Driving and operating motor vehicles and bicycles safely, thinking about community policies and safer roads is undoubtedly an important aspect of health literacy. Having the chance to observe people riding bicycles and motorcycles in two continents the last years, I have been interested in why there are so many people going without a helmet? Furthermore why are these adults NOT teaching their young children to wear helmets as we know that modeling good and positive behaviors will likely lead to the perception of children also following in these “healthy footsteps”.

More recently a forensics doctor in Sacramento, California had posted on Facebook an autopsy of what a broken head looked like in his frustration (and the family’s I am sure) of young men not following the road rules for helmet use — indeed it was shocking  as it looked like an open egg, with only a few layers including the dermis (outer skin) of how one of our most important organs the brain needs to be protected both from internal harm (bleeding, chemical alterations) and external influences (injuries).  I was reminded of an older Sting song which says how fragile we are (even though the song is more political in nature, as a health educator and counselor this hits home)…. many a family member and the community lament their loved one’s fate.  In the past I recall in a lower income neighborhood in Athens, Greece on one street there were at least two deaths of young people who did not wear helmets, and guess what? Their friends showed up at the funeral without a helmet!

For two days this last week I conducted my own observation (see photos) during the hottest part of the day (1-2 p.m.), and during a cooler evening time (9 p.m.), by counting the first 15 motorcyclists I saw (30 each day, total 60 persons observed) on two major Avenues in Attica (Vouliagmenis and Poseidonos Ave.), Greece to see how many wore helmets, as evidenced by the photos (age was irrelevant, gender seemed more important though many couples were heading to their evening excursions without helmets).  Out of the 30 people in the 1st day, I noticed 5 using helmets (the numbers seemed worse in the evening, so the idea that they are ‘hot’ from the sun is not the excuse), and the 2nd day I noticed 6 using helmets — average of ~ 19% using helmets, so 81% did not! Today I heard of a woman’s brother who was driving on a country road and a young guy driving his motorcycle without a helmet about 120 km. an hour (75 miles/hour) hit his car, went flying in the air and you guessed it, cracked his head and died. The 2nd evening of my observation I also noticed a public ambulance trying to get through and almost no one pulling to the side… interestingly the ambulance only had their flashing lights on and very little siren sounds, so this signaled a partial emergency? Very confusing (notice the man with no helmet on the left too). In other countries the sirens are loud and if one doesn’t move to the side there are laws and fines, so people have learned their lessons and abide to road rules.

So what is it? Why are we not doing more to teach young people, old people, all people? Here are some general thoughts:

• Developmentally adolescents through young adults like to experience sensation-seeking (which also explains not using condoms consistently, using illicit drugs, drinking and driving, etc.)
• The obsession with looking good?  Hair styling (the gone with the wind look… emphasis on “gone” here)? Being noticed? Looking cool?
• The fear of the helmet being stolen? My favorite is people carrying helmets on their arm (in Greece the law for helmet use was ‘enforced’ in 2007 but there may be a few loopholes, since one needs to “wear a helmet” … not necessarily worn on your head? what??!! Are Greeks above the law? Why are police not enforcing more effectively (the last two years since they are underpaid it seems there is no one on the road monitoring) and why do we continue this strange behavior… check out one tourist’s account when he rented a bike in Greece)
• In my last post I mentioned how problematic health behaviors are more true with men, it stands with this situation as well.
• Consistency of enforcement of laws — it cannot be only one person getting pulled aside for blocking an ambulance or a fire engine, or the break-down lane. It cannot be two people every three months getting fined for non-helmet use, it has to be on a daily basis, observed and safety discussed in schools (ministry of health and ministry of education working together).
• Driver’s Education — I recall being shown traumatic images of those who did not wear helmets, were driving drunk, or were speeding excessively in Driver’s Ed at the age of 16 (that was enough for me to ‘think’ about it). I also learned about how to drive in bad weather conditions, etc. Never mind not tailgating or bullying people off the road (it seems that SUVs, fancier cards, mainly men drivers showcase these behaviors many countries regardless of ethnicity from personal stories I’ve heard, experienced, or pure observation).
• Surprisingly older children are less likely to wear helmets than younger children… they have more confidence, but what about the roads they are riding their bike on?  In countries where the economy is horrible the roads and sidewalks are full of potholes, these bumps lead to imbalance and unnecessary injuries.  If you are blessed with a community where kids can even bicycle to the store or school, great idea to have consistency in helmet use.  Check out Huffington Post‘s article on “Cycling to School: Does Your Child Wear a Helmet?” it appears this ‘being cool’ phenomenon exists in other countries who pride themselves on safety campaigns!
• Rules change for multiple ‘riders’?  Some countries have taken this into account several years ago like Uttar Pradesh, India of compulsory helmet use.

One article written by Papadaki et al. (2013) attempted through a sample explore the motivations for helmet use and in the sample found usage quite low in Greece. We know the risk of injury is higher as well as costs in disabilities, socio-economic costs to countries suffering in their crises like Greece, and CDC has great outlines of related issues on their site’s post  — Motorcycle Safety & Head injuries and Bicycle Safety and how many laws and money can be saved for people and their communities!

Of course there are more organized groups of cyclers that do wear their bike helmets in Greece like Cycle Greece (and if any of you are interested in this venture a good idea to look them up!) . However I have observed both in Athen’s city center near Parliament and also on Poseidonos Avenue other organized ‘groups’ members on evening group cycling  go without a helmet, so again consistency? People know how cars race down the main Avenues (again minimal policing for speeding) … do you really want to get carried away with that? How about promoting stories of safety and preventing injury and tragedy to our communities and schools using better social marketing campaigns — I like this image from the UK company on wearing helmets seen below.

Your head needs to be protected as much as possible, wear a helmet!