title: Helmet use among motorcyclists in Cambodia: a survey of use, knowledge, attitudes, and practices.
abstract: OBJECTIVE
  Road traffic injuries (RTIs) are a leading cause of disability and fatality globally. Motorcycle-related injuries, mainly head injuries, and related deaths and disabilities are a significant contributor to the burden of disease in low- and middle-income countries (LMICs). Helmets have been proven to be an effective way to reduce the risk of head injury. As motorcycle use continually increases in Cambodia, head injuries and related deaths and disabilities are expected to rise. This article aims to assess the current status of helmet use in Cambodia, as well as the knowledge, attitudes, and practices among motorcyclists, in order to assist with better planning and implementation of injury prevention strategies.
  
  
  METHODS
  Two separate methodologies were employed for this study. Helmet observations were conducted in Phnom Penh, Kandal, Kampong Speu, Siem Reap, and Kampong Cham to assess the current status of helmet use during the day and at night. Roadside knowledge, attitudes, and practice (KAP) interviews were also conducted in Phnom Penh, Kandal, and Kampong Speu to determine the prevailing beliefs around helmet use in Cambodia.
  
  
  RESULTS
  Based on observations, the proportion of helmet wearing across all study sites was 25 percent at night and 43 percent during the day among all motorcyclists. The observed proportion was up to 10 times higher among drivers compared to passengers. The top 3 reasons for always wearing a helmet were lifesaving potential, legal duty, and police fines. Almost 60 percent of respondents said that their use or nonuse of a helmet depended on where they were driving. Helmet quality, price, style, and color were important factors influencing the decision to purchase a helmet.
  
  
  CONCLUSIONS
  A paradox appears to exist in Cambodia; though awareness of the benefits of wearing a helmet is high, actual helmet use remains low in the country. Daytime usage is higher than nighttime, and these proportions are significantly higher among drivers compared to passengers. There is a continuing need to improve the proportion of all-day helmet wearing, especially at night and among motorcycle passengers in Cambodia.
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. abachani@jhsph.edu
authors.forename: Abdulgafoor M
authors.initials: AM
authors.lastname: Bachani
authors.forename: Nhan T
authors.initials: NT
authors.lastname: Tran
authors.forename: Socheata
authors.initials: S
authors.lastname: Sann
authors.forename: Michael F
authors.initials: MF
authors.lastname: Ballesteros
authors.forename: Chandara
authors.initials: C
authors.lastname: Gnim
authors.forename: Amra
authors.initials: A
authors.lastname: Ou
authors.forename: Panhavuth
authors.initials: P
authors.lastname: Sem
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Nie
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
mesh_terms: D000293:Adolescent; D000328:Adult; D002160:Cambodia; D006259:Craniocerebral Trauma / Q000517:prevention & control*; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009049:Motorcycles; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult