Day and Months of Georgia Motorcycle Deaths



THE IMPACT OF MOTORCYCLE HELMET NON USE

WITH IMPLICATIONS FOR GEORGIA

THE IMPACT OF MOTORCYCLE HELMET NON USE

WITH IMPLICATIONS FOR GEORGIA

List of Charts

Title Page

Chart 1a: Changes in Percent of Total U. S. Deaths Related to Motorcycles…………… 1

Chart 1b: Changes in Percent of Total U. S. Deaths Related to Cars…………………… 1

Chart 2a: Distribution of 2002 Crash Deaths in States with Helmet Laws……………… 3

Chart 2b: Distribution of 2002 Crash Deaths in States with No Helmet Laws……..…… 3

Chart 3: Helmet Use in Texas Motorcycle-related Crash Deaths (1994-2002)………... 5

Chart 4: Helmet Use in Florida Motorcycle-related Crash Deaths (1994-2002)……….. 6

Chart 5: Helmet Use in Georgia Motorcycle-related Crash Deaths (1994-2002)………. 8

Chart 6: Ten-Year Trend in Georgia Motorcycle Registrations……………….……….. 9

Chart 7: Ten-Year Trend in Georgia Motorcycle Fatalities……………….…………….. 9

Chart 8: Trend in Georgia Death Rate per 100,000 Registered Motorcycles………….... 10

Chart 9: Ten-Year Trend in Georgia Motorcycle Registrations, Fatalities, and Rates…. 10

Chart 10: License Status of Georgia’s 2002 Motorcycle-related Crash Deaths Victim….. 11

Chart 11: Georgia Motorcycle-related Crash Deaths by Age of Victim………………….. 11

Chart 12: Frequency of Georgia Motorcycle-related Crash Deaths by Month………….... 12

Chart 13: Frequency of Georgia Motorcycle-related Crash Deaths by Day………….….... 12

Chart 14: Prediction of Motorcycle-related Crash Deaths After Georgia Law Repeal……. 16

List of Tables

Title Page

Table 1: Post-repeal Changes in Texas Motorcycle Trends 1997-2002)…………………… 4

Table 2: Helmet Use in Fatal Texas Motorcycle Crashes……………………………….. 5

Table 3: Five Year Comparisons………………………………………………………… 5

Table 4: Post-repeal Changes in Florida Motorcycle Trends 2000-2002.………………… 6

Table 5: Helmet Use in Fatal Florida Motorcycle Crashes…………….………………… 7

Table 6: Percent Increase in Citations Issued for Helmet Non-use in Florida..….……… 7

Table 7: Four Year Comparison…………………………………………………………. 7

Table 8: Helmet Use in Fatal Georgia Motorcycle Crashes……………………………… 8

Table 9: Ten Year Motorcycle Trends in Georgia……………………………………….. 10

Table 10: Comparison of Registration States of Motorcycles and Cars in Georgia Deaths 13

Table 11: Average Hospital Charges per Case by Head Injury Status……………………….= 14

Table 12: Predicted Fatality Outcomes of Georgia Helmet Law Repeal………………….. 15

Table 13 Predicted Fatalities Among Non-Helmeted Georgia Motorcyclists……………. 16

Table 14: Helmet Laws in 50 States and Washington, D.C…………..…………………… 18

THE IMPACT OF MOTORCYCLE HELMET NON USE

WITH IMPLICATIONS FOR GEORGIA

BACKGROUND

In the first four years after the November 25, 1995 repeal of the universal federal helmet law, motorcyclist fatalities increased 61% while motorcycle registrations increased by only 15%.[1] Studies have documented that motorcyclists experience sixteen times the death rate of passenger car occupants per vehicle miles traveled.[2] The primary cause of these deaths is related to head injuries.[3] Charts 1a and 1b illustrate that while the overwhelming majority of crash deaths continue to occur to occupants of automobiles, their numbers have steadily declined as motorcycle-related deaths have consistently increased.

Analysis of the most recently available national death data (2002) demonstrates that states with helmet laws have a lower percentage of fatalities occurring to motorcyclists when compared to states with no helmet requirements. In the states that require helmet use, 8% of the 2002 crash deaths occurred to occupants of motorcycles. In states with no requirements for helmet use, 10% of all crash deaths occurred to occupants of motorcycles.[4]

As of January 1, 2004, Georgia, along with eighteen other states and the District of Columbia, requires both drivers and passengers to wear motorcycle helmets. Thirty-one states have no helmet requirements for adult riders of motorcycles. Twenty-eight of these states have requirements for riders who are under age 20, 18, or 17. Colorado, Illinois, and Iowa have no helmet use laws. (Table 12.)

