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Epidemiology:
doi: 10.1097/EDE.0b013e31826d2403
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Does Risk Compensation Undo the Protection of Ski Helmet Use?

Ruedl, Gerhard; Kopp, Martin; Burtscher, Martin

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Department of Sport Science, University of Innsbruck, Innsbruck, Austria, gerhardruedl@uibk.ac.at

Deartment of Sport Science, University of Innsbruck, Innsbruck, Austria

Department of Sport Science, University of Innsbruck, Innsbruck, Austria

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To the Editor:

Head injuries in alpine skiing and snowboarding account for 9% to 19% of all winter sport injuries.1,2 Consistent with the so-called risk-compensation theory, studies have found that up to one-third of skiers and snowboarders reported engaging in more risk taking when wearing a ski helmet.3,4 This raises the question of whether risk compensation undoes the protective effect of ski helmet use.

Sulheim et al2 showed that skiers who reported themselves as risk takers were more likely to wear a helmet than those who considered themselves as cautious skiers (odds ratio [OR] = 1.48). In contrast, helmet wearers in a study by Scott et al4 reported that they skied at slower speeds (OR = 0.64) and challenged themselves less (0.76) than people who did not wear helmets.4 Ruedl et al,5 measuring speed in about 500 skiers and snowboarders with a radar speed gun, found that people who reported risk taking skied faster than self-declared cautious persons (53 vs. 45 km/h). However, helmet use was nearly equal in both groups (59% vs. 60%).5 In addition, the proportion of more skilled skiers was considerably higher (77% vs. 59%) in helmet users, while the distribution of risk-taking behavior was equal (30%).5 Therefore, the use of a helmet seems to not be associated with a higher level of risk taking but primarily with a higher skill level.5 As risk-taking behavior might also be associated with the personality trait of sensation seeking, a recent study evaluated if and how self-reported risk-taking behavior was associated with sensation seeking in alpine skiing and snowboarding.3 Multivariate analyses of a cohort of about 680 persons showed that a more risky behavior increased with male sex (OR = 2.7), with an age < 25 years (1.6), with skiing (1.3), higher skill level (5.7), and a mean skiing time > 28 days per season (2.2).3 In addition, total score for sensation seeking was significantly higher in more risky compared with more cautious people (24 vs. 20, P < 0.001).3 Ski helmet use, however, was not found to be predictive for a more risky behavior.3 Thus, the authors concluded that the personality trait of sensation seeking rather than the wearing of a ski helmet is associated with riskier behavior on ski slopes.3

Recently published studies1,2 reported that the use of ski helmets was associated with a reduction of head injuries up to 60% among children and adults. It is unlikely that this would have occurred if risk compensation due to ski helmet use generally results in an increase in individual risk-taking behavior. In addition, Hagel et al6 found no evidence that ski helmet use increased the risk of severe injury or high-energy crash circumstances due to a higher speed. Their results suggest that helmet use in skiing and snowboarding is not associated with riskier activities leading to non-head–neck injuries.6 Additionally, although ski helmet use has steadily increased worldwide over the past 10 years (up to 70% in Austria and Switzerland in the 2010 winter season),7 the overall injury rate in alpine skiing remained constant at below 2 injuries per 1000 skier visits.8

In conclusion, available data do not support the risk compensation theory in this special field, and the risky behavior in some ski helmet wearers is no argument against the protective effect of ski helmet use.

Gerhard Ruedl

Department of Sport Science

University of Innsbruck

Innsbruck, Austria

gerhard ruedl@uibk.ac.at

Martin Kopp

Department of Sport Science

University of Innsbruck

Innsbruck, Austria

Martin Burtscher

Department of Sport Science

University of Innsbruck

Innsbruck, Austria

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REFERENCES

1. 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;182:333–340

2. Sulheim S, Holme I, Ekeland A, Bahr R. Helmet use and risk of head injuries in alpine skiers and snowboarders. JAMA. 2006;295:919–924

3. Ruedl G, Abart M, Ledochowski L, Burtscher M, Kopp M. Self reported risk taking and risk compensation in skiers and snowboarders are associated with sensation seeking. Accid Anal Prev. 2012;48:292–296

4. Scott MD, Buller DB, Andersen PA, et al. Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding. Inj Prev. 2007;13:173–177

5. Ruedl G, Pocecco E, Sommersacher R, et al. Factors associated with self-reported risk-taking behaviour on ski slopes. Br J Sports Med. 2010;44:204–206

6. Hagel B, Pless IB, Goulet C, Platt R, Robitaille Y. The effect of helmet use on injury severity and crash circumstances in skiers and snowboarders. Accid Anal Prev. 2005;37:103–108

7. Ruedl G, Brunner F, Kopp M, Burtscher M. Impact of a ski helmet mandatory on helmet use on Austrian ski slopes. J Trauma. 2011;71:1085–1087

8. Johnson RJ, Ettlinger CF, Shealy JE. Update on injury trends in alpine skiing. J ASTM Intl. 2009;5:11–22

© 2012 Lippincott Williams & Wilkins, Inc.

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