Helmets - the definitive thread.. ** Mod Note - Please read Opening Post **

Iwannahurl

Group E: non-cycling moralisers who wish to promulgate the self-serving notion that the biggest danger facing cyclists is themselves.

tomasrojo

tomasrojo wrote: »

Chris Boardman being taken to task by Headway:
https://aseasyasridingabike.wordpress.com/2014/11/04/headways-brick-wall/

And he replies:
http://www.britishcycling.org.uk/campaigning/article/20141103-campaigning-news-Boardman--Why-I-didn-t-wear-a-helmet-on-BBC-Breakfast-0

Good for Chris Boardman.

I realise this whole topic is done to death but as an everyday Dublin cyclist it is INSANE the number of people cycling around like lunatics with a poorly fitted helmet atop their head that they no doubt believe is some sort of magical totem that keeps all harm at bay.

Sometimes I wonder if they do more harm than good.

check_six

Deleted User wrote: »

Good for Chris Boardman.

I realise this whole topic is done to death but as an everyday Dublin cyclist it is INSANE the number of people cycling around like lunatics with a poorly fitted helmet atop their head that they no doubt believe is some sort of magical totem that keeps all harm at bay.

Sometimes I wonder if they do more harm than good.

The badly fitted helmet doesn't really do anything. Maybe those guys are the ones who are pestered to wear a hat/helmet by their friends and family, and just lash it on any old way for a quiet life. Some have lots and lots of hair that the hat has to balance on. They can look very peculiar.

Maybe they just don't know how to figure out the straps. People can miss the instructions.

I spoke to a lady the other evening at traffic lights. I hinted that she may have forgotten to switch on the light on the back of her bike (it was dark). She said she hadn't forgotten, she just didn't know how to turn it on!

It was one of those standard Smart lights you see in every shop. Nice and bright, good value, and easy to use 'cause they just have the one button.

I showed her the switch.

She also mentioned that she had a front light, but it seemed to be missing from the bike, or broken off, or something. I imagine that she doesn't know you can remove the lights too.

So I suppose the lesson is that some people go around with all the right stuff, but they just don't know how it works.

RainyDay

check_six wrote: »

I spoke to a lady the other evening at traffic lights. I hinted that she may have forgotten to switch on the light on the back of her bike (it was dark). She said she hadn't forgotten, she just didn't know how to turn it on!

Good to know that I'm not the only one who speaks to other cyclists about this. I was going to have a word with a guy about having no back light last night, when I noticed something twinkling behind his saddlebag at the last minute. It turned out he had a light, but his saddlebag was blocking it most of the time. He was grateful for hearing that his light was fairly useless.

JamJamJamJam

This is regarding the use of helmets among children (in the US)(original, from the high impact medical journal, the New England Journal of Medicine).

They found that 4% of head trauma in children (younger than 19 years old) was due to cycling crashes. 72% of those injuries occurred in children who were not wearing a helmet. That information isn't *that* valuable, because we don't know how many children wear helmets in general. However, when you consider the 4% of those in a cycling crash who were diagnosed with Traumatic Brain Injury, it's surprising that 93% of this group were not wearing a helmet. Maybe it's different for adults for a few reasons (e.g. commuting on busy roads more often, may be higher off the ground, etc.), but I think it serves as a good reminder that we should encourage kids to wear helmets, at least.

TL;DR: Kids wearing helmets when in a bike crash are likely to be less seriously injured than kids that were not wearing a helmet.

tomasrojo

JamJamJamJam wrote: »

This is regarding the use of helmets among children (in the US)(original, from the high impact medical journal, the New England Journal of Medicine).

Might be a good one for the Helmet Definitive Thread. Is there a link to a summary or something like that that isn't behind a registration wall?

(Seasoned watchers of that thread know, just know in their hearts that there's another paper based on a different method that says there is no significant difference for children, and lo. Usual caveats about each method having its shortcomings apply.)

Beasty

Last 2 posts moved from off topic thread

galwaycyclist

JamJamJamJam wrote: »

TL;DR: Kids wearing helmets when in a bike crash are likely to be less seriously injured than kids that were not wearing a helmet.

In children helmets are likely to be an indicator of social class. In children social class is an indicator of likely injury severity in the event of traffic accidents. Kids whose parents have money generally show lower rates of death or serious injury.

Edit: As an example in Scotland it has been shown that, for child pedestrians, the traffic injury expectation is six times higher in areas with the highest levels of social deprivation when compared with areas with the highest average income.

JamJamJamJam

tomasrojo wrote: »

Might be a good one for the Helmet Definitive Thread. Is there a link to a summary or something like that that isn't behind a registration wall?

