Background: Motorcyclists are the most vulnerable vehicle users in India. No
published study has assessed the validity of self-reported estimates of helmet
use in India. The objectives of this study were to assess helmet use by comparing
observed and self-reported use and to identify factors influencing use among
motorcyclists in Hyderabad, India.
Methods: Population-based observations were recorded for 68 229 motorcyclists
and 21 777 pillion riders (co-passengers). Concurrent roadside observations and
interviews were conducted with 606 motorcyclists, who were asked whether they
“always wear a helmet”. Multivariate logistic regression analyses were conducted
to determine factors influencing helmet use.
Results: In the population-based study, 22.6% (n = 15,426) of motorcyclists and
1.1% (n = 240) of pillion riders (co-passengers) were observed wearing helmets. In
roadside interviews, 64.7% (n = 392) of the respondents reported always wearing
a helmet, 2.2 times higher than the observed helmet use (29.4%, n = 178) in
the same group. Compared with riders aged =40 years, riders in the age groups
30–39 years and 18–29 years had respectively 40% (95% confidence interval
[CI]: 0.4 to 1.0, P < 0.05) and 70% (95% CI: 0.2 to 0.5, P < 0.001) lower odds of
wearing a helmet after controlling for other covariates. Riders with postgraduate
or higher education had higher odds of wearing a helmet (adjusted odds ratio
[OR]: 4.1, 95% CI: 2.5 to 6.9, P < 0.001) than those with fewer than 12 grades of
schooling. After adjusting for other covariates, younger riders also had 40% (95%
CI: 0.3 to 0.9, P < 0.05) lower odds of self-reporting helmet use, while those with
postgraduate or higher education had 2.1 times higher odds (95% CI: 1.3 to 3.3,
P < 0.01) of reporting that they always wear a helmet. Police had stopped only
2.3% of respondents to check helmet use in the three months prior to the interview.
Conclusion: Observed helmet use is low in Hyderabad, yet a larger proportion of
motorcyclists claim to always wear a helmet, which suggests that observational
studies can provide more valid estimates of helmet use. Interview findings suggest
that a combination of increased enforcement, targeted social marketing and
increased supply of standard helmets could be a strategy to increase helmet use
in Hyderabad.