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Abstract: Background: In India, motorized two-wheeler (MTW) road traffic accidents injure or kill 72,000 women annually. Before the Motor Vehicle Act of 1988, which required mandatory helmet use for MTW riders, a study found 0.6% of all MTW pillions (backseat passengers) were helmeted. Citing religious protests to the legislation, Delhi's high court exempted the city's 12 million women from the law. We hypothesize that currently male pillions use helmets more frequently than females, and that overall pillion helmet usage has increased over the last 20 y. Methods: Continuous video was recorded in half-hour blocks at four locations in Delhi on separate days, totaling 8 hours of high- and low-volume traffic. Videos were reviewed with at least two reviewers extracting the number of MTW pillions, as well as their gender, approximate age, and helmet usage. Results: Of 4010 pillions identified, 63.8% were male, 32.4% female, and 3.3% children. Among males, there were significantly more helmeted pillions (88.4%, P < 0.001); among females, there were significantly more unhelmeted pillions (99.4%, P < 0.001). Among unhelmeted pillions, significantly more were female (81.4%) than male (P < 0.001). Current overall pillion helmet use is significantly higher than historical rate (P < 0.001). Conclusions: The significantly higher male pillion helmet usage compared with females indicates Delhi's helmet law is associated with increased compliance among those who fall under its jurisdiction. This augments the growing body of evidence that mandatory helmet laws are efficacious, thus repealing the exemption of women is an important step in increasing female pillion helmet usage. [Copyright &y& Elsevier]

Background Motorized two-wheelers (MTWs) such as scooters and motorcycles place drivers and passengers at significant risk of injury and death in the event of a road traffic accident. In India, where road traffic is poorly regulated and consists of vehicles ranging from semitrucks to animal carts, the MTW pillion rider (backseat passenger) is particularly vulnerable. Annually, approximately 140,000 Indians are injured or killed in MTW road traffic accidents. In 2011, the city of New Delhi renewed a mandatory helmet use exemption for its 8 million women. We sought to identify the patterns of injury among MTW pillion riders in the city of New Delhi, including differences between helmeted and unhelmeted male and female pillion riders. Methods All records of incoming trauma patients to the Jai Prakash Narayan Apex Trauma Center, New Delhi, were reviewed for the 23-mo period from April 1, 2009 until March 1, 2011. More than 3000 charts were reviewed selecting for patients who were MTW pillion riders involved in road traffic accidents. Data including Glasgow Coma Scale score, number of surgical procedures performed, length of stay, and demographic information were collected from charts that met the criteria. Fisher's exact test was used for categorical variables and Kruskal–Wallis test for continuous variables. Results A total of 466 charts of MTW pillions in road traffic accidents were identified with 108 helmeted males, 161 unhelmeted males, three helmeted females, and 194 unhelmeted females. Females, both unhelmeted and helmeted, were more likely to have head and neck injury than unhelmeted males or helmeted males (66.0% and 66.7% versus 53.4% and 27.8%, P < 0.001). Unhelmeted females were most likely to suffer inhospital mortality (17.6%, P = 0.008) and require intensive care unit admission (40.0%, P = 0.004). Unhelmeted pillions, both male and female, had significantly lower Glasgow Coma Scale scores than helmeted pillions (12.6 and 12.8 versus 13.8 and 15, P = 0.04). Conclusions Female pillions are more likely to have head and neck injury than male pillions, and unhelmeted pillions are more likely to have injuries resulting in their death. This firmly establishes the protective benefit of helmet use for pillions. Encouraging helmet use among all pillions may prevent a significant number of injuries and deaths, and mandatory helmet laws may decrease morbidity and mortality of MTW road traffic accidents for the women of New Delhi and all of India. [ABSTRACT FROM AUTHOR]

Abstract: Background: In India, female motorized two-wheeler users involved in road traffic accidents account for 70,000 injuries and fatalities annually. Despite federal helmet laws, New Delhi exempted female pillion riders (backseat passengers) from mandatory helmet usage in response to religious and cultural opposition. This study attempts to elucidate factors influencing female pillion riders' helmet usage, hypothesizing religious-based opposition and poor understanding of helmet efficacy. Materials and methods: A cross-section of female pillion riders in five areas of New Delhi were approached by trained surveyors. Surveys were self-completed (n = 52) or completed with assistance (n = 243). Demographics, helmet use habits, opinions, and media influence data were collected. Data were analyzed using χ2, Fisher exact test, and multivariable logistic regression. Results: Of 305 women surveyed, 69.8% were Hindus (n = 213), 10.8% Muslims (n = 33), and 10.4% Sikhs (n = 32). More Muslim (33.3%, P = 0.001) and Sikh (25%, P = 0.04) women opposed mandatory helmet use compared with Hindu women (10.6%). There were 66 women who self-reported helmet use, with one woman (Sikh) who abstained from helmets for religious practices (0.9%). The most common reason for helmet disuse was discomfort (n = 40, 36.7%). Most respondents reported media positively influenced helmet use (57.7%). Conclusions: Despite arguments of infringement on religious rights, women pillions ride without helmets for comfort and appearance purposes primarily. Furthermore, though significantly fewer Sikh and Muslim women support mandatory helmet laws, supporters remain a clear majority in both groups. Most women report media outlets as influential on helmet use, principally television, suggesting that mass media campaigns may improve helmet compliance. [Copyright &y& Elsevier]