Mandatory Bicycle Helmet Laws in the United States: Origins, Context, and Controversies

Abstract

This article examines the origins and context of mandatory bicycle helmet laws in the United States. Localities began to enact such laws in the early 1990s, having experimented with helmet laws for motorcycles previously. As cycling became increasingly popular in the 1970s and 1980s because of a variety of historical trends, from improved cycle technology to growing environmental consciousness, cycling-related injuries also increased. Bicycle safety advocates and researchers alike were particularly troubled by head injuries. National injury surveillance systems and a growing body of medical literature on bicycle-related injuries motivated a number of physicians, cyclists, children, and other community members to advocate helmet laws, which they argued would save lives. Controversy over these laws, particularly over whether they should apply universally or only to children, raised public health ethics concerns that persist in contemporary debates over bicycle helmet policies. (Am J Public Health. 2020;110:1198–1204. doi: 10.2105/AJPH.2020.305718)

The use of bicycles has always raised safety and policy concerns; however, efforts to mandate head protection did not occur until the late 1980s. Today, numerous localities have helmet laws, although there have also been some well-publicized instances in which such laws have been forgone, such as for bike-share programs.¹ In this article, we examine the origins of mandatory helmet laws for bicycle riders in the United States. Such mandates create a conflict between individual liberty and the public health goal of reducing preventable harm. While these laws were often accompanied by helmet distribution programs and educational campaigns, we focus on the arguments for and against the adoption of mandates. We seek to highlight what evidence was used in support of making helmet use voluntary or mandatory, which claims were considered persuasive, the ethical issues raised, and how these debates resulted in contrasting treatment of riders of different ages.

What Happened? A Cyclist Takes a Spill. Published as cover of Harper’s Weekly (November 6, 1897). Public domain. Courtesy of Library of Congress Prints and Photographs Division.

GROWTH OF BIKING AND INJURY PREVENTION

While there are many forebears of the modern bicycle, the most direct ancestor is the velocipede, introduced in 1863. By the 1870s, the ordinary or penny farthing became popular for recreational use among young men able to afford the expensive machines. The enlarged front wheel of this “high wheeler” bicycle rose higher as manufacturers realized that the larger the front wheel, the more efficient the bicycle. The increase in wheel height was accompanied by an increase in the distance that a rider could fall.² Falls were not uncommon; when the front wheel stopped abruptly, the body of the bicycle rotated around it, resulting in the rider going face-first into the ground. An 1883 New York Times account of the recently formed League of American Wheelmen’s third annual meeting observed that “a good number” of riders “took headers” during their parade down New York City’s Fifth Avenue. Those cyclists were lucky: “Twenty bicycles were broken in this process but no one suffered anything worse than a good shaking.”³

Over time, various innovations, such as the “safety bicycle” with equal-sized wheels, made bicycles more appealing to women (whose attire had constrained their bicycle use) and to those desiring a less-daunting experience.⁴ With the advent of mass production in the 1890s, bicycles became cheaper and more common. In the 1910s and 1920s, amid the growth of the automobile industry, manufacturers increasingly marketed bicycles to children, particularly during the Christmas season. Increasing suburbanization, prosperity, and the introduction of new “high-riser” style bicycles, such as Schwinn’s Sting-Ray, further facilitated the purchase of bicycles for youths in the post–World War II era.⁵

By the early 1970s, a new “bicycle boom” was under way in the United States, primarily among adults. In 1972, manufacturers estimated that more than 60 million bicycles were in use.⁶ An article that year noted that increasingly biking was “being taken up by adults who regard bikes as a legitimate form of transportation.”⁷ A number of factors likely contributed to the bike boom: a decline in motorcycle ridership, an increase in environmental consciousness, a nationwide energy crisis resulting in gas shortages, improvements in bicycle technology, and interest in physical fitness.⁸

Safety had been an issue from the start—for instance, late-19th-century bicyclists had campaigned for smooth-surfaced roads, rather than rough paths that could easily result in falls. But the increasing number of cyclists spurred growing attention to safety at mid-20th century, particularly when it came to protecting young riders.⁹ As early as the 1960s, several physicians warned of increasing bicycle-related injuries among children. In the journal Pediatrics, they questioned whether bicycle design and ownership patterns were contributing to an “epidemic” of craniofacial injuries. The National Safety Council, an independent group focused on safety standards, highlighted that nearly two thirds of bicycle–vehicle collision deaths in 1964 were among child riders aged five to 14 years.¹⁰

