003 to 2009 shows similar annual numbers with lower NSGA figures that more accurately reflect the 7-17yo age criteria.

Albeit using different survey methods, NSGA and OIA all-age cycling participation results are similar (2006 - 38,457,000 / 35,600,000; 2007 - 38,940,000 / 37,400,000 / 2008 - 38,114,000 / 38,700,000; 2009 - 40,140,000 / 38,100,000 / 2010 - 39,320,000 / 39,800,000; 2011 - 40,348,000 / 39,300,000; 2012 - 39,232,000 / 39,300,000).

The NSGA annual numbers are generally lower than OIA surveys because they estimate 7-17yo rather than 6-17yo participation. The NSGA participation survey result is used for 2012 and is consistent with Census Bureau data trends from 1995 to 2009.

Some timescale calculations include data for states that were voluntary at first but have since enacted child helmet laws, with no adjustment for their early absence of law so as to maintain a consistent baseline. Due to different and at times large state populations, adjustments distort trends and normally exaggerate fatality and injury rates in states that now have child helmet laws.

Census Bureau participation data for 2008 is significantly above trend. Assuming the bureau is consistent and accurate in its survey methodology, the 2008 spike may be related to cycling interest generated by the Beijing Olympics, consecutive Tour de France victories by Lance Armstrong, above average summer temperatures across the US 24 and/or record high gasoline prices above US$4 per gallon 29.


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Conclusion

All public and private data sources confirm that child and teenage cycling participation in the United States has fallen by at least a third since the 1990s with latest surveys suggesting the decline has continued in 2015. The reduction in cycling is maintained in older age groups but at a progressively smaller rate, with an increase in cyclist numbers since 1995 among people aged 45-64.

A reduction of almost 18,000,000 cyclists aged <17yo from 1995 to 2015, ignoring population growth over that period, signals a substantial decline in recreational exercise among American youth.

The rate of all-body injury to <17yo cyclists has increased per million cyclists during this time, despite the participation downturn, and public agency data suggest concussion injuries have increased per cyclist in this age group.

If concussion injuries are indicative of head injury, these data show the significant increase in child and teenage mandatory/voluntary helmet wearing since 1995 has failed to reduce injuries per cyclist including head injuries.

Although youth cycling participation rates in each state are unknown, childhood disdain for helmet wearing is a likely cause of the decline in cycling participation, coupled with increased parental safety fears.

Child cycling participation rates in all American states warrant further study to determine if the reduction is related to helmet laws. A breakdown of child cyclist fatalities per million population in states with and without laws shows little difference, which conflicts with expectations that rates should be lower in states where more children wear helmets.

The counterintuitive conclusion that accident/injury rates per child cyclist are greater in helmet law states may be explained by influences such as risk compensation 25 and safety in numbers 26, 30.

It should be noted that according to An Overview of the Bicycle Study 31, there were an estimated 66.9 million Americans of all ages cycling (at least once per year) in 1991 with about 531,000 hospital emergency department injuries (excluding bike passengers). This represents 0.7937219730941704% of all cyclists in 1991 being injured (531,000/66,900,000). According to annual surveys by the Outdoor Foundation 32, in 2012 there were an estimated 42,336,000 cyclists aged 6+ who had cycled at least once in the previous year, with 519,473 emergency department injuries.

If the 1991 participation/injury percentage (0.7937219730941704) is applied, there should have been 336,030 cyclist injuries in 2012 instead of 519,473. Such data consistently suggests an increase in the ratio of overall injuries to cyclists participating over the past 22 years, despite child helmet laws in half the American states, similar parental or school enforcement in other states, and about half the adult population voluntarily wearing helmets.

Consistent data from public and private agencies suggest reduced recreational cycling among children and teenagers with potential future health implications. Increased per cyclist injury rates and similar state fatality rates point to a failure in public policy for cycling safety in the United States.


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References

1) Bicycle Helmet Laws Are Associated with a Lower Fatality Rate from Bicycle–Motor Vehicle Collisions - William P. Meehan, Lois K. Lee, Christopher M. Fischer, Rebekah C. Mannix
http://www.ncbi.nlm.nih.gov/pubmed/23706604

2) Bicycle helmet use among children in the United States: the effects of legislation, personal and household factors, Dellinger, Kresnow
http://www.ncbi.nlm.nih.gov/pubmed/20846554

3) Injury Prevention
http://injuryprevention.bmj.com/content/8/1/42.full.pdf

4) US Census Bureau
http://www.census.gov/

5) US Consumer Product Safety Commission National Electronic Injury Surveillance System
https://www.cpsc.gov/cgibin/NEISSQuery/home.aspx

6) Centers for Disease Control and Prevention web-based Injury Statistics Query and Reporting System (WISQARS) 13/7/4
http://www.cdc.gov/injury/wisqars/nonfatal.html

7) The Outdoor Industry Association
https://www.outdoorindustry.org/research/participation.php

8) National Sporting Goods Administration
http://www.nsga.org/i4a/pages/index.cfm?pageid=4653

9) National Highway Traffic Safety Administration’s Fatality Analysis Reporting System
http://www-fars.nhtsa.dot.gov//QueryTool/QuerySection/SelectYear.aspx

10) U.S. Department of Transportation, Federal Highway Administration, National Household Travel Survey
http://nhts.ornl.gov/det/Extraction3.aspx

11) Alliance Bicycling and Walking Benchmarking Project
http://www.peoplepoweredmovement.org/site/index.php/site/memberservices/C529

