An Analysis of Technology-Related Distracted Biking Behaviors and Helmet Use Among Cyclists in New York City

Bicycling is becoming an increasingly utilized mode of transportation in New York City. Technology-related distracted bicycling and helmet use are behaviors that can impact bike safety. The aims of this study were twofold: (1) to determine rates and types of technology-related distracted behaviors among bicyclists in the borough of Manhattan in New York City; and (2) to assess the rate of bicycle helmet use among these cyclists. Bicyclists in five popular riding areas in Manhattan were observed for a total of 50 h using a digital video camera during summer months in 2014. Videos were coded and enumerated for the total number and gender of cyclists, type of bicycle, number wearing headphones/earbuds and/or using a mobile phone, and whether the cyclist was wearing a helmet. Almost 25,000 cyclists were observed across the five selected locations (n = 24,861). Riders were almost four times more likely not to wear a helmet on rental bikes as compared with non-rentals (Citi Bike^® OR 3.8; 95 % CI 2.5, 5.9: other rental OR 3.8; 95 % CI 3.0, 4.9). Significantly increased odds of not wearing a helmet were observed for females relative to males (OR 1.4; 95 % CI 1.1, 1.8) across varied times and locations. Overall, rates of technology-related distraction were low, with headphone use being most prevalent. Males were more likely to wear headphones/earbuds (OR 2.0; 95 % CI 1.4, 2.9), as were cyclists on Citi Bikes relative to other rental bikes (OR 2.2; 95 % CI 1.3, 3.6). Findings from this study contribute to the growing literature on distracted biking and helmet use among bike share program riders and other cyclists and can inform policymakers and program planners aiming to improve bicycle safety in urban settings.     

Helmet Use Among Users of the Citi Bike Bicycle-Sharing Program: A Pilot Study in New York City

The use of bicycle helmets to prevent or reduce serious head injuries is well established. However, it is unclear how to effectively promote helmet use, particularly in the context of bicycle-sharing programs. The need to determine rates of helmet use specifically among users of bicycle-sharing programs and understand if certain characteristics, such as time of day, affect helmet use, is imperative if effective promotion and/or legislative efforts addressing helmet use are to be developed. We estimated the prevalence of helmet use among a sample of Citi Bike program users in New York City. A total of 1,054 cyclists were observed over 44 h and across the 22 busiest Citi Bike locations. Overall, 85.3 % (95 % CI 82.2, 88.4 %) of the cyclists observed did not wear a helmet. Rates of helmet non-use were also consistent whether cyclists were entering or leaving the docking station, among cyclists using the Citi Bikes earlier versus later in the day, and among cyclists using the Citi Bikes on weekends versus weekdays. Improved understanding about factors that facilitate and hinder helmet use is needed to help reduce head injury risk among users of bicycle sharing programs.     

Helmet use by motorcyclists injured in traffic accidents in Londrina, southern Brazil]

OBJECTIVE: To describe helmet use among motorcyclists injured in traffic accidents in Londrina, a medium-sized city in Paraná, a state in southern Brazil, and to identify factors associated with not wearing a helmet at the time of the accident. METHODS: We analyzed data concerning motorcycle users (drivers and passengers) who received care in 1998 from the only pre-hospitalization trauma and emergency care ambulance service in Londrina. The following variables were assessed: helmet use at the time of the accident; age; sex; seating position (driver or passenger); smell of alcohol on the breath; time of the day, day of the week, and month when the accident happened; and location of the accident (in the downtown area or outside of it). RESULTS: The average rate of helmet use was 63.2%. Factors independently associated with not using a helmet were (according to strength of association): being younger than 18 years of age (odds ratio (OR) = 6.61), having alcohol on the breath (OR = 3.93), accident occurring at night (OR = 2.51), accident happening outside the city's downtown area (OR = 2.27), and accident taking placing during the weekend (OR = 2.25). CONCLUSIONS: It is imperative to implement public policies aimed at promoting safety for motorcyclists, ongoing education in defensive driving, and the use of helmets and other safety equipment. Interventions should take into account that driving behaviors depend not just on individuals but also on the overall social and historical context.     

Long-Term Effects of Education and Legislation Enforcement on All-Age Bicycle Helmet Use: A Longitudinal Study

Bicycle-related injuries are a leading cause of child and youth hospitalizations in Canada. The use of helmets while bicycling reduces the risk of brain injuries. This study investigated the long-term effect of legislation coupled with enforcement to improve helmet use rates. We conducted a longitudinal observational study of helmet use at 9, 11, and 14 years after bicycle helmet legislation was enacted. Data were compared to baseline observations collected after legislation was passed in 1997. A comprehensive enforcement and educational diversion program, Operation Headway–Noggin Knowledge (OP–NK), was developed and implemented in partnership with regional police during the study period. Helmet use was sustained throughout the post-legislation period, from 75.3 % in the year legislation was enacted to 94.2 % 14 years post-legislation. The increase in helmet use was seen among all age groups and genders. Helmet legislation was not associated with changes in bicycle ridership over the study years. OP–NK was associated with improved enforcement efforts as evidenced by the number of tickets issued to noncompliant bicycle riders. This observational study spans a 16-year study period extending from pre-legislation to 14 years post all-age bicycle helmet legislation. Our study results demonstrate that a comprehensive approach that couples education and awareness with ongoing enforcement of helmet legislation is associated with long-term sustained helmet use rates. The diversion program described herein is listed among best practices by the Public Health Agency of Canada.     

Barriers to bicycle helmet use among Dutch paediatricians

Background In the Netherlands, bicycle helmet wearing rates are very low and perceived social barriers to helmet use are important. We aimed to determine why Dutch paediatricians do or do not wear helmets while bicycling and whether their personal behaviour is influencing their position about the promotion of helmet use. Methods Attendants to the annual meeting of the Dutch Paediatric Society (7–9 November 2006) were surveyed about bicycle riding frequency, helmet use, reasons for not wearing a helmet, helmet use among their own children and personal position about the promotion and legislation of bicycle helmet use. Results Of the 1110 paediatricians who are active in the Netherlands, 258 answered the survey. Ninety‐six per cent of the respondents ride a bicycle (68% more than once a week). Bicycle was used as a mean of transport (32%), as a recreation/sport (11%) or with both purposes (57%). When cycling for transportation, 94% never wear a helmet and 2% always wear it. When cycling for recreation, 70% never wear a helmet and 18% always wear it. The most common reasons given for not wearing a helmet were: ‘I never thought about that’ (43%), ‘Poor appearance’ (31%), ‘Nobody uses it in the Netherlands’ (27%) and ‘Uncomfortable’ (25%). A majority (91%) of the respondents agreed that bicycle helmets are effective in reducing the rate of head injury to bicyclists and that they should be advised to children (82%) and adolescents (54%). Conclusions Our results indicate that among Dutch paediatricians, cycling rate is high and helmet wearing rate is very low and that they experience numerous personal barriers to bicycle helmet use. This might explain why bicycle helmet promotion campaigns are scarcely supported by Dutch paediatricians.     

A prevalence survey of behavioural risk factors in Taipei City, Taiwan

In 1986, we conducted a telephone survey of 2514 residents of Taipei City, Taiwan, to establish baseline prevalence estimates of behavioural risk factors associated with the leading causes of death among adults. Estimates from this survey revealed a high prevalence of sedentary lifestyle (85.6%), seatbelt non-use (67.5%) and motorcycle helmet non-use (31.3%). The smoking rate (26.1%) was similar to that in the US, however, there was almost a tenfold difference between smoking rates in men and women (48.0% versus 5.1%, respectively). Behaviours related to alcohol misuse (binge drinking, chronic heavy drinking and driving and drinking) were also much more prevalent among men than women. This survey demonstrated the feasibility of using the telephone to collect data on the prevalence of behavioural risk factors in a newly industrialized country like Taiwan.     

