Increased patterns of risky behaviours among helmet wearers in skiing and snowboarding

Is badger culling associated with risk compensation behaviour among cattle farmers?

BACKGROUND

Risk compensation theory suggests that behaviours are modified in response to interventions that remove risks by substituting them with other risky behaviours to maintain a 'risk equilibrium'. Alternatively, risk reduction interventions may result in spill-over behaviours that seek to minimise risks further. This paper assessed evidence for these behavioural risk responses among farmers in response to badger culling that seeks to remove the risk of bovine tuberculosis in cattle.

METHODS

Data from the UK's randomised badger culling trial were re-analysed, comparing farmers' cattle movement practices in proactive and reactive culling areas and control areas. Analysis compared cattle movements during and after the trial using zero-inflated negative binomial regression.

RESULTS

The analysis found no strong evidence of risk compensation behaviours among farmers who experienced proactive culling. However, strong evidence for a reduction in cattle movements in reactive culling areas was found. The results indicate high levels of inertia within farming systems in relation to cattle purchasing.

LIMITATIONS

Data do not account for the risk of cattle purchases and reflect previous policy regimens. Evidence from recent badger culling interventions should be analysed.

CONCLUSION

Proactive badger culling was not associated with risk compensation behaviours, while reactive badger culling was associated with decreased risk taking among farmers.

Headgear safety attitudes: a national survey of collegiate women's lacrosse stakeholders

Controversy exists among collegiate lacrosse about the use of headgear and whether its use will facilitate greater risk compensation by players and thus contribute to unsafe gameplay. We aimed to characterize the attitudes of headgear among women's collegiate lacrosse stakeholders. A total of 190 women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32) participated in this study. Participants completed a survey surrounding attitudes of headgear in women's lacrosse. Descriptives, multiple regressions, and Kruskal-Wallis analyses compared attitudes surrounding headgear among stakeholder groups. Scales of Headgear Affects Play (β = -0.38, p < 0.001) and Sports Development and Safety Practices (β = 0.26, p < 0.05) significantly predicted endorsement on Headgear Safety Attitudes Scale. Among players, Aesthetics (β = 0.51, p < 0.001) and Intention to Wear Headgear (β = 0.31, p < 0.05) predicted endorsement on Headgear Safety Attitudes Scale. Stakeholders did not agree if headgear should be worn in women's lacrosse. Items related to sports development, safety and potential changes in gameplay predicted attitudes to headgear safety among all participants.

Effectiveness of an injury prevention video on risky behaviours in youth snow sports: A randomized controlled trial

Objectives

Ski and snowboard-related injuries are common among Canadian youth. Analyzing the role of risky behaviours that contribute to injury risk is essential for gaining an understanding of injury prevention opportunities. The objective was to determine if rates of risky behaviour seen at the ski hill were lower for children and adolescents exposed to an educational injury prevention video.

Methods

This single-blinded cluster randomized controlled trial included students (ages 7-16) from 18 Calgary schools who were enrolled in novice levelled school-sanctioned ski and snowboard programs. Consenting schools were randomly assigned to the intervention or control. The control group followed standard preparation including watching a general ski hill orientation video that was created by the ski hill. The intervention group viewed the intervention video focussed on injury prevention. The Risky Behaviour and Actions Assessment Tool was used by blinded research assistants to observe and record students' risky behaviours at an Alberta ski hill.

Results

In total, 407 observations estimated the rate of risky behaviour. The overall rate of risky behaviour was 23.31/100 person runs in the control group and 22.95/100 person runs in the intervention group. The most commonly observed risky behaviours in both groups were skiing too close to other skiers/snowboarders and near collision with an object/person.

Conclusions

Both groups showed similar rates of risky behaviour and demonstrated the same most common type of behaviour. Practical applications: future work should focus on mitigating common risky behaviours.

Association of personal and equipment-related factors on ACL injury risk in alpine skiers with cautious or risk-taking behaviour: A case-control study

Background

In recreational alpine skiing ACL injury risk depends on the interaction of individual characteristics and behaviours as well as on equipment-related factors.

Aim

to evaluate if and to what extent personal characteristics and equipment-related parameters are associated with ACL injury risk in cautious and risk-taking recreational alpine skiers.

