Options for improving motorcycle safety

Note: This report represents information on this subject as of December 1998.

Full text

Motorcycling is a common mode of transportation and popular recreational activity enjoyed by millions of Americans. The typical motorcycle rider is a married male, about 38 years of age, who has attended college, and earns about $44,000 a year (this compares to the US population average age of 34 years and $36,500 median income).¹  In 1996, about 4 million motorcycles were registered for use on public roads in the United States, comprising about 2 percent of all motor vehicle registrations.²

Motorcycling is also a high-risk activity. Motorcycles are low-mass, high-performance vehicles that can be difficult for other motorists to see and provide minimal rider protection. In 1996, motorcycles were involved in about 1 percent (67,000) of all police-reported traffic crashes, accounting for more than 2,000 deaths and an additional 56,000 injuries.³ Head injuries are the leading cause of death in motorcycle crashes, occurring in more than 50 percent of all motorcycle-related fatalities.⁴

Despite a significant reduction in motorcycle-related deaths in this decade (2,161 motorcyclists died in 1996 compared with 3,244 in 1990), motorcyclists are more likely to be injured or killed in a crash than other motorists. According to the National Highway Traffic Safety Administration (NHTSA), nearly 80 percent of all motorcycle crashes result in injury or death to the motorcycle rider compared with about 30 percent of passenger car crashes that result in injury or death to the vehicle occupant.³ While motorcycles are involved in only about 1 percent of traffic crashes, motorcyclists account for 5 percent of all traffic fatalities. Per vehicle mile traveled, motorcycle operators are 16 times more likely than passenger-car occupants to be killed in a motor vehicle crash and about 4 times more likely to be injured.³

This report identifies options for improving motorcycle safety and identifies national organizations that are involved with these issues. An extensive review of the epidemiology of motorcycle crashes and injuries and proposed safety measures is beyond the scope of this report. Information on these topics is available from previous AMA reports^5,6 and other publications.^4,8-11

Methods

Twenty-five national organizations involved with traffic safety issues were contacted regarding their motorcycle safety activities. Organizations were identified from a recent resource guide¹²  and from consultation with experts in this field.   Table 1 lists the organizations contacted and summarizes their motorcycle safety activities.

Epidemiological and clinical information on motorcycle crash injuries was derived from a MEDLINE search of English-language articles, published from 1980 to 1998, using the key words "motorcycle crashes," "motorcycle injuries," and "motorcycle safety." Articles were also derived by manual review of references listed in pertinent publications and from consultation with experts in this field.

Options to improve motorcycle safety

The NHTSA is the lead federal agency within the US Department of Transportation responsible for improving motor vehicle safety. Its mission is to support programs that save lives, prevent injuries, and reduce economic costs associated with traffic crashes. In keeping with this mission, the NHTSA works with national and state organizations to develop and implement comprehensive motorcycle safety programs. These programs focus on preventing motorcycle crashes (e.g., by improving state motorcycle operator licensing, education, and training programs; supporting awareness programs to reach motorists who share the road with motorcyclists; and reducing alcohol and other drug involvement in motorcycling), reducing crash injuries (e.g., by increasing use of personal protective equipment by motorcyclists), and providing rapid emergency medical services response and better treatment for motorcycle crash victims. Over the past 5 years, the NHTSA has budgeted about $340,000 each year for its motorcycle safety program.¹³  About one-fourth of these dollars have been targeted for motorcycle helmet activities.

The AMA supports a comprehensive approach to improve motorcycle safety. Existing policy encourages efforts to promote training programs for the safe operation of motorcycles (Polices H-10.977, H-15.980,  AMA Policy Compendium); advocates for regulations that tie the receipt of federal highway funds by states to state laws for the mandatory use of motorcycle helmets (H-15.971); calls for the AMA to assist state medical societies in achieving and preserving universal helmet laws (H-10.977, H-15.994); urges physicians to counsel patients about helmet usage and appropriate clothing to wear while riding (H-10.977); and encourages the motorcycle industry to improve the safety and reliability of these vehicles and support measures to improve motorcycle safety (H-10.977).

Increasing helmet usage through enactment of universal helmet laws

The use of appropriate personal protective equipment is recommended for all motorcycle riders.^6,7  Approved helmets, durable jackets and trousers (e.g., denim, leather), gloves, proper footwear, and eye protection are essential to protect riders from environmental elements and provide injury protection. Through the use of brightly colored or reflective material, protective equipment can make riders more conspicuous to other motorists.

Motorcycle helmets are the most important protective equipment and principal safety measure for preventing head injuries from motorcycle crashes.^14,15 In 1981, an investigation of 900 motorcycle crashes that resulted in 980 head and neck injuries concluded that wearing a helmet was the single most critical factor in preventing head and neck injuries among motorcycle riders.¹⁰ Numerous subsequent studies support this finding.^4,14-23  While helmets cannot protect riders from all injuries, the NHTSA estimates that motorcycle helmets reduce the risk of fatal injuries by 29 percent and the risk of traumatic brain injury by 67 percent.^14,22  In states that require all motorcycle riders to use helmets, significant reductions (from 15 percent to 37 percent) in the number of motorcycle crash fatalities have occurred.¹³  From 1986 through 1996, the NHTSA estimates that motorcycle helmet use has prevented more than 7,900 motorcyclist fatalities and saved more than $10 billion.²⁴

Motorcycle helmet use reduces crash fatalities and injuries by reducing the number of serious head injuries, particularly traumatic brain injury. Prevention of traumatic brain injury is important because it is more likely to be severe, requiring expensive and long-term medical treatment, and may result in lifelong disability.²² Motorcycle riders without helmets who sustain serious head injuries are more likely to require ambulance service; be admitted to a hospital; incur higher hospital charges; require neurosurgery, intensive care, rehabilitation, and long-term care; and have permanent disabilities.¹⁵

Despite the effectiveness of motorcycle helmets in reducing head injuries and fatalities, observational surveys indicate that only about 64 percent of motorcycle riders in the United States use helmets.²⁵ An effective means of increasing this percentage is through the enactment and enforcement of universal helmet laws, which apply to all motorcycle riders.

Currently, less than half the states have universal helmet laws. As shown in   Table 2, the District of Columbia, Puerto Rico, and 22 states require all motorcycle riders to wear helmets. In 25 states, certain populations such as persons under 18 years of age are required to wear helmets. Three states (Colorado, Illinois, and Indiana) have no helmet use requirements. Less restrictive laws requiring helmets for certain age groups are not as effective and are more difficult to enforce than universal helmet laws.^15,22,23 In the United States, helmet laws that apply only to younger riders result in helmet use rates of 34 percent to 54 percent.²⁵  In states with universal helmet laws, this percentage generally exceeds 90 percent.

In 1995, Congress passed the National Highway System Designation Act, which removed federal sanctions against states without universal helmet laws. Since that law was enacted, many states have considered or are considering legislation to repeal or weaken motorcycle helmet laws. Recently Arkansas, Kentucky, and Texas weakened their motorcycle helmet laws to include only young riders. Although motorcycle helmet laws enjoy strong support within the health community, they are a topic of ongoing controversy and debate in society at large, particularly from opponents who argue that such laws are an unwarranted infringement of personal liberty.¹⁵

Improving state operator licensing systems

The safe operation of a motorcycle requires different knowledge and skills than driving a car. Testing and licensing of motorcycle operators help ensure that riders can demonstrate basic knowledge of motorcycle operation and safely perform basic handling skills. While all 50 states require a separate driver's license endorsement to operate a motorcycle, it is estimated that about 20 percent of the national motorcyclist population is either unlicensed or improperly licensed.^25,26 Low compliance with state licensing laws is indicated by federal statistics showing that more than 40 percent of motorcyclists involved in fatal crashes are not properly licensed. While it appears that unlicensed motorcyclists are over-represented in highway mortality statistics, more research is needed to determine the relationship between operator licensing and motorcycle crash rates.²⁶

Expanding motorcycle rider education and training

Research suggests that many motorcyclists involved in crashes fail to use the full braking capability of their vehicle.^10,26 In particular, novice or inexperienced motorcyclists may not possess the skill or knowledge needed to brake effectively in emergency situations. Nationally recognized rider education and training programs taught by trained instructors teach motorcyclists about safety issues and the unique characteristics of motorcycle braking, acceleration, and steering systems.

Currently, more than 40 states have statewide rider education and training programs, usually funded by motorcycle license or registration fees.²⁷ In 18 states, such programs are mandatory. While many states include rider education and training programs as part of a comprehensive approach to improve motorcycle safety, more research is needed to assess the effectiveness of these programs in reducing motorcycle crashes.^26,28,29

Delivering informational materials to motorcyclists and other motorists

Automobile interference with the right-of-way of motorcyclists is a main cause of multi-vehicle motorcycle crashes.²⁶ Such crashes occur because motorists either fail to see the motorcycle or misjudge its speed and distance. Prevention of multi-vehicle crashes requires that motorists be aware of the special characteristics of motorcycles so that they can interact safely with motorcycles in everyday driving situations.

Informational materials are available for truck and automobile drivers to increase their awareness of motorcycles; materials are also available for motorcyclists to increase their awareness of state rider education, training and licensing programs, the dangers of riding while impaired by alcohol and other drugs, and the use of appropriate protective equipment.³⁰ More research is needed to evaluate public information campaigns and their effectiveness in reaching target audiences, inducing desired behavioral changes, and ultimately improving motorcycle safety.²⁶

Reducing the number of alcohol-impaired motorcyclists

Alcohol-related deaths among motorcyclists are higher than in any other driver group. According to the NHTSA, more than half of all motorcyclists killed in traffic crashes have measurable amounts of alcohol in their blood.²⁵ In 1996, 30 percent of fatally injured motorcycle operators were intoxicated (i.e., blood alcohol concentration of 0.10 grams per deciliter or greater) compared with 19 percent of passenger car drivers.

The adverse effects of alcohol on motor vehicle drivers are well-documented.³¹ Increased efforts are needed to prevent alcohol-related crashes and to educate all drivers that alcohol use, even at low levels, impairs driving performance and poses significant health and safety risks.

Improving motorcycles and highway environments

Motorcycles have changed considerably in the past 20 years, with technical improvements in safety, design, and performance.²⁶ Many motorcycles are now manufactured with bodywork featuring graphics that may be more visible to oncoming traffic. Full-time (or daytime running) headlights have been required on motorcycles since the late 1970s. Variable-intensity or modulating headlamps have also been allowed by federal statute since 1986. To improve braking performance, anti-lock brakes and integrated braking systems are available on some motorcycles to replace dual braking systems. As these technologies and enhancements are available, research is needed to document their operational, performance, and safety benefits, as well as their effectiveness in reducing motorcycle crash rates.²⁶

The highway environment is often overlooked as a motorcycle hazard.²⁶ Guardrails, potholes, road gratings, and railroad tracks are examples of possible roadway hazards for motorcyclists. More research is needed to identify motorcycle hazards in the highway environment and develop cost-effective interventions.²⁶

Research priorities to improve motorcycle safety

Motorcycle safety research aims to identify human, environmental, and vehicle factors that contribute to motorcycle crashes and injuries. With such knowledge, researchers can design, develop, and test safety measures to reduce crash risks. In 1981, researchers from the University of Southern California published a landmark NHTSA-funded motorcycle safety study, which carefully examined environmental, vehicle, and driver characteristics that contributed to 900 motorcycle crashes in Los Angeles.¹⁰ This work is one of the most comprehensive sources of epidemiological information on motorcycle crashes and injuries, and has provided a research basis for numerous motorcycle safety recommendations. In 1994, a committee of the Transportation Research Board (which is a unit of the National Research Council and serves as an independent advisor to the federal government on transportation issues) re-addressed the issue of motorcycle safety and determined that sufficient technical, demographic, market, and regulatory changes had occurred in motorcycling to warrant a more contemporary study of motorcycle crashes and safety.²⁶

