A price-performance analysis of the protective capabilities of wholesale bicycle helmets.

OBJECTIVE: Although bicycle helmets are an effective countermeasure against head injury, many cyclists do not wear one. One avenue for facilitating widespread helmet use is through community-driven helmet safety initiatives, which often give away or subsidize wholesale helmet models that are manufactured at a low price point. However, the impact performance of such helmets during real-world accident conditions has yet to be explored. The present study seeks to investigate trends between wholesale bicycle helmet price and protective capabilities. METHODS: Nine common wholesale helmet models (price range $3.65-$12.95) were evaluated according to the bicycle Summation of Tests for the Analysis of Risk (STAR) methodology, which analyzes helmet performance in 24 oblique impact tests reflecting common cyclist head impact conditions. Resulting head peak linear acceleration (PLA) and peak rotational velocity (PRV) were collected and used to predict risk of concussion. Concussion risks were then combined using the STAR algorithm in order to summarize each model's risks into a single, weighted metric. RESULTS: Large ranges in kinematic results led to large variations in concussion risks between helmets, and in turn, large variations in STAR values (13.5-26.2). Wholesale helmet price was not significantly associated with STAR, although incorporating 30 previous bicycle helmet STAR results produced a weak negative correlation between price and STAR overall. Nonetheless, the best-performing wholesale helmet produced one of the lowest overall STAR values for a price of $6.45. Helmet style was instead a superior predictor of STAR, with multi-sport style helmets producing significantly higher linear accelerations and resulting STAR values than bike style helmets. CONCLUSIONS: These results show that the impact performance of wholesale helmets ranges considerably despite their low price-points. Results can also guide helmet safety promotion organizers toward distributing wholesale bicycle helmet models associated with lower overall concussion risks.

Cost-effectiveness of mandatory bicycle helmet use to prevent traumatic brain injuries and death.

BACKGROUND: Traumatic brain injury (TBI) is the main cause of mortality and severe morbidity in cyclists admitted to Dutch emergency departments (EDs). Although the use of bicycle helmets is an effective way of preventing TBI, this is uncommon in the Netherlands. An option to increase its use is through a legal enforcement. However, little is known about the cost-effectiveness of such mandatory use of helmets in the Dutch context. The current study aimed to assess the cost-effectiveness of a law that enforces helmet use to reduce TBI and TBI-related mortality. METHODS: The cost-effectiveness was estimated through decision tree modelling. In this study, wearing bicycle helmets enforced by law was compared with the current situation of infrequent voluntary helmet use. The total Dutch cycling population, consisting of 13.5 million people, was included in the model. Model data and parameters were obtained from Statistics Netherlands, the National Road Traffic Database, Dutch Injury Surveillance System, and literature. Effects included were numbers of TBI, death, and disability-adjusted life years (DALY). Costs included were healthcare costs, costs of productivity losses, and helmet costs. Sensitivity analysis was performed to assess which parameter had the largest influence on the incremental cost-effectiveness ratio (ICER). RESULTS: The intervention would lead to an estimated reduction of 2942 cases of TBI and 46 deaths. Overall, the incremental costs per 1) death averted, 2) per TBI averted, and 3) per DALY averted were estimated at 1) € 2,002,766, 2) € 31,028 and 3) € 28,465, respectively. Most favorable were the incremental costs per DALY in the 65+ age group: € 17,775. CONCLUSIONS: The overall costs per DALY averted surpassed the Dutch willingness to pay threshold value of € 20,000 for cost-effectiveness of preventive interventions. However, the cost per DALY averted for the elderly was below this threshold, indicating that in this age group largest effects can be reached. If the price of a helmet would reduce by 20%, which is non-hypothetical in a situation of large-scale purchases and use of these helmets, the introduction of this regulation would result in an intervention that is almost cost-effective in all age groups.

The prevalence and determinants of helmet use amongst commercial motorcyclists in Ido-Osi local government area.