(Seasoned watchers of that thread know, just know in their hearts that there's another paper based on a different method that says there is no significant difference for children, and lo. Usual caveats about each method having its shortcomings apply.)

Sorry, I forgot about the registration wall. Here is the article from Medscape (I've deleted the parts not related to cycling):

Major Causes of Head Trauma in Children Identified
Larry Hand
November 13, 2014

With prospective data on more than 43,000 head injuries in children younger than 19 years, researchers pinpoint the main causes of head trauma in different age groups, as well as the frequency of traumatic brain injury (TBI).

The new data, published in the November 13 issue of the New England Journal of Medicine, should be used to develop injury-prevention strategies, researchers say.

Kimberly S. Quayle, MD, from the Washington University School of Medicine in St. Louis, Missouri, and colleagues conducted a prospective, multicenter study and analyzed the records of 43,399 pediatric patients who were treated for head injuries at 25 US emergency departments in the Pediatric Emergency Care Applied Research Network between 2004 and 2006. Medscape Medical News reported previously on the group's earlier development of TBI prediction rules for children.

[...]

In the overall population, the most common mechanism of injury was a fall from any distance (27%), followed by a fall while standing, walking, or running (11%); a collision with a stationary object when walking or running (6%); a motor vehicle crash (9%); and a bicycle crash (4%).

Among those injuries caused by a motor vehicle crash or a bicycle crash, a substantial proportion occurred when the child was not using a seat belt (36%) or wearing a helmet (72%).

[...]

Children not using the recommended safety device made up a disproportionate fraction of patients diagnosed with TBI. Specifically, 16% of patients in a motor vehicle crash were diagnosed with a TBI, and a slight majority of those (52%) were not using a seat belt at the time. Of those in a bicycle crash, 4% had a TBI, and of those with a TBI, 93% were not wearing a helmet.

[...]

"Our findings may be useful in the development of future injury-prevention measures and age-stratified targeted interventions, such as campaigns to promote the use of bicycle helmets and automobile restraints."

This research was supported by a grant from the Health Resources and Service Administration/Maternal and Child Health Bureau and the Education and the Emergency Medical Services for Children Program. The authors have disclosed no other relevant financial relationships.

N Engl J Med. 2014;371:1945-1947.

It's the first time I've really engaged with the topic, and I'm not familiar with the other studies, so I'll have to take a look at them. I'm showing my bias now, because I've only seen the methods of the study that I mentioned, but I'd have a fair bit of faith in it based on that, and even simply because the NEJM is such an extremely highly respected journal. But as I say, I don't know much about the topic. I just thought it might be of interest!

Thanks, also, for recommending this thread, and thanks to Beasty for moving it.

galwaycyclist

Just as an observation on the weight that should be given to articles on cycling safety in medical journals.

1. Cycling safety is a multifactoral topic encompassing, inter alia, the influence of things like road design, traffic management, vehicle design, traffic law, traffic policing, town planning, road user education ..... etc etc

2. The topics covered in point 1. are unlikely to be covered in any detail in any typical medical education and , most importantly, unlikely to be well understood by members of a typical peer review panel for a medical journal.

3. There is a saying in IT captured by the acronym GIGO. When the medical profession get involved in cycling safety, unfortunately, GIGO often comes to the fore.

CatFromHue

What does GIGO mean?

I agree with what you say.

For me when it comes to helmets it should be about the energy absorption characteristics of them but this is never really mentioned, other than the MIPS helmets.

JamJamJamJam

galwaycyclist wrote: »

In children helmets are likely to be an indicator of social class. In children social class is an indicator of likely injury severity in the event of traffic accidents. Kids whose parents have money generally show lower rates of death or serious injury.

Edit: As an example in Scotland it has been shown that, for child pedestrians, the traffic injury expectation is six times higher in areas with the highest levels of social deprivation when compared with areas with the highest average income.

That's interesting, I didn't know that. Perhaps the quality of helmets makes a difference, and cheaper helmets may be less effective?? I wonder how the disparity in outcomes among helmet wearers and non-helmet wearers would look if they were split by socioeconomic class in this recent study. It does divide those patients who were hit by an automobile and those who fell off their bikes, so that might be of some interest: http://www.nejm.org/action/showImage?doi=10.1056%2FNEJMc1407902&iid=t01

Of course, the primary function of this study is not to establish the value of helmets, and for a definitive answer, a very large cohort study would be required, but it is food for thought. I don't know much about the topic, as I've said, but do you know if any study suggests that wearing helmets could be associated with worse outcomes (such as through more reckless behaviour, etc.)? Personally, I'd feel inclined to wear one myself, because for me as an individual, I couldn't imagine that it would not help in the event of a crash!

galwaycyclist

CatFromHue wrote: »

What does GIGO mean?

