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SECTION V--DESCRIPTION OF STRATEGIES Objective F--Increase Use of Bicycle Safety Equipment Strategy F1: Increase Use of Bicycle Helmets (P) The use of bicycle helmets has been proven to reduce fatalities and serious head injuries that result from bicycle crashes. Studies have shown that riders wearing helmets are 70 to 88 per- cent less likely to suffer serious head injuries or fatalities in a bicycle crash than unhelmeted riders. There is, however, no evidence that use of helmets reduces collisions and crashes. This strategy of encouraging increased helmet use is recommended as an approach for improving bicyclists' behavior (i.e., the decision to wear a helmet) that will result in fewer fatalities. The option of mandatory helmet use laws should be seriously considered. Helmet laws, along with enforcement of those laws, are effective in increasing helmet use, and helmet use decreases fatalities. This is the only proven strategy for reducing bicyclist fatalities when crashes do occur. Education Despite clear and convincing data regarding the effectiveness of bicycle helmets, few people across the United States are usually observed wearing bicycle helmets. The latest estimates from 1994 of helmet ownership and helmet use among children in the United States are 50.2 percent and 25.0 percent, respectively. Helmet use varies widely across the country, due to the local variation in educational campaigns and the presence of helmet laws. Education of bicycle helmet effectiveness in preventing head injury is one popular method used in the attempt to increase and sustain bicycle helmet use. Education interventions can be community-based, school-based, physician-based, or some combination of these settings. They can be multifaceted in their means of increasing helmet use or may just have one method of employing the strategy. Also, they should combine education about proper use and fitting with helmet discount programs that offer helmets for free or at reduced prices. Information about discount programs can be found at http://www.helmets.org/toolkit.htm. Helmet interventions are likely most effective when combined with related activities, such as bike rodeos and media announcements. Legislation Mandatory helmet use laws are an effective means of increasing helmet use. Legislation is quite effective in increasing helmet use, and the effect is not heavily dependent on enforcement. Legislation can be at the level of a municipality, county, or entire state and can affect just children, adolescents, or the entire age spectrum. The effectiveness of legislation in augmenting helmet use can be evaluated by direct observation of helmet use, sales of helmets, injuries reported, citations written, or some combination of these data. As of February 2007 there were 21 state laws (including the District of Columbia) requiring minors to wear helmets while bicycling, and at least another 149 local ordinances, some of which cover bicyclists of all ages. For a comprehensive, state-by-state review on bicycle laws in the United States, visit http://www.helmets.org/mandator.htm. V-94

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SECTION V--DESCRIPTION OF STRATEGIES The Centers for Disease Control and Prevention (CDC) included a compendium of bicycle helmet safety program evaluations in the Morbidity and Mortality Weekly Report (MMWR) issue titled, "Injury Control Recommendations: Bicycle Helmets" (see http://www.helmets. org/evaluate.htm). The Bicycle Helmet Safety Institute conducted a formal study on the effect of bicycle helmet legislation on bicycling fatalities that can be found at http://www.helmets.org/leggrant.htm. EXHIBIT V-62 Strategy Attributes for Increasing Use of Bicycle Helmets (P) Attribute Description Technical Attributes Targets This strategy targets the behavior of bicyclists. Expected Wearing an approved helmet in the proper manner (i.e., taut chin strap, helmet shifted Effectiveness forward on the head, and proper-fitting helmet) is the most effective way one can prevent serious head injury or death from a bicycle crash or collision. Even a modest increase in helmet use rates can prove beneficial in reducing these rates. Overall, helmets decrease the risk of serious head injury by as much as 85 percent and the risk of brain injury by up to 88 percent. Helmets have also been shown to reduce the risk of injury to the upper and mid face by 65 percent. A Consumer Product Safety Commission study concluded that the presence of a State law increases helmet use by 18.4 percent (http://www.helmets.org/briefs.htm# rodgers_state_laws). Keys to Success Passage of mandatory helmet use laws are the most important key to success. Education programs to increase helmet use should be closely coordinated with other bicycle-related education programs, and they should draw from the techniques and programs that are discussed in Strategy E1--Provide Bicyclist Skill Education. An important element in intervention programs is the participation of parents. Studies have provided further evidence that children are more likely to wear helmets if their riding partners, whether adults or children, are also wearing helmets. Helmet education programs should be based on research data, focus on a carefully selected target age group, include the use of a bicycle helmet (through discounts or donation) in addition to other tactics, and