title: A comparison of observed and self-reported helmet use and associated factors among motorcyclists in Hyderabad city, India.
abstract: OBJECTIVE
  India has a high burden of fatal road traffic injuries (RTIs). A large proportion of fatal RTIs in India are among motorcyclists. The overall goal of this study is to assess and compare observed and self-reported prevalence of helmet use; and to identify factors associated with helmet use and over-reporting in Hyderabad city, India.
  
  
  METHODS
  Roadside knowledge, attitude and practice interviews.
  
  
  METHODS
  Six rounds of roadside interviews were conducted with motorcyclists (drivers and pillion riders) between July 2011 and August 2013 using a structured tool developed for this study. Observations on helmet use were recorded and respondents were also asked if they 'always wear a helmet'. Prevalence of helmet use was calculated and a paired t-test was used to compare observed and self-reported helmet use proportions. Unadjusted and adjusted odds ratios were calculated to identify factors associated with helmet use and over-reporting.
  
  
  RESULTS
  A total of 4872 respondents participated in the roadside interview. The response rate was 94.4%. The overall observed helmet use was 34.5% and 44.5% of respondents reported that they 'always wear a helmet'. As the observed helmet use increased, the over-reporting of helmet use was found to decrease. However, factors associated with observed and self-reported helmet use are similar. Male gender, youth (≤24 years), a lower level of education and non-ownership of helmet were associated with a higher risk of not wearing helmets. Male gender, youth (≤24 years), no schooling, riding a lower engine capacity motorcycle and using a motorcycle for purposes other than travelling to school/work were associated with over-reporting of helmet use.
  
  
  CONCLUSIONS
  Self-reports provide an overestimate of helmet use that lessens as actual helmet use increases. Interviews also allow identification of factors associated with helmet use. Increasing helmet ownership and enhanced enforcement may help increase helmet use.
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Department of International Heath, 615 N. Wolfe Street, Suite E8132, Baltimore, MD 21205, USA. Electronic address: swadhwa2@jhu.edu.
authors.forename: S
authors.initials: S
authors.lastname: Wadhwaniya
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Department of International Heath, 615 N. Wolfe Street, Suite E8132, Baltimore, MD 21205, USA.
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Indian Institute of Technology Kharagpur, Department of Civil Engineering, Kharagpur, West Bengal 721302, India.
authors.forename: S
authors.initials: S
authors.lastname: Mitra
authors.affiliation: Indian Institute of Public Health, Hyderabad, Plot #1, A N V Arcade, Amar Co-operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India.
authors.forename: S
authors.initials: S
authors.lastname: Tetali
authors.affiliation: Indian Institute of Public Health, Hyderabad, Plot #1, A N V Arcade, Amar Co-operative Society, Kavuri Hills, Madhapur, Hyderabad 500033, India.
authors.forename: L K
authors.initials: LK
authors.lastname: Josyula
authors.affiliation: National Institute of Mental Health and Neuro Sciences, Department of Epidemiology, Hosur Road, Bangalore 560029, India.
authors.forename: G
authors.initials: G
authors.lastname: Gururaj
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Department of International Heath, 615 N. Wolfe Street, Suite E8132, Baltimore, MD 21205, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Hyder
mesh_terms: D000056:Accident Prevention; D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D001290:Attitude; D002947:Cities; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D009049:Motorcycles; D010067:Ownership; D015995:Prevalence; D012574:Schools; D057566:Self Report; D011795:Surveys and Questionnaires; D014195:Travel; D014505:Urban Population / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000517:prevention & control*; D055815:Young Adult
keywords: Helmet; India; Injuries; Road safety; Road traffic; Self-report