Helmet use among adolescent motorcycle and moped riders - Rome, Italy, 1994

Morbidity and Mortality Weekly Report, April 19, 1996

In Italy, motor-vehicle crashes are the leading cause of death among persons aged 15-20 years, and motorcycles account for a substantial proportion of traffic-related fatalities: in 1993, of the 6349 traffic-related deaths reported in Italy, 1342 (21.1%) occurred among motorcycle and moped users, and 261 (19.4%) of these deaths were among persons aged 15-20 years. Because of the risks for head injury and death, in 1986 a national law was enacted requiring operators of motorcycles or mopeds to use helmets under specified conditions. To assess compliance with this law and factors associated with helmet use among adolescents in a metropolitan area, in October 1994 the National Institute for Health conducted a survey of a sample of high school students in Rome. This report presents findings of this survey, which indicate that helmet use was low, particularly among moped users and among passengers.

In Italy, motor-powered cycles are classified by engine size. Motorcycles with engines 50-125 cc may be operated by persons aged [greater than or equal to]16 years; persons must be aged [greater than or equal to]18 years to operate motorcycles with engines >125 cc. For both, drivers' education and a license are required. Mopeds (vehicles with engines [greater than or equal to]50 cc)-which are designed for use in urban areas and are smaller than motorcycles-may be operated by anyone aged [greater than or equal to]14 years; neither a license nor drivers' training is required. Carrying passengers on mopeds is prohibited regardless of the age of the driver. A 1986 law mandated helmet use for all moped drivers aged <18 years; for those aged [greater than or equal to]18 years, helmet use is required only when mopeds are operated outside urban centers. The 1986 law also mandated helmet use by both drivers and passengers of motorcycles, regardless of the operator's age and location of motorcycle use.

The survey was conducted in October 1994 at six public schools located in central Rome, representing the three types of high schools in Italy (classical, scientific, and technical). All students in the first, third, and fifth years (mean ages: 14, 16, and 18 years, respectively) who were present on the day of the survey were asked to complete an anonymous self-administered questionnaire regarding sociodemographic characteristics, motorcycle and/or moped use and use of helmets during the previous year, and attitudes about helmet use.

Of the 1690 students present on the day of the survey, 1673 (99.0%) students (mean age: 16.4 years; range: 13-23 years) completed the questionnaire. More than half (988 [59.1%1) reported having been a passenger on (565 [57.2%1) or driven (423 [42.8%1) either a moped or motorcycle during the previous year. Males and females were equally likely to use motor-powered cycles, although males were more than twice as likely as females to be drivers (34.9% versus 16.4%). Nearly one fourth (23.1%) of respondents reported daily use of at least 1 hour of either motorcycles or mopeds. Most (897 [90.8%1) motor-powered cycle users were moped riders, of whom 396 (44.1%) were drivers and 501 (55.9%) were passengers.

Of the moped and motorcycle users, 494 (50.0%) reported helmet use (sometimes or always wore a helmet when riding). Of those reporting helmet use, more than two thirds (71.2%) reported sometimes using helmets, and 28.8% reported always using helmets. Helmet use was greater among drivers (59.8%) than passengers (42.7%; p<0.01) (Table 1) and was greater among motorcycle users than moped users (82.9% versus 48.6%; p<0.01). Among those using mopeds and who where aged <18 years (i.e., mandated to use helmets), 54.9% reported using helmets sometimes or always; among those aged [greater than or equal to]18 years (i.e., required to use helmets only when traveling outside city limits), 24.6% reported using helmets sometimes or always (p<0.01).

Helmet use during the most recent trip was reported by 23.2% of all motorcycle a nd moped users and was more common among those who reported always using a helmet (89.4%) than among those who reported occasional use (23.1%). Among those who reported using helmets sometimes or always during the previous year, 70.6% reported always fastening the chin strap, 19.8% reported doing so sometimes, and 6.9% reported that they never did. Constant correct use of helmets was reported by 17.30/o of motorcycle and moped users overall.

Among respondents who reported always using helmets, the most common reasons for use were that helmets provided protection (57.4%) and that they were required by law (31.9%). Among those who reported sometimes or never using helmets, the most frequent reasons for nonuse were that they are uncomfortable (40.9%), not available (20.4%, all passengers), or useless (5.7%).

Among all respondents, 81.8% believed helmets provided protection in crashes, and 65.7% believed use should be compulsory; however, nonusers of motorcycles and mopeds were more likely to favor compulsory use than users (80.0% versus 56.8%, respectively). Most respondents considered motorcycle riding to be dangerous (48.2%) or very dangerous (37.0%).

Of the 423 drivers, 268 (63.2%) reported having been involved in at least one crash. Of these, 53 (19.9%) reported injuries requiring an emergency department visit, and 12 (4.3%) required inpatient admissions.