title: Survey of helmet influences of female pillions in New Delhi.
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.
  
  
  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 χ(2), 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.
authors.affiliation: Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
authors.forename: Selma
authors.initials: S
authors.lastname: Siddiqui
authors.forename: Sumant
authors.initials: S
authors.lastname: Arora
authors.forename: John
authors.initials: J
authors.lastname: Peipert
authors.forename: Sushma
authors.initials: S
authors.lastname: Sagar
authors.forename: Marie
authors.initials: M
authors.lastname: Crandall
authors.forename: Mamta
authors.initials: M
authors.lastname: Swaroop
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D015438:Health Behavior / Q000208:ethnology*; D018596:Hinduism; D006801:Humans; D007194:India / Q000453:epidemiology; D007514:Islam; D016015:Logistic Models; D008875:Middle Aged; D009049:Motorcycles / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D014947:Wounds and Injuries / Q000208:ethnology / Q000517:prevention & control*; D055815:Young Adult
keywords: Helmet use; Motorized-two-wheeler; Pillion riders