Middle School Students and Bicycle Helmet Use: Knowledge, Attitudes, Beliefs, and Behaviors

ABSTRACT: Previous research has shown that bicycle helmet use among older children and adolescents continues to be low. This study determined middle school students' knowledge, attitudes, beliefs, and behaviors related to bicycle helmet use. Six middle schools in Hillsborough County, Fla., served as the research settings. A pretested survey instrument was administered to students. Overall. 3,333 sixth and seventh graders responded. Results showed that most children owned a bicycle, 38.1% owned a helmet, but only 15.8% wore a helmet the last time they rode a bike. Many students (49.7%) did not know or did not believe there was a bicycle helmet law in Florida. Predictors of helmet use were intention to use a helmet the next time one rides a bike, having a helmet, siblings' use of helmets, and friends' use of helmets.     

Postpartum Depression in Adolescent and Adult Mothers: Comparing Prenatal Risk Factors and Predictive Models

Our objective was to assess whether postpartum depression risk factors differ between adolescent and adult mothers and to evaluate the need for adolescent specific screening instruments. We performed a retrospective cohort study using data from the Rhode Island Pregnancy Risk Assessment Monitoring System, 2004–2008. We identified maternal age specific risk factors using weighted logistic regression and developed predictive models using a forward selected weighted logistic regression. Notable differences in odds ratios were observed for risk factors such as maternal race (OR Hispanic vs. White: 0.99, 95 % CI 0.49–1.99 among adolescents; 3.32, 95 % CI 2.01–5.49 among adults), pre-pregnancy alcohol use (OR use vs. non-use: 2.04, 95 % CI 1.08–3.86 among adolescents; 0.49, 95 % CI 0.33–0.73 among adults), and pregnancy intention (OR unintended vs. intended: 1.05, 95 % CI 0.37–2.97 among adolescents; 2.67, 95 % CI 1.51–4.74 among adults). In predictive models, adolescent postpartum depressive symptoms were most influenced by prior depression and social support while adult postpartum depressive symptoms were associated with risk factors including maternal race, pregnancy intention, SES, prior depression, mental health during pregnancy, stressors, and social support. We were able to identify similarities and dissimilarities in risk factors for postpartum depressive symptoms among adolescents and adults. Predictive models developed in the general population of pregnant women performed poorly among adolescents relative to age specific predictive models, suggesting that current screening tools may not adequately identify high risk adolescents.     

Trends and subgroup differences in transportation-related injury risk and safety behaviors among high school students, 1991-1997.

PURPOSE: To examine national trends in transportation-related injury risk and safety behaviors among U.S. high school students. METHODS: To examine secular trends in riding with a driver who had been drinking, driving after drinking, and using seat belts, bicycle helmets, and motorcycle helmets, we used logistic regression to analyze data from national Youth Risk Behavior Surveys (YRBS) conducted in 1991, 1993, 1995, and 1997. The YRBS is a self-administered, anonymous survey that uses a national probability sample of U.S. students in public and private schools from grades 9-12 (N = 55,734 for all years combined). RESULTS: The percentages of students who rode with a driver who had been drinking (36.6% in 1997), drove after drinking alcohol (16.9% in 1997), always wore seat belts (33.2% in 1997), and always wore a motorcycle helmet when riding a motorcycle (45.0% in 1997) remained stable between 1991 and 1997. From 1991 to 1997, the percentage of bicycle riders who always wore a helmet when bicycling showed a small but statistically significant increase (1.1% in 1991 to 3.8% in 1997), but helmet use remained low. CONCLUSION: Many young people place themselves at unnecessary risk for motor vehicle- and bicycle-related crash injuries and fatalities. Improved motor vehicle- and bicycle-related injury prevention strategies are needed that specifically target adolescents.     