Commercial motorcycle (CM) accidents constitute a major public concern in Nigeria. There is 8:10 chance that injuries resulting from these accidents are severe and debilitating including head and spinal injuries. This study is aimed at producing useful data on the prevalence, frequency, and determinants of helmet use among commercial motorcyclist in Ido-Osi Local Government Area, Ekiti State, Nigeria. The study was a descriptive/cross-sectional study. A total of 360 respondents were selected by multi-stage sampling technique and interviewed using assisted self-administered, semi-structured questionnaire. Data were analyzed using SPSS version 21. Determinants of helmet use examined included age, educational level, marital status and religion. There was a 100% response rate. More than half of the respondents were within the age range of 20-29 years 164(53.6%) with the mean age of the study participants 29.9. The prevalence of helmet usage among commercial motorcyclist was 23.5%. The commonest reason for not using a crash helmet in this study was non-availability. The commonest reason for the non-availability of the welding helmet was the cost of the helmet. Less than half of the respondents were able to show or present helmet although some of the helmet presented were sub-standard (39.7%). The study also revealed irregular use of helmets among the respondents that used a helmet while riding a motorcycle as only 2.7% of them used it for all the five riding sessions assessed in this study. There was a statistically significant relationship between age, educational level, marital status and the use of helmets among respondents with p values of 0.005, 0.027, and 0.009, respectively. The prevalence of the use of helmets among the motorcyclist in this study is low despite the high level of awareness of legislation among the respondents on the use of helmets during riding. There is a need for the government to make provision for a safety helmet for this group of people at a subsidized rate if it cannot be given free of charge because of the economic situation of the country. There is a need to carry out behavioral change communication for this group of people.

Impact of Helmet Use on Injury and Financial Burden of Motorcycle and Moped Crashes in Hawai'i: Analysis of a Linked Statewide Database.

Helmet use reduces injury severity, disability, hospital length of stay, and hospital charges in motorcycle riders. The public absorbs billions of dollars annually in hospital charges for unhelmeted, uninsured motorcycle riders. We sought to quantify, on a statewide level, the healthcare burden of unhelmeted motorcycle and moped riders. We examined 1,965 emergency medical service (EMS) reports from motorcycle and moped crashes in Hawai'i between 2007-2009. EMS records were linked to hospital medical records to assess associations between vehicle type, helmet use, medical charges, diagnoses, and final disposition. Unhelmeted riders of either type of vehicle suffered more head injuries, especially skull fractures (adjusted odds ratio (OR) of 4.48, P < .001, compared to helmeted riders). Motorcyclists without helmets were nearly three times more likely to die (adjusted OR 2.85, P = .001). Average medical charges were almost 50% higher for unhelmeted motorcycle and moped riders, with a significant (P = .006) difference between helmeted ($27,176) and unhelmeted ($40,217) motorcycle riders. Unhelmeted riders were twice as likely to self-pay (19.3%, versus 9.8% of helmeted riders), and more likely to have Medicaid or a similar income-qualifying insurance plan (13.5% versus 5.0%, respectively). Protective associations with helmet use are stronger among motorcyclists than moped riders, suggesting the protective effect is augmented in higher speed crashes. The public financial burden is higher from unhelmeted riders who sustain more severe injuries and are less likely to be insured.

Motorcycle Helmets: The Economic Burden of an Incomplete Helmet Law to Medical Care in the State of Connecticut.

The lack of a mandatory motorcycle helmet law leads to increased injury severity and increased health care costs. This study presents a financial model to estimate how the lack of a mandatory helmet law impacts the cost of health care in the state of Connecticut. The average cost to treat a helmeted rider and a nonhelmeted rider was $3,112 and $5,746 respectively (cost adjusted for year 2014). The total hospital treatment cost in the state of Connecticut from 2003 through 2012 was $73,106,197, with $51,508,804 attributed to nonhelmeted riders and $21,597,393 attributed to helmeted riders. The total Medicaid cost to the state of Connecticut for treating nonhelmeted patients was $18,277,317. This model demonstrates that the lack of a mandatory helmet law increases overall health care costs to the state of Connecticut, and provides a framework by which hospital costs can be reduced to contribute to the economic stability of health care economics in the state.

National mandatory motorcycle helmet laws may save $2.2 billion annually: An inpatient and value of statistical life analysis.

