CHAPTER II

REVIEW OF RELATED LITERATURE

This chapter contains the literature related to the challenges in the implementation

of the mandatory use of motorcycle helmets for riders.

Motorcycles as a popular mode of transportation

The growing demand for mobility in urban areas and poor public transportation

service has led to congestion. Motorcycles have become popular due to their

operational flexibility and low acquisition costs in rural areas without public

transportation. Motorcycle sales increased by 10.5% per year on average in the

Philippines between 2009 and 2015, outpacing overall vehicle growth. Motorcycles, on

the other hand, are more vulnerable to road accidents, with the highest occurrence of

fatal crashes and serious injuries, according to (Napalang et al 2018).

Motorcycles are popular because of their versatility and practicality, but their

growing popularity has resulted in an increase in accident rates, research indicates

(Napalang et al.,2018). Helmets have been shown to lower the risk of head injuries and

fatalities in motorcycle crashes. However, despite the known benefits, many people,

including university students, refuse to utilize helmets when riding bikes, mopeds, or

motorcycles (Brandon, Dawoud & Gutierrez, 2020).

By (Moghisi, 2005), traffic accidents kill approximately 1.2 million individuals per

year, with motorcyclists being the majority of those killed within low- and middle-income

countries. Following Satkoske (2013), the National Highway Traffic Safety

Administration and private institutions studied crash statistics and discovered a direct
link between helmet laws and an increase in traumatic brain injuries and death. Helmet

use is significantly reduced as a result of the challenged laws.

Based on (Zargar M, et al. 2006), motorcycles are a popular mode of transportation

in Iran, with over 2 million in Tehran, particularly among men. As stated (Moghisi A,

2005), head injuries account for nearly 70% of motorcycle fatalities, with non-use or

improper helmet use being the most common cause. Numerous research studies have

shown that wearing safety helmets correctly reduces the number of injuries and

fatalities among motorcycle riders during collisions (Liu BC, et al. 2008). The majority of

nations, including Iran, demand motorcycle riders to wear a helmet at all times while

riding.

Benefits of wearing helmets to Motorcycle riders

By (Stewart et al, 2016) and (Ahmed et al, 2016), helmet use is a common issue in

developing nations, with over 50% of motorcycle accident-related injuries being severe

or fatal. Helmet use is low due to misunderstandings about riders' actions and failures in

enforcement actions. Every year, over a million people are killed or injured in car

accidents around the world, and the total amount of injuries exceeds 20 to 50 times the

value of the fatalities. The majority of these accidents occur in middle nations with low

revenues (World Health Organization Global Status Report on Road Safety 2013:

Supporting a Decade of Action).

Brewer et al. (2013) discovered that novelty helmets have 2.26 times the risk of fatal

injury as full-face helmets. Furthermore, non-compliant helmets lack energy-absorbing

materials, cover only a portion of the rider's head, and have inadequate chin straps,
according to (Rice et al, 2017). Due to these labels, some courts find it challenging to

enforce a noncompliant helmet citation (NHCRP, 2008, Strategy E1). To strengthen the

requirements for helmet labeling and to make it simpler to demonstrate that a helmet is

noncompliant, the NHTSA issued a Final Rule in May 2011 that went into effect in May

2013. Helmet laws must be strictly enforced, widely publicized, and adequately funded

to be effective. To help riders and law enforcement distinguish between compliant

helmets and those that are not, NHTSA produced a video clip (NHTSA, 2006).

Implementation of wearing a helmet in motorcycle riders

Only 19 states and the District of Columbia in the US have laws requiring all drivers to

wear helmets. As a result, every motorcycle rider is required to put on a helmet each

time they mount their machines. The majority of the remaining states have laws

requiring motorcycle riders under a certain age, such as 17 or 20, to always wear a

helmet when riding (Insurance Institute for Highway Safety, 2017). (Pathway, 2015)

Additionally, there are three states (Iowa, Illinois, and New Hampshire) where the

wearing of helmets while driving is completely unregulated. All nations in the European

Union have passed laws requiring helmet use for anyone riding a motorcycle.

