Identifying psychological and socio-economic factors affecting motorcycle helmet use

•We modeled helmet use based on interviews in motorcycle repair-shops.•Discrete choice modeling was able to predict helmet use an inconsistent behavior.•Despite of high rate of helmet ownership, helmet use rate is low in Mashhad.•Norms, tendency to use a helmet and risky traffic behavior affect helmet use.•Perception of enforcement on helmet use does not reliably affect helmet use.

Sixty percent of motorcyclist fatalities in traffic accidents of Iran are due to head injuries, but helmet use is low, despite it being a legal requirement. This study used face-to-face interviews to investigate the factors associated with helmet use among motorcycle riders in Mashhad city, the second largest city in Iran. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were used for data reduction and identification of consistent features of the data. Ordered and multinomial logit analyses were used to quantify the influences on helmet use and non-use.The data show that 47% of the sample used a helmet, but a substantial proportion of these did not wear their helmet properly. In addition, 5% of motorcyclists believed that helmets reduced their safety. Norms, attitudes toward helmet use, risky traffic behavior and awareness of traffic rules were found to be the key determinants of helmet use, but perceptions of enforcement lacked influence. Duration of daily motorcycle trips, riding experience and type of job also affected helmet use. Results indicate that motorcyclist training, safety courses for offending motorcyclists and social programs to improve social norms and attitudes regarding helmet use are warranted, as are more effective law enforcement techniques, in order to increase proper use of helmets in Iranian motorcyclists. In addition, special safety courses should be considered for motorcyclists who have committed traffic violations.