This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and

Transcription

1 This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier s archiving and manuscript policies are encouraged to visit:

2 Accident Analysis and Prevention 48 (2012) Contents lists available at SciVerse ScienceDirect Accident Analysis and Prevention jo ur n al hom ep a ge: Self reported risk taking and risk compensation in skiers and snowboarders are associated with sensation seeking Gerhard Ruedl, Markus Abart, Larissa Ledochowski, Martin Burtscher, Martin Kopp Dept. of Sport Science of the University of Innsbruck, Austria a r t i c l e i n f o Article history: Received 20 October 2011 Received in revised form 24 January 2012 Accepted 28 January 2012 Keywords: Alpine skiing Ski helmet Risk compensation Risk taking Sensation seeking a b s t r a c t In alpine skiing, a controversial discussion has been taking place regarding the potential influence of wearing a ski helmet on the individual level of risk taking behaviour. The aim of this study was to evaluate whether self reported risk taking behaviour and self reported risk compensation are associated with the personality trait sensation seeking (SS) in alpine skiing and snowboarding. In total, 683 persons (36% males and 64% females) completed an online-survey about attitudes and use of protective gear in winter sports including the German version of the sensation seeking scale form V. A logistic regression analysis including gender, age, nationality, preferred winter sport, self reported skiing ability, mean skiing time per season, use of ski helmets, and SS total score was used to estimated adjusted odds ratios (ORs) and their 95% confidence intervals (95 CI) for self reported risk taking behaviour. Regression analysis revealed that a more risky behaviour increased with male gender (OR: 2.7), with an age < 25 years (OR: 1.6), with skiing (OR: 1.3), higher skill level (OR: 5.7), and a mean skiing time > 28 days per season (OR: 2.2). In addition, SS total score was significantly higher in more risky compared to more cautious people (23.8 vs. 20.3, p <.001). Ski helmet use was not found to be predictive for a more risky behaviour (p >.05). Also, skiers and snowboarders with self reported risk compensation while wearing a ski helmet had higher SS total scores compared to those who did not report risk compensation (23.8 vs. 20.9, p =.001). In addition, self reported risk compensation in helmet wearers increased with an age < 25 years (OR: 2.2), a higher skill level (OR: 2.5) and a mean skiing time > 28 days per season (OR: 2.1). In conclusion, self reported risk taking and self reported risk compensation are associated with higher sensation seeking total scores. The personality trait sensation seeking, not wearing of a ski helmet, appears to be associated with riskier behaviour on the ski slopes Elsevier Ltd. All rights reserved. 1. Introduction In alpine skiing and snowboarding head injuries account for 9 19% of all injuries reported by ski patrols and emergency departments (Ruedl et al., 2010a; Russel et al., 2010). Severe head injuries include traumatic brain injury which is a leading cause of traumatic deaths among winter sport participants (Russel et al., 2010; Ruedl et al., 2011). However, the use of ski helmets has the potential to reduce the risk of head injuries up to 60% (Hagel et al., 2005a; Sulheim et al., 2006; Mueller et al., 2008; Ruedl et al., 2010a; Russel et al., 2010; Cusimano and Kwok, 2010). Nevertheless, a controversial discussion has been taking place regarding the potential influence of wearing a ski helmet on the individual level of risk taking behaviour (Hagel and Meeuwisse, 2004; Sulheim et al., 2006; Corresponding author at: Dept. of Sport Science of the University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria. Tel.: ; fax: address: gerhard.ruedl@uibk.ac.at (G. Ruedl). Hagel et al., 2005b; Scott et al., 2007; Ruedl et al., 2010b). The so called risk compensation hypothesis is based on the assumption that safety appliances cause a false sense of security in their users resulting in an increased risk taking behaviour (Scott et al., 2007). Bürkner et al. (2009) reported that winter sport participants wearing safety devices have a higher level of risk taking compared to those not using such devices. Shealy et al. (2005) demonstrated that the average speed on ski slopes was significantly higher for helmet users compared to non helmet users (46 km/h vs. 41 km/h). In addition, Sulheim et al. (2006) showed