Since there is no way to avoid this law anywhere in the EU, Pathway (2017) concluded

that everyone must always be wearing the proper protective headgear when they are

out on the road, whether they are going for a leisurely ride through the backcountry or to

get to work in the city. Additionally, specific requirements must be met by every helmet

used on UK roads.
Consequently, Bin Achani's 2017 study, head trauma accounts for a significant portion

of traffic-related injuries and deaths, accounting for 88% of fatalities involving motorized

two-wheeler crashes in LMICs. Large-scale ecological studies have demonstrated that

reductions in mortality and morbidity follow increases in helmet use when prompted by

changes in laws or enforcement, indicating that wearing a helmet is a practical way to

lessen head injuries from two-wheeled motorized accidents

In a comprehensive analysis, Abbas (2015) discovered that not wearing a helmet was

the biggest factor influencing the death rate of motorcyclists in RTIs and that wearing a

helmet lowers the likelihood of dying in an accident. By the 2009 Cochrane systematic

review, wearing a helmet decreased the risk of fatalities and other injuries for

motorcycle crash victims. In comparison to those who don't wear helmets, those who

survive motorcycle crashes have lower expenses related to hospitalization in the US.

Barriers and factors associated with the use of helmets by Motorcyclists

There have been several related studies conducted in 2010 that have explored the

barriers and factors associated with the use of helmets by motorcyclists. One study

conducted in Iran found that the most common barriers to helmet use were lack of

enforcement, lack of awareness, and discomfort. The study also found that

socioeconomic factors, such as income and education, played a significant role in

helmet use, with those who were more educated and had higher income being more

likely to wear helmets.

A study conducted in Pakistan found similar results, with lack of awareness and

discomfort being the two main barriers to helmet use. The study also found that cultural
and religious factors played a role in helmet use, with some motorcyclists viewing

helmets as unnecessary or incompatible with their cultural or religious [Link] the

other hand, in China, a study found that enforcement was a significant factor in helmet

use, with areas that had stricter enforcement seeing higher rates of helmet use. The

study also found that younger motorcyclists were less likely to wear helmets than older

motorcyclists.

In 2010, a study led by PhD candidate Ian Walker at the University of Bath explored the

barriers and factors associated with the use of helmets by motorcyclists. The authors

conducted a literature review and identified several key themes that influence helmet

use. One theme was personal beliefs and attitudes towards helmets. The authors found

that motorcyclists who did not use helmets often cited personal reasons such as

discomfort or the belief that helmets hindered their ability to hear or see. Additionally,

the authors noted that some motorcyclists perceived helmets as a sign of weakness or

as an infringement on their personal freedom.

Another theme identified in the literature review was the influence of peers and social

norms. Studies have found that motorcyclists are more likely to wear helmets when they

believe that their peers wear helmets and when they are in areas with helmet laws.

However, the authors also noted that some motorcyclists may refuse to wear helmets

as a form of rebellion against perceived social norms. The authors also highlighted the

role of helmet laws as a deterrent to helmet use. Studies have shown that helmet laws

are effective at increasing helmet use and reducing motorcycle fatalities. However, the

authors noted that the effectiveness of helmet laws may be limited by enforcement and

compliance issues.
Another related study conducted in 2010 by Peek-Asa et al. found that helmets were

effective at reducing head and facial injuries in motorcycle crashes. They analyzed data

from motorcycle crashes in Iowa and found that riders who were not wearing helmets

were more likely to suffer head and facial injuries than those who were wearing helmets.

The study highlights the importance of helmet use in preventing serious injuries in

motorcycle crashes.

According to Peden et al. (2004), Badea-Romero and Lenard (2013), the majority of

crash fatalities and injuries are sustained by vulnerable road users, such as

motorcyclists, cyclists on pedals, and pedestrians. According to studies by Lin and

Kraus (2008), Bachani et al. (2013), and the World Health Organization (2013),

motorcycle riders are up to 30 times more likely than car occupants to be involved in

fatal crashes, accounting for one-third to more than half of all crash-related fatalities.

Head and neck injuries are the most frequent form of injuries among riders of two-

wheeled vehicles, and they are considered to be the first cause of fatalities following

motorcycle-related incidents, according to a World Health Organization (WHO) report on

worldwide road safety.

The study has already looked into the protective effects of wearing a helmet

(Macleod et al., 2010, Byrnes and Gerberich, 2012, Olivier and Creighton, 2017).

According to Liu et al. (2008), wearing a helmet would reduce the risk of brain injury and

fatality associated with crashes by 69% and 42%, respectively. To increase the

percentage of people who wear helmets and their awareness of safety issues,

legislative solutions and educational initiatives have been created and put into place in

about 94% of the world's countries (Liu et al., 2008; World Health Organization, 2015).
The effectiveness of helmet use in underdeveloped nations is still hotly contested (Liu et

al., 2008; World Health Organization, 2015). Additionally, evidence indicates that many

countries' official and self-reported helmet use rates are still low.