have a built-in evaluation component. A community-wide program that has these four factors can give an intervention the best chance for success and possibly provide the basis for local, state, and nationwide campaigns. Potential Difficulties Developing a comprehensive program to increase helmet use will involve an ongoing dedication of effort and resources. Not all bicyclists can afford a helmet, and this issue should be addressed as part of passing a mandatory helmet law. There are multiple organizations that have established criteria for helmets, which may confuse helmet users. Although many helmets meet all standards, some less expensive ones are only tested by one, rather than multiple, agencies. Mandatory helmet laws that refer to "established and generally accepted standards" are less likely to cause confusion or resistance about this issue. V-95

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SECTION V--DESCRIPTION OF STRATEGIES EXHIBIT V-62 (Continued) Strategy Attributes for Increasing Use of Bicycle Helmets (P) Attribute Description Technical Attributes Helmets are often thought by inexperienced users to be uncomfortable, to mess up rider's hair, or to be too hot. Ongoing advances in bicycle helmet design may enable manufacturers and promoters of helmet use to circumvent obstacles against helmet use such as poor fit and poor air circulation, high cost, and the "uncoolness" of wearing a helmet. These obstacles, especially peer pressure, are particularly difficult to overcome among children. Legislation mandating bicycle helmets is not universally accepted. The opponents view such legislation as an infringement on personal freedom that will cause some bicyclists to give up a healthy form of exercise. There is evidence that mandatory helmet laws result in less people riding (Robinson, 2006). Opponents of legislation may also claim that bicyclists wearing helmets might engage in risky behavior, which brings their risk of serious injury back up to the same level it would be if they were not required to wear helmets. Appropriate Measures This strategy can be evaluated by direct observation of helmet use, sales of helmets, and Data injuries reported, or some combination of these data. To avoid excessive costs, direct observation of helmet use could be conducted through sample observations at a limited number of locations, rather than trying to observe all use. Associated Needs Although it makes inherent sense that helmets would protect against head injury, establishing the real-world effectiveness of helmets is important. Numerous studies have established the effectiveness of bicycle helmets. A listing of many of these studies can be found at http://depts.washington.edu/hiprc/practices/topic/bicycles/helmeteffect.html. In all studies reviewed, there are consistent data indicating that wearing an industry- approved bicycle helmet significantly reduces the risk of head injury during a crash or collision. Organizational and Institutional Attributes Organizational, A common evaluation barrier for programs that target youth is gaining permission to Institutional, and collect data in a school environment. Arranging this permission through the involvement Policy Issues of the school (district-level or individual school) is a key step for being able to evaluate programs targeted towards children. Issues Affecting A helmet education and promotion program can be implemented in less than 3 months. Implementation Time Developing legislation relating to helmet use may require significant time, as public involvement is a necessary component for new rules and regulations. Costs Involved Costs for enacting legislation are low, although if enforcement activities are part of the legislative strategy, they will require law enforcement resources. Costs for helmet promotion programs may include acquiring helmets (sometimes available for low cost through local bicycle stores or directly from suppliers) as well as regular costs associated with developing and implementing any education program. Training and Other Any individuals involved in actually fitting helmets should be qualified to provide sound Personnel Needs advice and guidance to people unfamiliar with helmet use. V-96

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SECTION V--DESCRIPTION OF STRATEGIES EXHIBIT V-62 (Continued) Strategy Attributes for Increasing Use of Bicycle Helmets (P) Attribute Description Organizational and Institutional Attributes Legislative Needs Developing new helmet-related legislation is a legislative process that requires evaluation of alternatives (i.e., which ages, implementation timeline, enforcement policies, etc.) and consensus-building before new policies can be adopted. Other Key Attributes National The National Strategies for Advancing Bicycle Safety includes goals, strategies, and Strategies short-and long-term actions that can be taken to reduce injury and mortality associated with bicycle-related incidents. Efforts to change the cycling environment have five key goals (http://www.nhtsa.dot.gov/people/injury/pedbimot/bike/bicycle_safety/): Motorists will share the road Bicyclists will ride safely Bicyclists will wear helmets The legal system will support safe bicycling Roads and paths will safely accommodate bicyclists Strategy F2: Increase Rider and Bicycle Conspicuity (T) It is illegal in most states to ride in low light conditions without a front