To improve motorcycle safety, the Transportation Research Board Committee on Motorcycles and Mopeds developed and prioritized 10 independent research proposals for the consideration of highway transportation officials. These are listed in Table 3. It is worth noting that the committee decided not to propose a study of the effectiveness of helmets and helmet use laws because these issues were being studied by the NHTSA and others. Due to lack of funding for motorcycle safety research, these priorities remain unchanged (Personal communication. John W. Billheimer, PhD, Chair, Transportation Research Board Committee on Motorcycles and Mopeds, July 1998).

National partnerships to improve motorcycle safety

The NHTSA has established national goals to increase motorcycle helmet use to 80 percent and reduce motorcycle-related fatalities and injuries by 5 percent by the year 2000.³² Achievement of these goals may be difficult, however, due to a lack of coordinated effort for improving motorcycle safety. As shown in Table 1, many national health and safety organizations have policy supporting motorcycle helmet laws, and some may advocate for such laws, but few have dedicated programs in motorcycle safety.

To better coordinate national programs and activities, the NHTSA recently initiated a motorcycle safety strategic planning effort with the Motorcycle Safety Foundation (a private industry-funded motorcycle safety advocacy group) to solicit input from traffic and motorcycle safety groups to develop an agenda for motorcycle safety activities over the next 5 years.³³ These groups will assess the effectiveness of various motorcycle safety programs and determine appropriate target audiences and partnerships to promote motorcycle safety. Focus group meetings will assess the needs of motorcyclists and national organizations representing motorcycle interests, traffic safety, medicine, public health, and law enforcement. The strategic plan is tentatively scheduled for release in late 1999.

Other collaborative projects of the NHTSA include efforts to increase the number of properly licensed motorcycle operators and improve rider education and training programs. Recently, the NHTSA worked with the Motorcycle Safety Foundation and the American Association of Motor Vehicle Administrators to update the Motorcycle Licensing System, which is a guide for improving licensing systems in the United States.³⁴  Currently, the NHTSA is working with the National Association of State Motorcycle Safety Administrators to promote motorcycle licensing and enable motorcycle safety program administrators to plan, develop, and implement more comprehensive licensing programs in their states and communities.³³  The NHTSA is also working with the Motorcycle Safety Foundation to increase awareness of state motorcycle rider education and training programs.

A role for physicians and organized medicine

The prevention of motorcycle-related trauma requires a multifaceted approach that includes education, legislation, law enforcement, and research, and requires the active participation of physicians at local, state, and national levels. Physicians have a direct role in preventing motorcycle-related trauma by encouraging their patients who ride motorcycles to comply with state licensing laws and counseling them about effective safety measures. Motorcyclists should be counseled to wear helmets that meet federal safety standards and receive proper training in the safe operation of their vehicle. In addition, motorcyclists should be warned about the dangers of operating a motorcycle while under the influence of alcohol and other drugs.

At the national level, the NHTSA is seeking involvement by the medical community to develop a future agenda for improving motorcycle safety. The AMA and other national medical societies can participate in this process and identify opportunities for educating physicians and patients about motorcycle safety issues. Concerned physicians and medical societies can also participate in state and community efforts to improve motorcycle safety.

The AMA also can work with the Federation to promote motorcycle safety issues and advocate for scientifically sound legislation to protect all motorcycle riders. As respected patient and community health advocates, physicians and organized medicine have a responsibility to protect public safety by supporting the enactment and enforcement of universal helmet laws in all states and opposing attempts to weaken or repeal existing laws. The AMA should provide national leadership in this effort.