The MORE HEALTH Bicycle Safety Project

ABSTRACT: A K-2 MORE HEALTH bicycle safety education program was provided in nine elementary schools in Hillsborough County, Florida. This innovative community program consisted of interactive education sessions and reduced-cost bicycle helmet sales. Evaluation of the pilot program showed that it affected helmet use in the intervention schools compared to nine other schools that served as controls. More than 1,000 helmets were distributed through the bicycle helmet sales. Approximately 3,500 children participated in the education sessions. The preprogram helmet use rate among all schools was 8.5%. Postprogram results showed that the helmet use rate among intervention schools was significantly greater than among control schools (p < .01). This report describes the MORE HEALTH bicycle helmet promotion program.     

Trends and Subgroup Differences in Transportation-Related Injury Risk and Safety Behaviors Among US High School Students, 1991-2007

Background:  Seventy percent of unintentional injury-related fatalities—the leading cause of death among youth in the United States—are motor vehicle traffic related. Examining traffic-related safety, therefore, is crucial to public health. This study examines trends in traffic safety issues among US high school students: helmet use while riding a bicycle, seat belt use as a passenger, driving when drinking alcohol, and riding in a car with a driver who had been drinking alcohol.
Methods:  Data from the 1991-2007 national Youth Risk Behavior Surveys (YRBS) were analyzed. The YRBS is a self-administered, anonymous survey that uses a national probability sample of US students in public and private schools in grades 9-12. Demographic subgroup differences were determined for 2007 data using t tests. Temporal changes were analyzed using logistic regression analyses.
Results:  From 1991 to 2007, the percentage of high school students who rarely or never wore bicycle helmets decreased from 96.2% to 85.1%; decreases were also seen in the percentage who never wore a seat belt (from 25.9% to 11.1%), rode with a driver who had been drinking alcohol (39.9-29.1%), and who drove when drinking alcohol (16.7-10.5%).
Conclusions:  Although the trends are encouraging, many students still put themselves at risk. Policy approaches (eg, state or local laws or ordinances) complemented by community and school programs may be the best approach to reducing transportation-related injuries and fatalities.     

A comparison of the effect of different bicycle helmet laws in 3 New York City suburbs.

OBJECTIVES: This study was conducted to evaluate the effectiveness of 3 different bicycle helmet laws. METHODS: A direct observational study of nearly 1000 cyclists at 20 matched sites in each of 3 contiguous counties--Rockland and Westchester in New York and Fairfield in Connecticut--was carried out. Rockland's bicycle helmet law requires approved helmets for all cyclists regardless of age; Westchester's, by state law, requires cyclists younger than 14 years to wear helmets; and Fairfield's, also by state law, requires cyclists younger than 12 years to wear helmets when riding on highways. RESULTS: Rockland cyclists had the highest helmet use rate (35%), followed by Westchester (24%) and Fairfield (14%) cyclists. As a subgroup, teenagers used helmets least, a trend that was seen in all 3 counties. CONCLUSIONS: Our study suggests a positive effect of bicycle helmet legislation with no age limitation.     

Salivary gland cancer: an exploratory analysis of dietary factors

This study was an exploratory analysis of dietary and other risk factors for primary salivary gland cancer in a population-based case-control study in Ontario, Canada. Cases were men and women diagnosed between 1995 and 1996 with a first primary cancer of the salivary gland, identified through the Ontario Cancer Registry. Controls were an age-matched random sample of the population of Ontario, identified through property assessment files. Cases (n = 91) and controls (n = 1897) completed a self-administered questionnaire with information on diet, smoking, height and weight, and other lifestyle and socio-demographic factors. Multivariate logistic regression was used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Among dietary variables, high relative to low intakes of alcohol (OR: 1.26; 95% CI: 0.68-2.35), fruits (OR: 1.26; 95% CI: 0.68-2.33), sweets (OR: 1.66; 95% CI: 0.85-3.25), dairy (OR: 1.41; 95% CI: 0.77-2.58), and starchy foods (OR: 1.78; 95% CI: 0.96-3.3) were associated with non-statistically significant increased risk of salivary gland cancer; whereas vegetables and meats were linked with non-statistically significant decreased risks of the disease. Among non-diet factors, male sex, obese BMI, exposure to occupational radiation, family history of cancer, and household income were suggestive of increased disease risk. Future work with larger numbers of cases are needed to further explore these associations.     

