Objective The aim of this study was to compare attitudes regarding ski helmet use in helmet wearers and non-wearers.

Methods In total, 924 persons ≥18 years (52% men and 48% women) participating in sport programmes at the University Sports Institute Innsbruck/Austria were interviewed about their attitudes regarding ski helmets and scored 14 statements on a five-level Likert Scale. A factor analysis was employed to determine clusters of underlying attitudes that have subsequently been used as predictors of helmet non-use in a conditional logistic regression analysis.

Results In total, 65% of participants declared to use a helmet during their preferred winter sport activity while more than 80% of helmet wearers and non-wearers totally agreed that helmets protect from head injuries. According to the factor analysis, attitudes about ski helmets clustered around four major dimensions—subjective disadvantages, safety awareness, comfort/style and risk compensation. Adjusted ORs of regression analysis showed that helmet non-use increased with age and decreased with increasing skill level (beginner: OR 5.4, 95% CI 2.6 to 11.1; intermediate: OR 4.3, 95% CI 2.4 to 7.9; advanced: OR 3.1, 95% CI 1.7 to 5.4). In addition, helmet non-use was associated with subjective disadvantages (OR 2.3, 95% CI 1.8 to 2.9). However, a negative association between helmet non-use and safety awareness (OR 0.3, 95% CI 0.2 to 0.4) was found.

Conclusion Helmet use was associated with higher safety awareness, while most arguments against helmet use seem to belong to subjective perception and to represent anticipatory negative cognitions, poorly supported by evidence. Therefore, evidence-based information about wearing a ski helmet should be implemented in preventive helmet campaigns focusing on non-wearers. In addition, health communication programmes should be instituted to get non-helmeted skiers and snowboarders to try out helmets to eliminate their potential prejudices.