BACKGROUND: While statistics exist regarding the overall rate of fatalities in motorcyclists with and without helmets, a combined inpatient and value of statistical life (VSL) analysis has not previously been reported. METHODS: Statistical data of motorcycle collisions were obtained from the Centers for Disease Control, National Highway Transportation Safety Board, and Governors Highway Safety Association. The VSL estimate was obtained from the 2002 Department of Transportation calculation. Statistics on helmeted versus nonhelmeted motorcyclists, death at the scene, and inpatient death were obtained using the 2010 National Trauma Data Bank. Inpatient costs were obtained from the 2010 National Inpatient Sample. Population estimates were generated using weighted samples, and all costs are reported using 2010 US dollars using the Consumer Price Index. RESULTS: A total of 3,951 fatal motorcycle collisions were reported in 2010, of which 77% of patients died at the scene, 10% in the emergency department, and 13% as inpatients. Thirty-seven percent of all riders did not wear a helmet but accounted for 69% of all deaths. Of those motorcyclists who survived to the hospital, the odds ratio of surviving with a helmet was 1.51 compared with those without a helmet (p < 0.001). Total costs for nonhelmeted motorcyclists were 66% greater at $5.5 billion, compared with $3.3 billion for helmeted motorcyclists (p < 0.001). Direct inpatient costs were 16% greater for helmeted riders ($203,248 vs. $175,006) but led to more than 50% greater VSL generated (absolute benefit, $602,519 per helmeted survivor). CONCLUSION: A cost analysis of inpatient care and indirect costs of motorcycle riders who do not wear helmets leads to nearly $2.2 billion in losses per year, with almost 1.9 times as many deaths compared with helmeted motorcyclists. The per capita cost per fatality is more than $800,000. Institution of a mandatory helmet law could lead to an annual cost savings of almost $2.2 billion. LEVEL OF EVIDENCE: Economic analysis, level III.

Societal cost of traumatic brain injury: A comparison of cost-of-injuries related to biking with and without helmet use.

OBJECTIVE: The goal of this study is to determine if a difference in societal costs exists from traumatic brain injuries (TBI) in patients who wear helmets compared to non-wearers. METHODS: This is a retrospective cost-of-injury study of 128 patients admitted to the Montreal General Hospital (MGH) following a TBI that occurred while cycling between 2007-2011. Information was collected from Quebec Trauma Registry. The independent variables collected were socio-demographic, helmet status, clinical and neurological patient information. The dependent variables evaluated societal costs. RESULTS: The median costs of hospitalization were significantly higher (p = 0.037) in the no helmet group ($7246.67 vs. $4328.17). No differences in costs were found for inpatient rehabilitation (p = 0.525), outpatient rehabilitation (p = 0.192), loss of productivity (p = 0.108) or death (p = 1.000). Overall, the differences in total societal costs between the helmet and no helmet group were not significantly different (p = 0.065). However, the median total costs for patients with isolated TBI in the non-helmet group ($22, 232.82) was significantly higher (p = 0.045) compared to the helmet group ($13, 920.15). CONCLUSION: Cyclists sustaining TBIs who did not wear helmets in this study were found to cost society nearly double that of helmeted cyclists.

Hospital charges associated with motorcycle crash factors: a quantile regression analysis.

BACKGROUND: Previous studies of motorcycle crash (MC) related hospital charges use trauma registries and hospital records, and do not adjust for the number of motorcyclists not requiring medical attention. This may lead to conservative estimates of helmet use effectiveness. METHODS: MC records were probabilistically linked with emergency department and hospital records to obtain total hospital charges. Missing data were imputed. Multivariable quantile regression estimated reductions in hospital charges associated with helmet use and other crash factors. RESULTS: Motorcycle helmets were associated with reduced median hospital charges of $256 (42% reduction) and reduced 98th percentile of $32,390 (33% reduction). After adjusting for other factors, helmets were associated with reductions in charges in all upper percentiles studied. Quantile regression models described homogenous and heterogeneous associations between other crash factors and charges. CONCLUSIONS: Quantile regression comprehensively describes associations between crash factors and hospital charges. Helmet use among motorcyclists is associated with decreased hospital charges.

Endoscopic-assisted correction of metopic synostosis.

