A local bicycle helmet 'law' in a Swedish municipality - the effects on helmet use.

The municipality of Motala in Sweden introduced a local bicycle helmet 'law' on May 1, 1996. This is not a legally enacted ordinance, but instead a legislated recommendation backed up by information and education. Formally, the law applies to children (aged 6-12 years), although the intention is to increase helmet use by all cyclists. The objective of the present study was to quantitatively evaluate the impact of the Motala helmet law on observed use of helmets by children and adults. Bicycle helmet use was monitored in Motala (n = 2,458/year) and in control towns (n = 17,818/year) both before and after adoption of the helmet law (1995-1998). Chi-square tests showed that helmet wearing 1995-1998 increased in Motala among all bicyclists (from 6.1% to 10.5%) and adults biking on cycle paths (from 1.8% to 7.6%). Helmet use by school children aged 6-12 increased during the first 6 months after introduction of the law (from 65.0% to 75.7%) but then progressively decreased to the pre-law level. Considering children cycling on cycle paths and for recreation in housing areas, there was a tendency towards increased helmet use during the first post-law year, but this was followed by a reduction to a lower level in 1998 than in 1995. Logistic regression analysis taking into account data from the control towns indicated that the helmet law had a positive effect on children cycling to schools during the first 6 months, and a weak delayed but more long-term positive effect on adult cyclists on cycle paths. There were no positive effects on children in housing areas and on cycle paths. The Motala helmet law probably would have had greater and more lasting effects on helmet use by bicyclists, if certain problems had been avoided during the initiation phase. Moreover, although it did have a positive influence on both school children and adults, it is not legally binding, and hence no penalties can be imposed. Presumably, compulsory legislation would have a more substantial impact on helmet wearing than a non-mandatory helmet 'law' such as that introduced in Motala.