Methods

A retrospective questionnaire-based, case-control study of ACL-injured and uninjured in a cohort of cautious as well as risk-taking recreational skiers was conducted. Participants self-reported their demographics, skiing skill level, and risk-taking behaviour. Ski length, side-cut radius, widths of the tip, waist, and tail were recorded from each participant's skis. Standing heights at the front and rear components of the ski binding were measured with a digital sliding caliper, and a standing height ratio between the front and rear components was calculated. Ski boot sole abrasion at the toe and heel pieces was also measured with the digital sliding caliper.

Results

In total, 1068 recreational skiers (50.8% females) with a mean age of 37.8 ± 12.3 years participated, of whom 193 (22.0%) sustained an ACL injury, and 330 (30.9%) participants reported a risk-taking behaviour. Results of the multiple logistic regression analyses revealed that a higher age, a lower skill level, a higher standing height ratio, and greater ski boot sole abrasion at the toe as well as heel pieces were independently associated with an increased ACL injury risk in both the cautious and the risk-taking group. Among cautious skiers, a longer ski length was an additional significant risk factor for sustaining an ACL injury. In conclusion, the same personal and equipment related characteristics contribute to an increase in the ACL injury risk regardless of risk-taking behaviour, with the only difference that longer skis represent an additional risk factor in cautious skiers.

Incidence of concussions and helmet use in equestrians

OBJECTIVES

Equestrians have a high risk of concussions per hospital records. However, most concussions occur in private settings where concussions are not tracked. We determined concussion incidence by self-report, expressed per 1000 h of exposure, and determined helmet usage and concussion knowledge.

DESIGN

Descriptive epidemiological study.

METHODS

Equestrians were recruited using a snowball method of sampling in which enrolled participants recruited more equestrians. Participants completed a survey of equestrian experience and history of concussion, symptoms and provided estimates of hours spent in various equestrian activities. From these data, incidences of concussions were calculated. In addition, they answered questions regarding helmet usage and willingness to take risks when concussed.

RESULTS

210 participants (203 women) reported 27 ± 14 years of equine experience and 728 concussions, 3.47 ± 5.34 per person (0-55). Incidence while riding was 0.19/1000 h which was greater than the incidence while driving (0.02/1000 h) or handling horses (0.03/1000 h). Riders were helmeted at the time of injury 85% of the time. While concussion knowledge was high, most reported willingness to risk permanent injury by continuing to work with horses while injured.

CONCLUSIONS

To our knowledge this is the first study to document incidence of concussions in equestrians: incidence is higher while riding than during football or rugby training. Helmets were far more commonly worn at the time of concussion than reported in hospital data, suggesting that helmets effectively reduce concussions severe enough to warrant urgent medical care.

Psychological Femininity and Masculinity and Motivation in Team Sports

It is hypothesized that levels of femininity and masculinity may be relevant to specific types of engagement in action. For this reason, the aim of this study was to search for relationships between psychological dimensions of femininity and masculinity and different forms of motivation, as well as their specific parts, among women and male athletes practicing team sports games. We researched 49 women aged 19 to 32 years representing sports such as football, handball, hockey, volleyball, and basketball and 56 men aged 18 to 31 years practicing football, hockey, volleyball, basketball, and handball. The respondents completed the Inventory to Assess Psychological Gender (IPP) and the Polish adaptation of the Sport Motivation Scale (SMS). It was determined that the psychological dimension of femininity was (in the male group) positively related to the dimension of amotivation, i.e., the lack of perception of a relationship between one's action and the outcome. In turn, the psychological dimension of masculinity was positively related to the motivation to know, motivation to accomplish, and motivation to experience stimulation, as well as the overall level of intrinsic motivation and the overall dimension of extrinsic motivation. Furthermore, the masculinity dimension is, in male athletes, related to the level of the introjection motive, i.e., the process of integrating accepted patterns.

Gender differences in snowboarding accidents in Austria: a 2005-2018 registry analysis

OBJECTIVES

To elucidate gender differences in snowboarding accidents.

DESIGN

Retrospective registry analysis within the Austrian National Registry of Mountain Accidents.

SETTING

Snowboard-related emergencies between November 2005 and October 2018.

PARTICIPANTS

All injured snowboarders with documented injury severity and gender (3536 men; 2155 women).