Our 6-year experience with correction of metopic synostosis using a minimally invasive endoscopic-assisted technique followed by postoperative cranial vault helmet molding is presented. In addition, a simple, objective method for quantification of the frontal vault contour is described.A total of 16 patients, 13 males and 3 females, with nonsyndromic, single-suture synostosis were included in the study. Patient age at operation averaged 2.9 months and the mean weight was 6 kg. The mean operative time was 79 minutes. The estimated blood loss during the procedure was 82.8 mL. Three patients required blood transfusions (18.7%). There were no significant postoperative complications. The mean hospitalization was 1.6 days. The average surgical cost, including the helmets, was $12,400, in contrast to $33,000 charged for the equivalent open procedure.Very good esthetic results, judged by physical examination and photograph comparison, were obtained in all patients. No relapses were noted. Objectively, the outcome of the operative repair was evaluated using laser scanning. For quantification of the distortion and the postoperative level of correction, the metopic angle was defined and used. This angle changed from preoperative value of 104.9 degrees to 111.3 degrees at 3 months (P = 1.59E-06) and to 114.9 degrees at 1 year postoperatively (P = 2.51E-09).Due to its promising attributes, minimally invasive strip craniectomy emerges as an ideal modality for correction of metopic synostosis. Furthermore, the metopic angle should provide clinicians with an objective measure of the frontal cranial vault deformity and its correction.

The use of non-standard motorcycle helmets in low- and middle-income countries: a multicentre study.

BACKGROUND: The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. METHODS: Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. FINDINGS: 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. INTERPRETATION: Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.

HElmet therapy Assessment in infants with Deformed Skulls (HEADS): protocol for a randomised controlled trial.

BACKGROUND: In The Netherlands, helmet therapy is a commonly used treatment in infants with skull deformation (deformational plagiocephaly or deformational brachycephaly). However, evidence of the effectiveness of this treatment remains lacking. The HEADS study (HElmet therapy Assessment in Deformed Skulls) aims to determine the effects and costs of helmet therapy compared to no helmet therapy in infants with moderate to severe skull deformation. METHODS/DESIGN: Pragmatic randomised controlled trial (RCT) nested in a cohort study. The cohort study included infants with a positional preference and/or skull deformation at two to four months (first assessment). At 5 months of age, all children were assessed again and infants meeting the criteria for helmet therapy were asked to participate in the RCT. Participants were randomly allocated to either helmet therapy or no helmet therapy. Parents of eligible infants that do not agree with enrolment in the RCT were invited to stay enrolled for follow up in a non-randomisedrandomised controlled trial (nRCT); they were then free to make the decision to start helmet therapy or not. Follow-up assessments took place at 8, 12 and 24 months of age. The main outcome will be head shape at 24 months that is measured using plagiocephalometry. Secondary outcomes will be satisfaction of parents and professionals with the appearance of the child, parental concerns about the future, anxiety level and satisfaction with the treatment, motor development and quality of life of the infant. Finally, compliance and costs will also be determined. DISCUSSION: HEADS will be the first study presenting data from an RCT on the effectiveness of helmet therapy. Outcomes will be important for affected children and their parents, health care professionals and future treatment policies. Our findings are likely to influence the reimbursement policies of health insurance companies.Besides these health outcomes, we will be able to address several methodological questions, e.g. do participants in an RCT represent the eligible target population and do outcomes of the RCT differ from outcomes found in the nRCT? TRIAL REGISTRATION: ISRCTN18473161.

Helmet use among motorcyclists who died in crashes and economic cost savings associated with state motorcycle helmet laws--United States, 2008-2010.

In 2010, the 4,502 motorcyclists (operators and passengers) killed in motorcycle crashes made up 14% of all road traffic deaths, yet motorcycles accounted for <1% of all vehicle miles traveled. Helmet use consistently has been shown to reduce motorcycle crash-related injuries and deaths, and the most effective strategy to increase helmet use is enactment of universal helmet laws. Universal helmet laws require all motorcyclists to wear helmets whenever they ride. To examine the association between states' motorcycle helmet laws and helmet use or nonuse among fatally injured motorcyclists, CDC analyzed 2008-2010 National Highway Traffic Safety Administration (NHTSA) data from the Fatality Analysis Reporting System (FARS), a census of fatal traffic crashes in the United States. Additionally, economic cost data from NHTSA were obtained to compare the costs saved as a result of helmet use, by type of state motorcycle helmet law. The findings indicated that, on average, 12% of fatally injured motorcyclists were not wearing helmets in states with universal helmet laws, compared with 64% in partial helmet law states (laws that only required specific groups, usually young riders, to wear helmets) and 79% in states without a helmet law. Additionally, in 2010, economic costs saved from helmet use by society in states with a universal helmet law were, on average, $725 per registered motorcycle, nearly four times greater than in states without such a law ($198).

Costs associated with helmet use in motorcycle crashes: the cost of not wearing a helmet.

