title: Achieving all-age helmet use compliance for snow sports: strategic use of education, legislation and enforcement.
abstract: Nova Scotia is the first jurisdiction in the world to mandate ski and snowboard helmet use for all ages at ski hills in the province. This study represents a longitudinal examination of the effects of social marketing, educational campaigns and the introduction of helmet legislation on all-age snow sport helmet use in Nova Scotia.
  
  
  
  A baseline observational study was conducted to establish the threshold of ski and snowboarding helmet use. Based on focus groups and interviews, a social marketing campaign was designed and implemented to address factors influencing helmet use. A prelegislation observational study assessed the effects of social marketing and educational promotion on helmet use. After all-age snow sport helmet legislation was enacted and enforced, a postlegislation observational study was conducted to determine helmet use prevalence.
  
  
  
  Baseline data revealed that 74% of skiers and snowboarders were using helmets, of which 80% were females and 70% were males. Helmet use was high in children (96%), but decreased with increasing age. Following educational and social marketing campaigns, overall helmet use increased to 90%. After helmet legislation was enacted, 100% compliance was observed at ski hills in Nova Scotia.
  
  
  
  Results from this study demonstrate that a multifaceted approach, including education, legislation and enforcement, was effective in achieving full helmet compliance among all ages of skiers and snowboarders.
authors.affiliation: Division of Neurosurgery, Dalhousie University, Halifax, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Fenerty
authors.affiliation: Nova Scotia Department of Health and Wellness, Halifax, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Heatley
authors.affiliation: Nova Scotia Department of Health and Wellness, Halifax, Canada.
authors.forename: Julian
authors.initials: J
authors.lastname: Young
authors.affiliation: Division of Neurosurgery, Dalhousie University, Halifax, Canada.
authors.forename: Ginette
authors.initials: G
authors.lastname: Thibault-Halman
authors.affiliation: Division of Neurosurgery, Dalhousie University, Halifax, Canada.
authors.forename: Nelofar
authors.identifier: 0000-0001-8770-3080
authors.initials: N
authors.lastname: Kureshi
authors.affiliation: Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Beth S
authors.initials: BS
authors.lastname: Bruce
authors.affiliation: Division of Neurosurgery, Dalhousie University, Halifax, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Walling
authors.affiliation: Division of Neurosurgery, Dalhousie University, Halifax, Canada.
authors.forename: David B
authors.initials: DB
authors.lastname: Clarke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001265:Athletic Injuries / Q000517:prevention & control*; D000070642:Brain Injuries, Traumatic / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003258:Consumer Behavior / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006260:Head Protective Devices / Q000706:statistics & numerical data / Q000600:supply & distribution; D006266:Health Education / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D008402:Mass Media; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D011050:Policy Making; D015397:Program Evaluation; D038161:Snow Sports / Q000293:injuries*; D040241:Social Marketing; D055815:Young Adult