Recommendations

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 1998 AMA Interim Meeting.

1. Existing AMA Policies H-10.977, H-15.971, H-15.980, and H-15.994 are reaffirmed.  
2. The AMA will encourage the National Highway Traffic Safety Administration to work with medical and public health organizations, national motorcycle rider organizations, state motor vehicle licensing agencies, law enforcement officials, and the motorcycle industry to develop a comprehensive national motorcycle safety plan that addresses rider education, training, and licensing; use of motorcycle helmets and other protective gear; public awareness of motorcycles; alcohol use among motorcyclists and other motor vehicle drivers; measures to increase the visibility of motorcyclists and motorcycles to other drivers; engineering and design of motorcycles and highway environments; and research to determine the effectiveness of current and proposed safety measures.  
3. The AMA will seek opportunities to work with the NHTSA to educate and inform physicians and patients about motorcycle safety issues.  
4. The AMA encourages physicians to (a) be aware of motorcycle risks and safety measures and (b) counsel their patients who ride motorcycles to wear appropriate protective gear and helmets that meet federal safety standards, receive appropriate training in the safe operation of their motorcycle, comply with state licensing laws, and avoid riding a motorcycle while under the influence of alcohol and other drugs.  
5. The AMA will report on conclusions and recommendations of the motorcycle safety strategic planning effort that is being coordinated by the National Highway Traffic Safety Administration and the Motorcycle Safety Foundation.