that skiers who reported themselves as risk takers were more likely to wear a helmet than skiers who rated themselves as cautious skiers (43.3% vs. 29.2%; OR: 1.48). In contrast, Ruedl et al. (2010b) showed that self-reported risk taking skiers and snowboarders skied faster than cautious persons (53 km/h vs. 45 km/h) while helmet use was nearly equal in both groups (59.2% vs. 59.7%). In addition, the proportion of more skilled skiers was significantly higher (76.9% vs. 59.0%) in helmet users while the distribution of risk-taking behaviour was nearly equal (29.8% vs. 30.2%) compared to non-helmet users (Ruedl et al., 2010b). Also other studies showed that helmet use is higher in /$ see front matter 2012 Elsevier Ltd. All rights reserved. doi: /j.aap

3 G. Ruedl et al. / Accident Analysis and Prevention 48 (2012) more skilled compared to less skilled skiers and snowboarders (Buller et al., 2003; Andersen et al., 2004; Sulheim et al., 2006; Ruedl et al., 2010c; Cundy et al., 2010) indicating that the use of a ski helmet is not necessarily associated with a higher level of risk taking but primarily with a higher skill level (Ruedl et al., 2010b). However, the studies by Sulheim et al. (2006) and Ruedl et al. (2010b) used a single question to assess self reported risk taking behaviour which has not been formally validated. Risk taking behaviour might be associated with the personality trait sensation seeking (SS) (Bouter et al., 1988). SS is a trait defined by the seeking of varied, novel, complex, and intense sensations and experiences, and the willingness to take physical, social, legal, and financial risk for the sake of such experience (Zuckerman, 1994). SS is commonly assessed by a standardized self-report questionnaire comprised of the four dimensions of thrill and adventure seeking, experience seeking, disinhibition, and boredom susceptibility (Roberti, 2004). Regarding risk compensation, Scott et al. (2007) asked ski helmet wearers whether they skied/snowboarded faster, slower or at about the same speed and whether they challenged themselves more, less or about the same compared when not wearing a helmet. Although Scott et al. (2007) found no support for the risk compensation hypothesis it is likely that some skiers and snowboarders do engage in more risk taking when wearing helmets. To our knowledge, no study has yet investigated whether or not an increase in risk taking is associated with the personality trait SS when wearing a ski helmet. Therefore, the aims of this study were to evaluate if and how self reported risk taking behaviour and self reported risk compensation are associated with SS in alpine skiing and snowboarding. 2. Subjects and methods 2.1. Data collection procedures An online-survey about attitudes and use of protective gear in winter sports was conducted between January and March 2011 at the University of Innsbruck. The survey was distributed via the mailing list for students to more than 26,000 persons. Mean duration of the online-survey was about 15 min. The study was performed in conformity with the ethical standards laid down in the 2008 Declaration of Helsinki. Inclusion criteria were skiing or snowboarding as preferred winter sport and a completely filled out survey. Demographic data (gender, age classes, nationality) as well as the preferred winter sport (snowboarding vs. skiing), self reported skiing ability (beginners, intermediates, advanced, experts) according to Sulheim et al. (2007), use of ski helmets, mean skiing time per season ( 7 vs vs vs vs. >28 days) and self reported risk taking behaviour (more cautious vs. more risky) according to Sulheim et al. (2006) and Ruedl et al. (2010b) were recorded. Furthermore, participants were divided into less skilled (beginners and intermediates) and into more skilled (advanced and experts) persons as a tendency was observed to underestimate individual skiing ability, especially among female skiers (Sulheim et al., 2007). Sensation seeking was assessed with the German version of the sensation seeking scale form V (SSS-V; Beauducel et al., 2003). The SSS-V is a 40-item forced-choice questionnaire assessing the sensation seeking construct as a total score derived from the following four subscales (Bouter et al., 1988): 1. Thrill and adventure seeking (TAS): TAS-items indicate a desire to engage in risky and adventurous activities and sports providing unusual sensations. 2. Disinhibition (DIS): DIS-items describe the seeking of sensation through drinking, partying, gambling and sexual variety. 