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Melur Sukumar G, Patel N, B R RG, Roy A, Akashanand A, Roy R, Sakhi P, P P, M N A, G G, Bachani AM. Prevalence and patterns of helmet use among motorized two-wheelers: findings from a large observational study in an Indian metropolis. Int J Inj Contr Saf Promot 2024:1-8. [PMID: 39183529 DOI: 10.1080/17457300.2024.2394484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/10/2024] [Accepted: 08/15/2024] [Indexed: 08/27/2024]
Abstract
Motorized two-wheeler users account for 45% of road fatalities in 2021 in India. Correct helmet use decreases the risk of fatalities, but information about the prevalence of correct helmet use is limited in the Indian context. This study aims to assess the prevalence of helmet use and factors associated with correct helmet use among motorized two-wheeler users in Bengaluru city, India. This observational cross-sectional assessment was conducted in a random-representative sample of 98021 motorized two-wheelers sampled from 15 intersections. Helmet use and other information were collected by trained Field Data Collectors via hand-held tablet devices and the KoBo collect application, following a globally used checklist. The prevalence of helmet use (all types) was 88% among riders and pillion together and 92.4% among riders. However, the prevalence of correct helmet use is 38% among riders, and non-standard helmet use is 27%. This study reveals a correct helmet use gap in Bengaluru city. The study recommends the need to shift enforcement, messaging, and intervention focus towards correct helmet use and the implementation of routine population-based surveillance for helmet use in the city.
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Affiliation(s)
- Gautham Melur Sukumar
- Department of Epidemiology, WHO Collaborating Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Nishit Patel
- Johns Hopkins International Injury Research Unit (JH-IIRU), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ravikanthe Gowda B R
- Inspector General of Police (Central Range), Karnataka State Police, Bengaluru, India
| | - Aaheli Roy
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Akashanand Akashanand
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Runalika Roy
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Padma Sakhi
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Priyanka P
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Anucheth M N
- Joint Commissioner of Police, (Traffic), Bengaluru, India
| | - Gururaj G
- WHO Collaborating Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Khan UR, Zia N, Khudadad U, Wright K, Sayed SA. Perceptions, barriers, and strategies regarding helmet use by female pillion riders in Pakistan: A qualitative study. Injury 2023; 54 Suppl 4:110740. [PMID: 37573069 DOI: 10.1016/j.injury.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 03/28/2023] [Accepted: 04/14/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Despite the existence of a national motorcycle helmet law that applies to both riders and pillion riders, the use of helmets among female pillion riders is low in Pakistan. This study aimed to explore perceptions, barriers, and strategies related to helmet use by female pillion riders. METHODS Data was collected from nine focus group discussions held with female pillion riders and male riders working at the Aga Khan University. Focus group discussions were transcribed verbatim and checked for accuracy before being imported into NVivo2. Transcriptions were analyzed using a thematic analysis approach. RESULTS Four overarching themes emerged, including: (1) motorcycle as mode of transportation, (2) law on helmet use and its enforcement, (3) barriers to helmet use among female pillion riders, and (4) strategies to improve helmet use among female pillion riders. Female participants never wore a helmet or considered wearing it even though "safety" was the most important benefit of helmet usage expressed. The motorcycle is an economical mode of transportation for families, particularly those in the middle and lower socioeconomic groups. Helmet laws are not strictly enforced for pillion riders, including females. Possible barriers to helmet use among female pillion riders included discomfort in wearing a helmet, uninvited attention from others, concerns about physical appearance, and substandard quality and design of helmets. Suggested strategies for implementing helmet use among female pillion riders encompassed awareness generation through media, complementary distribution of helmets, strict law enforcement in the form of fines, and the influence of religious leaders regarding social norms and cultural barriers. CONCLUSION Motorcycles are a risky mode of transport, and there are several social and cultural barriers regarding helmet use by female pillion riders. Enforcing helmet laws for female pillion riders, raising awareness about helmet laws, and making helmet use among pillion riders a norm are some essential steps to take to promote helmet use among female pillion riders in Pakistan.
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Affiliation(s)
- Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Hospital, 75950 Karachi, Pakistan.