In the 1960s, increasing federal involvement in highway safety, in conjunction with a growing consumer safety movement, contributed to the creation of the Consumer Product Safety Commission (CPSC) and several national injury surveillance systems in the early 1970s. Subsequent data collection helped draw public health attention to the prevalence of bicycle injuries. In particular, the Fatal Accident Reporting System and the National Electronic Injury Surveillance System motivated epidemiological studies of the topic. Researchers pointed to National Electronic Injury Surveillance System data, as well as local police department figures, that substantiated concerns that bicycle injuries were on the rise. According to Fatal Accident Reporting System data from the National Highway Traffic Safety Administration, by 1980, nearly 1000 cyclists were killed per year, and an estimated half million cyclists visited hospital emergency departments with injuries.¹¹

However, bicycle safety was not yet popularly equated with helmets. In 1975, Stanford University’s Department of Public Transportation and the Urban Bikeway Design Collaborative, a nonprofit organization, published a comic book to highlight ways cyclists could avoid injuries. Sprocket Man, the comic’s superhero, advised on how to navigate intersections safely, but none of the cartoon cyclists were depicted wearing head protection.¹² Likewise, the American Automobile Association Foundation for Traffic Safety’s 1975 film “Only One Road: The Bike-Car Traffic Mix” made no mention of bicycle helmets; only one short segment of the 25-minute film showed a cyclist wearing headgear.¹³ Instead of head protection, the National Safety Council emphasized following the rules of the road, while newspapers highlighted the development of bikeways and the use of reflective tape.¹⁴

DEVELOPING BIKE-SPECIFIC HELMETS

One reason so few cyclists wore headgear was that no helmets were designed specifically for bicyclists until the 1970s. For more than a century, some cyclists had sought to protect their heads. The earliest form of protection was the pith helmet, a hat made of plant fibers that European colonialists in India used to shield themselves against the sun. These were good only for one impact, but they offered some protection and had a chin strap to keep them on.¹⁵ In the United States, early 20th-century bike racers began wearing round, leather head protectors, similar to the headgear then worn by American football players. Experienced riders reported that the leather protectors “don’t help at all in the initial impact, but they keep your ears from being ground off while you’re sliding over the pavement.”¹⁶

The deaths of several bicycle racers in the early 1970s drew further attention to the risks of brain trauma, as well as the limitations of then-existing helmets to protect riders. In 1972, nationally syndicated “Dr. Bicycle” responded to a reader question by observing that some cyclists resorted to “wearing hockey helmets as a compromise . . . safer than leather caps and lighter than motorcycle helmets, although not as sturdy.”¹⁷ Other bicycle riders did use motorcycle helmets. The president of the National Capital Velo Club, an amateur bike-racing group, told the Washington Post in 1974 that “There is no (suspension plastic) helmet made just for bicycles.” Nonetheless, he stated, the club was encouraging riders to at least choose helmets made of a stronger material. “We’re recommending to our 160 club members that they buy one of several types of helmets that are a vast improvement over the leather ones.”¹⁸

Bell Auto Parts unveiled the first modern bicycle helmet in 1975. The “Bell Biker” was composed of a hard plastic shell padded with expanded polystyrene.¹⁹ Cycling helmets were high-end side products for the company, which was then largely focused on motorcycle helmets. However, with a decline in motorcycling and the increase in cycling, bicycle helmets became a new focus for Bell. In 1984, Bell introduced an infant helmet, the Li’l Bell Shell.²⁰

Around the same time, bike helmet standards were also developed. The Snell Memorial Foundation, a nonprofit organization founded in 1957, tested the effectiveness of crash helmets in an effort to better protect auto racers and motorcyclists. In 1975, members of the recently established Washington Area Bicyclist Association (WABA) approached the Snell Memorial Foundation about testing and rating bicycle helmets.²¹ After 4 years, WABA and Snell developed the Bicycle Helmet Wearability Study. In 1983, WABA cyclist Tom Balderston wrote up the study’s findings for Bicycling magazine, and a number of media outlets reported on the research. Balderston opened by citing CPSC statistics on bicycle injuries, as well as data from an Australian study estimating that “80 to 85 percent of [bicycle] deaths are due to head injuries.” While acknowledging helmet design limitations, he nonetheless urged readers to “remember, the best bicycle helmets we tested will indeed save your life in many, perhaps most crashes.”²²