PRIMARY AND SECONDARY OUTCOME MEASURES

Gender-specific analysis of emergency characteristics and injury patterns.

RESULTS

Over time, the number of mild, severe and fatal injuries per season decreased in men but not in women. Accidents most frequently were interindividual collisions (>80%) and occurred when heading downhill on a slope. Men more often suffered injuries to the shoulder (15.1% vs 9.2%) and chest (6.8% vs 4.4%), were involved in accidents caused by falling (12.9% vs 9.6%) or obstacle impact (4.3% vs 1.5%), while on slopes with higher difficulty levels (red: 42.6% vs 39.9%; black: 4.2% vs 2.5%), while snowboarding in a park (4.8% vs 2.1%) and under the influence of alcohol (1.6% vs 0.5%). Women more often sustained injuries to the back (10.2% vs 13.1%) and pelvis (2.9% vs 4.2%), on easier slopes (blue: 46.1% vs 52.4%) and while standing or sitting (11.0% vs 15.8%). Mild injuries were more frequent in women (48.6% vs 56.4%), severe and fatal injuries in men (36.0% vs 29.7% and 0.9% vs 0.4%). Male gender, age and the use of a helmet were risk factors for the combined outcome of severe or fatal injuries (OR (99% CI): 1.22 (1.00 to 1.48), 1.02 (1.02 to 1.03) and 1.31 (1.05 to 1.63)). When wearing a helmet, the relative risk (RR) for severe injuries increased while that for mild injuries decreased in male snowboarders only (RR (95% CI): 1.21 (1.09 to 1.34) and 0.88 (0.83 to 0.95)).

CONCLUSIONS

Snowboard injuries are proportionally increasing in women and the observed injury patterns and emergency characteristics differ substantially from those of men. Further gender-specific research in snowboard-related injuries should be encouraged.

TRIAL REGISTRATION NUMBER

NCT03755050.

Examining the Role of Risk Compensation in Extreme Sports

This study explored the relations between sensation seeking, impulsivity, risk compensation, and extreme-sports injury to better understand contributing factors to risk taking in extreme sports and subsequent adverse outcomes. Data included cross-sectional survey responses from 1,107 college students (Mage = 19.47, SD = 2.14). Poisson, logistic, and negative binomial regressions were used to investigate the relations of interest. Results indicate that sensation seeking and impulsivity are significantly associated with both risk compensation and extreme-sports injury. Risk compensation is significantly and positively associated with extreme-sports injury in mountain biking and snowboarding. Risk compensation did not significantly moderate the relation between the personality constructs of interest and extreme-sports injury. These results show that the role of risk compensation in extreme-sports injury is highly sport-specific. These results highlight the importance of considering both personality and risk compensation in prevention and intervention efforts.

Geriatric Skiers: Active But Still at Risk, a National Trauma Data Bank Study

BACKGROUND

Downhill skiing accounts for a large portion of geriatric sport-related trauma. We assessed the national burden of geriatric versus nongeriatric ski trauma.

MATERIALS AND METHODS

Adults presenting to level 1/2 trauma centers after ski-associated injuries from 2011 to 2015 were identified from the National Trauma Data Bank by ICD-9 code. We compared demographics, injury patterns, and outcomes between geriatric (age ≥65 y) and nongeriatric adult skiers (age 18-64 y). A multiple regression analysis assessed for risk factors associated with severe injury (Injury Severity Score >15).

RESULTS

We identified 3255 adult ski trauma patients, and 16.7% (543) were geriatric. Mean ages for nongeriatric versus geriatric skiers were 40.8 and 72.1 y, respectively. Geriatric skiers more often suffered head (36.7 versus 24.3%, P < 0.0001), severe head (abbreviated injury scale score >3, 49.0 versus 31.5%, P < 0.0001) and thorax injuries (22.2 versus 18.1%, P = 0.03) as compared with nongeriatric skiers. Geriatric skiers were also more often admitted to the ICU (26.5 versus 14.9%, P < 0.0001), discharged to a facility (26.7 versus 11.6%, P < 0.0001), and suffered higher mortality rates (1.3 versus 0.4%, P = 0.004). Independent risk factors for severe injury included being male (OR: 1.68, CI: 1.22-2.31), helmeted (OR: 1.41, CI: 1.07-1.85), and having comorbidities (OR: 1.37, CI: 1.05-1.80). Geriatric age was not independently associated with severe injury.