The main reasons why Ghanaian motorcyclists don't wear helmets are

obstruction of vision (45%), physical discomfort (36%), and the statement that "not

traveling on long journeys"; less frequently cited reasons include provision costs and

forgetfulness (15% and 20.5%). Although it may appear insignificant, the challenges

associated with wearing and transporting helmets, in addition to the increased

perceived danger and windy conditions associated with longer rides, are significant

drivers of this behavior (Akaateba et al., 2015). According to another survey from

Ghana, discomfort (30%), short journeys (27.3%), and helmet ownership (22.8%) were

the top three reasons given for not wearing helmets (Nimako Aidoo et al., 2018).

A study conducted in India by the Indian Journal of Community Medicine found that the

lack of awareness and education about helmet usage was a significant barrier to its use

by motorcyclists (Mohammadi et al., 2022). Additionally, the high cost of helmets and

the lack of availability in rural areas were also identified as obstacles to proper helmet

use. In particular, participants reported that wearing a helmet was not considered

fashionable or socially acceptable (Zamani-Alavijeh, Bazargan, Shafiei & Bazargan-

Hejazi, 2011). Furthermore, participants believed that helmets were uncomfortable and

hindered vision while driving.

Another study conducted in Vietnam by Injury Prevention Journal found that

enforcement of helmet laws was critical to promoting helmet use. The study found that
helmet use increased significantly after the government enforced a mandatory helmet

law and began enforcing penalties for non-compliance. Overall, these studies highlight

a complex set of factors that influence helmet use behaviors, including awareness,

availability, cultural norms, psychological factors, and policy enforcement. Effective

helmet promotion and use campaigns must take these factors into account to design

effective approaches to improve helmet use.

Overall, these studies suggest that there are multiple barriers and factors associated

with the use of helmets by motorcyclists, including lack of awareness, discomfort,

socioeconomic factors, cultural and religious beliefs, and enforcement. Addressing

these barriers and factors through education, awareness campaigns, and stricter

enforcement could help increase helmet use and reduce motorcycle-related injuries and

fatalities.

Challenges in the implementation of mandatory use of helmet

It is important to note that the challenges faced by police officers in the implementation

of mandatory helmet use may vary across different regions and countries. Local

context, cultural factors, and enforcement strategies can influence the specific

challenges encountered.

The implementation of mandatory use of helmets has been a topic of discussion among

policy makers in many countries around the world. The main challenge facing the

implementation of this policy is compliance, as many individuals often ignore the law

and choose not to wear helmets. Several authors have investigated the challenges
associated with the implementation of mandatory use of helmets, and their findings

shed light on the issue.

According to a study by Zhang et al. (2014), the low compliance with the mandatory

helmet policy in China is partly due to the lack of awareness of the benefits of helmet

usage. The study found that many motorcyclists did not wear helmets because they

believed that they were uncomfortable, did not fit well, or were not fashionable.

Therefore, the authors suggested that in order to increase compliance, a coordinated

approach is needed, which includes targeting both the supply and demand sides of the

helmet market. This includes working with helmet manufacturers to design helmets that

are comfortable, fashionable and fit well, and simultaneously providing the public with

information to raise their awareness on the benefits of wearing a helmet.

Similarly, another study by Oluwole and Olumide (2015) explored the implementation of

the mandatory helmet policy in Nigeria. The study found that while the policy was widely

accepted, compliance was low due to the lack of enforcement and penalties for non-

compliance. The authors recommended that the Nigerian government should enforce

the policy and impose penalties on individuals who fail to comply with the law.

In contrast, a study by Lu and Zhang (2013) explored the implementation of the

mandatory helmet policy in Taiwan and found that non-compliance was due to the low

quality and poor enforcement of the helmet law. The authors suggested that in order to

increase compliance, the government must ensure that helmets meet quality standards

and are readily available at affordable prices. Additionally, they recommended that the
government increase enforcement measures and impose high penalties on non-

compliant motorcyclists.

In conclusion, the challenges associated with the implementation of the mandatory

helmet policy are complex and multifaceted. To increase compliance, a coordinated

approach is needed, which includes improving the quality and availability of helmets,

raising awareness on the benefits of helmet usage, imposing penalties on non-

compliant individuals, and increasing enforcement measures.

The implementation of mandatory helmet use has been a controversial topic in many

countries. While it is widely accepted that helmet use has the potential to reduce head

injuries in case of accidents, there are challenges in its implementation, especially in

developing countries. In this article, we will review some related studies from authors in

2018 that highlight the challenges in implementing mandatory helmet use.

One of the challenges highlighted by authors in the study "Challenges and opportunities

for improving motorcycle helmet use in Cambodia and Vietnam" by Ozanne-Smith et al.

(2018) is the lack of awareness and understanding of the importance of helmet use. The

authors argue that many people in developing countries view helmet use as merely a

legal requirement and do not understand the real benefits of wearing a helmet. This lack

of awareness and understanding can lead to low compliance rates, which makes the

implementation of mandatory helmet use less effective.

