Association for Academic Surgery Survey of helmet influences of female pillions in New Delhi Selma Siddiqui, MD, a Sumant Arora, MBBS, b John Peipert, MA, c Sushma Sagar, MBBS, d Marie Crandall, MD, MPH, FACS, a and Mamta Swaroop, MD, FACS a, * a Northwestern University, Feinberg School of Medicine, Chicago, Illinois b Government Medical College, School of Medicine, Chandigarh, India c Division of General Medical Sciences, Washington University in St. Louis, St. Louis, Missouri d Department of Surgery, All India Institute of Medical Sciences, New Delhi, India article info Article history: Received 15 January 2013 Received in revised form 24 May 2013 Accepted 30 May 2013 Available online 22 June 2013 Keywords: Helmet use Pillion riders Motorized-two-wheeler 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. Materials and methods: A cross-section of female pillion riders in five areas of New Delhi were approached by trained surveyors. Surveys were self-completed (n ¼ 52) or completed with assistance (n ¼ 243). Demographics, helmet use habits, opinions, and media influence data were collected. Data were analyzed using c 2 , Fisher exact test, and multivariable logistic regression. Results: Of 305 women surveyed, 69.8% were Hindus (n ¼ 213), 10.8% Muslims (n ¼ 33), and 10.4% Sikhs (n ¼ 32). More Muslim (33.3%, P ¼ 0.001) and Sikh (25%, P ¼ 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 ¼ 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. ª 2013 Elsevier Inc. All rights reserved. 1. Introduction With the addition of a motor to the bicycle in the late 19th century, the motorized two-wheeler (MTW) arrived, followed swiftly by the mandatory helmet use debate. In the United States, despite evidence of morbidity and mortality benefits of helmets, the legal infringement of mandatory helmet laws on individual rights led to repeal or reduction in 27 of the initial * Corresponding author. Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair, Suite 650, Chicago, IL 60611. Tel.: þ1 312 695 4835; fax: þ1 312 695 3644. E-mail address: mamta.swaroop@gmail.com (M. Swaroop). Available online at www.sciencedirect.com journal homepage: www.JournalofSurgicalResearch.com journal of surgical research 184 (2013) 404 e410 0022-4804/$ e see front matter ª 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2013.05.103