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Department of International Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Umerdad Khudadad
- Department of Emergency Medicine, Aga Khan University Hospital, 75950 Karachi, Pakistan
| | - Kate Wright
- Department of health, behavior & society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sayeeda Amber Sayed
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4 Canada
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Urréchaga EM, Kodadek LM, Bugaev N, Bauman ZM, Shah KH, Abdel Aziz H, Beckman MA, Reynolds JM, Soe-Lin H, Crandall ML, Rattan R. Full-face motorcycle helmets to reduce injury and death: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg 2022; 224:1238-1246. [PMID: 35821175 DOI: 10.1016/j.amjsurg.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND While motorcycle helmets reduce mortality and morbidity, no guidelines specify which is safest. We sought to determine if full-face helmets reduce injury and death. METHODS We searched for studies without exclusion based on: age, language, date, or randomization. Case reports, professional riders, and studies without original data were excluded. Pooled results were reported as OR (95% CI). Risk of bias and certainty was assessed. (PROSPERO #CRD42021226929). RESULTS Of 4431 studies identified, 3074 were duplicates, leaving 1357 that were screened. Eighty-one full texts were assessed for eligibility, with 37 studies (n = 37,233) eventually included. Full-face helmets reduced traumatic brain injury (OR 0.40 [0.23-0.70]); injury severity for the head and neck (Abbreviated Injury Scale [AIS] mean difference -0.64 [-1.10 to -0.18]) and face (AIS mean difference -0.49 [-0.71 to -0.27]); and facial fracture (OR 0.26 [0.15-0.46]). CONCLUSION Full-face motorcycle helmets are conditionally recommended to reduce traumatic brain injury, facial fractures, and injury severity.
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Affiliation(s)
| | | | | | | | - Kaushal H Shah
- Department of Emergency Medicine, Weill Cornell Medicine, USA.
| | | | | | | | - Hahn Soe-Lin
- Department of Surgery, St. Joseph's Medical Center, USA.
| | - Marie L Crandall
- Department of Surgery, University of Florida, Jacksonville, USA.
| | - Rishi Rattan
- Department of Surgery, University of Miami, USA.
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Mohammadi E, Azadnajafabad S, Keykhaei M, Shakiba A, Ebrahimi Meimand S, Hosseini Shabanan S, Mahdavi Sharif P, Asgardoon MH, Shafieian M, Ghodsi Z, Heydari ST, Atlasi R, Ansari-Moghaddam A, Sharif-Alhoseini M, O'Reilly GM, Rahimi-Movaghar V. Barriers and factors associated with the use of helmets by Motorcyclists: A scoping review. ACCIDENT; ANALYSIS AND PREVENTION 2022; 171:106667. [PMID: 35413615 DOI: 10.1016/j.aap.2022.106667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 03/10/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
Road Traffic Injuries (RTIs) have imposed a great global burden on public health. Motorcyclists and pedestrians comprise the most significant proportion of this burden. Several studies have demonstrated a link between helmet wearing and a decline in the impact of RTIs in motorcyclists. In this study, we aimed to review the barriers to helmet utilization by motorcyclists. This scoping review has been conducted in accordance with the guidelines for the systematic review of observational studies and the PRISMA Checklist. The search was conducted by using related keywords in EMBASE, PubMed, Scopus, and Cochrane Library. Four independent reviewers carried out the screening. The main outcomes of interest were barriers to helmet usage among motorcyclists, drawn from the finally included studies. Fifty-three records were selected for data extraction. According to these reports, the barriers and factors associated with helmet usage among motorcyclists were categorized into five entities as: legislations/enforcement strategies, helmet disadvantages (discomfort, visual/auditory blockage, and thermal dysregulation), risky behaviors (riding while drunk or high on drugs), sex and/or age factors, and the location and time of the injury event (rural vs. urban locations, day vs. night riding). From the perspective of policymakers, the findings of this review are of utmost importance and could be used in addressing the challenge of inadequate compliance with helmet use.
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Affiliation(s)
- Esmaeil Mohammadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, IL 60611, USA
| | - Ali Shakiba
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Ebrahimi Meimand
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Pouya Mahdavi Sharif
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Asgardoon
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Iranian Student Society for Immunodeficiencies, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.; Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mehdi Shafieian
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rasha Atlasi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gerard M O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; National Trauma Research Institute, The Alfred, Melbourne, Australia
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Universal Scientific Education and Research Network (USERN), Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran; Visiting Professor, Spine Program, University of Toronto, Toronto, Canada.