Indeed, by the 1980s, cycling advocates, news outlets, and medical literature articles were all encouraging helmet use. Some of this advocacy was blatant, some more subtle, such as the editor of the League of American Wheelmen’s magazine who “seldom publishes a photograph which does not show a helmeted rider.”²³ In 1984, the American National Standards Institute set voluntary bicycle helmet standards. The following year, the US Cycling Foundation required competitors to wear helmets that met both its standards and those of the Snell Foundation. These new requirements were not completely without protest, but there was a growing sense that bicycle helmets could provide meaningful protection. In 1986, the bicycle coordinator of New York City’s Department of Transportation told the New York Times, regarding his collision with a taxi cab, “I am alive today because I was wearing a helmet.”²⁴

THE MOTORCYCLE HELMET LAW PRECEDENT

Increasing bicycle ridership, changes in bike and helmet design, the development of helmet standards, and the emergence of the field of injury prevention all helped set the stage for bicycle helmet laws. So, too, did the earlier precedent of motorcycle helmet laws. While in 1966, only New York, Massachusetts, Michigan, and Puerto Rico had motorcycle helmet laws, between 1967 and 1975, nearly every state passed such legislation to avoid penalties under the National Highway Safety Act.²⁵ The laws were quickly tested in the courts, but most of these cases failed, leading opponents of motorcycle helmet laws to embrace advocacy. After a 1976 repeal of the Act’s penalties, 28 states had repealed their mandatory helmet laws by 1980. The fact that injuries soared did not stop the momentum against these laws.²⁶ Through the 1990s, many of the motorcycle laws that remained on the books were modified, limiting them to young riders. This was the daunting context in which bicycle advocates sought to enact helmet laws. Advocates’ focus on juvenile riders thus may have been not only a reflection of the high rates of head injuries among child cyclists but also a tacit acknowledgment of the difficulty of imposing mandates on adults.²⁷

ADVOCATING FOR HELMET LAWS

Physicians, cyclists, children, and other community members increasingly advocated for bicycle helmet mandates on the grounds that they would save lives. As early as 1972, “Dr. Bicycle” of the Washington Post predicted, “It is probably just a matter of time before bicycle helmet laws are enacted.”²⁸ Eleven years later, a Washington Post article describing the Bicycle Helmet Wearability Study developed by WABA and Snell opined, “Bicycle helmets aren’t required by local laws, but they should be part of the standard riding gear for all cyclists.”²⁹ Some cycling venues agreed; for example, the WABA Helmet Committee’s May 1983 update announced: “The Lehigh County Velodrome in Emmaus, PA . . . has adopted a policy requiring all entrants in its events to wear a helmet judged acceptable in the WABA/Snell study published in ‘Bicycling.’” Mandating protective equipment in competitions or indoor arenas was more straightforward than regulating helmet use on the open road.³⁰

In the quest for bicycle helmet laws, advocates relied on testimonies and personal stories, featuring tales of helmetless riders who had been severely injured or killed or, conversely, of riders who had been wearing a helmet and escaped serious or life-threatening injury. In 1984, Rick Peoples attributed his lack of serious injury after colliding with a car to his helmet. He wrote to the Los Angeles Times, “Mandatory bicycle helmet laws probably have no more chance in California than did the motorcycle helmet laws a few years ago. But that still doesn’t change the fact that helmets should be a required item for two-wheeled vehicles on city streets.”³¹

Many researchers agreed, based on studies that highlighted the particular dangers of head injuries to cyclists. Notably, a 1983 study of 173 fatally injured bicyclists in Dade County, Florida, found that the head or neck was the region most seriously injured in 86% of the deceased cyclists. The authors interpreted these data as indicating the importance of preventing head injury, adding that “an obvious countermeasure against head injury is helmet use.”³² In 1987, Selbst et al. published an epidemiological analysis of pediatric cases of trauma related to bicycle use. The pediatricians found that head and neck injuries accounted for 31% of emergency department visits for bike injuries and almost half of the admissions. They further noted that “virtually none of these children were using any sort of protective equipment.” Selbst et al. contended that helmets could potentially prevent some serious injuries, citing a 1981 study of fatal bicycle injuries, which found that none of those killed had worn helmets. The authors concluded that “parents and pediatricians should lobby for legislation that mandates helmet use for all children riding bicycles.”³³

In addition to physicians and groups like the League of American Wheelmen that had addressed bicycle safety for decades, new organizations began to take up the call for head protection. A social shift toward a more intensive style of parenting in the 1980s and 1990s, particularly among White, working mothers, heightened concerns with protecting child health.³⁴ Moreover, growing interest in bicycle safety emerged in conjunction with a broader focus on child and vehicular safety, such as seatbelt laws and child passenger safety laws in the United States. Notably, in 1987, the National Safe Kids campaign made bicycle helmet laws to protect children a policy priority. Their efforts further contributed to framing helmet use as a child health issue.³⁵

