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Like many low- and middle-income countries, Nepal is experiencing a massive motorization, predominantly from increased use of motorcycles which is driving a surge in road-related injuries and fatalities. Motorcycles and their riders have been identified as a focal point for road traffic injury prevention measures. While helmet use is mandatory for both motorcycle drivers and passengers, fines for helmet non-use are only levied on drivers, not on passengers, and it is unclear how this unequal enforcement translates to helmet use rates in Nepal. Hence, a video-based observation on motorcyclists’ helmet use was conducted alongside a questionnaire survey on fatalism, perceived police enforcement, risk-taking personality, and perceived usefulness of helmets. For the observation and questionnaire survey, seven rural and urban sites were selected from all seven provinces of Nepal, representing varied populations …