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BACKGROUND: Helmets significantly decrease morbidity and mortality from motorcycle crashes.  Many areas of the world lack universal helmet laws.  To educate motorcyclists in areas without helmet laws, more knowledge of motorcyclists belief systems are needed.  
METHODS: A 29-question, web-based survey was designed to assess motorcyclists attitudes, norms and behaviors towards helmets in a state with a limited helmet law. Survey invitations were mailed to 2006-2008 registrants for the states required motorcycle safety course. 
RESULTS: 414 surveys were completed; 68.4% of respondents reported always wearing a helmet.  Compared with always-helmeted (AH), non-helmeted (NH)respondents were more likely to be male, less educated, and reporting previous crashes.  The strongest correlates of being NH (v. AH) were attitudes that helmets were not protective (6.7% v. 0.4%, p<0.001) and impaired sight/hearing (45.2% v. 3.8%, p<0.001); and normative beliefs that they'd only wear helmets if forced by law (43.9% v. 7.1%, p<0.001). Both groups felt crashes were serious and unavoidable.  Overall, helmet use correlated more closely with attitudes than with norms.
CONCLUSIONS:  Among respondents to this web-based survey, attitudes -- especially whether helmets protect from injury and impair sight/hearing -- were strong correlates of motorcycle helmet use. Because attitudes are often more easily changed than norms, education may increase helmet use.  However, legislation may be a more efficient route, as 44% of non-helmeted said they would only wear a helmet if forced by law.

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