Effects of helmet laws and education campaigns on helmet use in young skiers Martin Burtscher MD PhD, Gerhard Ruedl PhD, Werner Nachbauer PhD M Burtscher, G Ruedl, W Nachbauer. Effects of helmet laws and education campaigns on helmet use in young skiers. Paediatr Child Health 2013;18(9):471-472. OBjECTIvE: Helmet-compulsory laws for young skiers, accompanied
by educational campaigns, have recently been implemented in several countries. However, data regarding compliance to these interventions during adolescence are scarce. METHODS: In 2011, a questionnaire survey was performed among 10- to 16-year-old students in 62 Austrian secondary schools. RESULTS: A total of 2655 questionnaires were completed by 1376 males and 1279 females. Helmet use was reported in 99% of 10- to 15-year-old skiers (for whom helmets are mandatory) and in 91% of 16-year-old skiers (for whom helmets are not mandatory). CONCLUSION: Compliance with helmet laws, which were accompanied by educational campaigns, was very high among adolescent skiers. Nevertheless, helmet use decreased slightly during adolescence, and this decrease was particularly pronounced when helmet use was no longer mandatory. Sophisticated multifaceted interventions may have the potential to increase the use of ski helmets among individuals who refuse to wear helmets. Key Words: Adolescence; Alpine skiing; Children; Education; Head
Les effets des lois sur le port du casque et des campagnes de sensibilisation sur l’utilisation du casque par les jeunes skieurs OBjECTIF : Des lois sur le port obligatoire du casque par les jeunes
skieurs, accompagnées de campagnes de sensibilisation, ont récemment été adoptées dans plusieurs pays. Cependant, il existe très peu de données sur l’adhésion à ces interventions pendant l’adolescence. MÉTHODOLOGIE : En 2011, les élèves de dix à 16 ans de 62 écoles secondaires autrichiennes ont rempli un sondage par questionnaire. RÉSULTATS : Au total, 1 376 garçons et 1 279 filles ont rempli un total de 2 655 questionnaires. Ainsi, 99 % des skieurs de dix à 15 ans (pour qui le port du casque est obligatoire) et 91 % des skieurs de 16 ans (pour qui le port du casque n’est pas obligatoire) ont déclaré porter un casque. CONCLUSION : L’adhésion aux lois sur le port du casque, accompagnée de campagnes de sensibilisation, était très élevée chez les skieurs adolescents. Néanmoins, le port du casque a diminué légèrement pendant l’adolescence, et cette diminution était particulièrement prononcée lorsque le port du casque n’était plus obligatoire. Des interventions pluridimensionnelles élaborées permettraient peut-être d’accroître l’utilisation du casque chez les personnes qui refusent de le porter.
injuries; Helmet law; Ski helmet
lpine skiing is the most popular winter sport, with a high participation rate among young people all over the world. Head injuries are the primary cause of skiing fatalities in children and adolescents (1). Helmet use is an important preventive measure and has been found to reduce the risk of head injuries by 35% (OR 0.66 [95% CI 0.55 to 0.79]) in the overall skier population, an effect that is even more pronounced in children younger than 13 years of age (OR 0.41 [95% CI 0.27 to 0.59]) (2). Consequently, helmet-compulsory laws for young skiers have been implemented in several countries, including most Austrian provinces, where the use of ski helmets has been mandatory for skiers younger than 16 years of age since 2009. Subsequently, in 2010, helmet use in skiers in this age group increased from 76% to 92% (3). However, the risk of head injury remained high among individuals who refused to use helmets. To further promote the use of ski helmets, advertising visuals featuring skiers regularly wearing helmets and television announcements made by famous alpine ski racers have been introduced. The present study aimed to evaluate the effects of helmet laws and ongoing helmet campaigns on helmet use in young skiers.
