title: Helmets for snow sports: prevalence, trends, predictors and attitudes to use.
abstract: BACKGROUND
  Traumatic head injury is the leading cause of mortality and serious morbidity in snow sports and is increasing in incidence. Helmet use in snow sports can reduce the incidence of head injury by up to 60%. Mandatory helmet use is not legislated in most recreational settings for snow sports. This study aimed to quantify the prevalence and trends of helmet use by skiers and snowboarders as well as to investigate predictors of helmet use and reasons why they are worn.
  
  
  METHODS
  A cross-sectional study including observation of skiers and snowboarders allocated to adult and child groups (5,267 persons), retrospective review of ski patrol accident report forms recorded between 2003 and 2008 (3,984), and completion of specially designed questionnaires by randomly approached snow sport participants (1,029).
  
  
  RESULTS
  In 2008, 16% of adults and 67% of children wore helmets. Helmet use increased for adult and child participants between 2003 and 2008. Children, men, and snowboarders were significantly more likely to wear a helmet than their respective counterparts. Significant predictors of helmet use were level of experience, past major crash requiring medical assistance, snow sport lessons, and location of activity. Key reasons for helmet use and disuse were identified.
  
  
  CONCLUSIONS
  Child helmet use far exceeded adult helmet use. Rates of voluntary helmet use are increasing but many remain unprotected from the benefits of a helmet. Identification of the snow sport participants least likely to wear a helmet and their reasons for not doing so should allow targeted helmet promotion and injury prevention strategies to reduce serious head injuries in snow sports.
authors.affiliation: The University of Adelaide, South Australia, Australia. thomas.cundy@adelaide.edu.au
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Cundy
authors.forename: Brenton J
authors.initials: BJ
authors.lastname: Systermans
authors.forename: William J
authors.initials: WJ
authors.lastname: Cundy
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Cundy
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Briggs
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001315:Australia / Q000453:epidemiology; D016009:Chi-Square Distribution; D002648:Child; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012865:Skiing / Q000293:injuries*; D011795:Surveys and Questionnaires