CONCLUSIONS

At level 1/2 trauma centers, geriatric age in ski trauma victims was associated with unique injury patterns, higher acuity, increased rates of facility care at discharge, and higher mortality as compared with nongeriatric skiers. Our findings indicate the need for specialized care after high impact geriatric ski trauma.

Stimulating injury-preventive behaviour in sports: the systematic development of two interventions

Background

In addition to the beneficial health effects of being active, sports are also associated with a risk of sustaining injuries. To avoid the occurrence of sports injuries, preventive measures can be applied. The aim of the current article is to provide insight into the systematic developmental process of two evidence-based interventions designed to stimulate injury-preventive behaviour in runners and skiers, in which Intervention Mapping (IM) and Knowledge Transfer Scheme (KTS) are used as developmental protocols. However, the ultimate steps in the process are adjusted to meet requirements of the intervention and the target group.

Methods

Using a three-step process, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. Sports participants, sports experts and behaviour experts contributed throughout steps two and three of the developmental process.

Results

In step one we started with a problem statement in which we used information about the number and the burden of running-related and skiing-related injuries in the Netherlands. In step two, in-depth research was performed using four research strategies. During this step we tried to answer the following question: Which preventive measures or actions should be executed to prevent what injuries by whom, and how should we do that? A desk research/systematic review of the literature, expert meetings, target user surveys, and target user focus group meetings were conducted. In step three of product development, both interventions were developed. During the developmental process, co-creation sessions with target users were held. Before finalizing the interventions, pre-tests of the interventions were performed with target users.

Conclusions

Through a three-step approach, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. To develop an intervention that fits the needs of the target population, and will be used by them, it is necessary to involve this population as soon and as much as possible. Several steps in the IM and KTS protocols have thus been adjusted in order to establish an optimal fit between intervention and target group.

Injury patterns after skiing and snowboarding sports accidents

BACKGROUND

Alpine sports are associated with risk of serious injuries. To gain insight into factors that may help reduce injury severity, accident characteristics and injury patterns were analyzed in a cohort of injured skiers and snowboarders.

METHODS

All patients with Alpine sports-related injuries, reporting the injury to a leading medical assistance organization in the Netherlands in the period of 2013-2016, were contacted. Medical data were collected from the patients' files. Only ski and snowboard incidents were included. Injuries were classified according to the Abbreviated Injury Scale (AIS) and Injury Severity Scale (ISS). Data on the accident conditions, i.e. risk factors, were collected using retrospective patient-reported questionnaires. Risk factors for injuries with ISS≥9 were analysed by multivariate modelling.

RESULTS

Of the 1588 included patients, 421 patients filled out the questionnaire. Skiers (N.=1370) had more knee injuries (20.4% vs. 7.4%, P<0.001), femur fractures (5.3% vs. 0.5%, P=0.002) and lower leg fractures (27.5% vs. 11.5%, P<0.001) compared to snowboarders (N.=218). Skiers were also more seriously injured (ISS>9) (P=0.01). Injured snowboarders sustained more brain concussions (8.8% vs. 15.7%, P=0.003) and lower arm fractures (5.4% vs. 16.1%, P<0.001). Only 'a higher skills level' was borderline significant for predicting serious injury (OR: 4.0 95% CI: 0.86-18.50; P=0.08). No additional risk factors were identified.

CONCLUSIONS

Injury patterns after skiing and snowboarding accidents differ, injury severity differed not. Preventive measures should therefore aim to protect specific body parts depending on the type of Alpine sport. Experienced skiers and snowboarders may be more at risk for serious injuries.

Are Risk-Taking and Ski Helmet Use Associated with an ACL Injury in Recreational Alpine Skiing?

