Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding

Scott, Michael D.; Buller, David B.; Andersen, Peter E.; Walkosz, Barbara J.; Voeks, Jennifer H.; Dignan, Mark; Cutter, Gary

doi:10.1136/ip.2006.014142

Cited by 79 publications

(68 citation statements)

References 25 publications

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“…The conclusion was simply that "No evidence of risk compensation among helmet wearers was found", adding, "decisions to wear helmets may be part of a risk reduction orientation." [40].…”

Section: Ski and Snowboard Helmetsmentioning

confidence: 99%

Risk Compensation: Revisited and Rebutted

Pless

2016

Safety

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This Commentary addresses the ongoing disagreements between many safety advocates who endorse traditional models of prevention and those who oppose them, arguing that safety measures are offset by risk compensation (RCT). The debate is especially heated with respect to regulatory or legislative prevention measures. After explaining the rationale behind risk compensation (aka risk homeostasis theory) (RHT), I provide examples of RCT studies to explain why I believe they should be rejected. The main basis for my rebuttal, however, rests on data that show steady declines in unintentional injury mortality, which, according to RCT, should not have occurred. There are many other reasons for rejecting this theory, and it seems that the time has come for the debate to finally be concluded.

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“…The conclusion was simply that "No evidence of risk compensation among helmet wearers was found", adding, "decisions to wear helmets may be part of a risk reduction orientation." [40].…”

Section: Ski and Snowboard Helmetsmentioning

confidence: 99%

Risk Compensation: Revisited and Rebutted

Pless

2016

Safety

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“…15 A survey of skiers and snowboarders in North America has suggested that those who wear helmets are in fact less likely to ski at high speeds or challenge themselves. 17 This finding could suggest that those who are apt to wear helmets are less prone to severe head injuries and that the helmet itself is not protective in isolation.…”

Section: Discussionmentioning

confidence: 99%

Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital

Rughani¹,

Lin²,

Ares

et al. 2011

PED

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Object Helmet use has been associated with fewer hospital visits among injured skiers and snowboarders, but there remains no evidence that helmets alter the intracranial injury patterns. The authors hypothesized that helmet use among skiers and snowboarders reduces the incidence of head injury as defined by findings on head CT scans. Methods The authors performed a retrospective review of head-injured skiers and snowboarders at 2 Level I trauma centers in New England over a 6-year period. The primary outcome of interest was intracranial injury evident on CT scans. Secondary outcomes included the following: need for a neurosurgical procedure, presence of spine injury, need for ICU admission, length of stay, discharge location, and death. Results Of the 57 children identified who sustained a head injury while skiing or snowboarding, 33.3% were wearing a helmet at the time of injury. Of the helmeted patients, 5.3% sustained a calvarial fracture compared with 36.8% of the unhelmeted patients (p = 0.009). Although there was a favorable trend, there was no significant difference in the incidence of epidural hematoma, subdural hematoma, intraparenchymal hemorrhage, subarachnoid hemorrhage, or contusion in helmeted and unhelmeted patients. With regard to secondary outcomes, there were no significant differences between the 2 groups in percentage of patients requiring neurosurgical intervention, percentage requiring admission to an ICU, total length of stay, or percentage discharged home. There was no difference in the incidence of cervical spine injury. There was 1 death in an unhelmeted patient, and there were no deaths among helmeted patients. Conclusions Among hospitalized children who sustained a head injury while skiing or snowboarding, a significantly lower number of patients suffered a skull fracture if they were wearing helmets at the time of the injury.

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“…35 Several studies have examined risk compensation in relation to helmet use among skiers and snowboarders. 15,24,[36][37][38][39] The evidence is mixed: some of the studies showed increased risk-taking among those who used helmets, 15,39 whereas others showed that helmet users were a more cautious subgroup of participants. 37 Fukuda and associates noted that helmet users were more likely than nonusers to have injuries related to jumping, which indicates that helmet users may attempt more risky manoeuvres.…”

Section: Discussionmentioning

confidence: 99%

“…15,24,[36][37][38][39] The evidence is mixed: some of the studies showed increased risk-taking among those who used helmets, 15,39 whereas others showed that helmet users were a more cautious subgroup of participants. 37 Fukuda and associates noted that helmet users were more likely than nonusers to have injuries related to jumping, which indicates that helmet users may attempt more risky manoeuvres. 24 Our work suggests no relation between helmet use and severity of injury or crash circumstances (non-helmet equipment damage, fast selfreported speed, participation in more difficult runs than normal, or jumping-related injury) after adjustment for confounding variables.…”

Section: Discussionmentioning

confidence: 99%

The effect of helmets on the risk of head and neck injuries among skiers and snowboarders: a meta-analysis

Russell¹,

Christie²,

Hagel³

2010

Canadian Medical Association Journal

174

118

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Background:The prevention of head injuries in alpine activities has focused on helmets. However, no systematic review has examined the effect of helmets on head and neck injuries among skiers and snowboarders. Methods:We searched electronic databases, conference proceedings and reference lists using a combination of the key words "head injury or head trauma," "helmet" and "skiing or snowboarding." We included studies that used a control group; compared skiers or snowboarders with and without helmets; and measured at least one objectively quantified outcome (e.g., head injury, and neck or cervical injury). Results:We included 10 case-control, 1 case-control/ casecrossover and 1 cohort study in our analysis. The pooled odds ratio (OR) indicated that skiers and snowboarders with a helmet were significantly less likely than those without a helmet to have a head injury (OR 0.65, 95% confidence interval [CI] 0.55-0.79). The result was similar for studies that used controls without an injury (OR 0.61, 95% CI 0.36-0.92), those that used controls with an injury other than a head or neck injury (OR 0.63, 95% CI 0.52-0.80) and studies that included children under the age of 13 years (OR 0.41, 95% CI 0.27-0.59). Helmets were not associated with an increased risk of neck injury (OR 0.89, 95% CI 0.72-1.09).Interpretation: Our findings show that helmets reduce the risk of head injury among skiers and snowboarders with no evidence of an increased risk of neck injury. AbstractStudies identified through search of electronic databases n = 184Potentially relevant studies n = 36Studies that met inclusion criteria n = 12Studies identified through search of grey literature n = 203Figure 1: Results of literature search.

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Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding

Cited by 79 publications

References 25 publications

Risk Compensation: Revisited and Rebutted

Risk Compensation: Revisited and Rebutted

Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital

The effect of helmets on the risk of head and neck injuries among skiers and snowboarders: a meta-analysis

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