3. Experience seeking (ES): ES-items represent the seeking of stimulation through the mind and the senses, e.g. through music, art, travelling and drugs. 4. Boredom susceptibility (BS): BS-items represent an aversion to repetitive experience, whether in work or with other persons. Restlessness and boredom arise when such constancy is unavoidable. The SS scale can range from 0 to 40 points and has proven to be both valid and reliable in previous research (Zuckerman, 1994). The internal consistency of the German version is acceptable as Beauducel et al. (2003) reported Cronbach s alpha for the total score of.82, although reliabilities for the subscales are somewhat lower (TAS:.80, DIS:.69, ES:.61, BS:.46). In addition, regarding risk compensation according to the study by Scott et al. (2007), helmet wearers were asked whether they believe they ski/snowboard faster or in a more risky way by wearing a ski helmet (no vs. yes) Analysis of data For providing internal consistency of our data Cronbach s alpha was computed. Multiple logistic regression analysis including gender, age classes, nationality, preferred winter sport, self reported skiing ability, mean skiing time per season, use of ski helmets, and SS total score was used to estimated adjusted odds ratios (ORs) and their 95% confidence intervals (95 CI) for self reported risk taking behaviour. To compare helmet wearers reporting risk compensation with helmet wearers not reporting risk compensation, multiple logistic regression analysis including gender, age classes, nationality, preferred winter sport, self reported skiing ability, mean skiing time per season, and SS total score was calculated. As an effect size parameter Cohen s d was calculated. All p-values were twotailed and values below.05 were considered to indicate statistical significance. 3. Results In total, the link of the survey was clicked by 2566 persons and 1898 surveys were sent back, respectively. With regard to inclusion criteria, 683 persons (36% males and 64% females) with skiing (69.7%) or snowboarding (30.3%) as preferred winter sport totally completed the online survey. In total, 81.1% of participants reported to use a helmet and 36.5% to be more risky on ski slopes, respectively. Cronbach s alpha for the total SS score was.79 and for the subscales somewhat lower (TAS:.72, DIS:.72, ES:.54, BS:.45). Multivariate regression analysis revealed 6 factors to be predictive for a more risky behaviour: gender, age classes, preferred winter sport, skill level, mean skiing time per season, and sensation seeking total score (Table 1). Adjusted ORs indicated that a more risky behaviour increased with male gender (OR: 2.7, Cohen s d =.58), with an age < 25 years (OR: 1.6, Cohen s d =.25), with skiing (OR: 1.3, Cohen s d =.13), higher skill level (OR: 5.7, Cohen s d =.96), and a mean skiing time > 28 days per season (OR: 2.2, Cohen s d =.43). In addition, SS total score was significantly higher in risky compared to cautious people (23.8 vs. 20.3, p <.001, Cohen s d =.61). Although self reported helmet use was higher in risky compared to cautious people (88% vs. 78%), ski helmet use was not shown to be a predictive factor for a more risky behaviour (p >.05). Regarding risk compensation, 24.7% of helmet users believed that they ski/snowboard faster or in a more risky way by wearing a ski helmet. Adjusted ORs indicated that risk compensation in

4 294 G. Ruedl et al. / Accident Analysis and Prevention 48 (2012) Table 1 Characteristics and multivariate odds ratios of predictive factors for self reported risk taking behaviour. More cautious More risky Adjusted OR (95 CI) a p Gender, N (%) Females 326 (75.1) 111 (44.6) Males 108 (24.9) 138 (55.4) 2.90 ( ) <.001 Age classes, N (%) 25 years 168 (38.7) 81 (32.5) <25 years 266 (61.3) 168 (67.5) 1.58 ( ).018 Nationality, N (%) Austria 297 (68.4) 166 (66.7) 1.06 ( ).918 Germany 81 (18.7) 57 (22.9) 1.07 ( ).906 Italy 43 (9.9) 1 (7.6) 0.96 ( ).946 Others 20 (3.0) 7 (2.8) Type of sport, N (%) Snowboarding 137 (31.6) 70 (28.1) Skiing 297 (68.4) 179 (71.9) 1.26 ( ).024 Skiing ability, N (%) Less skilled 107 (24.7) 8 (3.2) More skilled 327 (75.3) 241 (96.8) 5.65 ( ) <.001 Skiing per season, N (%) 7 days 143 (32.9) 38 (15.3) days 131 (30.2) 64 (25.7) 1.20 ( ) days 71 (16.4) 43 (17.3) 1.09 ( ) days 35 (8.1) 31 (12.4) 1.40 ( ).338 >28 days 54 (12.4) 73 (29.3) 2.18 ( ).009 Ski helmet use, N (%) 334 (78) 220 (88.4) 0.61 ( ).069 SS total score, mean (±SD) range 20.3 (5.9) (5.5) ( ) <.001 a Adjusted for all other variables in table. helmet wearers increased with an age < 25 years (OR: 2.2, Cohen s d =.44), a higher skill level (OR: 2.5, Cohen s d =.51) and a mean skiing time > 28 days per season (OR: 2.1, Cohen s d =.40) (Table 2). In addition, SS total score was significantly higher in helmet wearers reporting risk compensation compared to those who did not (23.8 vs. 20.9, p =.001, Cohen s d =.52). 