white light and a rear red reflector. These laws, however, are rarely followed and even more rarely enforced. Yet studies show that dark, unlighted conditions increase the severity of injuries to bicyclists and pedestrians relative to daylight conditions (Klop and Khattak, 1999). Darkness decreases bicyclist visibility, and therefore the reaction time of motorists near bicyclists. Logically, dark conditions increase the potential that a bicyclist will not be seen, and subsequently struck, by a motorist. Also, the Toronto Bicycle/Motor-Vehicle Collision Study (City of Toronto, 2003) concluded that when bicyclists mix with motor vehicle traffic in dark conditions, they become even more difficult to spot. There are four stages in the detection and recognition of bicyclists: 1. A motorist's expectation of encountering other vehicles--specifically bicycles, 2. The effort taken to look for the other vehicles or roadway users (including bicyclists), 3. The actual detection of a moving object, and 4. The recognition of the detected moving object as a bicyclist traveling along a potentially conflicting path. Darkness, poor visibility, and lack of conspicuity can hinder the last two stages of the detection and recognition process (City of Toronto, 2003). Increasing bicyclists' conspicuity can be achieved in several ways. Bicycle lanes, discussed in Strategy B1, provide a consistent and predictable space for bicyclists, making them easier to V-97

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SECTION V--DESCRIPTION OF STRATEGIES detect (City of Toronto, 2003). Some bicyclist education programs teach bicyclists that they can improve their detection and recognition by riding in a prominent position on the road. But the most effective way for bicyclists to make themselves more conspicuous, and hence more detectable and recognizable, is to use headlights and rear lights and to wear retroreflective clothing. Reflective and Retroreflective Clothing Studies have found that reflectorization can increase the visibility of bicyclists and pedestrians by a factor of five (Blomberg et al., 1984). Retroreflective materials reflect light using specially designed glass or synthetic beads. These materials are required for most roadway markings such as stop lines and lane markings, so their ability to increase conspicuity is established. Vests and other clothing for bicyclists have been made with retroreflective material. The standard specification for Nighttime Photometric Performance on Retroreflective Markings for Visibility Enhancement is set by the American Society for Testing and Materials (ASTM) International (ASTM, 2003). For access to ASTM standards, visit the ASTM web site, http://www.astm.org. Lights on Bicycle Exclusive use of reflectors on bicycles (as required by the Consumer Product Safety Commission) is not effective at increasing the conspicuity of bicyclists, except for when headlights shine directly on the reflector. For example, a car approaching an intersection will not see a reflector on a bicycle approaching on the intersecting street. A headlight, however, is more likely to be visible to the motorist. For this reason, headlights are recommended, if not required, for all riding in low light or dark conditions. Although many states require a headlight and a rear reflector, few have programs in place to help bicyclists acquire the headlight. Just as helmet discount programs are thought to help increase helmet use, headlight discount programs would likely increase headlight use. States that do not require headlights and rear reflectors should consider implementing such a requirement. EXHIBIT V-63 Strategy Attributes for Increasing Rider and Bicycle Conspicuity (T) Attribute Description Technical Attributes Targets This strategy targets the behavior of bicyclists who are riding at night near motor vehicle traffic, but also affects motorists by making bicyclists more conspicuous. Expected Bicyclists that are more visible are expected to be involved in fewer crashes during low Effectiveness light conditions. Although no studies have been identified that indicate this outcome, bicyclists that are more easily seen are likely to be more easily avoidable, as well. In addition, the use of headlights may provide bicyclists with better visibility of roadway conditions. V-98

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SECTION V--DESCRIPTION OF STRATEGIES EXHIBIT V-63 (Continued) Strategy Attributes for Increasing Rider and Bicycle Conspicuity (T) Attribute Description Technical Attributes A study by Blomberg et al. (1984) investigated the effectiveness of countermeasures to improve conspicuity of bicyclists and pedestrians. Measures such as reflective vests increased detection of users by more than 300 to 400 percent and recognition as a bicyclist or pedestrian by approximately 300 percent over someone not using a reflective vest. Use of lights increased detection by more than 600 percent and recognition by 300 percent. Keys to Success Efforts to increase use of lights on bicycles should be combined with activities to increase enforcement of laws that require their use. Also, studies of bicycle/motor vehicle nighttime collisions have concluded that bicyclists do not understand the potential benefits of adequate conspicuity. Therefore, education about the benefits of bicycle lights, as well as retroreflective materials, should be conducted in tandem