Impact of safe community program on motorcyclists' safety with focus on helmet usage in 14 cities of IR Iran.

The aim of this study was to evaluate the effectiveness of safe community interventions on motorcyclists' safety. Two cross sectional observations were conducted in 14 cities (five safe community practicing and nine safe community non-practicing cities) independently on 2005 and 2007. Ten percent of registered motorcycles were observed and interviewed (n=1114 in each observation). 87.9% used motorcycle for commercial purposes. All motorcyclists were male and mostly aged 18-29 years old. Death rate significantly rose from 122 to 254 per 100000 motorcyclists in Fars province since the first observation (p < 0.0001). Helmet usage rate was constant (13%). Recorded crashes increased from 16.4% to 23.1% in safe community setting (p < 0.0001). 11% carried more than one pillion. Heat disturbances, embarrassment, hearing blockage, and negligence were the most mentioned excuses for not using helmet. Law enforcement, public education, accessibility to helmets on discount rate, new legislation and, finally, access to new designed helmet were the most suggestions made by motorcyclists to promote helmet usage. No significant effect was noticed between two settings except in injury registration system in safe community. Community involvement in the safety programs could ensure sustainability of initiatives and continuity of interventions in safe communities.