4. Discussion The main findings of this study are that self reported risk taking behaviour and self reported risk compensation are associated with SS in alpine skiing and snowboarding. Regression analysis revealed that riskier behaviour was significantly associated with male gender, younger age, skiing, higher skill level, a mean skiing time > 28 days per season, and a higher SS total score, but not with helmet use. Self reported risk compensation in helmet wearers (i.e. skiing/snowboarding faster/more risky when wearing a helmet) was associated with younger age, higher skill level, a mean skiing time > 28 days per season and a significant higher SS total score compared to those who did not report risk compensation. Mean helmet use in this study with about 81% was somewhat higher compared to other recent studies of our group (Ruedl et al., 2010c; Ruedl et al., 2011a,b). This might be due to the fact that about 96% of study participants were between 15 and 35 years of age as studies reported a higher helmet rate in younger compared Table 2 Characteristics and multivariate odds ratios of predictive factors for self reported risk compensation in helmet wearers. No risk compensation Risk compensation Adjusted OR (95 CI) a p Gender, N (%) Females 259 (62.1) 85 (62.0) Males 158 (37.9) 52 (38.0) 0.75 ( ).215 Age classes, N (%) 25 years 165 (39.6) 31 (22.6) <25 years 252 (60.4) 106 (77.4) 2.20 ( ).001 Nationality, N (%) Austria 284 (68.1) 90 (65.7) 1.38 ( ).620 Germany 86 (20.6) 37 (27.0) 1.33 ( ).665 Italy 36 (8.6) 6 (4.4) 0.81 ( ).785 others 11 (2.6) 4 (2.9) Type of sport, N (%) Snowboarding 113 (27.1) 49 (35.8) Skiing 304 (72.9) 88 (64.2) 0.92 ( ).447 Skiing ability, N (%) Less skilled 70 (16.8) 7 (5.1) More skilled 347 (83.2) 130 (94.9) 2.50 ( ).040 Skiing per season, N (%) 7 days 91 (21.8) 19 (13.9) days 135 (32.4) 27 (19.7) 0.88 ( ) days 76 (18.2) 31 (22.6) 1.41 ( ) days 46 (11.0) 16 (11.7) 1.04 ( ).920 >28 days 69 (16.5) 44 (32.1) 2.08 ( ).038 SS total score, mean (±SD) range 20.9 (6.0) (5.1) ( ).001 a Adjusted for all other variables in table.

5 G. Ruedl et al. / Accident Analysis and Prevention 48 (2012) to older skiers (Andersen et al., 2004; Sulheim et al., 2006; Ruedl et al., 2010c). About 37% of participants of this study reported to be more risky on ski slopes. Well in accordance, 30 38% of people in studies by Sulheim et al. (2006) and Ruedl et al. (2010b) classified themselves as risk-taking skiers and snowboarders. Self reported risk taking in this study increased with male gender, younger age, skiing, higher skill level, and higher mean skiing time per season but not with helmet use being in agreement with other recent findings (Goulet et al., 2000; Scott et al., 2007; Ruedl et al., 2010b). Self reported risk taking in this study was associated with a higher SS total score compared to more cautious skiers and snowboarders (23.8 vs. 20.3). Well in accordance, Jack and Ronan (1998) reported a mean SS total score of 23.0 among high-risk sports participants (hang-gliders, mountaineers, sky-divers, automobile racers) and of 20.3 among low-risk sports participants (golfers, swimmers, marathon runners, aerobics), respectively. Zuckerman (1994) stated that risk taking is a correlate of sensation seeking. High-sensation seekers appraise the environment as less threatening while low-sensation seekers generally appraise risky or stressful situations as threatening and leading to negative consequences (Zuckerman, 1994). Therefore, the question used by Sulheim et al. (2006) and Ruedl et al. (2010b) to assess risk taking behaviour (i.e., more cautious vs. more risky) on ski slopes seems to be a valid single-item approach related to the SS total score. Our results indicate that ski helmet use in general seems not to lead to higher risk taking in skiing and snowboarding and, therefore, do not support the risk compensation theory. In accordance, Scott et al. (2007) found no evidence of risk compensation among helmet wearers in their study. Also, Ruedl et al. (2010b) showed that helmet use is not associated with riskier behaviour on slopes. In addition, Ruedl et