Independent research in Kentucky, Arkansas, California, Texas, Illinois, and Florida document the following health and economic outcomes of helmet non-use:

1. Drivers who fail to wear helmets are more likely to suffer traumatic brain injuries, severe head injuries, and higher acute care hospital charges.[5]

2. Following repeal of the Arkansas helmet law, there was a disproportionately higher hospital admission rate for non-helmeted motorcycle crash survivors.[6]

3. There was a significant increase in the number and severity of brain injuries admitted to trauma centers following repeal of the Florida motorcycle helmet law.[7]

4. California's use law covering all riders took effect January 1, 1992. Helmet use jumped to 99 percent from about 50 percent prior to the law. During the same period, the number of motorcycle fatalities decreased 38 percent to 327 in 1992 from 523 in 1991.[8]

5. Regardless of the equalizer used (population, motorcycle registrations, vehicle miles traveled, or motorcycle crashes), states with full helmet-use laws have consistently lower head injury death rates than states without such laws.[9]

Eleven out of twelve studies cited in a NHTSA report on medical cost of motorcycle crashes by helmet use found significantly higher costs associated with non-use.[10] A study at the University Hospital in Louisville, Kentucky calculated that motorcyclists who fail to wear helmets were more than four times as likely to suffer severe brain injuries as those who used helmets. [11] Motorcyclists without helmets who were treated at the hospital between 1995 and 2000 had acute-care charges totaling over $1.97 million, not including physicians' fees, rehabilitation and lost time from work.

Trends in Texas and Florida

To estimate the potential impact of helmet law repeal on motorcycle crash deaths, trends in Texas and Florida were studied. The Texas law was repealed in 1997 and the Florida law was repealed in 2000.

Texas

On September 1, 1997 the Texas helmet law repeal was enacted. Motorcycle-related crash deaths were examined to compare pre-helmet and post-helmet trends. Since the 1997 repeal of the helmet law, Texas has experienced a 10.14% increase in the number of motorcycle licenses issued, a 79.5% increase in motorcycle registrations and a 111.1% increase in total motorcycle-related fatalities. This result was a net increase of 17.6% in the fatality rate per 100,000 registered motorcycles, (Table 1.)

|Table 1: Post-repeal Changes in Texas Motorcycle Trends (1997-2002) |

| |

|Category |1997 |1998 |1999 |2000 |2001 |2002 |% Change |

| | | | | | | |(1997-2002) |

|Total Licenses |606,834 |615,539 |623,690 |629,663 |642,637 |668,106 |10.1% |

|New Licenses Issued (per year) |21,000 |22,798 |19,590 |24,024 |30,134 |32,157 |53.1% |

|Total Registrations |127,623 |143,962 |162,267 |180,345 |207,403 |229,057 |79.5% |

|Motorcycle Fatalities |117 |152 |182 |229 |243 |247 |111.1% |

|Fatality Rate (per 100K registered bikes) |91.68 |105.58 |112.16 |126.98 |117.16 |107.83 |17.6% |

As expected, helmet use in Texas declined sharply after the 1997 repeal. Chart 3 and Table 2 reveal that the growth in deaths was due entirely to a marked increase in the deaths of un-helmeted motorcyclists following helmet law repeal.

|Year |Table 2: Helmet Use in Fatal Texas Motorcycle Crashes |Total |

| |Used |Not Used |Unknown | |

| |Number |Percent |Number |Percent |Number |Percent |Number |

|1996 |89 |77.4 |26 |22.6 |0 |- |115 |

|1997 |74 |63.2 |39 |33.3 |4 |3.4 |117 |

|1998 |54 |35.5 |92 |60.5 |6 |3.9 |152 |

|1999 |64 |35.2 |113 |62.1 |5 |2.7 |182 |

|2000 |73 |31.9 |153 |66.8 |3 |1.3 |229 |

|2001 |71 |29.2 |166 |68.3 |6 |2.5 |243 |

|2002 |74 |30 |171 |69.2 |2 |0.8 |247 |

When 1996 and 2002 motorcycle-related deaths in Texas are compared, there was a 17% decrease in deaths occurring to helmeted cyclists, and a 558% increase in deaths occurring to un-helmeted motorcyclists. (Table 3.)