I agree with what you say.

For me when it comes to helmets it should be about the energy absorption characteristics of them but this is never really mentioned, other than the MIPS helmets.

Apologies, GIGO is shorthand for "Garbage In Garbage Out". Medical papers on cycling safety often seem to start by expressing assumptions that are not supported by the available facts and go downhill from there.

e.g. by saying that cycling is a significant source of traumatic brain injury when it does not seem to be at a population level.

JamJamJamJam

galwaycyclist wrote: »

Just as an observation on the weight that should be given to articles on cycling safety in medical journals.

1. Cycling safety is a multifactoral topic encompassing, inter alia, the influence of things like road design, traffic management, vehicle design, traffic law, traffic policing, town planning, road user education ..... etc etc

2. The topics covered in point 1. are unlikely to be covered in any detail in any typical medical education and , most importantly, unlikely to be well understood by members of a typical peer review panel for a medical journal.

3. There is a saying in IT captured by the acronym GIGO. When the medical profession get involved in cycling safety, unfortunately, GIGO often comes to the fore.

I'd say this is completely fair! Certainly not a part of my medical education anyway. I've learned plenty about this from just the comments responding to mine!

galwaycyclist

JamJamJamJam wrote: »

but it is food for thought. I don't know much about the topic, as I've said, but do you know if any study suggests that wearing helmets could be associated with worse outcomes (such as through more reckless behaviour, etc.)? Personally, I'd feel inclined to wear one myself, because for me as an individual, I couldn't imagine that it would not help in the event of a crash!

Ah ok. On my way to bed now. But to sum up. There is compelling evidence that the use of PPE by road users may have the opposite outcome to that intended. So in Ireland, as an example, the official road death statistics show an increase in driver deaths following the introduction of mandatory seatbelt wearing in 1979. Observations like this have been interpreted as indicating that drivers negatively change their driving style in response to an increased sense of protection.

For cycling helmets there is evidence that suggests a similar effect at a population level. However there are conflicting theories and interpretations. At the moment the money seems to be on the idea that those people who "spontaneously" wear cycle helmets are in a group who also take more risks.

At a population level in western societies the dominant "reckless" behaviours centre around poor diet and lack of excercise. These behaviours result in morbidity due to heart disease, diabetes, stroke etc. There is compelling evidence that promoting or legally mandating helmets puts non-risk takers off cycling putting them at increased risk from ill effects associated with other behaviours.

The result is argued to be an increase in morbidity due to sedentary lifestyles. At the same time you get smaller population of cyclist dominated by risk takers so the recorded safety of cycling declines. To add another confounding influence there is a "safety in numbers" effect where cyclists are safer the more of them there are on the road. The theory is that above certain threshhold, motorists become more aware and learn not to hit cyclists. If you reduce the number of cyclists by promoting helmets you make the roads more dangerous for those who still continue to cycle.

JamJamJamJam

galwaycyclist wrote: »

Ah ok. On my way to bed now. But to sum up. There is compelling evidence that the use of PPE by road users may have the opposite outcome to that intended. So in Ireland, as an example, the official road death statistics show an increase in driver deaths following the introduction of mandatory seatbelt wearing in 1979. Observations like this have been interpreted as indicating that drivers negatively change their driving style in response to an increased sense of protection.

For cycling helmets there is evidence that suggests a similar effect at a population level. However there are conflicting theories and interpretations. At the moment the money seems to be on the idea that those people who "spontaneously" wear cycle helmets are in a group who also take more risks.

At a population level in western societies the dominant "reckless" behaviours centre around poor diet and lack of excercise. These behaviours result in morbidity due to heart disease, diabetes, stroke etc. There is compelling evidence that promoting or legally mandating helmets puts non-risk takers off cycling putting them at increased risk from ill effects associated with other behaviours.

The result is argued to be an increase in morbidity due to sedentary lifestyles. At the same time you get smaller population of cyclist dominated by risk takers so the recorded safety of cycling declines. To add another confounding influence there is a "safety in numbers" effect where cyclists are safer the more of them there are on the road. The theory is that above certain threshhold, motorists become more aware and learn not to hit cyclists. If you reduce the number of cyclists by promoting helmets you make the roads more dangerous for those who still continue to cycle.

Thanks, I appreciate you taking the time to write that out. It's very interesting.