with efforts to encourage use of these items. Correct information should be communicated. For example, Blomberg et al. (1984) showed that wearing white or light-colored clothing does not effectively increase conspicuity, yet this remains a commonly recommended practice. Similarly, the use of reflective materials that highlight the movement of the bicyclist are more likely to increase recognition or shorten the time it takes a motorist to recognize a bicyclists, but the potential benefits of these types of products are rarely explained to bicyclists. Riding at night should not be discouraged. When properly using lights, bicycle-mounted reflectors, and retroreflective clothing, bicyclists can be sufficiently visible and recognizable at night. Combined with proper riding techniques, riding at night should be as safe as riding during daylight. Many bicyclists rely on their bicycle as primary or important modes of transportation. Promulgating the message that bicyclists should not ride at night may stigmatize those who do, and reduce the belief among drivers that they should expect bicycles at night. Effective recommendations should be that "If you ride at night..." followed by the recommended practice. The message to increase use of lights and retroreflective clothing should be part of any bicycle-related education. There are no established light- or reflector-only promotions, but this message is part of most bicycle rodeo and similar curriculums. The League of American Bicyclists offers advice to bicyclists about the use of lights. Their recommendations could be incorporated into a PI&E campaign (http://www.bikeleague.org/resources/better/advancedcycling.php). Potential Difficulties It has proven difficult to overcome numerous barriers to using conspicuity-increasing materials and lights. These include: 1. Lack of understanding by bicyclists of the benefits of lights and reflective materials. 2. Poor (or nonexistent) enforcement of existing laws requiring lights and reflectors on bicycles. 3. Resistance to use of lights and reflective materials based on associated costs, added weight, and inconvenience for bicyclists. 4. A sense that the current Consumer Product Safety Commission (CPSC) requirement of reflectors on new bicycles will make the bicycle adequately conspicuous. V-99

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SECTION V--DESCRIPTION OF STRATEGIES EXHIBIT V-63 (Continued) Strategy Attributes for Increasing Rider and Bicycle Conspicuity (T) Attribute Description Technical Attributes Over the years, numerous bicycle manufacturers have offered bicycles that included lighting systems. These bicycles have not enjoyed commercial success, so manufacturers only rarely offer products with pre-installed lights. No standards have been developed for evaluating retroreflective materials for bicyclists' conspicuity. It is not known whether commercially available materials are retroreflective enough. Also, the minimum distances at night for detection and recognition have not been determined. Comparisons have been drawn between early automobiles and bicycles; when automobiles were first sold, they did not include headlights. It was only over time, as evidence of their increasing nighttime use and the role of inadequate lighting became established, that governments (federal and state) began requiring lighting systems on all new cars. Further research is needed to understand both conspicuity of bicyclists and the lighting levels needed to effectively see the roadway. This research could lead to conspicuity and lighting standards that ensure visibility and recognizability to motorists, as well as ensure that bicyclists can properly see the roadway. Appropriate Measures A reduction in the frequency of low-light (dusk, nighttime, and early morning) bicycle and Data crashes is a prime measure of effectiveness. A surrogate measure might be the percentage of bicyclists using headlights or wearing more retroreflective clothing at night. Associated Needs There is need for education/awareness activities to convey the importance of being visible at night while bicycling. In states that do not have mandatory requirements for front headlights and rear reflectors, such laws should be put into place. Organizational and Institutional Attributes Organizational, Current CPSC regulations that require reflectors are insufficient yet may be referenced Institutional, and to support resistance to mandatory headlight requirements. Alternative national Policy Issues standards for lights, although considered by the CPSC, have not been adopted. Issues Affecting None identified. Implementation Time Costs Involved Costs for retroreflective materials are minimal, with adhesive materials costing between $5 and $15 and more extensive uses, such as reflective vests, costing up to $40. In addition, retroflective materials are increasingly included in non-bicycling specific outerwear, as well as bicycling-specific commuting clothing. Lighting systems vary widely in cost. Less expensive lights cost between $12 and $25, while the top-of-the line lighting systems can cost over $350. In general, more expensive lights are brighter, have better battery systems, and are easier to install and remove. One relatively recent development that has reduced the cost of bright, low cost lights with long battery lives is the increasing use of light emitting diodes (LEDs) as headlights. V-100