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References

1. 1998 Motorcycle Owner Survey: Today's Riders are Healthy, Wealthy and Wise [press release]. Irvine, California: Motorcycle Industry Council; June 24, 1998.  
2. Motorcycle Industry Council.  1997 Motorcycle Statistical Annual. Irvine, California: Motorcycle Industry Council, Inc.;1997.  
3. National Highway Traffic Safety Administration.  Traffic Safety Facts 1996. Washington, DC: National Center for Statistics and Analysis;1997. Publication DOT HS 808 649.  
4. Sosin DM, Sacks JJ, Holmgreen P. Head injury-associated deaths from motorcycle crashes: relationship to helmet-use laws.  JAMA. 1990;264:2395-2399.  
5. Board of Trustees, American Medical Association. Motorcycle safety.  Proceedings of the American Medical Association House of Delegates. Chicago, Illinois: American Medical Association; June 1986. Report N.  
6. Council on Scientific Affairs, American Medical Association. Helmets and preventing motorcycle- and bicycle-related injuries.  JAMA. 1994;272:1535-1538.  
7. National Highway Traffic Safety Administration.  Motorcycle Safety. Washington, DC: National Highway Traffic Safety Administration;1994. Publication DOT HS 807 709.  
8. Kraus JF, Riggins RS, Franti CE. Some epidemiological features of motorcycle collision injuries. I: introduction, methods and factors associated with incidence.  Am J Epidemiol. 1975;102:74-98.  
9. Kraus JF, Riggins RS, Franti CE. Some epidemiological features of motorcycle collision injuries.  II: factors associated with severity of injuries.  Am J Epidemiol. 1975;102:99-109.  
10. Hurt HH, Ouellet JV, Thom DR.  Motorcycle Accident Cause Factors and Identification Countermeasures, Volume 1: Technical Report. Washington, DC: National Highway Traffic Safety Administration;1981. Publication DOT HS 805 862.  
11. Preusser DF, Williams AF, Ulmer RG. Analysis of fatal motorcycle crashes: crash typing.  Accid Anal Prev. 1995;27:845-851.  
12. Education Development Center, Inc., Department of Emergency Medicine University of Illinois at Chicago.  Who s Who in Traffic Safety: A Guide to Agencies and Organizations. Newton, Massachusetts: Education Development Center, Inc.;1996.  
13. US General Accounting Office.  Highway Safety: NHTSA's Activities Concerning State Motorcycle Helmet Laws. Washington, DC: US General Accounting Office;1997. Publication RCED-97-185R.  
14. Wilson D.  The Effectiveness of Motorcycle Helmets in Preventing Fatalities. Washington, DC: National Highway Traffic Safety Administration;1989. Publication DOT HS 807 416.  
15. US General Accounting Office.  Highway Safety: Motorcycle Helmet Laws Save Lives and Reduce Costs to Society. Washington, DC: US General Accounting Office; 1991. Publication GAO/RCED-91-170.  
16. Chenier TC, Evans L. Motorcycle fatalities and the repeal of mandatory helmet wearing laws.  Accid Anal Prev. 1987;19:133-139.  
17. Centers for Disease Control and Prevention. Head injuries associated with motorcycle use Wisconsin, 1991.  MMWR. 1994;43:423-431.  
18. Kraus JF, Peek C, McArthur DL, Williams A. The effect of the 1992 California motorcycle helmet usage law on motorcycle crash fatalities and injuries.  JAMA. 1994;272:1506-1511.  
19. Orsay EO, Holden JA, Williams J, Lumpkin JR. Motorcycle trauma in the state of Illinois: analysis of the Illinois Department of Public Health Trauma Registry.  Ann Emerg Med. 1995;26:455-460.  
20. Rowland J, Rivara F, Salzberg, Soderberg, Maier R, Koepsell T. Motorcycle helmet use and injury outcome and hospitalization costs from crashes in Washington state.  Am J Public Health. 1996;86:41-45.  
21. Peek-Asa C, Kraus JF. Estimates of injury impairment after acute traumatic injury in motorcycles crashes before and after passage of a mandatory helmet use law. Ann Emerg Med. 1997;29:630-636.  
22. National Highway Traffic Safety Administration. 1996 Crash Outcome Data Evaluation System (CODES): Report to Congress on Benefits of Safety Belts and Motorcycle Helmets. Washington, DC: National Highway Traffic Safety Administration;1996. Publication DOT HS 808 347.  
23. National Highway Traffic Safety Administration.  Further Analysis of Motorcycle Helmet Effectiveness Using CODES Linked Data. Washington, DC: National Highway Traffic Safety Administration;1998. Research Note.  
24. National Highway Traffic Safety Administration.  State Legislative Fact Sheet: Motorcycle Helmet Use Laws. Washington, DC: National Highway Traffic Safety Administration; January 1998.  
25. National Highway Traffic Safety Administration.  Traffic Safety Facts 1996: Motorcycles. Washington, DC: National Center for Statistics and Analysis;1997.  
26. Committee on Motorcycles and Mopeds, Transportation Research Board. Research problem statements for motorcycles and mopeds.  Transportation Research Circular. Washington, DC: National Research Council;1994. Publication 424.  
27. National Association of State Motorcycle Safety Administrators.  State Motorcycle Program Survey. Fridley, Minnesota: National Association of State Motorcycle Safety Administrators; 1997.  
28. Billheimer JW.  California Motorcyclist Safety Program: Program Effectiveness (Executive Summary). Los Altos, California: Systan, Inc.;1996. Publication D275.  
29. Graitcer PL. Helmets work best.  Ann Emerg Med. 1197;29:643-44. Editorial.  
30. National Association of State Motorcycle Safety Administrators.  Idea Sampler to Promote Observance of Motorcycle Safety Awareness Week/Month. Fridley, Minnesota: National Association of State Motorcycle Safety Administrators;1995.  
31. Council on Scientific Affairs. Drivers impaired by alcohol.  Proceedings of the American Medical Association House of Delegates. Chicago, Illinois: American Medical Association; June 1997. Report 14.  
32. National Highway Traffic Safety Administration.  Strategic Plan (Draft). Washington, DC: National Highway Traffic Safety Administration; March 1998.  
33. National Highway Traffic Safety Administration.  Safety Countermeasures. Washington, DC: National Highway Traffic Safety Administration; Fall 1997. Newsletter.  
34. Mayhew D, Simpson H.  Motorcycle Operator Licensing System: Guidelines for Motor Vehicle Administrators. Washington, DC: National Highway Traffic Safety Administration;1997. Publication DOT HS 807 563.

