OBJECTIVE To determine the relationship among helmet use, alcohol use, and ethnicity in people killed on motorcycles. METHODS Retrospective review of all motorcycle fatalities in New Mexico from 1984 through 1988. METHODS Office of the Medical Investigator, State of New Mexico. METHODS All decedents of motorcycle crashes in New Mexico from 1984 through 1988. METHODS Review of all autopsies, medical investigator reports, traffic fatality reports, and toxicological studies on fatally injured motorcyclists. RESULTS Nine of the helmeted drivers (18%) were legally intoxicated compared with 67 of the nonhelmeted drivers (51%) (chi 2 = 15.7, P less than .0001); 42 of the white nonHispanic decedents (37%), ten of Hispanic decedents (12%), and none of the Native-American decedents were wearing helmets. The head and neck region was the most severely injured body region in 42 of the nonhelmeted cases (84%) and in eight of the helmeted cases (50%) (Fisher's exact test, P less than .02). CONCLUSIONS There is an association between nonuse of helmets and alcohol intoxication in fatally injured motorcyclists in New Mexico. Strategies for preventing motorcycle fatalities should address alcohol abuse and ethnicity in conjunction with helmet use.