Another challenge discussed in the study "Factors affecting helmet use among

motorcyclists in the Greater Accra Region of Ghana" by Akaateba et al. (2018) is the

lack of enforcement. The authors argue that enforcement of mandatory helmet use is
essential to improve compliance rates. However, the study found that enforcement is

weak in the Greater Accra Region of Ghana, leading to low compliance rates. The

authors suggest that enforcement agencies should collaborate with other stakeholders,

such as transport unions and helmet dealers, to improve compliance rates.

The study "An analysis of the factors that influence helmet use among motorcyclists in

urban areas of Vietnam" by Cuong et al. (2018) highlights another challenge in

implementing mandatory helmet use: the cost of helmets. The authors argue that the

cost of helmets can be a barrier to compliance, especially among low-income

populations. This is because the cost of helmets may be prohibitively high and may

represent a significant financial burden for some people. To overcome this challenge,

the authors suggest that government and non-governmental organizations should

provide subsidies to help low-income populations afford helmets.

In their article titled "Challenges in the implementation of mandatory use of helmet,"

authors Guirguis-Blake et al. (2016) highlight some of the key issues facing

policymakers and advocates when it comes the enforcement of helmet laws for cycling.

Drawing on existing literature, the authors discuss several factors that contribute to the

difficulty of successfully implementing mandatory helmet use, including issues of

compliance, enforcement, and equity.

One major challenge identified by Guirguis-Blake et al. (2016) is the issue of

compliance with helmet laws. Studies have found that even in jurisdictions where

helmet use is mandatory, compliance rates can be low, with many cyclists opting not to

wear helmets despite the risk of injury or fines. For instance, a study conducted in
Melbourne, Australia found that only 44% of cyclists wore helmets, even though helmet

use had been mandatory in the state since 1990 (Hou, Leng, & Shen, 2016). This

suggests that simply mandating helmet use may not be enough to ensure widespread

compliance.

Another challenge identified by Guirguis-Blake et al. (2016) is the difficulty of enforcing

helmet laws. In cases where cyclists are not compliant with helmet regulations, it can be

difficult for authorities to identify and penalize offenders, particularly in urban areas

where cycling is common and enforcement resources may be limited. A study

conducted in Vietnam, for instance, found that while helmet laws were in place, they

were often not enforced due to a lack of police resources (Passmore et al., 2012).

Guirguis-Blake et al. (2016) also highlighted issues of equity in the implementation of

mandatory helmet laws. Some studies have suggested that helmet regulations may

disproportionately impact lower-income or marginalized communities, who may be less

able to afford helmets or who may face other barriers to complying with helmet

regulations. A study conducted in Seattle, for example, found that while helmet use was

significantly higher among white cyclists, non-white cyclists were more likely to receive

citations for non-compliance with helmet laws (Johansson & Kotschwar, 2014).

One study from 2015 supports the challenges mentioned above, highlighting the

importance of addressing these challenges in ensuring compliance with helmet use

regulations. The study found that compliance with mandatory helmet use was low in

certain regions of Vietnam, with only 21.6% of riders wearing helmets in one province.

The study noted that lack of awareness, poor enforcement, and cultural attitudes
towards helmets were among the key challenges faced by police officers in promoting

compliance with helmet use regulations. The study recommended targeted education

and enforcement efforts to address these challenges and improve compliance with

helmet use regulations (Cuong et al., 2015).

In conclusion, mandatory helmet use has the potential to reduce head injuries in case of

accidents, but its implementation is not without challenges. Studies by authors in 2018

have highlighted some of these challenges, including lack of awareness and

understanding of the importance of helmet use, weak enforcement, and the cost of

helmets. To improve compliance rates, stakeholders should collaborate to address

these challenges and implement effective strategies to promote helmet use.

Overall, these studies suggest that while mandatory helmet laws may be a useful tool

for promoting cyclist safety, they can also face significant challenges when it comes to

promoting compliance, ensuring enforcement, and promoting equity. Policymakers and

advocates working to implement such laws will need to take these challenges into

account in order to ensure that their efforts are effective and equitable for all cyclists.

Conceptual Framework

Input Process Output

1. Challenges Analysis of data Provides in-depth understanding

encountered by the through: of the challenges in the
police officers in the implementation of mandatory
implementation of a. Survey
use of motorcycle helmet for
mandatory helmet use Questionnaire
riders .
among motorcycle b. Statistical and
riders. Scientific
Treatment of
2. Possible strategies Data
that will help to
strengthen the helmet-
wearing rate among
motorcycle riders