Project: Cycle Helmets - A Review of Their Efficacy

Reference: S101F

Last update: 03/10/2003 17:43:54


The objectives are:
To provide a critical review of research and literature on the efficacy of cycle helmets. It is intended that this will provide a valuable reference source in formulating future policy and research decisions.
Consider where and how cycle helmets are worn compulsorily and the impact of this on cycling and safety.
Identify gaps in existing knowledge and research.


As part of its policy to improve the safety of pedal cyclists, DfT promotes the use of cycle helmets, particularly amongst children. However, there is a wealth of published evidence both for and against promotion and compulsory use of cycle helmets, and DfT requires an independent objective critique of the most up to date evidence on the efficacy of cycle helmets. It is also important to have up to date information on legislative measures internationally and their impact on cycling activity levels and safety


University of Newcastle
Department of Architecture Town & Country Planning, Newcastle Upon Tyne, NE1 7RU

Contract details

Cost to the Department: £17,560.00

Actual start date: 01 October 2001

Actual completion date: 01 May 2002


Bicycle helmets - A review of their effectiveness: a critical review of the literature
Author: Towner E, Dowswell T, Burkes M, Dickinson H, Towner J and Hayes M
Publication date: 04/11/2002
Source: Department for Transport
More information:

Summary of results

  1. The critical review of the extensive literature concludes that there is a considerable amount of scientific evidence that bicycle helmets are effective at reducing the incidence and severity of head, brain and upper facial injury. They have been found to be effective in reducing injury for users of all ages, though particularly for children. While most studies indicate that helmets offer protection from head injury, the relative risk of injury in helmeted and unhelmeted bicyclists has varied in different studies. There is equivocal evidence relating to the link between helmet use and neck injury. There is very little evidence relating to helmet use and cycling style. There is considerable heterogeneity in the studies relating to definitions of head and brain injury, choice of controls, target group and context in which cycling takes place.
    On average between 1998-2000, inclusive, in Great Britain 28 children and 123 adults were killed as pedal bicyclists each year, according to police records and this is likely to be an underestimate. Males are four times as likely to be killed or injured as females. Most bicycle injuries occur in teenage children or young adults. Head and face injuries make up a significant proportion of all bicycle injuries. Bicycle helmet wearing rates in Great Britain have increased steadily in the last decade but are still low. In 1999 on busy roads the wearing rate was 22% and on minor roads 8%.
    Bicycle helmets aim to reduce the risk of injury due to impacts on the head by reducing the deceleration of the skull, by spreading the area over which the forces of impact apply and by preventing direct impact between the skull and impacting object. A range of different helmet standards have been developed in different countries but they are substantially similar. The main differences relate to the impact energy during the drop tests. Only the Australian/New Zealand and Canadian standards take account of the requirements of children, whose tolerances are lower. The review found little evidence that helmets of different standards perform better in protecting the wearer.
    In terms of promotion the researchers found that most bicycle helmet educational campaigns have been targeted at children. Bicycle helmet education campaigns can increase the use of helmets. Younger children and girls showed the greatest effects from the campaigns. Reducing the costs of helmet through discounts, and give-away programmes facilitates uptake and use.
    Bicycle helmet legislation has been associated with head injury reductions and, with supporting educational activities, has been found to be an effective means of increasing observed helmet use. However, compulsory helmet wearing may discourage some bicyclists leading to decreased bicycle use. In Australia, New Zealand and Canada, legislation has not been introduced until high levels of helmet wearing have been attained in the population.
    Over time, helmet use has increased, but there remain differences in helmet-wearing rates between and within countries. Most of the literature on barriers and facilitators of helmet use has focused on children and teenagers. Barriers to helmet use include age (teenagers), social background (lower income), geographical factors, group effects associated with companionship, cost and discomfort. Attitudinal barriers to helmet use include low risk perception, peer pressure and parental influence.
    After consideration of the range of opinion pieces concerning bicycle helmets the authors conclude that 'The way in which the debate has been conducted is unhelpful to those wishing to make a balanced judgement on the issue.' The pro- bicycle helmet group base their argument overwhelmingly on one major point: that there is scientific evidence that, in the event of a fall, helmets substantially reduce head injury. The anti- helmet group base their argument on a wider range of issues including: compulsory helmet wearing leads to a decline in cycling, 'risk compensation' theory negates health gains, scientific studies are defective, the overall road environment needs to be improved.