Bicycle helmet use in Sweden during the 1990s and in the future

This paper describes how the use of bicycle helmets in Swedenhas changed for different categories of cyclists from 1988 to2002, and it also estimates future trends in voluntary wearingof bicycle helmets up to the year 2010. Observational studiesof the use of bicycle helmets were conducted once a year from1988 to 2002 at 157 sites in 21 cities. The subjects observedwere children cycling to school (average n = 5471/year) andin their free time (average n = 2191/year), and adults cyclingto workplaces and on public bike paths (average n = 29 368/year).The general trend in helmet use from 1988 to 2002 was determinedby linear regression analysis, and the results were also employedto estimate future helmet wearing for the period 2003–2010.Differences in helmet use according to gender and size of citywere analysed by chi-square tests. From 1988 to 2002, all categoriesof cyclists showed an upward trend in helmet use (p < 0.01,p < 0.001). Helmet wearing increased from about 20 to 35%among children (10 years) cycling during free time, from approximately5 to 33% among school children, and from around 2 to 14% inadults. Total average helmet use rose from about 4 to 17%. However,during the last 5 years of the study period (1998–2002),none of the categories of cyclists studied showed an upwardtrend in helmet wearing. It is estimated that 30% of cyclistswill wear helmets voluntarily by the year 2010, if helmet promotionactivities are continued at the same level as previously. Theresults suggest that Sweden will probably not reach its officialgoal of 80% helmet use unless a national bicycle helmet lawis passed.     

Alcohol use and abuse by adolescents: the impact of living in a border community.

PURPOSE: To determine the rates of alcohol consumption and alcohol-related risk behaviors among a sample of high school students living on the U.S.-Mexico border, as well as to investigate factors associated with alcohol use among this population. METHODS: A self-administered anonymous questionnaire was administered to students in grades 9-12 during Fall and Spring semesters of 2001 (n = 1366; 639 males and 722 females) in 16 high schools in a community along the U.S.-Mexico border. The questionnaire addressed demographic factors, alcohol consumption, and alcohol-related behaviors. Surveys were completed by Chi-square tests for homogeneity of the odds ratio and logistic regression models were used to identify factors significantly associated with the outcome variables. RESULTS: Rates of binge drinking (45%), drinking and driving (19%), and riding with a driver who had been drinking (46%) were higher for our study population when compared with state and national rates. Students who consumed alcohol were more likely to report alcohol-related problems and lower academic grades. Drinking while in Mexico was significantly associated with binge drinking (OR = 6.44), drinking and driving (OR = 5.39), and riding with a driver who has been drinking (OR = 3.12). CONCLUSIONS: The high rates of alcohol risk behaviors among students living on the U.S.-Mexico border underscore the need to develop and implement culturally appropriate prevention programs that address alcohol consumption in Mexico, particularly in terms of students driving back home.     