ROK ON

The issue with the above debate is that not that
(I) the more cyclists on the road then the more safe all cyclists are likely to be and,
(II) the more cyclists there are the lower the likely incidence of obesity and related illnesses
These are highly likely.
This issue as I see it is that the first is a second or even third order effect - so it is difficult to quantitatively prove (and be understood by non-quants) even if it seems intuitive. This matters in society where evidence based policy is practiced - (not here).
The issue with the second point is that it is too long term and policy makers/politicians do not have long term incentives.

I think if you want to make roads safer you should think about getting people to accept vulnerability and attempt to influence behaviour as opposed to mitigating the risk and actually leading to this theory that a helmet or hi-viz makes you invulnerable so that the wearer or other road users can carry on regardless.

Read Hans Monderman.
http://www.theguardian.com/news/2008/feb/02/mainsection.obituaries

The theory is reduce road furniture designed to make roads in urban spaces safer. For example, reduce or remove road markings, traffic lights, zebra crossings etc etc.
the resulting increase in vulnerability felt by drivers, cyclists and pedestrians can cause a shift in behaviour that results in a safer and more pleasant use of a shared space.

I first came across this guy while researching the fragility of the banking system - someone proposed that fewer banks would fail if society stopped trying to guarantee them and make them safer.
Fascinating insight into human behaviours.
Sorry for long post.

RainyDay

ROK ON wrote:

Read Hans Monderman.
http://www.theguardian.com/news/2008/feb/02/mainsection.obituaries

The theory is reduce road furniture designed to make roads in urban spaces safer. For example, reduce or remove road markings, traffic lights, zebra crossings etc etc.
the resulting increase in vulnerability felt by drivers, cyclists and pedestrians can cause a shift in behaviour that results in a safer and more pleasant use of a shared space.

That's exactly the basis for the new DMURS road design manual

http://www.slideshare.net/JasonTaylor11/self-regulating-streets

RayCun

galwaycyclist wrote: »

Edit: As an example in Scotland it has been shown that, for child pedestrians, the traffic injury expectation is six times higher in areas with the highest levels of social deprivation when compared with areas with the highest average income.

That's a red herring.
Children in areas of social deprivation are more likely to be injured in traffic - yes, for obvious reasons.
The NEJM of medicine did not reason
- children in areas of social deprivation are more likely to be injured
- children in these areas are less likely to wear helmets
- therefore helmets good

They found that, of those people treated for head injuries, people without helmets were more likely to have serious head injuries.

Writing this off because it is in a medical journal, and offering no critique of the methodology beyond that!, is a fine example of HISS.
(head in sand syndrome)

if the NEJM writers said "we found cyclists without helmets were more likely to have serious head injuries THEREFORE government should make helmet wearing and hi-vis use mandatory!" you could argue that they are moving too far from their area of expertise, and they should be aware of all the other things that affect safety etc etc etc. But that doesn't mean you should write off medical research because the people who carried it out were only doctors.

RayCun

galwaycyclist wrote: »

There is compelling evidence that promoting or legally mandating helmets puts non-risk takers off cycling putting them at increased risk from ill effects associated with other behaviours.

I have seen evidence that legally mandating helmets puts people off cycling.
I have not seen evidence that promoting helmets has the same effect.

Should we avoid all safety campaigns directed at cyclists? If we warn people that undertaking a long vehicle at a junction can get you killed, do we not risk scaring them off the road?

CramCycle

RayCun wrote: »

Should we avoid all safety campaigns directed at cyclists? If we warn people that undertaking a long vehicle at a junction can get you killed, do we not risk scaring them off the road?

I suppose you should compare the number of cyclists killed by left turning vehicles versus the number killed because they were not wearing a helmet. One is an absolute, one is an opinion or at least far from determinable. Hence why a safety campaign to promote one makes more sense than the other.

CramCycle

galwaycyclist wrote: »

e.g. by saying that cycling is a significant source of traumatic brain injury when it does not seem to be at a population level.

A problem with many journals like that is that often what the author thinks is significant is determined by the writer to be significant before it is written and then the posts are moved to agree with the original assumption.

ROK ON wrote: »

The theory is reduce road furniture designed to make roads in urban spaces safer. For example, reduce or remove road markings, traffic lights, zebra crossings etc etc.
the resulting increase in vulnerability felt by drivers, cyclists and pedestrians can cause a shift in behaviour that results in a safer and more pleasant use of a shared space.
....
Fascinating insight into human behaviours.
Sorry for long post.

There was a great experiment/test in a city in the UK where they removed traffic lights at a junction where there were constant delays as two roads merged. They found that once the lights were removed, people started going in turns and the time to get through the junction was reduced by more than half. Will look it up properly once home.