Table 3: Five Year Comparison

|Year |Helmet |

| |Used |Not Used |

|1996 |89 |26 |

|2002 |74 |171 |

|% Change |-17% |558% |

Florida

On July 1, 2000, Florida became the 30th state to repeal mandatory motorcycle helmet laws. Since the repeal of the helmet law, Florida has experienced an estimated 4% increase in motorcycle registrations and a 21% increase in total motorcycle-related fatalities. This result was a net increase of 15% in the fatality rate per 100,000 registered motorcycles, (Table 4.)

Table 4: Post-repeal Changes in Florida Motorcycle Trends (2001-2002)

|Category |2000 |2001 |2002*** |% Change |

| | | | |(2000 - 2002)|

|Total Registrations |299,424 |305,412 |311,520 |4% |

|Motorcycle Fatalities |227 |252 |274 |21% |

|Fatality Rate (per 100K registered bikes) |75.81 |82.51 |87.96 |16% |

***2002 estimated registrations from the Florida DMV

Chart 4 and Table 5 illustrate that following the 2000 repeal of the helmet law, deaths occurring to un-helmeted Florida motorcyclists increased dramatically while deaths to helmeted occupants declined.

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|Year |Table 5: Helmet Use in Fatal Florida Motorcycle Crashes |Total |

| |Used |Not Used |Unknown | |

| |Number |Percent |Number |Percent |Number |Percent |Number |

|1996 |136 |85 |23 |14.4 |1 |0.6 |160 |

|1997 |156 |84.8 |28 |15.2 |0 |- |184 |

|1998 |160 |87.4 |22 |12 |1 |0.5 |183 |

|1999 |155 |87.1 |22 |12.4 |1 |0.6 |178 |

|2000 |182 |70.3 |77 |29.7 |0 |- |259 |

|2001 |123 |42.9 |163 |56.8 |1 |0.3 |287 |

|2002 |107 |33.5 |212 |66.5 |0 |- |319 |

While Florida’s helmet law requires motorcyclists under the age of 20 to wear helmets, persons in this age group are increasingly violating the law, as evidenced by the number of citations issued. Following the helmet law repeal, Florida experienced a 35% increase in year 2000 and a 20% increase in year 2001 citations issued for non-use of helmets among riders under age 20 (Table 5).

|Table 6: Percent Increases in Citations Issued for Helmet Non-Use in Florida |

|1997 |1998 |1999 |2000 |2001 |

|Number |% change |

| |Used |Not Used |

|1999 |155 |22 |

|2002 |107 |212 |

|% Change |-31% |864% |

Georgia

From 1994 through 2002, Georgia motorcycle-related deaths increased by 55%. During this same period, the number of registered motorcycles increased by 77%. Georgia’s rate of deaths relative to motorcycle registrations actually declined somewhat during this time period. Table 8 compares deaths occurring to Georgia motorcyclists based on helmet use and non-use over the past eight years.

|Year |Table 8: Helmet Use in Fatal Georgia Motorcycle Crashes |Total |

| |Used |Not Used |Unknown | |

| |Number |Percent |Number |Percent |Number |Percent |Number |

|1994 |37 |67.3 |14 |25.5 |4 |7.3 |55 |

|1996 |40 |85.1 |4 |8.5 |3 |6.4 |47 |

|1997 |44 |78.6 |12 |21.4 |0 |- |56 |

|1998 |58 |87.9 |7 |10.6 |1 |1.5 |66 |

|1999 |47 |79.7 |11 |18.6 |1 |1.7 |59 |

|2000 |52 |85.2 |8 |13.1 |1 |1.6 |61 |

|2001 |76 |80 |18 |18.9 |1 |1.1 |95 |

|2002 |72 |84.7 |11 |12.9 |2 |2.4 |85 |

Chart 5 illustrates changes in crash deaths occurring to Georgia motorcyclists between 1994 and 2002. The increase that occurred between 2000 and 2001 was largely due to un-helmeted riders who experienced a 125% increase (from 8 to 18) compared to helmeted drivers who experienced a 46% increase.

Trends in Georgia Motorcycle Registrations

In the past decade, Georgia motorcycle registrations climbed from 61,674 in 1992 to 109,174 in 2002, an increase of 77%. (Table 6.)

During this same period, motorcycle related crash deaths increased from 55 to 85, a gain of 55%.

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The motorcycle crash death rate per 100,000 registered vehicles went from 89.2 in 1992 to 77.9 in 2002, a net decrease of 13%.