12) US single year cyclist injuries and population 2001-2011 (Excel)
http://www.cycle-helmets.com/us-yearly-injuries-2001-2011.xls

13) Bicycle Retailer and Industry News: Light at the end of the tunnel? Maybe.
http://www.bicycleretailer.com/opinion-analysis/2012/06/05/light-end-tunnel-maybe#.UdeXduDxaVg

14) Bicycle Retailer and Industry News: More women, fewer kids riding bikes
http://www.bicycleretailer.com/studies-reports/2013/06/20/nsga-more-women-fewer-kids-riding-bikes

15) US Census Bureau bike riding participation data
http://www.cycle-helmets.com/us-census-bike-riding-1995-2009.pdf

16) Centers for Disease Control and Prevention tabulated age and injury data (Excel)
http://www.cycle-helmets.com/us-cdc-age-injuries.xls

17) The Centers for Disease Control and Prevention Surveillance for Traumatic Brain Injury Related Death - United States, 1997-2007
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6005a1.htm

18) Traumatic Brain Injury
http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf

19) US Consumer Product Safety Commission National Electronic Injury Surveillance System concussion data
http://www.cycle-helmets.com/us-neiss-concussions-1996-2012.xls

20) US Department of Transportation National Highway Traffic Safety Administration
http://www-nrd.nhtsa.dot.gov/Pubs/811743.pdf

21) US Department of Transportation National Highway Traffic Safety Administration Traffic Safety Facts 2011
http://www-nrd.nhtsa.dot.gov/Pubs/811743.pdf

22) FARS and US Census data tables (Excel)
http://www.cycle-helmets.com/us-state-fatalities-per-pop.xls

23) A case-control study of the effectiveness of bicycle safety helmets, Thompson, Rivara
http://www.ncbi.nlm.nih.gov/pubmed/2716781

24) National Oceanic and Atmospheric Administration
http://www.noaanews.noaa.gov/stories2008/20080911_ncdcsummerwrap.html

25) The Risk Compensation Theory and Bicycle Helmets; J Adams, M Hillman
http://injuryprevention.bmj.com/content/7/2/89.full

26) Safety in numbers? A new dimension to the bicycle helmet controversy
http://injuryprevention.bmj.com/content/7/4/343.2.full

27) Walking and Cycling in the United States, 2001-2009: Evidence from the National Household Travel Surveys, Pucher et al
http://bloustein.rutgers.edu/wp-content/uploads/2014/10/NHTS_TRB_25Jan2011.pdf

28) NHTSA FARS cyclist fatalities 0-16yo and all-ages in different states (Excel)
http://www.cycle-helmets.com/nhtsa-state-fatalities-1994-2011.xls

29) US Energy Information Administration: Gasoline and Diesel Fuel Update
http://www.eia.gov/petroleum/gasdiesel/gaspump_hist.cfm

30) Safety in numbers: more walkers and bicyclists, safer walking and cycling; PL Jacobsen
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1731007/pdf/v009p00205.pdf

31) An Overview of the Bicycle Study; Gregory B Rodgers
http://www.cpsc.gov/PageFiles/112701/344.pdf

32) An Overview of the Bicycle Study; Gregory B Rodgers
ParticipationStudy2013.pdf


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Appendix charts and tables


Chart 21


american state cyclist fatalities us state cycling deaths


Chart 22


american cyclist and pedestrian fatalities american cyclist and pedestrian fatalities


Chart 23


american cyclist and car fatalities american cyclist and car fatalities american cyclist and car fatalities


Table 9


american state cycling fatalities american state cycling fatalities


Table 10


american state cycling injuries american state cycling injuries


Note: In January 2015, Health Economics published Effects of Bicycle Helmet Laws on Children's Injuries (PDF download 217K) by Sara Markowitz and Pinka Chatterji who found similar evidence to this paper that the laws discourage cycling with unintended injury consequences.


Note: In August 2015, the Centers for Disease Control and Prevention published Bicyclist Deaths Associated with Motor Vehicle Traffic — United States, 1975–2012 by Vargo et al who again found similar evidence to this paper.


Note: In September 2015, the Journal of the American Medical Association published Bicycle Trauma Injuries and Hospital Admissions in the United States, 1998-2013 by Sanford et al who again found similar evidence to this paper, with injuries among cyclists aged 18+ increasing 28%, hospital admissions increasing 120% and head injuries increasing 60%.


Note: In December 2016, Research and Practice published Trends in Walking and Cycling Safety: Recent Evidence From High-Income Countries, With a Focus on the United States and Germany by Buehler and Pucher, its cyclist injury conclusions similar to the study on this page.

The rate of serious cyclist injuries per 100 million kilometres in the United States fell from 230.5 in 2001-02 to 207.1 in 2008-09. However, the rate of severe cyclist injuries was 4.7 times higher in the US than in Germany.

The severe injury rate for cyclists in 2008–2009 in the US was much higher for children (415.7) than the national average (207.1), despite most children wearing helmets due to state laws, local regulations or school and parent demand. The severe injury rate for children rose significantly between 2001-02 and 2008-09, from 392.9 to 415.7.

Between 2001-02 and 2008-09, the severe injury rate per 100 million kilometres for 15-24yo fell from 305.2 to 176.0, increased for 25-64yo from 141.5 to 156.5, and fell for 65yo+ from 351.3 to 337.3.


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