OBJECTIVE: The relationship between injuries sustained in a motorcycle crash (MCC) by unhelmeted motorcyclists and the multitude of costs associated with those injuries has been a decades-long debate. Results from research addressing injuries and mortality due to helmet use in MCCs demonstrates that unhelmeted motorcyclists experience more severe injuries, resulting in higher health care costs and an increased likelihood of requiring care beyond the hospital in other facilities. However, a link between injury severity and hospital costs has not been established with its spillover effect onto health insurance providers. This retrospective study was designed to delineate the health care and insurance costs of adult trauma patients admitted to a Level 1 trauma center due to an MCC. METHODS: The study included adult trauma patients 18 years of age or older admitted to a Level 1 trauma center due to an MCC between January 1, 2005, and December 31, 2010. The center is a receiving hospital for the central third of a Midwestern state, serving a medium-sized city as well as rural and isolated population areas. Patients were stratified into 2 groups based on helmet use. Patient variables included mechanism of injury, clinical characteristics, total units of blood used, intensive care unit (ICU) length of stay (LOS), hospital LOS, days on a ventilator, mortality, number of procedures during hospital stay, primary payor, discharge location, and total hospital charges. A linear regression model was used to predict the charges associated with the severity of injuries. RESULTS: A significant difference was found for total hospital charges. The mean total hospital charge for helmeted patients was $4184.26 compared to $7383.31 for unhelmeted patients. The prediction model was statistically significant, indicating that not wearing a helmet starts the patient at a cost of $3199.06. The cost of treatment for patients who wore helmets was $256.93 for each incremental increase in Injury Severity Score (ISS) compared to $537.57 for unhelmeted patients. ICU LOS, hospital LOS, and vent days were statistically significant, with durations longer for unhelmeted patients. Helmeted patients also required more units of blood. The total number of procedures for each patient approached significance, with the unhelmeted group requiring more procedures. CONCLUSIONS: The goal of the study was to delineate the medical costs associated with helmet use and nonuse in motorcyclists. The results demonstrate that medical costs due to an MCC for an unhelmeted motorcyclist were significantly higher than for a helmeted motorcyclist. These costs were paid by providers of health insurance, mainly Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), Medicaid, and commercial insurance.

A study on bicycle-related injuries and their costs in Shanghai, China.

China is known as the Bicycle Kingdom, but the nature, extent, and costs of bicycle-related injuries remain largely unknown. The authors' findings showed that the bicycle-related mortality rate increased 99% from 1992 to 2004, and it increased with age, from 0.64 per 100,000 population in the 0-14 age group to 5.93 per 100,000 population in the 65 and older age group. Labor force groups represented the majority of fatalities (70.8%) and nonfatal injuries (81.5%). The male mortality rate was 2.4 times higher than the female mortality rate. Head injuries accounted for 71.9% of fatalities and 33.1% of the hospitalizations. People with lower levels of education had higher injury rates. The poorer districts located in the countryside had the highest mortality rates compared to those located in the central, wealthier regions. The total annual cost of bicycle-related injuries was 1.1 billion CHY (Chinese Yuan) (over $137 million U.S.). To reduce bicycle-related injuries, mandatory helmet legislations, environmental modifications, and representative monitoring systems in China are required.

Cost effectiveness of wearing head protection on all-terrain vehicles.

The use of all-terrain vehicles (ATVs) has increased in the United States and elsewhere over the last three decades, along with an increased frequency of incidents resulting in serious injuries, among which have been head injuries. ATVs are designed for motorized off-highway work and recreation, can weigh up to 600 lbs (272 kg), and may reach speeds as high as 75 mph (120 km/h). ATV crashes, including collisions and overturns, were responsible for 8104 fatalities from 1982 to 2006. One third of those killed were youth under 16 years of age. Helmets may reduce risk of death by 42% and nonfatal injury by 64%. In this study, a decision analysis was applied to determine the potential reduction in the rate of fatal and nonfatal head injuries associated with crashes, based upon the universal wearing of head protection while riding on ATVs. In addition, based upon this reduction in injury rate, a cost-effectiveness analysis was conducted to determine the savings per injury averted among ATV riders with head protection. The authors found that 238 head injuries, including 2 fatalities per 100,000 ATV drivers with an average of 145 hours of annual operation, could be averted by the universal wearing of head protection while riding on ATVs. Taking into account the social direct and indirect costs of fatal and nonfatal head injuries at a 5% discount rate, US$364,306 could be saved per injury averted over a 50-year period if there were universal wearing of head protection by ATV drivers. If the exposure is adjusted to 2000 hours per year for an equivalent work year, 3276 head injuries could be averted including 23 fatalities per 100,000 at a social cost savings of US$509,172.

