Injuries among cyclists constitute a traffic safety problem in many countries. For instance, the fatality rate among cyclists per 100,000 population in th year 2000 were about 1.00 in both Japan, the Netherlands, Denmark and Finland. In Sweden the fatality rate was about 0.5 the same year. If the amount of exposure to bicycling is considered, the fatality rate is somewhat lower in the Netherlands than in Sweden, but on the other hand the fatality rate per exposure is more than twice as high in United Kingdom compared to Sweden. In the context of hospital care in Sweden, injured bicyclists are of major concern. About one third of all road user inpatients are bicyclists, which is about 4,000 cyclists each year and roughly the same number that is seen for car drivers and passengers. From the perspective of traffic safety, it is important to find measures that could increase the use of helmets among bicyclists. One strategy is to use helmet promotional activities to increase the voluntary use of bicycle helmets. Another strategy is to use obligatory means like helmet legislation. The aim of this paper is to review the effect of using voluntary or compulsory means to increase the helmet wearing rate among bicyclists. The inclusion criteria for the literatures in this paper were based on perceived relevance for the objective of the review and not strictly on the type of design of the included studies. There is therefore a risk that the results might be biased because the review could include studies of low quality. On the other hand, the risk of using very rigorous inclusion criteria is that new interventions with potential effects could be missed. The general findings in this paper does, however, agree well with the conclusions from other reviews conducted in recent years (A). For the covering abstract of the conference see E217780.
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