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Table 9: Ten Year Georgia Motorcycle Trends

|Category |1992 |1993 |1994 |1995 |1996 |1997 |1998 |2000 |2001 |2002 |

|Registered Motorcycle |

|Motorcycles |Passenger Cars |

|Registration State |% of |Registration State |% of |

| |Total | |Total |

|Alabama |2% |Alabama |2% |

|Florida |1% |Arkansas |0% |

|Georgia |67% |California |0% |

|Mississippi |1% |Colorado |0% |

|New York |1% |Florida |2% |

|North Carolina |1% |Georgia |82% |

|South Carolina |2% |Illinois |0% |

|No Registration |22% |Indiana |0% |

|Unknown |1% |Michigan |0% |

|Total |100% |Mississippi |1% |

|  | |New Jersey |0% |

|  | |New York |0% |

|  | |North Carolina |1% |

|  | |Ohio |0% |

|  | |Pennsylvania |0% |

|  | |South Carolina |1% |

|  | |Tennessee |0% |

|  | |Texas |0% |

|  | |Virginia |0% |

|  | |No Registration |8% |

|  | |Unknown |0% |

|  |  |Total |100% |

Economic Cost of Helmet Non-use

Research documents that motorcycle-related crash injuries and deaths are extremely costly.[12] These costs include acute and long-term medical, short-term work loss, long-term disability, and lost quality of life. A study of impaired driving in Georgia concluded “wearing a motorcycle helmet in Georgia reduces a rider’s risk of death by 29% and nonfatal injury risk by 15%. On average, a helmet costs about $220 in Georgia and prevents nearly $3,700 in injury costs [per injury].”[13] These figures represent 1998 data. Another study reviewed 25 motorcycle safety studies and found that helmet use significantly reduced the cost of medical treatment, the length of hospital stay, the need for special medical treatments, and the probability of long-term disability.[14] Table 11 illustrates the results of four independent studies that compared the average costs of hospital charges by the status of head injury. Each study documents a significantly lower cost when no head injury was involved.

Table 11: Average Hospital Charges per Case by Head Injury Status

|  |Head Injury |No Head Injury |Ratio |

|Trauma Center-Admitted |

|   Orsay & al. [15] |$43,214 |$15,528 |2.78 |

|Hospital-Admitted |

|   Bried & al.[16] |$21,945 |$11,941 |1.84 |

|   Max & al.[17] |$18,527 |$10,350 |1.79 |

|   NHTSA [18] |$27,000 |$12,000 |2.25 |

Probable Outcome of Georgia Helmet Law Repeal

According to the University of Georgia Survey Research Center, in 2003 Georgia motorcyclists wore helmets at a rate of 96%. In all states where helmet laws have been repealed, there has been a dramatic drop in helmet usage and an immediate increase in fatalities. By examining trends following helmet law repeals in Texas and Florida, it is possible to determine the probable impact of repeal in Georgia. Using two years of death data for pre- and post- law repeals, Texas experienced a 37% increase in motorcycle-related deaths and Florida experienced a 49% increase. If Georgia’s law were repealed in 2004, using Georgia’s pre-repeal average of 88.5 deaths and using trends in Texas and Florida as predictors, the Georgia two-year post-repeal average number of motorcycle-related crash deaths could range from a low of 121 to a high of 132, or an additional 32.5 to 43.5 deaths per year attributable to repeal.

Table 12: Predicted Fatality Outcome of Georgia Helmet Law Repeal

|STATE |Pre-Law |Post-Law |% Change |

| |Fatality Mean|Fatality Mean| |

| |(2-years) |(2-years) | |

|TEXAS |118 |161.5 |37% |

|FLORIDA |183 |272 |49% |

|GEORGIA* |88.5 |121 |37% |

|GEORGIA** |88.5 |132 |49% |

*Texas model

**Florida model

In the two years following repeal of their state helmet laws, helmet non-use among motorcyclists in fatal crashes increased by 252% in Texas and 380% in Florida. Using these states’ trends as predictors, annual fatalities involving motorcyclists not wearing helmets in Georgia would jump from 14.5 to as many as 69.6 in the first two years following repeal of Georgia’s helmet law (See Table 13).

Table 13: Predicted Fatalities Among Non-Helmeted Motorcyclists

|STATE |Pre-Law |Post-Law |% Change |

| |Helmet |Helmet | |

| |Non-Use in |Non-use in | |

| |Fatal Crashes|Fatal Crashes| |

|TEXAS |29 |102 |252% |

|FLORIDA |25 |120 |380% |

|GEORGIA1 |14.5 |51 |252%* |

|GEORGIA2 |14.5 |69.6 |380%* |

1Texas model

2Florida model

*Predicted

The dotted line in Chart 14 uses the Florida model to illustrates the dramatic increase in the number of deaths that would probably occur if Georgia’s helmet law were repealed.

