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Bicyclists, helmets and head injuries: a rider-based study of helmet use and effectiveness

Wasserman RC, Waller JA, Monty MJ, Emery AB, Robinson DR.
American Journal of Public Health, 1988 Sep;78(9):1220-1.

Summary of paper (from authors' abstract)
516 bicyclists over the age of 10 were interviewed regarding helmet use and head injuries. Although 19% owned helmets, only 8% were wearing them when interviewed. Riders wearing helmets were more highly educated and reported higher car seat belt use. Nearly 4% of the bicyclists reported striking their heads in a cycling mishap during the previous 18 months; those wearing helmets at the time were less likely to have sustained head injuries.

Peer criticism
By Towner et al [1]:

• The actual number of cyclists hitting their heads was only 21, of whom just 7 suffered head injuries. These are very small numbers for comparison.
• The fact that helmeted cyclists were better educated and more likely to use seat belts was a source of bias between cases and controls.
• Self-report data, subject to bias.
• No data on injury severity.
• The number of cyclists using helmets was small.
• There was a very large proportion of students in the sample.
• Due to the small numbers involved, little weight can be put on this study.

References

[1] Towner E, Dowswell T, Burkes M, Dickinson H, Towner J, Hayes M. Bicycle helmets - a review of their effectiveness: a critical review of the literature: Technical Annexe. Department for Transport, Road Safety Research Report 30.