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Vasan SS, Gururaj G. Unhelmeted two-wheeler riders in India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:171-172. [PMID: 34825550 DOI: 10.25259/nmji_455_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- S S Vasan
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - G Gururaj
- WHO Collaborating Centre for Injury Prevention and Safety Promotion, Centre for Public Health, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, Karnataka, India
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Saeed M, Siddiqui SM, Khan UR, Swaroop M. Perceptions regarding helmet use: a cross-sectional survey of female pillions in Karachi, Pakistan. J Surg Res 2017; 211:261-265. [DOI: 10.1016/j.jss.2016.11.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/08/2016] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
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Wadhwaniya S, Gupta S, Mitra S, Tetali S, Josyula LK, Gururaj G, Hyder AA. A comparison of observed and self-reported helmet use and associated factors among motorcyclists in Hyderabad city, India. Public Health 2017; 144S:S62-S69. [PMID: 28288734 DOI: 10.1016/j.puhe.2016.11.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/22/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES India has a high burden of fatal road traffic injuries (RTIs). A large proportion of fatal RTIs in India are among motorcyclists. The overall goal of this study is to assess and compare observed and self-reported prevalence of helmet use; and to identify factors associated with helmet use and over-reporting in Hyderabad city, India. STUDY DESIGN Roadside knowledge, attitude and practice interviews. METHODS Six rounds of roadside interviews were conducted with motorcyclists (drivers and pillion riders) between July 2011 and August 2013 using a structured tool developed for this study. Observations on helmet use were recorded and respondents were also asked if they 'always wear a helmet'. Prevalence of helmet use was calculated and a paired t-test was used to compare observed and self-reported helmet use proportions. Unadjusted and adjusted odds ratios were calculated to identify factors associated with helmet use and over-reporting. RESULTS A total of 4872 respondents participated in the roadside interview. The response rate was 94.4%. The overall observed helmet use was 34.5% and 44.5% of respondents reported that they 'always wear a helmet'. As the observed helmet use increased, the over-reporting of helmet use was found to decrease. However, factors associated with observed and self-reported helmet use are similar. Male gender, youth (≤24 years), a lower level of education and non-ownership of helmet were associated with a higher risk of not wearing helmets. Male gender, youth (≤24 years), no schooling, riding a lower engine capacity motorcycle and using a motorcycle for purposes other than travelling to school/work were associated with over-reporting of helmet use. CONCLUSIONS Self-reports provide an overestimate of helmet use that lessens as actual helmet use increases. Interviews also allow identification of factors associated with helmet use. Increasing helmet ownership and enhanced enforcement may help increase helmet use.
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Affiliation(s)
- S Wadhwaniya
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Department of International Heath, 615 N. Wolfe Street, Suite E8132, Baltimore, MD 21205, USA.
| | - S Gupta
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Department of International Heath, 615 N. Wolfe Street, Suite E8132, Baltimore, MD 21205, USA
| | - S Mitra
- Indian Institute of Technology Kharagpur, Department of Civil Engineering, Kharagpur, West Bengal 721302, India
| | - S Tetali
- Indian Institute of Public Health, Hyderabad, Plot #1, A N V Arcade, Amar Co-operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India
| | - L K Josyula
- Indian Institute of Public Health, Hyderabad, Plot #1, A N V Arcade, Amar Co-operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India
| | - G Gururaj
- National Institute of Mental Health and Neuro Sciences, Department of Epidemiology, Hosur Road, Bangalore 560029, India
| | - A A Hyder
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Department of International Heath, 615 N. Wolfe Street, Suite E8132, Baltimore, MD 21205, USA
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Siddiqui SM, Sagar S, Misra MC, Gupta A, Crandall M, Swaroop M. Patterns of injury among motorized two-wheeler pillion riders in New Delhi, India. J Surg Res 2016; 205:142-6. [PMID: 27621011 DOI: 10.1016/j.jss.2016.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Motorized two-wheelers (MTWs) such as scooters and motorcycles place drivers and passengers at significant risk of injury and death in the event of a road traffic accident. In India, where road traffic is poorly regulated and consists of vehicles ranging from semitrucks to animal carts, the MTW pillion rider (backseat passenger) is particularly vulnerable. Annually, approximately 140,000 Indians are injured or killed in MTW road traffic accidents. In 2011, the city of New Delhi renewed a mandatory helmet use exemption for its 8 million women. We sought to identify the patterns of injury among MTW pillion riders in the city of New Delhi, including differences between helmeted and unhelmeted male and female pillion riders. METHODS All records of incoming trauma patients to the Jai Prakash Narayan Apex Trauma Center, New Delhi, were reviewed for the 23-mo period from April 1, 2009 until March 1, 2011. More than 3000 charts were reviewed selecting for patients who were MTW pillion riders involved in road traffic accidents. Data including Glasgow Coma Scale score, number of surgical procedures performed, length of stay, and demographic information were collected from charts that met the criteria. Fisher's exact test was used for categorical variables and Kruskal-Wallis test for continuous variables. RESULTS A total of 466 charts of MTW pillions in road traffic accidents were identified with 108 helmeted males, 161 unhelmeted males, three helmeted females, and 194 unhelmeted females. Females, both unhelmeted and helmeted, were more likely to have head and neck injury than unhelmeted males or helmeted males (66.0% and 66.7% versus 53.4% and 27.8%, P < 0.001). Unhelmeted females were most likely to suffer inhospital mortality (17.6%, P = 0.008) and require intensive care unit admission (40.0%, P = 0.004). Unhelmeted pillions, both male and female, had significantly lower Glasgow Coma Scale scores than helmeted pillions (12.6 and 12.8 versus 13.8 and 15, P = 0.04). CONCLUSIONS Female pillions are more likely to have head and neck injury than male pillions, and unhelmeted pillions are more likely to have injuries resulting in their death. This firmly establishes the protective benefit of helmet use for pillions. Encouraging helmet use among all pillions may prevent a significant number of injuries and deaths, and mandatory helmet laws may decrease morbidity and mortality of MTW road traffic accidents for the women of New Delhi and all of India.