al. (2011b) recently reported that the factor risk compensation was not predictive for helmet non-use. Furthermore, Hagel et al. (2005b) demonstrated that helmet use in skiing and snowboarding is not associated with riskier activities that lead to non-head-neck injuries which could be expected if protective equipment as ski helmets may prompt users to act more aggressively and thereby to increase the potential for serious injuries. In addition, although ski helmet use strongly increased in past years in Austria (Ruedl et al., 2011a) fatalities on Austrian ski slopes remained constantly (Ruedl et al., 2011). Nevertheless, about 25% of helmet wearers stated to ski/snowboard faster or more risky because of wearing a helmet. In comparison, we recently found that 23 28% of helmet wearers and non-wearers rather or totally agreed that helmet use increases risk taking (Ruedl et al., 2011b). Also Scott et al. (2007) found that one third of all interviewed skiers and snowboarders reported currently engaging in more risky behaviours, with 34% skiing/snowboarding faster and 36% challenging themselves more. We found that skiers and snowboarders with self reported risk compensation had higher SS total scores than those who did not report risk compensation (23.8 vs. 20.9). Hagel and Meeuwisse (2004) stated that whether the skiers increased their risk-taking behaviour in response to wearing the helmet or they wore a helmet because they planned on taking greater risks is a subtle but important distinction with implications for the risk compensation theory. As a reply to this statement by Hagel and Meeuwisse (2004), our results suggested that riskier behaviour in skiing and snowboarding depends rather on the personality trait SS than on ski helmet use. Therefore, ski helmets should be recommended as studies showed that helmet use may reduce head injury risk up to 60% in children and adults (Sulheim et al., 2006; Ruedl et al., 2010a; Russel et al., 2010). Also, helmet use is associated with reduced rates of skull fractures among hospitalized children (Rughani et al., 2011). In addition, Ruedl et al. (2011b) recently reported that most arguments contra helmet use seem to belong to subjective perception and to represent anticipatory negative cognitions, poorly supported by evidence Limitations A few limitations have to be considered. The online survey was conducted at the University of Innsbruck. Therefore, actual helmet use and practising the preferred winter sport could not be proved. In addition, a possible selection bias cannot entirely be excluded because only about 36% of received surveys were included according to our inclusion criteria. However, gender distribution was comparable between total received surveys and survey included in analysis. In general, a response rate of one third is typical for webbased surveys (Cook et al., 2000). Also, most participants studying at the University of Innsbruck may have a higher grade of education and may have a younger mean age compared to the average skiing population. However, studies (Buller et al., 2003; Andersen et al., 2004) have suggested that education and younger ages are associated with higher helmet use. The gender proportion in this study might be different to the average gender proportion on a ski slope. However, other research also showed higher response rates in females when using web-based surveys (Crutzen and Göritz, 2010). As no data were collected to past injury, and other personality characteristics, potentially confounding variables may have been neglected in our study. In general, the current data from Austria cannot be generalized to other populations. 5. Conclusion In conclusion, self reported risk taking and self reported risk compensation are associated with higher sensation seeking total scores. The personality trait sensation seeking, not wearing of a ski helmet, appears to be associated with riskier behaviour on the ski slopes. We suggest a more selective approach in skiing safety information campaigns to figure out if different types of personality (i.e. high or low sensation seekers ) might differ not only in risk behaviour when wearing protective gear but also in their receptivity to safety information. Conflict of interest None to declare. References Andersen, P.A., Buller, D.B., Walcosz, B.J., Voeks, J.H., Cutter, G.R., Dignan, M.B., The prevalence and diffusion of helmet use at ski areas in Western North America in Inj. Prev. 10, Beauducel, A., Strobel, A., Brocke, B., Psychometric properties and norms of a German version of the Sensation Seeking Scales, Form V. Diagnostica 49, (in German). Bouter, L.M., Knipschild, P.G., Feij, J.A., Volovics, A., Sensation seeking and injury risk in downhill skiing. Person. Individ. Diff. 9, Buller, D.B., Andersen, P.A., Walkosz, B.J., Scott, M.D., Cutter, G.R., Dignan, M.B., Voeks, J.H, The prevalence and predictors of helmet use by skiers and snowboarders at ski areas in western North America in J. Trauma 55 (5), Bürkner, A., Eichbichler, A., Simmen, H.P., Safety requirements and risk factors of skiers and snowboarders. Sportverl. Sportschad. 