J Community Health DOI 10.1007/s10900-014-9836-8


Helmet Use Among Cyclists in New York City Corey H. Basch • Emily A. Zagnit • Sonali Rajan • Danna Ethan • Charles E. Basch

Ó Springer Science+Business Media New York 2014

Abstract Lack of helmet use while bicycling can have deleterious effects on health. Despite evidence that helmets can greatly reduce the risk of head injury, the prevalence of helmet use among riders, including those in urban bicycleshare programs, has been shown to be very low. Building upon the authors’ previous work, this study’s aim was to assess prevalence of helmet use among cyclists riding on widely used New York City (NYC) bike lanes. Across a 2-month period, cyclists were filmed in five NYC locations with bike lanes. Filming took place at two separate time periods (recreation and commute) at each location. Helmet use was coded for each cyclist. A total of 1,921 riders were observed across 10 h. Overall, half (50.0 %) of all riders were observed wearing a helmet. Rates of using a helmet were consistent across all five locations. In addition, only 21.7 % of Citi Bike users and 15.3 % of other bicycle rentals were observed wearing helmets while cycling. The prevalence of helmet use was significantly higher among males than females (z = 4.48, p \ .001). Cyclists observed during the recreational time period were also less likely than those observed during the commuting time period to be wearing a helmet (z = 7.17, p \ .001). The results of

C. H. Basch (&) Department of Public Health, William Paterson University, Wing 150, Wayne, NJ 07470, USA e-mail: [email protected] E. A. Zagnit  S. Rajan  C. E. Basch Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA D. Ethan Department of Health Sciences, Lehman College, City University of New York, Bronx, NY, USA

this study contribute to the growing literature about cyclist helmet use in urban areas. Keywords Distracted biking  Helmet use  New York City  Citi Bike

Introduction Over the past three decades, Americans’ bicycling and bike sharing has increased substantially [1]. A recent review on benefits of bicycling showed improved physical and mental health, decreased obesity, and reduced risk of cardiovascular disease as well as reduction in noise emissions, air pollutants, and greenhouse gases [2]. In contrast, riding a bicycle can also result in injury and death. Nationally, there were an estimated 48,000 injuries and 677 deaths among cyclists involved in police-reported motor vehicle crashes in 2011 [3]. In New York City (NYC) alone, there were over 4,200 injuries and 20 fatalities from accidents involving bicycles in 2012 [4]. Over 90 % of these injuries and deaths involved a motor vehicle [4]. Of the more than half a million bicycle-related emergency room visits, almost 85,000 were due to head injuries [5]. Two-thirds of the 600 lives lost to bicycle-related accidents nationally are attributed to traumatic brain injury [5]. In NYC, a comprehensive report of cyclist fatalities and serious injuries from 1996 to 2005 revealed that 74 % of the 225 fatal crashes between cyclists and motor vehicles involved a head injury [6]. Of the cyclists who died (91 % of whom were male) and for whom helmet use was known, 97 % were not wearing a helmet [6]. Helmet use has been shown to reduce the risk of head injury by up to 88 % and facial injury by 65 % [7], yet this behavior has been shown to be alarmingly low. In a recent


J Community Health

study of bike share riders in NYC, over 85 % of the 1,054 cyclists observed were not wearing a helmet [8]. This low rate of use was consistent across observation sites, times of day and days of week [8]. Rates of use have also been found to be lower in certain groups, for example, bike share riders in other urban areas and males [9, 10].

number of cyclists, gender, helmet use and type of cycle (Citi Bike, a bicycle sharing program instituted in NYC in 2013, other rental bike, or non-rental). This study was approved by the Institutional Review Boards at William Paterson University, Teachers College, Columbia University, and Lehman College. Data Analysis