Table 1. Motorcycle Helmet Policies and Safety Activities of National
Organizations Contacted by AMA Staff

Organization	Location	Helmet use policies & motorcycle safety programs
AAA Foundation for Traffic Safety	Washington, DC (www.aaafts.org)	None
Advocates for Highway and Auto Safety	Washington, DC (www.saferoads.org)	Policy supports universal helmet laws. Works at national and state levels against repeal or weakening of universal helmet laws.
American Academy of Pediatrics	Elk Grove Village, IL (www.aap.org)	None
American Academy of Orthopedic Surgeons	Rosemont, IL (www.aaos.org)	Policy supports universal helmet laws.
American Association of Motor Vehicle Administrators	Arlington, VA (www.aamva.org)	Works with national organizations and the NHTSA on motorcycle safety training and licensing issues.
American Association of Neurological Surgeons	Park Ridge, IL (www.aans.org)	Policy supports universal helmet laws.
American Association of State Highway and Transportation Officials	Washington, DC (www.aashto.org)	Works with state and national groups on variety of motorcycle safety initiatives.
American College of Family Physicians	Kansas City, MO (www.aafp.org)	Policy supports universal helmet laws.
American College of Emergency Physicians	Dallas. TX (www.acep.org)	Policy supports universal helmet laws. Works with the NHTSA on motorcycle safety issues. Works at national and state levels against repeal or weakening of mandatory helmet laws.
American Motorcyclist Association	Westerville, OH (www.ama-cycle.org)	Individual membership organization. Works with other national groups on variety of motorcycle safety issues. Policy supports voluntary helmet use for adults; does not oppose mandatory helmet laws for minors.
American Trauma Society	Upper Marlboro, MD (www.amtrauma.org)	None
American Public Health Association	Washington, DC (www.apha.org)	Policy supports universal helmet laws.
Association for the Advancement of Automotive Medicine	Des Plaines, IL (www.carcrash.org)	Policy supports universal helmet laws. Annual meeting provides a forum for presentations on motorcycle safety issues.
Brain Injury Association	Alexandria, VA (www.biausa.org)	Advocates at state and national levels against repeal or weakening of universal helmet laws.
Centers for Disease Control and Prevention	Atlanta, GA (www.cdc.gov)	Funds a multi-state surveillance system to monitor traumatic brain and spinal cord injury. This database captures motorcycle-related head and spinal cord injuries. No funding is appropriated for research programs related to motorcycle safety.
Insurance Institute for Highway Safety	Arlington, VA (www.iihs.org)	Has funded research on motorcycle safety issues, including effectiveness of helmets and helmet laws.
International Association of Chiefs of Police	Alexandria, VA (www.iacp.org)	Works with national motorcycle safety organizations and the NHTSA on motorcycle safety issues.
Motorcycle Safety Foundation	Irvine, CA (www.msf-usa.org)	Working with the NHTSA to develop a comprehensive national motorcycle safety strategic plan. Works with the NHTSA and other organizations to improve motorcyclist education and licensing. Compiles state-specific data on motorcycle safety education, rider training and licensing programs.
National Association of EMS Physicians	Lenexa, KS (www.naemsp.org)	None
National Association of Governors' Highway Safety Representatives	Washington, DC (www.naghsr.org)	Policy supports helmet use and encourages states to develop and support comprehensive motorcycle safety programs.
National Association of State Motorcycle Safety Administrators	Fridley, MN (www.motorcyclesafety.org)	Compiles state data on motorcycle rider education, training, and licensing programs. Works with the NHTSA to develop and distribute materials to promote motorcycle licensing. Sponsors annual meeting on motorcycle safety.
National Highway Traffic Safety Administration	Washington, DC (www.nhtsa.dot.gov)	Lead federal agency for compiling motorcycle crash statistics. Funds and coordinates educational and research initiatives to improve motorcycle safety. Developing multi-media package to help policymakers make informed decisions about helmet laws for all riders. NHTSA's motorcycle safety program includes support to national organizations that develop and deliver rider education programs; increased motorcycle operator licensing; and reduced alcohol involvement in motorcycling. Currently developing a strategic plan that includes formation of public-private partnerships to improve motorcycle safety.
National Safety Council	Itasca, IL (www.nsc.org)	None
State and Territorial Injury Prevention Directors' Association	Marietta, GA (www.stipda.org)	None
Transportation Research Board	Washington, DC (www.trb.org)	Committee on Motorcycles and Mopeds issued a report in 1994 that identified options for improving motorcycle safety. The report will be revisited in 2 to 3 years.