23, (in German). Cook, C., Heath, F., Thompson, R., A meta-analysis of response rates in web-or internet-based surveys. Educ. Psychol. Meas. 60 (6), Cundy, T.P., Systermans, B.J., Cundy, W.J., Cundy, P.J., Briggs, N.E., Robinson, J.B., Helmets for snow sports: prevalence, trends, predictors, and attitudes to use. J. Trauma 69 (6), Cusimano, M.D., Kwok, J., The effectiveness of helmet wear in skiers and snowboarders: a systematic review. Br. J. Sports Med. 44 (11), Crutzen, R., Göritz, A.S., Social desirability and self-reported health risk behaviors in web-based research: three longitudinal studies. BMC Public Health 10, 720. Goulet, C., Regnier, G., Valois, P., Ouellet, G., In: Johnson, R.J., Zucco, P., Shealy, J.E. (Eds.), Injuries and Risk Taking in Alpine Skiing. ASTM STP 1397,

6 296 G. Ruedl et al. / Accident Analysis and Prevention 48 (2012) Skiing Trauma and Safety: Thirteenth Volume. ASTM International, West Conshohocken, PA, pp Hagel, B.E., Pless, I.B., Goulet, C., Platt, R., Robitaille, Y., 2005b. The effect of helmet use on injury severity and crash circumstances in skiers and snowboarders. Accid. Anal. Prev. 37, Hagel, B.E., Pless, I.B., Goulet, C., Platt, R.W., Robitaille, Y., 2005a. Effectiveness of helmets in skiers and snowboarders: case control and case crossover study. BMJ 330, Hagel, B.E., Meeuwisse, W., Risk compensation: a side effect of sport injury prevention? Clin. J. Sport Med. 14 (4), Jack, S.J., Ronan, K.R., Sensation seeking among high- and low-risk sports participants. Person. Individ. Diff. 25, Mueller, B.A., Cummings, P., Rivara, F.P., Brooks, M.A., Terasaki, R.D., Injuries of the head, face, and neck in relation to ski helmet use. Epidemiology 19, Roberti, J.W., A review of behavioural and biological correlates of sensation seeking. J. Res. Person. 38, Ruedl, G., Bilek, H., Ebner, H., Gabl, K., Kopp, M., Burtscher, M., Fatalities on Austrian ski slopes during a 5 year period. Wilderness Environ. Med. 22, Ruedl, G., Brunner, F., Kopp, M., Burtscher, M., 2011a. Impact of ski helmet mandatory on helmet use on Austrian ski slopes. J. Trauma 71 (4), Ruedl, G., Kopp, M., Rumpold, G., Holzner, B., Ledochowski, L., Burtscher, M., 2011b. Attitudes regarding ski helmet use among helmet wearers and non-wearers. Inj. Prev., doi: /injuryprev Ruedl, G., Sommersacher, R., Woldrich, T., Kopp, M., Nachbauer, W., Burtscher, M., 2010a. Risk factors of head injuries on Austrian ski slopes. Dtsch. Z Sportmed. 61 (4), Ruedl, G., Pocecco, E., Sommersacher, R., Gatterer, H., Kopp, M., Nachbauer, W., Burtscher, M., 2010b. Factors associated with self reported risk taking behaviour on ski slopes. Br. J. Sports Med. 44 (3), Ruedl, G., Sommersacher, R., Woldrich, T., Pocecco, E., Hotter, B., Nachbauer, W., Burtscher, M., 2010c. Who is wearing a ski helmet? Helmet use on Austrian ski slopes depending on various factors. Sportverl. Sportschad. 24, Rughani, A.I., Lin, C., Ares, W.J., Cushing, D.A., Horgan, M.A., Tranmer, B.I., Jewell, R.P., Florman, J.E., Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital. J. Neurosurg. Pediatr. 7, Russel, K., Christie, J., Hagel, B.E., The effects of helmets on the risk of head and neck injuries among skiers and snowboarders: a meta-analysis. CMAJ 182 (4), Scott, M.D., Buller, D.B., Andersen, P.A., Walkosz, B.J., Voeks, J.H., Dignan, M.B., Cutter, G., Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding. Inj. Prev. 13, Shealy, J.E., Ettlinger, C.F., Johnson, R.J., How fast do winter sports participants travel on alpine slopes? J. ASTM Int. 2, 1 8. Sulheim, S., Ekeland, A., Bahr, R., Self-estimation of ability among skiers and snowboarders in alpine skiing resort. Knee Surg Sports Traumatol. Arthrosc. 15, Sulheim, S., Holme, I., Ekeland, A., Bahr, R., Helmet use and risk of head injuries in alpine skiers and snowboarders. JAMA 296, Zuckerman, M., Behavioral Expressions and Biosocial Bases of Sensation Seeking. Cambridge Press, New York.