Protective Assets for Non-use of Alcohol,Tobacco and Other Drugs among Urban American Indian Youth in Oklahoma

Objective This study explored associations between nine youth assets and tobacco, alcohol and other drug non-use among participating American Indian adolescents. Methods Data from 134 American Indians, ages 13–19 years, participating in an inner-city youth asset study, were analyzed. Individual logistic regression analyses were conducted, controlling for demographic variables, with nine youth assets as the independent variables and alcohol, tobacco and other drug non-use as the dependent variables. Results Among American Indian youth, nearly 79% reported not using alcohol in the past 30 days. The prevalence of tobacco non-use was somewhat lower than that of alcohol, with 71% reporting not using tobacco in the past 30 days. For other drug non-use, 87% reported not using other drugs in the past 30 days. The non-parental adult role models asset was significantly associated with non-use of alcohol (OR = 4.4, 95% CI 1.5–13.3), tobacco (OR = 7.5, 95% CI 2.2–25.6), and other drugs (OR = 5.0, 95% CI 1.5–16.8). The use of time (religion) asset was also significantly associated with alcohol non-use (OR = 2.8, 95% CI 1.1–7.2). The family communication asset was associated only with other drug non-use (OR = 3.1, 95% CI 1.02–9.4). For tobacco non-use, an interaction was observed between family structure and the good health practices (exercise/nutrition) asset. Among youth in single-parent households, the odds of tobacco non-use were 4.4 times greater among those who possessed the good health practices (exercise/nutrition) asset. Conclusions Despite the relatively small sample size of American Indian youth, these results suggest an important role for specific youth assets in the prevention of substance abuse among American Indian youth.     

Rates of bicycle helmet use in an affluent Michigan County.

Bicycle helmet use in the United States has remained low despite clear demonstration of its beneficial effect on reducing the incidence of serious head injury. Several interventions have been reported, with variable results and costs. Much of the recent literature has focused on child cyclists and on demographic factors associated with helmet use. This paper reports on helmet use by children and adults in a sample of 652 riders in an affluent southeast Michigan region, chosen to minimize the effect of previously recognized socioeconomic negative predictors that are not readily changed by intervention. Subjects were classified by age, sex, location, riding surface, type of bicycle, child bicycle seat use, child bicycle trailer use, and helmet use by companions. Overall helmet use was 24 percent; infants and toddlers had the highest rate of helmet use at 61 percent, followed by adults at 26 percent and school-aged children at 17 percent. The strongest predictor of helmet use in all age categories was the presence of a helmeted companion. Adult helmet use was also positively predicted by riding in the street and by riding a racing-type bicycle. The use of a city-type bicycle negatively predicted helmet use. For non-adults, female sex and the use of a child seat or trailer were positive predictors. Fostering peer pressure to increase helmet use may be an effective yet relatively inexpensive way to achieve the goal of widespread use of bicycle helmets.     

Bicycle injuries: road trauma is not the only concern

Data on bicycle injury presentations at a public hospital emergency department for 1991–95 inclusive were analysed to determine the nature and extent of bicycle injuries in the community. There were 599 bicycle injury presentations during the study period, representing more than 2.0% of all injury-related presentations to the emergency department. The main outcome measures were severity and type of injury. Distribution by gender, age, helmet use (1991 and 1992 only), location and mechanism was examined. Rider-only injuries (falls or collisions with stationary objects) accounted for 79.3% of all presentations with only 5.2% due to collisions on a public road or footpath with other moving traffic. Of all injuries where a location was determined, 61.6% occurred in off-road locations. There was little difference in the overall proportions of hospital admissions from injuries on-road (12.4%) and off-road (9.0%). Cyclists injured in on-road collisions with traffic had a higher proportion of hospital admissions (40.0%) than those injured on-road by other mechanisms (7.6%). Children under 10 years of age who had been riding without a helmet suffered a much higher proportion of injuries to the head (53.2% of all injuries) than older cyclists riding without a helmet (19.4%). The majority (83.1%) of head injuries in children under 10 years of age occurred off-road and helmet use was lowest in this group (28.6%). Given previous evidence that helmet use can prevent head injuries, strategies to increase helmet use among cyclists, particularly young children, while riding both on and off-road, should be given a high priority. Rider-only injuries are also an important public health issue.     