Limitations

1. These analyses focused on motorcycle-related fatalities. Other outcomes of motorcycle crashes include nonfatal, but disabling brain injuries, hospitalizations, rehabilitation, and related costs. Data from other states documents that each of these would increase as well.

2. Helmet use as reported does not include the number of novelty helmets which do little to provide the needed head protection. In the absence of a defined statewide standard for protective headgear, there is evidence that more cyclists are opting to wear flimsy lightweight helmets that do not provide a basic level of protection. Without conducting a formal study, it is impossible to measure the prevalence or impact of this practice on death and injury rates in Georgia.

Conclusions

The data since 1992 shows that with Georgia’s mandatory helmet use law, percentage growth in motorcycle-related deaths at 55% is substantially lower than percentage growth in motorcycle registrations at 77%. In contrast, while experiencing similar growths in motorcycle registrations, Texas experienced a 5-year post-repeal growth in deaths in excess of 111%. Florida experienced a 2-year post-repeal growth in deaths of 21%. Were Georgia to repeal its mandatory helmet law, Georgia’s motorcycle death numbers would increase by 37% to 49%, or an additional 32 to 45 deaths per year during the two years following repeal.

Table 14: Helmet Laws in 50 States and Washington D.C.

|State Helmet Use Laws State |Motorcycle Riders |Bicycle Riders |

| |Covered by Helmet Law |Covered by Helmet Law |

|Alabama |all riders |riders younger than 16 |

|Alaska |17 yrs. and younger1 |no law |

|Arizona |17 yrs. and younger |no law |

|Arkansas |20 yrs. and younger |no law |

|California |all riders |riders younger than 18 |

|Colorado |no helmet use laws |

|Connecticut |17 yrs. and younger |riders younger than 16 |

|Delaware |18 yrs. and younger |riders younger than 16 |

|District of Columbia |all riders |riders younger than 16  |

|Florida |20 yrs. and younger2 |riders younger than 16 |

|Georgia |all riders |riders younger than 16 |

|Hawaii |17 yrs. and younger |riders younger than 16 |

|Idaho |17 yrs. and younger |no law  |

|Illinois |  no helmet use laws |

|Indiana |17 yrs. and younger |no law |

|Iowa |  no helmet use laws |

|Kansas |17 yrs. and younger |no law |

|Kentucky |20 yrs. and younger2,3 |no law |

|Louisiana |17 yrs. and younger2 |riders younger than 12 |

|Maine |14 yrs. and younger4 |riders younger than 16 |

|Maryland |all riders |riders younger than 16 |

|Massachusetts |all riders |riders older than 1 and younger than 135 |

|Michigan |all riders |no law |

|Minnesota |17 yrs. and younger3 |no law |

|Mississippi |all riders |no law |

|Missouri |all riders |no law |

|Montana |17 yrs. and younger |no law |

|Nebraska |all riders |no law |

|Nevada |all riders |no law |

|New Hampshire |17 yrs. and younger |no law |

|New Jersey |all riders |riders younger than 14 |

|New Mexico |17 yrs. and younger |no law |

|New York |all riders |riders older than 1 and younger than 145 |

|North Carolina |all riders |riders younger than 16 |

|North Dakota |17 yrs. and younger6 |no law |

|Ohio |17 yrs. and younger7 |no law |

|Oklahoma |17 yrs. and younger |no law |

|Oregon |all riders |riders younger than 16 |

|Pennsylvania |20 yrs. and younger8 (eff. 09/04/03) |riders younger than 12 |

|Rhode Island |20 yrs. and younger8 |riders younger than 16 |

|South Carolina |20 yrs. and younger |no law |

|South Dakota |17 yrs. and younger |no law |

|Tennessee |all riders |riders younger than 16 |

|Texas |20 yrs. and younger2 |no law |

|Utah |17 yrs. and younger |no law |

|Vermont |all riders |no law |

|Virginia |all riders |no law |

|Washington |all riders |no law |

|West Virginia |all riders |riders younger than 15 |

|Wisconsin |17 yrs. and younger3 |no law |

|Wyoming |18 yrs. and younger |no law |

1Alaska's motorcycle helmet use law covers passengers of all ages, drivers younger than 18, and drivers with instructional permits.