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Affiliation(s)
- Selma Marie Siddiqui
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Sushma Sagar
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh C Misra
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Marie Crandall
- Department of Surgery, University of Florida Jacksonville, Jacksonville, Florida
| | - Mamta Swaroop
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Mundi R, Chaudhry H, Flores-Miranda N, Puthukudy N, Petrisor B, Schemitsch EH, Bhandari M. Roads in India: safety and knowledge cross-sectional evaluation. J Orthop Trauma 2014; 28 Suppl 1:S30-2. [PMID: 24857995 DOI: 10.1097/bot.0000000000000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The World Health Organization estimates that more than 15% of the global burden of road traffic trauma is in India. We performed an image-based survey of 3 major roadways in New Delhi, India, to evaluate collision-prone vehicle and pedestrian behaviors. METHODS We used a cross-sectional survey design with photograph- and video-based data collection. The study was performed at 3 purposively sampled high traffic volume roadways in New Delhi, India. The authors reviewed preliminary photographs and came to a consensus pertaining to the definition and criteria for dangerous and collision-prone behaviors. Analysis was descriptive and was based on frequency data. RESULTS A total of 11,214 subjects were evaluated. Eighty-six percent were vehicles (n = 9624), whereas the remaining 14% were pedestrians (n = 1572). In 99% of the frames, 1 or more predefined behavioral infraction was identified, with a total of 21% (n = 2392) of subjects committing these infractions. Specifically, 15% of all vehicles (n = 1468) and 59% of all pedestrians (n = 924) displayed a risk-taking infraction. CONCLUSIONS Road users in New Delhi, India, engage in unacceptably high rates of collision-prone behavior. There is a need for interventions that will improve the behaviors of road users.
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Affiliation(s)
- Raman Mundi
- *Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada; and †Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Swaroop M, Marie Siddiqui S, Sagar S, Crandall ML. The problem of the pillion rider: India's helmet law and New Delhi's exemption. J Surg Res 2014; 188:64-8. [PMID: 24529884 DOI: 10.1016/j.jss.2014.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND In India, motorized two-wheeler (MTW) road traffic accidents injure or kill 72,000 women annually. Before the Motor Vehicle Act of 1988, which required mandatory helmet use for MTW riders, a study found 0.6% of all MTW pillions (backseat passengers) were helmeted. Citing religious protests to the legislation, Delhi's high court exempted the city's 12 million women from the law. We hypothesize that currently male pillions use helmets more frequently than females, and that overall pillion helmet usage has increased over the last 20 y. METHODS Continuous video was recorded in half-hour blocks at four locations in Delhi on separate days, totaling 8 hours of high- and low-volume traffic. Videos were reviewed with at least two reviewers extracting the number of MTW pillions, as well as their gender, approximate age, and helmet usage. RESULTS Of 4010 pillions identified, 63.8% were male, 32.4% female, and 3.3% children. Among males, there were significantly more helmeted pillions (88.4%, P < 0.001); among females, there were significantly more unhelmeted pillions (99.4%, P < 0.001). Among unhelmeted pillions, significantly more were female (81.4%) than male (P < 0.001). Current overall pillion helmet use is significantly higher than historical rate (P < 0.001). CONCLUSIONS The significantly higher male pillion helmet usage compared with females indicates Delhi's helmet law is associated with increased compliance among those who fall under its jurisdiction. This augments the growing body of evidence that mandatory helmet laws are efficacious, thus repealing the exemption of women is an important step in increasing female pillion helmet usage.
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Affiliation(s)
- Mamta Swaroop
- Division of Trauma and Critical Care, Department of Surgery, Northwestern University, Chicago, Illinois.
| | - Selma Marie Siddiqui
- Division of Trauma and Critical Care, Department of Surgery, Northwestern University, Chicago, Illinois; Department of Surgery, St. Joseph Hospital, Chicago, Illinois
| | - Sushma Sagar
- Department of Trauma Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Marie L Crandall
- Division of Trauma and Critical Care, Department of Surgery, Northwestern University, Chicago, Illinois
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