Methods This cross-sectional, observational study builds upon the authors’ earlier work [8] and was conducted from September to October 2013. Two hours of video were filmed at each of the following locations in Manhattan, NYC: (1) Central Park East (between 96th Street and 72nd Street), (2) Central Park West (between 96th Street and 72nd Street), (3) Parkway (running/biking path) (between West 59th Street and West 23rd Street), (4) Battery Park City (between Chambers Street and Battery Place), and (5) Parkway (between East 59th Street and East 23rd Street). These sites were selected because they are commonly used by cyclists and also have bike lanes [11]. Across 1-h intervals, a digital video camera was used to film cyclists (going toward and away from camera). Taping took place twice at each location: once during a weekday commute period (8:00–9:00 a.m. or 5:00–6:00 p.m.) and once during a weekday recreational time period (11:00 a.m.–3:00 p.m.). Observations were conducted on all 5 weekdays. Weekends were excluded due to the inability to include a commute time. Two individuals (C.H.B. and E.A.Z.) uploaded the digital video to iMovieÒ and coded the observations on slow speed to enumerate the total

Table 1 Prevalence of helmet use among riders by site

Site (total participants observed) Parkway West (n = 698) Males (n = 545) Females (n = 153) Parkway East (n = 56) Males (n = 53) Females (n = 3) Battery Park (n = 245) Males (n = 173) Females (n = 72)

Results A total of 1,921 cyclists were observed (n = 1,045 during recreational time and n = 876 during commute time). There were almost three times as many males versus females observed (1,406 vs. 515). A mean of 192 cyclists (SD = 143)

Overall prevalence n = 1,921 (%)

Recreational time period n = 1,045 (%)

Commute time period n = 876 (%)







60.3 40.1

60.5 33.3

60.2 46.9



45.2 33.3















Males (n = 301)




Females (n = 162)







Males (n = 334)




Females (n = 125)




Central Park East (n = 463)

Central Park West (n = 459)


The mean number of cyclists observed across all five locations was computed using the individual and the site as the unit of analysis. In addition, mean helmet use was estimated with the site as the unit of analysis using weighted values to adjust for variability in the number of cyclists observed at the different sites. This weighted value was calculated by multiplying the percentage of cyclists observed wearing helmets at each site by the site’s observed sample size, calculating the sum of these values, and dividing by the total sample size. Mean helmet use was also estimated for males and females and by time period observed for each site. Chi square analysis and z-ratios were used to assess differences in helmet use by gender and time period. Data were organized and analyzed in SPSS (version 20.0).

J Community Health

were observed at each site. Overall, 50.0 % (n = 960) of cyclists observed were wearing a helmet. The prevalence of helmet use was significantly higher among males (52.7 %, n = 1,406) than females (41.2 %, n = 515; z = 4.48, p \ .001), and was higher during the commute versus recreational time period (58.9 %, n = 876 vs. 42.4 %, n = 1,045; z = 7.17, p \ .001). There was notable variability in the number of cyclists observed between each site (range 56–698); therefore we present the prevalence of helmet use by gender and time period for each site in Table 1. Across the five locations, the overall mean of participants wearing a helmet and the corresponding 95 % confidence interval was found to be 46.4 % (95 % CI 33.9, 58.9 %). The weighted mean percentage of participants wearing a helmet was subsequently computed to adjust for the difference in observed sample size at each site and found to be 50.9 %. Compared with commuting times, helmet use was observed less frequently during recreational times [V2 (1, n = 1,921) = 52.1, p \ .001]. Citi Bike, a bicycle-sharing program instituted in NYC in 2013, has over 96,000 annual members and over 6 million trips taken since its launch [12]. Riders can also rent bicycles from several other companies in NYC. Among Citi Bike users (n = 138), the proportion of riders not wearing helmets was found to be consistent with the authors’ earlier work [8]. Specifically, only 21.7 % of Citi Bike users were found wearing helmets. Similarly, among users of other bicycle rentals (n = 334), 15.3 % were observed wearing helmets while cycling.