RayCun

CramCycle wrote: »

I suppose you should compare the number of cyclists killed by left turning vehicles versus the number killed because they were not wearing a helmet. One is an absolute, one is an opinion or at least far from determinable. Hence why a safety campaign to promote one makes more sense than the other.

Not my point.

galwaycyclist argues that promoting helmet use reduces the numbers cycling, because it makes cycling seem like a risky activity. Wearing helmets reduces risk of serious brain injury -> OMG if I cycle there is a risk of brain injury -> get me the biggest car possible, I'll be safe there!
But the same could be said about any campaign that highlights dangers involved in cycling. Beware of trucks turning left -> OMG, if I cycle I could get crushed by a left-turning truck -> I'll be safe in a car!

There is a good point in there somewhere. Increasing the number of people cycling does make everyone safer (and generally healthier), so we should encourage people to cycle rather than scaring them away.
But you reduce that to absurdity if you say we can never talk about how to make cycling safer in case talking about safety makes people think cycling is dangerous.

CramCycle

RayCun wrote: »

Not my point.

Having a campaign for helmets implies that cycling is dangerous in all situations. Having one for not undertaking left turning vehicles implies that if you cycle into a dangerous situation then something could happen.

ROK ON

CramCycle wrote: »

. . . people started going in turns and the time to get through the junction was reduced by more than half. Will look it up properly once home.

You know I found the theory difficult to believe, however I spent a bit of time working in Milan. Man junctions have no lights and yet traffic simply flows. This is Italy - a place renowned for inconsiderate driving. If it can work in a large contested Italian City then surely it could be considered here.
I mentioned this to a mate of mine who is a local politician. He responded that they had considered it but the council legal officer and insurance company warned against it -that's what we are up against.

RayCun

CramCycle wrote: »

Having a campaign for helmets implies that cycling is dangerous in all situations.

No, only that you aren't always able to predict if your cycle will contain any dangerous situations when you set out.
Do you carry a bicycle pump?

tomasrojo

RayCun wrote: »

I have seen evidence that legally mandating helmets puts people off cycling.
I have not seen evidence that promoting helmets has the same effect.

I've certainly often heard the latter asserted, but proving it is tricky.

This is a round-up:
http://www.cyclehelmets.org/1020.html

The evidence is indirect, at best.

Helmet promotion campaigns have tended to talk up the dangers of cycling and ridicule people who don't wear them. I personally find it likely that helmet promotion as it traditionally has been practised has discouraged cycling.

CramCycle

RayCun wrote: »

No, only that you aren't always able to predict if your cycle will contain any dangerous situations when you set out.

As a long time cyclist I have what I see to be a reasonable assessment of the risks. But what I was asserting is that it puts non cyclists off from starting or parents from encouraging due to an increase in perceived risks (they are spending money on a campaign to tell you that you should wear helmets, there must be something dangerous there).

tomasrojo

RayCun wrote: »

That's a red herring.
Children in areas of social deprivation are more likely to be injured in traffic - yes, for obvious reasons.
The NEJM of medicine did not reason
- children in areas of social deprivation are more likely to be injured
- children in these areas are less likely to wear helmets
- therefore helmets good

They found that, of those people treated for head injuries, people without helmets were more likely to have serious head injuries.

You can still hypothetically see how confounding with social class can occur though. Say the child cyclists from poorer areas are presenting at hospital with a relatively large percentage of injuries being acquired from being struck by a car, and child cyclists from wealthier areas are presenting with injuries nearly all arising from simple falls; you would expect nearly all the severe head injuries to be among the poorer non-helmet wearers, even if helmets were only weakly effective, or completely ineffective -- even, in fact, if helmets made injuries from simple falls worse.

HivemindXX

CramCycle wrote: »

Having a campaign for helmets implies that cycling is dangerous in all situations. Having one for not undertaking left turning vehicles implies that if you cycle into a dangerous situation then something could happen.

I think this hits the nail on the head (so to speak).

I have no qualms telling people not to pass left turning vehicles on the inside. As far as I'm concerned this is "this action is dangerous, don't do it".

I don't tell people they need to wear a helmet while commuting by bike. I feel that is closer to telling people "cycling is dangerous, if (when) you are hit by a car this might reduce your injuries".

The current promotion of helmets where even showing a family riding in a park without helmets is seen as irresponsible is really promoting the idea that cycling is dangerous and if you must do it you should wear a helmet. Of course most people don't have to cycle so they don't.

In my experience "it's too dangerous" easily beats "it's too wet", "I need to carry too much stuff" and "I can't arrive sweaty" as reasons people give for not cycling.