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Table 2. Status of state motorcycle helmet use requirements (July 1998)

22 States, District of Columbia and Puerto Rico require use for all riders	25 States require use for a specific segment of riders(usually under age 18 unless noted)	Not required in 3 states
Alabama California District of Columbia Florida Georgia Louisiana Maryland Massachusetts Michigan Mississippi Missouri Nebraska Nevada New Jersey New York North Carolina Oregon Pennsylvania Puerto Rico Tennessee Vermont Virginia Washington West Virginia	Alaska Arkansas Arizona Connecticut Delaware (1) Hawaii Idaho Indiana Kansas Kentucky (2) Maine (3) Minnesota Montana New Hampshire New Mexico North Dakota Oklahoma Ohio (4) Rhode Island (5) South Carolina South Dakota Texas (6) Wisconsin Wyoming	Colorado Illinois Iowa

• Riders under age 19 must wear helmets and helmets must be in the possession of other riders, even though use is not required. 
• Required for riders under age 21 and novice riders.Required for riders over 21 unless exemption decal is obtained via providing proof of insurance when obtaining or renewing Kentucky registration and paying $3 fee. 
• Required only for riders under 15 years of age, novices, and holders of learner's permits. 
• Riders under 18 and first year novices are also required to wear helmets. 
• Riders under 21 and first year operators must wear helmets. 
• Riders 20 and under and those who have not completed a rider training course or who do not have $10,000 medical insurance coverage.
  

Source: National Highway Traffic Safety Administration, July 1998.

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Table 3. Research priorities in motorcycle safety

1. Determine the crash incidence among licensed and unlicensed riders.   
2. Document the size of the unlicensed riding population in each state and relate this to state licensing practices, permit requirements, and sanctions.   
3. Evaluate the effectiveness of motorcycle rider training programs.   
4. Document the drinking and riding patterns of motorcyclists through roadside surveys and assemble objective data on the blood alcohol concentrations of motorcyclists involved in crashes of different injury severity.   
5. Assess the response and performance of various existing and proposed systems to improve motorcycle braking capability.   
6. Assess the effectiveness of various motorcycle conspicuity measures to riders and motorcycles (e.g., use of reflective helmets and clothing, daytime running lights).   
7. Determine the statistical profile of U.S. motorcyclists, including information on age, experience, riding habits, crash history, annual mileage, and license status of motorcyclists to improve knowledge of individual and regional differences among motorcycle operators.   
8. Identify and mitigate road hazards to motorcyclists (e.g., potholes, unprotected guardrails, railroad tracks, gratings).   
9. Evaluate the effectiveness of motorcyclist informational campaigns.   
10. Compare the causes and characteristics of automobile/automobile and automobile/motorcycle crashes to identify conspicuity factors that may be amenable to prevention efforts.
    Source: Committee on Motorcycles and Mopeds, Transportation Research Board. Research problem statements for motorcycles and mopeds. Transportation Research Circular. Number 424. Washington, DC: National Research Council;1994.
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