ENACTING THE FIRST HELMET LAWS

Despite increasing calls for legislative action, it would take the death of a child and the advocacy of his classmates to motivate the first mandatory helmet law for bicycle riders. In fall 1989, 13-year-old Christopher Kelley of Howard County, Maryland, was struck by a car while cycling. The collision killed Kelley, who was not wearing a helmet.³⁶ In the wake of this tragedy, many of his classmates began advocating for a mandatory helmet law to prevent other such deaths. With the help of several teachers, about 50 eighth-grade students got involved, preparing surveys to document the need for a law, calling newspapers and television stations seeking editorial support, and testifying during a Howard County Council meeting.³⁷

Originally, the proposed bill would have required children younger than 16 years to wear bicycle helmets while riding on county roads or paths. In May 1990, the council stripped the language that would have restricted the bill to children younger than 16 years. Andy Dannenberg of the Johns Hopkins Injury Prevention Center speculated that the amendment expanding the law to all riders had been introduced in an effort to defeat the bill: “If that’s what they were trying, it backfired, because the amendment passed anyway.”³⁸ The council approved the new ordinance by a 3–2 vote.³⁹ The chair of the American Academy of Pediatrics Maryland Committee on Accident and Poison Control told AAP News in June 1990, “Without the support of children, I’m not sure it would have passed.”⁴⁰

The application of the helmet law to adults as well as children proved particularly contentious. Echoing objections to motorcycle helmet mandates, opponents of the new law emphasized its restrictions on individual freedom. One bicycling enthusiast who began a petition drive seeking to force a referendum on the law complained, “they’re telling people they’re too stupid to determine for themselves what is safe.”⁴¹ Some residents charged the local government with playing “Big Brother.” In July 1990, the law was amended to apply only to riders younger than 16 years.⁴² The controversy highlighted concerns over public health and government paternalism.⁴³

As helmet law debates spread beyond Howard County, health professionals and advocates largely framed bicycle helmets as a child health issue. Medical literature compared helmets with other childhood health interventions and emphasized the importance of preventing youth injuries to promote lifelong health. For example, in 1991, a JAMA editorial likened the childhood death rate from cycling unhelmeted to the preimmunization death rate from bacteria associated with meningitis. “Yet, while we now immunize all the nation’s children against [Haemophilus] influenzae, we do little or nothing on a national level about bicycle-related deaths.”⁴⁴ The following year, another JAMA commentary noted that “the primary focus of bike safety programs is the child rider” and that serious health outcomes resulting from head injuries “may last a lifetime.”⁴⁵

While Howard County’s 1990 law was the first mandating child cyclists to wear helmets, it did not maintain this distinction long. That same year, the Cleveland suburb of Beachwood, Ohio, passed a bicycle helmet law that applied to riders younger than 16 years. Michael Macknin, a Cleveland Clinic pediatrician described as “a force behind the Beachwood law,” had become a passionate advocate for youth bicycle helmet use after caring for three children on respirators because of permanent bike-related head injuries. ⁴⁶ Macknin and Medendorp described the Beachwood legislation as resulting “primarily from the efforts of one councilman who vigorously supported the legislation” as well as from the support of community members, including “the President of the Ohio Chapter of the American Academy of Pediatrics (who also lives in Beachwood).”⁴⁷

The law mandated that all children younger than 16 years wear American National Standards Institute– or Snell-approved bicycle helmets when riding two-wheeled bikes off the property of their residence. Upon first violation, the child would receive an oral warning and his or her parents a written warning. Subsequent violations could result in parents being issued $25 tickets. Accompanying the mandate, Beachwood provided “an extensive educational program promoting bicycle helmet purchase and use in grades K through 6.” This program involved school assemblies, safety videos, and letters sent to students’ homes about the importance of bicycle helmets. The Beachwood school district’s parent–teacher association actively promoted bicycle helmets among pupils, offering discounts on helmet purchase (and free helmets for those unable to purchase them), selling helmets at a school open house, sponsoring a “bike rodeo,” awarding helmets to the winners of classroom art and essay contests, and distributing hundreds of coupons for free cheeseburgers to children spotted wearing helmets.⁴⁸

Beachwood’s efforts created a natural experiment in which this community could be compared with three demographically similar neighborhoods, one of which passed a similar helmet law the year after Beachwood but that had no educational outreach and two of which had neither bicycle helmet–related legislation nor educational initiatives. Cleveland Clinic researchers—one of whom had been the motivating force behind the Beachwood law—found that “helmet legislation plus a bicycle safety education program for children in Beachwood, Ohio, resulted in the highest use of bicycle helmets by self-report and direct observation to date in the United States, to our knowledge.”⁴⁹ The Howard County and Beachwood laws were followed by numerous other municipal helmet mandates, some applying only to children, others to cyclists of all ages.⁵⁰