Absence of religious beliefs,unhealthy eating habits,illicit drug abuse,and self-rated health is associated with alcohol and tobacco use among college students — PADu study

Aim

Describing the factors associated with the alcohol consumption, tobacco use, binge drinking, and “binge drinking and tobacco use” by college students.

Subject and methods

Cross-sectional study carried out with 356 first-semester college students of a public educational institution at Minas Gerais, Brazil. Sociodemographic characteristics, lifestyle habits (alcohol consumption, tobacco and illicit drugs use, exposure time on screens, and eating habits), and health conditions (weight, height, self-rated health, symptoms of anxiety, and depression) were collected. Statistical analysis was performed using Stata® software version 13.0.

Results

The prevalence of alcohol consumption, tobacco use, binge drinking, and “binge drinking and tobacco use” were 73.9%, 17.4%, 43.5%, and 13.4%, respectively. Had no religious beliefs was associated with alcohol consumption (OR: 1.86 95% CI 1.06–3.27), tobacco use (OR: 2.00 95% CI 1.06–3.78), and “binge drinking and tobacco use” (OR: 2.33 95% CI 1.09–4.96). Unhealthy eating habits was associated with alcohol consumption (OR: 2.06 95% CI 1.06–3.97) and tobacco use (OR: 2.74 95% CI 1.33–5.68; OR: 0.75 95% CI 0.31–1.80). Illicit drugs was associated with alcohol consumption (OR: 8.55 95% CI 1.12–65.42) and tobacco use (OR: 3.19 95% CI 1.20–8.51). Self-rated health was associated with tobacco use, combined (OR: 2.93 95% CI 1.37–6.28) or not (OR: 2.46 95% CI 1.32–4.61) with binge drinking. Additionally, tobacco use was associated with white skin color (OR: 2.62 95% CI 1.35–5.07) and being homosexual (OR: 0.37 95% CI 0.18–0.75). Moreover, “binge drinking” was associated with being overweight (OR: 1.72 95% CI 1.03–2.84). Associations remained in the age and sex adjustment.

Conclusion

It was observed that some factors associated with alcohol consumption and tobacco use are modifiable risk factors. Therefore, we suggest strategic actions focusing on raising the population’s awareness to change these factors. Longitudinal studies are necessary to understand the causal relationship between studied variables and, thus, develop strategic actions to improve the life quality of this population group.

     

Epidemiology of accidents among users of two-wheeled motor vehicles. A surveillance study in two Italian cities

BACKGROUND: This paper describes a study on the epidemiology of accidents among users of two-wheeled motor vehicles in two Italian cities, Rome and Naples. METHODS: A surveillance study was conducted, recruiting the victims of accidents among users of two-wheeled motor vehicles, visiting the emergency departments of two Italian hospitals. The registration form includes personal data of the involved person, circumstances of the accident, means of arrival at the hospital, type of vehicles involved, helmet use, and eventually third parties involved, and data on the specific injury diagnosis. RESULTS: 736 injured drivers of two-wheeled motor vehicles were investigated for the study (65.1% males, 34.9% females). The mean age of the victims was 22.92 years; 42.9% of the injuries were the result of a single accident. In 35.5% of the injuries cars were involved and in 8.6% of the cases there was a passenger included. Only 12% of the injured people were wearing a helmet. Most of the lesions concerns the knee or lower leg (27.5%), followed by the head (17.5%), elbow and forearm (8.8%), wrist and hand (8.6%), shoulder and upper arm (8.4%) and ankle and foot (6.9%). Helmet use has a protective effect (OR = 0.23), whereas accidents in Naples and during dark hours are associated with an increased risk of head injury (respectively OR = 1.93, and OR = 1.46). CONCLUSION: In this study the lower injury risk due to the use of the helmet on the frequency and severity of head trauma was confirmed. Moreover, the results confirm that Emergency Departments can provide essential epidemiological information, and they have already provided clear arguments in favour of extending the compulsory use of helmets to people above 18 years in Italy.