2Florida, Kentucky, Louisiana, and Texas provide exceptions for riders over a certain age. In Florida and Kentucky, the law requires that all riders younger than 21 yrs. wear helmets, without exception. In Florida, those 21 yrs. and older may ride without helmets only if they can show proof that they are covered by a medical insurance policy. Louisiana's law allows riders 18 yrs. and older to ride without helmets if they can show proof that they are covered by a medical insurance policy. Texas exempts riders 21 yrs. or older if they either 1) can show proof of successfully completing a motorcycle operator training and safety course or 2) can show proof of having a medical insurance policy.

3Motorcycle helmet laws in Kentucky, Minnesota, and Wisconsin also cover drivers with instructional/learner's permits.

4Maine's motorcycle helmet use law covers passengers 14 years and younger, drivers with learner's permits, and passengers if their drivers are required to wear a helmet.

5Bicycle helmet use laws in Massachusetts and New York prohibit people from transporting passengers younger than age 1.

6North Dakota's motorcycle helmet use law covers all passengers traveling with drivers who are covered by the law.

7Ohio's motorcycle helmet use law covers all drivers during the first year of licensure and all passengers of drivers who are covered by the law

8Rhode Island's motorcycle helmet use law covers all drivers during the first year of licensure and all passengers. Pennsylvania's motorcycle helmet use law covers all drivers during the first two years of licensure unless the driver has completed the safety course approved by the department or the Motorcycle Safety Foundation.

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[1] National Highway Traffic Safety Administration, State Legislative Fact Sheets; Motorcycle Helmet Use Law, January 2001.

[2] Branas C.C., Knudson M.M. “State helmet laws and motorcycle rider death rates.” LDI Issue Brief. September 7, 2001; (1): 1-4.

[3] Ibid

[4] 2002 Fatalities Analysis Reporting System. National Highway Traffic Safety Administration. U. S. Department of Transportation. 2002.

[5] Christian W.J., et al. “Motorcycle helmets and head injuries in Kentucky.” 1995-2000. Journal of the Kentucky Medical Association. January 2003; 101 (1): 21-6.

[6] Bledsoe G.H., et al “The negative impact of the repeal of the Arkansas motorcycle helmet law.” Journal of Trauma. December 2002; 53(6):1078-86.

[7] Hotz, G.A., et al “The impact of a repealed motorcycle helmet law in Miami-Dade County.” Journal of Trauma. March 2002; 52(3): 469-74.

[8] Kraus J.F., et al “The effect of the 1992 California motorcycle helmet use law on motorcycle crash fatalities and injuries.” Journal of the American Medical Association. November 16, 1994; 272: (19) 1506-11.

[9] Sosin D.M., Sacks, J.J., “Motorcycle helmet-use laws and head injury prevention.” Journal of the American Medical Association. March 25, 1992; 265 (12): 1649-51.

[10] NHTSA “Cost of injuries resulting from motorcycle crashes: A Literature Review” U.S. Department of Transportation September 2002; 242: 1-15.

[11] Carroll, J. The Louisville Courier Journal, October 30, 2003

[12] Hartunian, N.S.; Smart, C.N.; Willemain, T.R.; and Zador, P.L. 1983. The economics of safety deregulation: lives and dollars lost due to repeal of motorcycle helmet laws. Journal of Health Politics, Policy, and Law 8:76-98.

[13] “The Cost of Impaired Driving.” Pacific Institute for Research and Evaluation, Calverton, Maryland

[14] “Costs of Injuries Resulting from Motorcycle Crashes: A Literature Review.” U. S. Department of Transportation DOT HS 809 242, November 2002.

[15] Orsay, E., Holden, J.A., Williams, J., & Lumpkin, J.R. (1995). Motorcycle trauma in the state of Illinois: Analysis of the Illinois Department of Public Health Trauma Registry. Annals of Emergency Medicine, 26(4), 455-460.

[16] Bried, J.M., Cordasco, F.A., & Volz, R.G. (1987). Medical and economic parameters of motorcycle-induced trauma. Clinical Orthopedics and Related Research, 233, 252-256.

[17] Max, W., Stark, B., & Root, S. (1998). Putting a lid on injury costs: The economic impact of the California motorcycle helmet law. Journal of Trauma, Injury, Infection, and Critical Care, 45(3), 550-556.

[18] National Highway Traffic Safety Administration. (1998). Further Analysis of Motorcycle Helmet Effectiveness Using CODES Linked Data. (Research Note). Washington, DC: U.S. Department of Transportation.

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