Impact of a Ski Helmet Mandatory on Helmet Use on Austrian Ski Slopes

Background: A helmet mandatory for people younger than 16 years was implemented in most Austrian provinces in the winter season 2009/2010. The objective of this study was to evaluate the impact of a ski helmet mandatory on age-dependent helmet use. Methods: We compared helmet use in people aged 15 years or less and older than 15 years of Austrian provinces with and without helmet mandatory between the 2008/2009 (n = 16,342) and 2009/2010 (n = 32,011) winter seasons. Results: Helmet use in people aged 15 years or less in the 2009/2010 season increased by 16.2% in provinces with helmet mandatory and decreased by 2.1% in provinces without helmet mandatory (all p < 0.001), respectively. However, provinces with and without helmet mandatory did not differ regarding mean helmet use in people aged 15 years or less (92.2% vs. 92.8%, p = 0.506) in the 2009/2010 season. Helmet use in people older than 15 years in the 2009/2010 season had increased by 11.7% in provinces with helmet mandatory and by 17.9% in provinces without helmet mandatory (all p < 0.001), respectively. Helmet use in people older than 15 years was lower in provinces with helmet mandatory compared with provinces without mandatory (63.1% vs. 68.1%, p < 0.001) in the 2009/2010 season. Conclusion: A helmet mandatory for people aged 15 years or less may increase helmet use in involved age groups when helmet use is relatively low. However, public discussions and preventive helmet campaigns based on sound theories of health behavior change may also induce increases in helmet use in skiers aged older than 15 years without helmet mandatory.