In 1992, New Jersey became the first state to pass a mandatory helmet law for child cyclists, requiring all riders and passengers younger than 14 years to wear a helmet. The assemblyman who sponsored the bill explained that “bicycles are not harmless toys” and cited CPSC data indicating that nearly 50 000 children younger than 15 years suffered serious head injuries each year.⁵¹ The legislation was strongly backed by the New Jersey Safe Kids Campaign. Two years after the passage of the law, the director of New Jersey’s Department of Law and Public Safety reported that bicycle related-fatalities among children in the state declined from 10 to two deaths in the first full year after the law was enacted.⁵² In 1993, the governor of California signed a mandatory bicycle helmet law for riders younger than 18 years, calling it “vital to the health of our children.”⁵³

By 1994, nine states had mandatory bicycle helmet laws, and seven had pending legislation. These laws were implemented in a broader context of bike helmet laws passed in numerous jurisdictions worldwide in the 1990s, including in Australia, Canada, Iceland, and New Zealand. At present, there are no statewide all-age helmet mandates in the United States; ongoing work remains in tracing the provisions of local laws and how they may be differentially applied across various communities.⁵⁴ According to the Insurance Institute for Highway Safety, an 89% decline in deaths among cyclists younger than 20 years took place from 1975 to 2018, whereas deaths among cyclists aged 20 years and older tripled in that same time period. Given that in most bicyclist deaths the majority of serious injuries are to the head, it is possible that age-based helmet mandates and varying rates of bike helmet usage by age may contribute in part to this trend.⁵⁵

CONCLUSION

By the 1960s and 1970s, medical case reports and epidemiological surveillance systems demonstrated a clear link between cycling and head injury. Meanwhile, the first helmets designed specifically for cyclists came on the market in the 1970s. Medical and civil society groups took it upon themselves to advocate policies to prevent avoidable injury, particularly in youths. They deployed research data as well as personal narratives, either to credit use of a bicycle helmet with saving a life or preventing serious injury or as a cautionary tale about what might happen if a helmet was not used. Drawing on these diverse types of evidence, a variety of stakeholders united in advocating bike helmets. Some communities focused on educational and persuasive strategies. In other localities, these tactics were paired with, or dropped in favor of, helmet mandates. To some, the country’s recent experience with motorcycle helmet mandates provided a compelling blueprint for how to prevent injuries among cyclists, whereas others regarded such laws as a threat to personal liberty.

In 2011, Carpenter and Stehr observed that, as with many public health policies, efforts to increase bicycle helmet use “have reflected two distinct types of approaches: carrots and sticks.”⁵⁶ They list, as examples of carrots, “bicycle helmet giveaways, educational outreach about the life-saving effects of helmets, and media campaigns designed to change social norms by, for example, making it seem ‘cool’ to wear a bicycle helmet.” In contrast, they deem helmet laws “the most direct example of the stick approach.”⁵⁷ The extent to which jurisdictions were willing to engage with the “stick approach” varied. Some jurisdictions implemented all-age helmet laws; others did not; and still others limited these laws to children, potentially because age-limited mandates were seen as more politically palatable. Alternatively, it could be that the advocacy of pediatrician and other child-focused stakeholders had led the general public to link bicycle helmets with children. The question of whether bike helmet laws should apply to young children only, to all children including adolescents, or to all riders turned not only on scientific evidence about the efficacy of helmets but also on cultural beliefs about childhood and paternalism, attitudes toward brain injury risks, changing patterns of bicycle use, and the advocacy strategies of medical and civil society organizations.

Knowing the origins of bicycle helmet mandates, the contexts in which they were first debated, and the evidence marshaled to support their enactment provides an important case study of the uptake of public health interventions. The motorcycle and bike helmet sagas both deal with issues of injury prevention and the limitation of personal autonomy in the name of public health, yet the two stories have thus far played out quite differently. It may be that it is easier to mandate helmet use for children than for adults; after all, even the famously paternalistic public health advocate and former Mayor of New York City Michael Bloomberg did not impose a universal helmet law upon New York City cyclists.⁵⁸ With no shortage of other public health issues for which a possible response may entail a limitation of personal autonomy, the histories of bicycle helmet mandates in different times, places, and populations offer valuable lessons about possible policy approaches to prevent injuries and death.