According to the risk compensation hypothesis, the use of a ski helmet might provide a false sense of security, resulting in a riskier behavior by skiing faster or more aggressively, which might lead to an increased injury risk. Injury of the anterior cruciate ligament (ACL) is a common diagnosis in downhill skiers. Thus, the aim of the study was to evaluate the potential impact of risk-taking and ski helmet use on ACL injury risk in recreational skiing. Eighty-two ACL injured and 446 uninjured skiers with a mean age of 37.3 ± 11.9 years (52% females) were surveyed during the winter season 2018/19 about age, sex, self-reported risk-taking behavior, self-reported skill level, perceived speed, and ski helmet use. Multiple regression analysis revealed that older age (OR: 1.3, 95% CI: 1.2–1.4), riskier behavior (OR: 5.4, 95% CI: 2.8–10.5), and lower skill level (OR: 6.7, 95% CI: 3.4–13.3) were found to be factors associated with ACL injury, while ski helmet use was not. In conclusion, no support for the risk compensation hypothesis was found with regard to ACL injuries. Therefore, we doubt that ski helmet use increases the risk for ACL injury and recommend wearing a ski helmet due to reported protective effects.

Epidemiology of Snow Skiing- Versus Snowboarding-Related Concussions Presenting to the Emergency Department in the United States from 2010 to 2014

OBJECTIVES

To examine the trend of concussions in skiers and snowboarders from 2010 to 2014; and to quantify and compare the incidence of concussions injuries in skiers and snowboarders who presented to emergency departments in the United States in 2014.

DESIGN

Cross-sectional study of concussions in skiers and snowboarders who were evaluated in emergency departments in the United States.

MAIN OUTCOMES MEASURE

Incidence of concussions.

RESULTS

The trend of the annual incidence of concussions for skiers and snowboarders remained stable from 2010 to 2014. An estimated total of 5388 skiing-related concussions and 5558 snowboarding-related concussions presented to emergency departments in the United States between January 1st, 2014, and December 31st, 2014. This represented an incidence of 16.9 concussions per 1 000 000 person-years for skiers and 17.4 concussions per 1 000 000 person-years for snowboarders. The incidence of concussions in the pediatric and young adult population of skiers was significantly higher than the incidence in the adult population. Similarly, the incidence of concussions in the pediatric and young adult population of snowboarders was significantly higher than the incidence in the adult population. The incidence of concussions was significantly higher in males compared with females in both skiing and snowboarding.

CONCLUSIONS

The incidence of concussions from 2010 to 2014 plateaued in both skiers and snowboarders. Pediatric and young adult skiers and snowboarders had significantly higher incidences of concussion than the adult population. In contrast to the higher incidence of concussions in females in several sports including ice hockey, soccer, and basketball, the incidence of concussions was higher in males compared with females in both skiing and snowboarding.

Randomized controlled pilot trial of naloxone-on-release to prevent post-prison opioid overdose deaths

BACKGROUND AND AIMS

Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin injection have a high risk of drug-related death soon after release from prison. The NALoxone InVEstigation (N-ALIVE) pilot trial (ISRCTN34044390) tested feasibility measures for randomized provision of naloxone-on-release (NOR) to eligible prisoners in England.

DESIGN

Parallel-group randomized controlled pilot trial.

SETTING

English prisons.

PARTICIPANTS

A total of 1685 adult heroin injectors, incarcerated for at least 7 days pre-randomization, release due within 3 months and more than 6 months since previous N-ALIVE release.

INTERVENTION

Using 1 : 1 minimization, prisoners were randomized to receive on release a pack containing either a single 'rescue' injection of naloxone or a control pack with no syringe.

MEASUREMENTS

Key feasibility outcomes were tested against prior expectations: on participation (14 English prisons; 2800 prisoners), consent (75% for randomization), returned prisoner self-questionnaires (RPSQs: 207), NOR-carriage (75% in first 4 weeks) and overdose presence (80%).

FINDINGS

Prisons (16) and prisoners (1685) were willing to participate [consent rate, 95% confidence interval (CI) = 70-74%]; 218 RPSQs were received; NOR-carriage (95% CI = 63-79%) and overdose presence (95% CI = 75-84%) were as expected. We randomized 842 to NOR and 843 to control during 30 months but stopped early, because only one-third of NOR administrations were to the ex-prisoner. Nine deaths within 12 weeks of release were registered for 1557 randomized participants released before 9 December 2014.

CONCLUSIONS

Large randomized trials are feasible with prison populations. Provision of take-home emergency naloxone prior to prison release may be a life-saving interim measure to prevent heroin overdose deaths among ex-prisoners and the wider population.