Understanding on-road practices of electric bike riders: an observational study in a developed city of China

tAlthough millions of electric bikes (E-bikes) operate in China and many associated deaths and injurieshave been reported, E-bikers? on-road practices are poorly characterized and few direct observationalstudies have been performed. This study aims to describe riding behaviors among E-bikers and to inves-tigate factors influencing these practices to inform injury prevention. In March 2012, a cross-sectionalobservational study was conducted at 14 randomly selected intersections in Suzhou during a 7-day period.A pro-forma observation checklist was used to collect data on road riding practice. Adjusted Odds Ratios(OR) and 95 Confidence Intervals (CI) to assess the likelihood of specific riding practices among E-bikerswere evaluated using mixed-effects logistic regression. Among 18,150 E-bikers observed, 37.6 rode E-bikes with cycling pedals, 86.0 of E-bikes were registered, 26.6 did not comply with the road rules,and 41.1 wore at least one safety item. The overall prevalence of carrying passengers, riding in a motorvehicle lane, running red lights, riding in opposite directions (i.e., facing oncoming traffic), mobile phoneuse, and helmet use were 12.4 (95 CI: 11.9?12.9 ), 1.9 (95 CI: 1.7?2.1 ), 4.8 (95 CI: 4.5?5.1 ),3.4 (95 CI: 3.1?3.7 ), 0.4 (95 CI: 0.3?0.5 ), and 9.0 (95 CI: 8.5?9.4 ), respectively. Male E-bikerswas associated with increased helmet use and riding in motor vehicle lanes, whereas riding a registeredE-bike was associated with reduced likelihood of carrying passengers. This study demonstrates com-mon road rule violations and low helmet use among E-bikers and supports the urgent need to developadditional regulations and behavioral interventions to improve safety practice among E-bikers in China.