Discussion The findings of this study indicate that many cyclists do not use helmets. Our findings also suggest that females and recreational cyclists may be less likely to use helmets. Overall rates of helmet use among all cyclists observed indicate significant opportunities for reducing the risk of head injury among individuals cycling in a busy urban environment. These findings require verification in a larger sample. Our helmet use estimates were lower than those previously reported in our earlier study of helmet use in NYC [8]. In that study, which was delimited in scope to users of the Citi Bike bicycle sharing Program, 85 % of cyclists observed were not wearing a helmet. Limitations of this study include its cross-sectional design and small sample size. Also, despite the fact that taping was conducted in clear weather only, we only conducted observation during 2 months. Rates of use in summer months (with warmer temperatures) may yield different estimates. Improved understanding of differences in helmet use between recreational riders and commuters, and between males and females are needed. In our study, not using a helmet

was significantly higher during the recreational versus the commuting time period (57.6 vs. 41.1 %) and for females versus males (58.8 vs. 47.3 %, respectively). In contrast, a recent study of cyclists in Washington, DC and Boston, Massachusetts observed male riders not wearing helmets at a significantly higher rate than females [56.7 % (n = 2,202) vs. 48.9 % (n = 871), respectively] [10]. In addition to assessing the prevalence of helmet use in these groups, it is critical to identify logistical, social and perceptual barriers to wearing helmets. Such findings can inform more targeted health promotion strategies to increase helmet use. To develop effective policy and educational interventions targeting helmet use among cyclists, larger-scale studies are needed.

References 1. Pucher, J., Buehler, R., & Seinen, M. (2011). Bicycling renaissance in North America? An update and re-appraisal of cycling trends and policies. Transportation Research Part A, 45, 451–475. Retrieved from http://policy.rutgers.edu/faculty/pucher/ TRA960_01April2011.pdf. 2. Reynolds, C., Harris, M., Teschke, K., Cripton, P., & Winters, M. (2009). The impact of transportation infrastructure on bicycling injuries and crashes: A review of the literature. Environmental Health, 8, 47. Retrieved from http://www.biomedcentral.com/ content/pdf/1476-069X-8-47.pdf. 3. National Highway Traffic Safety Administration. Traffic Safety Facts 2011. Washington, DC: US Dept. of Transportation. Retrieved from http://www-nrd.nhtsa.dot.gov/Pubs/811754AR.pdf. 4. New York City Department of Transportation. Bicycle crash data 2012. The City of New York. Retrieved from http://www.nyc. gov/html/dot/downloads/pdf/2012-bicycle-crash-data-report.pdf. Published January 1, 2012. 5. American Association of Neurological Surgeons. (2011). Sportsrelated head injury. Retrieved from http://www.aans.org/Patient %20Information/Conditions%20and%20Treatments/Sports-Rela ted%20Head%20Injury.aspx. 6. Mandel-Ricci, J., Stayton, C., Nicaj, L., Assefa, S., Woloch, D., Jeffrey, K., et al. (2008). A multiagency effort to reduce bicyclist fatalities and serious injuries in New York City. Public Health Reports, 123(5), 652–654. 7. Thompson, D. C., Rivara, F., & Thompson, R. (2009). Helmets for preventing head and facial injuries in bicyclists. Cochrane Database of Systematic Reviews, (1), CD001855. 8. Basch, C. H., Ethan, D., Rajan, S., Samayoa-Kozlowsky, S., & Basch, C. E. (2013). Helmet use among users of the Citi Bike bicycle-sharing program: A pilot study in New York City. Journal of Community Health. doi:10.1007/s10900-013-9785-7. 9. Kraemer, J., Roffenbender, J., & Anderko, L. (2012). Helmet wearing among users of public bicycle-sharing program in the District of Columbia and comparable riders on personal bicycles. American Journal of Public Health, 102(8), 23–25. 10. Fischer, C. M., Sanchez, C. E., Pittman, M., Milzman, D., Volz, K. A., Huang, H., et al. (2012). Prevalence of bicycle helmet use by users of public bikeshare programs. Annals of Emergency Medicine, 60(2), 228–231. 11. Manhattan Bike Paths, Bike Lanes, & Greenways. Retrieved from http://www.nycbikemaps.com/maps/manhattan-bike-map/. 12. Citi Bike. System data. Citi Bike. Retrieved from http://citibike nyc.com/system-data.


Helmet use among cyclists in New York City.

Lack of helmet use while bicycling can have deleterious effects on health. Despite evidence that helmets can greatly reduce the risk of head injury, t...
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