Motorcycle helmets in Vietnam: ownership, quality, purchase price, and affordability.

OBJECTIVES: This study investigated motorcycle helmet ownership, quality, purchase price, and affordability in Vietnam. METHOD: A random sample of motorcyclists was interviewed to investigate aspects of helmet ownership, the purchase price, and affordability of a motorcycle helmet. Multivariate modeling conducted to determine factors associated with the purchase price and affordability of motorcycle helmets. Helmet quality was assessed based on current legal requirements in Vietnam. RESULTS: The prevalence of helmet use in Vietnam remains low (23.3%) despite a high level of helmet ownership (94%), indicating that this is an important area for public health intervention. Overall the quality of helmets appeared to be good; however, few helmets displayed legally required information. Motorcyclists with a high income purchase more helmets for their household rather than more expensive helmets. CONCLUSION: To ensure that helmets are accessible to the community, policy-makers need to consider pricing motorcycle helmets at a price indicated by the results of this study. Prior to universal motorcycle helmet legislation, the government will also need to ensure that standard helmets are available and that enforcement is at a level to ensure that motorcycle helmets are actually used.

Households' willingness to pay for a motorcycle helmet in Hanoi, Vietnam.

BACKGROUND: Injuries caused by both non-use of and substandard helmets in motorcycle accidents place a substantial cost on both the Vietnamese government and on victims and their families who are unfortunate enough to experience such an event. OBJECTIVE: To estimate Vietnamese households' willingness to pay (WTP) for a standard motorcycle helmet and to determine factors that affect the households' decision regarding the price at which they would purchase a motorcycle helmet. METHOD: A contingent valuation survey was administered to 420 households in two urban districts and one suburban district of Hanoi from January 2007 to February 2007. Both discrete-choice format and open-ended questions were used to examine households' WTP for a motorcycle helmet. Descriptive analysis and multivariate analysis were used to estimate possible predictors of households' WTP. RESULT: A total of 414 households agreed to participate in the study, giving a response rate of 98%. Eighty-seven percent of respondents owned a motorcycle helmet. Sixty-two percent of respondents agreed to purchase a helmet at the market price of Vietnamese Dong (VND)150 000 ($ US 9.38) [year 2007 values]. Households' WTP varied from VND81 635 to VND289 674 ($US 5.1-18.1), with a mean of VND163 794 ($US 10.24) and a median of VND161 718 ($US 10.11). It was estimated that if the government subsidizes VND61 043 ($US 3.82) for a helmet, 99% of the study population are willing to pay the additional cost for a standard helmet. Those households with a higher income and where the respondents were aged 40-55 years were more likely to purchase a helmet than those with a lower income and those of other ages. CONCLUSION: Respondents were prepared to pay a higher price than the market price of a standard helmet. To improve the quality of helmets in Vietnam, it is recommended that the government subsidize a helmet programme in conjunction with other programmes (such as education and strict enforcement policies) in order to increase the ownership of quality helmets in Vietnam and thereby reduce the severity of motorcycle road traffic injuries.

Helmets for skiers and snowboarders: an injury prevention program.

The authors' Level I trauma center has advocated the use of ski helmets for several years and in 1998, undertook a social-marketing campaign and a helmet loaner program to increase helmet use among skiers and snowboarders. The loaner program's effect on helmet acceptance was measured by comparing helmet acceptance in participating rental stores with acceptance in nonparticipating stores during 3 years. For the 1998-1999 season, 13.8% of renters in the participating stores accepted a helmet compared to 1.38% in the nonparticipating stores (p < .01); for 2000-2001, 33.5% to 3.93% (p < .01); and for 2001-2002, 30.3% to 4.48% (p < .01). The authors believe that efforts to increase helmet use--by increasing education and public awareness and decreasing barriers, such as through helmet loaner programs or routinely including helmets in rental packages--have significant potential to decrease the incidence and severity of brain injuries from skiing and/or snowboarding accidents in Colorado.