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The purpose of this blog is to foster public discussion about injury and violence prevention and response and gain perspectives of those we serve.

Policy as a powerful tool for changing health behavior

Categories: Home & Recreational Safety

Last month, I was in Barcelona for a conference. I noticed that everyone on a motorcycle wore a helmet. In stark contrast, practically no one on a bicycle wore a helmet.

Spain has a universal helmet use law for two-wheeled motorized vehicles. Everyone, regardless of age, must wear a helmet when riding a motorcycle or moped. A study conducted in Spain a few years after the law was passed showed that deaths among motorcycle riders, especially those involving traumatic brain injuries, dropped substantially.

For bicyclists, however, Spain does not have helmet use policies. And by my observations, helmet use among people on bikes is nearly nonexistent.

So, how about in the United States?

We have laws requiring motorcycle helmet use, but the specifics of these laws vary from state to state. As the laws vary, so does helmet use. In states requiring all motorcyclists to wear a helmet, nearly 100% do. Conversely, in states in which helmet use is optional or required only of minors, use is much lower.

States enacting universal helmet use laws have seen impressive decreases in motorcycle deaths and serious head injuries. As expected, states that have repealed universal helmet use laws have seen a rise in motorcycle-related brain injuries and deaths.

The laws for bicycle helmet use across the United States are as variable as the laws for motorcyclists, even though legislation has been recommended by CDC as a means to increase helmet use.

In public health, the focus is often on sharing information about risks and encouraging healthier alternatives. That’s enough to get some people to make healthy choices. But others need more of a “push.” We cannot underestimate the power of policy as impetus for change, especially when paired with programs to educate and raise awareness.

Where else might we explore the use of policies that require healthy behaviors or prohibit unhealthy ones? We welcome your ideas.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. November 24, 2008 at 4:03 pm ET  -   Bob Gunther

    Dear Dr. Arias:

    I am studying moped injury and wondered what sort of statistics are available on these type of injuries. With the recent increase in fuel prices (barring the recent drop) young people are turning to these vehicles more frequently. What do we know about moped injury?

    Severity? Deaths? I am concerned because these vehicles seem to have very little regulation amongst an age group that is generally more at risk.

    Best wishes:
    Bob Gunther, MD MPH

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  2. November 28, 2008 at 4:03 pm ET  -   Dr. Ileana Arias

    Dear Dr. Gunther,

    In the United States, the best resource for obtaining fatal crash statistics for persons who were riding mopeds and scooters is the “Fatality Analysis Reporting System” or FARS. They actually code for three types of powered two wheel vehicles:

    Code 81 Mopeds (Motorized Bicycles)

    Code 82 Three wheel motorcycle or Moped (not ATV)

    Code 88 Other motored cycle type (minibikes, motorscooters)

    You can query this database yourself. Here’s a link to the query which is all set up to query by “body type” for the year 2007: (you can then select among the three codes above):

    And here’s a link to the general query section for FARS:

    From there you first pick the year of interest, and then select the variable of interest, one of which could be “body type”, but there are many more.

    In terms of non-fatal injury statistics for mopeds/scooters, the National Electronic Injury Surveillance System-All Injury Program, or NEISS-AIP would theoretically be the best database to query. This database system utilizes medical records from ED departments around the United States. ED physicians however do not tend to consistently or reliably differentiate motorcycles from smaller powered two wheeled vehicles, and thus these two types of vehicles are not coded separately by NEISS coders.

    Generally speaking, much more research has been published in Europe than has been published in the United States regarding moped/scooter injuries and fatalities. These include:

    Kopjar, Branko, “Moped Injuries among adolescents: a significant forgotten problem?”

    Bostrom, Lennart, et al., Injured Moped Riders Who Required Admission to Hospital in Sweden from 1987 to 1994″

    Nja, Ove, Nesvag, Sverre, “Traffic Behavior among adolescents using mopeds and light motorcycles”

    These three articles are all available on Pubmed. These three articles make several observations regarding moped injuries, such as:

    -The social and cultural factors surrounding moped/scooter use are as important to understand as traditional factors or variables such as age, speed, engine size, etc, when studying moped injuries.

    -Teens are most frequently injured on mopeds in Sweden, with few being fatally injured. The elderly are the most likely to die of their moped-related injuries. Fractures of the extremities were the most common type of injury.

    -In Norway, the risk of injury from Mopeds is highest among “older children”, and the risk for this age group is “partially overlooked”

    Finally, here is some interesting observations regarding moped injuries which was published online by the “European Road Safety Observatory”, and available at:

    “Mopeds with their small engine and restricted top speed can be expected to have a lower accident rate than motorcycles. But this is not evident from the actual figures. They have accidents with less severe injuries than motorcycles, which results in lower fatality rates. Including less severe injuries results in rates that are not much different from or even higher than for motorcycles. There are some remarkable differences between countries. A report comparing the traffic safety in the United kingdom, Sweden and the Netherlands discusses the difference in moped accident rates. This rate (over all ages) for the Netherlands is almost double that for the other two countries. In the United Kingdom the moped is much less popular than in the Netherlands but the average kilometres per moped per year in the United Kingdom is about double that in the Netherlands. Therefore the use of the moped must be quite different. In the United Kingdom the moped is mainly used for commuting, in the Netherlands more for social or recreational purposes and in Sweden the moped is mainly used in the summer. In Great Britain moped riders have to obtain a license after taking a basic training course and passing a test (car drivers only have to take the training course and motorcyclists are already qualified). There is also a difference in traffic conditions, which are much less dense in Sweden. All these differences may affect the overall moped accident rates. In addition, the majority of mopeds in Sweden are light mopeds with a lower maximum speed. The Netherlands have the same type of moped, but without helmet. According to Noordzij [39] the accident rate per million kilometres (and corrected for age) for the light moped without helmet is about the same as for the faster moped.”

    Hope this is helpful. Feel free to contact us with any further questions.

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  3. July 29, 2010 at 6:08 pm ET  -   MCg

    I’m a long-time bicycle rider and passionate motorcyclist. I’ve also been involved in two significant motorcycle crashes (each motorcycle was totaled). In one crash, my helmet saved my head from getting split open like a busted watermelon. Needless to say, I’m an advocate for helmet use on motorcycles. Regardless, I’m not an advocate for “mandatory helmet” use for motorcyclists or bicyclists.

    BTW, there is a US DOT download titled: “Motorcycle Helmet Effectiveness Revisited,” which is available in the link below.

    Do You Need a Helmet?


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  4. June 25, 2012 at 7:24 am ET  -   clavier arab

    It’s really a great and helpful piece of info. I am satisfied that you shared this useful information with us. Please stay us up to date like this. Thank you for sharing.

    Link to this comment

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