The Austrian Ski Federation initiated a nationwide questionnaire survey among 10- to 16-year-old students of 62 secondary schools. In 2011, participants of school ski courses were asked by their teachers to complete an anonymous questionnaire (100% return rate). The questionnaire included questions regarding age, body
mass, height, skiing experience, yearly skiing frequency, previous head injuries and current helmet use. The χ2 test was used to compare differences between frequencies. Logistic regression analysis was used to examine the association between these variables and helmet use.
A total of 2655 questionnaires were completed by 1376 males and 1279 females. Helmet use was reported by 99% of skiers between 10 and 15 years of age (for whom helmets are mandatory) but remained significantly lower (91%) among 16-year-old skiers (for whom helmets are not mandatory) (Figure 1). Consequently, height, body mass and skiing experience were higher in helmet nonusers. The monthly skiing frequency did not differ between groups. In addition, the number of reported previous head injuries were not different between helmet users and nonusers (4.9% versus 10.2%; P=0.19). The percentages of helmet nonusers increased with age, and this increase was especially pronounced among individuals 15 to 16 years of age, the cut-off age for mandatory helmet use (Figure 1). Logistic regression analysis revealed an independent association between male sex (OR 2.7 [95% CI 1.1 to 6.2]), increasing age (OR 1.7 [95% CI 1.4 to 2.1]) and helmet nonuse.
These data indicate that helmet use among skiers 15 years of age and younger increased to 99%, but remained significantly lower
Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria Correspondence: Dr Martin Burtscher, Department of Sport Science, Medical Section, University of Innsbruck, 6020 Innsbruck, Austria. Telephone 43-512-507-45896, fax 43-512-507-45998, e-mail [email protected]
Accepted for publication July 2, 2013
Paediatr Child Health Vol 18 No 9 November 2013
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10 Males Females
Helmet non-users (%)
9 8 7 6 5 4 3 2 1 0 10
Helmet not mandatory
Figure 1) Proportions of age- and sex-dependent helmet nonusers in a large cohort (n=2655) of skiers between 10 and 16 years of age among individuals older than 15 years of age. The sharp increase in helmet nonusers older than 15 years of age may be explained by the fact that helmet use was no longer mandatory in this age group, and education campaigns did not fully compensate for the lack of helmet laws. Nevertheless, education campaigns may have helped to ensure a relatively high proportion of helmet users among skiers older than 15 years of age. Some helmet nonusers may have begun using helmets after sustaining a head injury, which may explain why no difference was observed between helmet users and
nonusers with regard to previous head injuries. In addition, a small proportion of males younger than 16 years of age, increasing with age, refused to wear ski helmets despite the helmet law. Due to the considerable number of young skiers, one must not overlook this group, who are not wearing helmets and are, therefore, placing themselves at higher risk for head injuries (1,2). Increasing risk and ‘antiauthority’ behaviour is normal during adolescence (4) but may have serious consequences when falling or crashing on the ski slope. Future education programs should specifically focus on adolescent helmet nonusers (5). ACKNOWLEDGEMENTS: The authors thank Dr Renate Sommersacher and Mag. Thomas Woldrich from the Austrian Ski Federation, and all the teachers for their support. DISCLOSURE: The authors have no conflicts of interest to declare.
1. Xiang H, Stallones L, Smith GA. Downhill skiing injury fatalities among children. Inj Prev 2004;10:99-102. 2. Russell K, Christie J, Hagel BE. The effect of helmets on the risk of head and neck injuries among skiers and snowboarders: A meta-analysis. CMAJ 2010;182:333-40. 3. Ruedl G, Brunner F, Kopp M, Burtscher M. Impact of a ski helmet mandatory on helmet use on Austrian ski slopes. J Trauma 2011;71:1085-7. 4. Lerner RM, Galambos NL. Adolescent development: Challenges and opportunities for research, programs, and policies. Ann Rev Psychol 1998;49:413-46. 5. Warda LJ, Yanchar NL; Canadian Paediatric Society, Injury Prevention Committee. Skiing and snowboarding injury prevention. Paediatr Child Health 2012;17:35-8.
Paediatr Child Health Vol 18 No 9 November 2013