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Istituto Superiore di Sanità
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Istituto Superiore di Sanità - EpiCentro


The Impact of a Universal Helmet Law on Helmet Use and Accidents among Moped Riders, Italy, 2000

Marco Giustini e Franco Taggi, Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Roma

 

In 1986, the Italian government introduced a law that made the use of helmets compulsory among motorcycle riders of all ages and moped riders 18 years of age and under. Helmet use among motorcyclists increased from 15% to 97% after passage of the law and has remained high. Although helmet use among moped riders initially rose from 4% to 52% (1), use subsequently declined to approximately 20%. This level was considerably lower than the value that would have been expected had all riders under 18 years been in compliance.

 

On the 30th of March 2000, a new law on helmet use was passed that made it mandatory for all moped riders, regardless of age, to wear a helmet. Those not wearing helmets are subject to fines of 63 thousand lire (US $31), and their moped may be confiscated for 30 days.

 

To monitor the effect of the new law on helmet use, a surveillance system known as Progetto Casco 2000 (Project Helmet 2000) was established.  A total of 57 Aziende Sanitarie Locale (Local Health Authorities; ASL) throughout the country, representing nearly a third of all ASLs, agreed to participate, including 26 in the North, 11 in the Center, and 20 in the South.  Observations were made at selected sites in each ASL’s jurisdiction for one hour a day at least three days per week from February to the end of June. In addition, detailed information was collected on emergency room visits related to moped injuries during this same time period in 27 of the 57 participating local health authorities.

 

More than 290,000 observations of moped helmet use were made during the study period. The mean prevalence of helmet use, weighted by the number of observations in each geographic area, showed that the use of helmets among moped riders was low before the law went into effect, especially in the Center and South of the country (Figure). After implementation, use rose dramatically, exceeding 95% in the North and Center. Although levels increased four-fold in the South, only 60% of moped riders were observed to be wearing helmets, with the prevalence of use in 20 ASLs of the South ranging from 31% in Cosenza to 98% in Salerno.

 

In the 27 local health units which collected emergency room data, a total of 1857 moped-related visits occurred over the study period. A comparison of the pre-implementation period (February and March) with that of the post-implementation period (April, May, and June) revealed a striking decrease in emergency room visits (-40%), in head injuries (-75%) and hospitalizations (-48%). In addition, there was a 79% decrease in neurologic and neurosurgical admissions, and an overall 63% decrease in “serious” injuries (Table -ita-). A surprising finding was a 25% decrease in injuries to the extremities, which perhaps may be attributed to safer driving practices after implementation of the law.

 

Based on mathematical models developed at ISS, the law has prevented an estimated 180 deaths, 350 serious disabilities, and a minimum of 8000 hospitalizations in the first 12 months following its implementation.

 

Studies of helmet use must take into account a variety of factors, including variations over time and season in the use of helmets, the impact on trauma and death rates, the patterns of trauma observed, and changes in patterns and frequency of moped use. Ongoing surveillance currently being conducted as part of the ULISSE surveillance system (a joint project involving both the Traffic and Road Safety Inspector General's Office, Ministry of Public Works and National Institute of Health, Ministry of Health)will provide additional detailed information on these factors. Nonetheless, preliminary data demonstrate that  a year after implementation of the helmet law, the initially observed increases in helmet use among moped riders have persisted over time. This finding is consistent with results from other sites demonstrating that universal laws are far more effective than laws directed to specific age groups within in the population (3). Finally, although overall levels of helmet use were high in the country, further efforts will be needed, however to reduce the substandard levels of coverage observed in the South and Islands.

 

1) Progetto Dati Incidenti Stradali - Accordo Quadro Ispettorato Generale Circolazione e Sicurezza Stradale; Ministero dei Lavori Pubblici - Istituto Superiore di Sanità - Ministero della Sanità1) Franco TAGGI Lancet, 1988, pag. 182.

2) Susan. P. Baker, Brian O'Neill, William Haddon, William B. Long, "The Injury Severity Score: Development and Potential Usefulness", Proceedings of the 18 Conference of the American Association for Automotive Medicine

3) Centers for Disease Control: Head injuries associated with motorcycle use. Wisconsin, 1991. MMWR, June 17, 1994; 43; 429-431.

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