Child and Adolescent Snow Sport Injuries: Lessons for SNOWSMART

Contents

I Introduction
II Youth and winter sports
III Why youth get hurt on ski hills
IV Risky behaviours
V Parental influence
VI Lessons learned for programming and prevention efforts
VII Conclusions and next steps
VIII References
IX Resources

--Submitted by Kathy Blair, Coordinator, Media Relations and Communications, Parachute

I Introduction

The national injury prevention organization, Parachute, bases its programming on lessons drawn from current research. Thus, a key element of our program planning is a research phase, which often includes a literature review. This was the case for a new program that will launch on five ski hills across Canada this winter. Funded by the Public Health Agency of Canada, Parachute worked with partners, the Canadian Ski Patrol System and the Canadian Snowboard Federation, to develop a SNOWSMART program. The aim is to reduce serious injury among young Canadians on the ski hills.

Parachute research coordinator Jayne Morrish prepared a literature review on child and adolescent ski and snowboard-related injuries as a basis for developing the SNOWSMART program.  Summarized below are highlights of this literature review and a brief look at key elements of SNOWSMART.

II Youth and winter sports

Adolescence is marked by increased risk-taking and novelty-seeking behaviours, more so than at any other point in the lifespan. It shows in the statistics – in fact, death rates double during this developmental period (Dahl 2004). Moreover, statistics on motor vehicle crashes, risky sexual behaviours, risk-taking during sporting or leisure activities, binge drinking and crime demonstrate that adolescents engage in more risk behaviours than any other age group, including children (Dahl, 2004; Steinberg, 2004).

Since many youth ski and snowboard, it’s an important area to consider when looking at how to reduce injury rates among Canadians. Indeed, the Public Health Agency of Canada has reported that 10–19-year-olds account for over 90% of the reported injuries for snowboarding and over 65% of the injuries for downhill skiing. In addition, after ice hockey, snowboarding accounts for the second highest number of winter sports injuries and skiing the third (Canadian Ski Council, 2009).

Head and neck fractures are the most common causes of fatal injuries in these sport activities (Meyers et al., 2007). Some Canadian research indicates that adolescents may be twice as likely to suffer head and neck trauma as other age groups (B.C. Injury Research and Prevention Unit, 2006 a and b).

III Why youth get hurt on ski hills
    
Body size: An estimated 15% of ski hill injuries among youth can be linked to the fact that they are still growing (Maffulli & Baxter-Jones, 1995). The force on children’s bodies from falls and collisions puts them at greater riskfor injury than adults. As well, their smaller size puts them closer to the ground when they fall, resulting in unique impact characteristics, which can contribute to brain injuries (Hoshizaki et al., 2012, p.133).

Skill level: Injury rates tend to be highest among beginning and intermediate boarders and skiers. (Bridges, Johnston & Rouah, 2003). Beginners may get hurt more often due to lack of experience while intermediate enthusiasts may push themselves beyond their abilities. (Meyers et al., 2007). Injury rates are also higher at the beginning of the season. Thus, both beginners and intermediate skiers and snowboarders are good targets for injury prevention programming.

Equipment: Because young people are growing continually, they may sometimes be using equipment they’ve outgrown, increasing their risk for injury.One study found that among youth, up to 35% of lower body injury trauma cases were attributed to ill-fitting equipment (Meyers et al., 2007).

Helmets: Helmet use is estimated to be about 55% across Canada with Quebec having the highest rate of use at 65% and Western Canada the lowest at 50% (Canadian Ski Council, 2009). A study in the Canadian Medical Association Journal found that helmet use among skiers and snowboarders reduced the likelihood of a head injury by 35%, as compared to users without helmets. Another study found the rate of head injury for adolescents was reduced by 59% with helmet use. On the other hand, some research has found that severity of injuries may be higher with helmet use, possibly because helmet users may feel safer and thus be more likely to take risks and ride faster (Lids on Kids, 2011). Programs focusing on skiing and snowboarding safety should emphasize that riders are not invincible just because they are wearing the gear. The Lids on Kids program teaches adolescents that if they are wearing a helmet they should “ski or snowboard as if you’re not wearing one” because helmets do not equate to absolute safety.

Heightened period of risk-taking: Another contributor to adolescents’ increased injury rates on the ski hill is their natural inclination toward risky behaviours. During adolescence and early adulthood, roughly between the ages of 14 to the mid-to-late 20s, there is a shift towards reward sensitivity that may create an increase in risk-taking (Cauffman, Steinberg &Woolard, 2002). When deciding whether or not to speed or attempt a risky move on the hill, adolescents’ judgment is clouded by their inability to accurately judge risks and their developmental focus towards rewards instead of potential consequences (e.g., injuring themselves or others). As such, programming that reminds them regularly about safety and the responsibility code of the hill may help to keep the consequences that they might otherwise naturally forget, in the forefront of their minds while enjoying a day on the ski hill.

IV Risky behaviours

Collisions: Colliding with objects and/or people is a leading cause of hospitalizations and fatalities among children and youth on the ski hill (Meyers et al., 2007). In fact, researchers have found that up to 76% of ski hill related hospitalizations and fatalities are related to a high-speed collision of some sort (Meyers et al., 2007; Skokan, Junkins & Kadish, 2003; Xiang & Stallones, 2003; Xiang, Stallones & Smith, 2004).

Excessive speed: Excessive speed is a causal factor in many of the collisions that occur on the ski hill (Meyers et al., 2007). Speed and distance are difficult for youth to judge even when behaving safely (Meyers et al., 2007), so these become even more difficult for them to manage when they start taking risks on the hill. Research has reported numerous recent instances where young skiers and snowboarders lost control due to travelling at speeds beyond their capabilities (Meyers et al., 2007).

Programming implications: Programmers should consider focusing on collisions and do so through efforts targeting the root causes of these injuries, namely excessive speed and risk-taking. Program efforts might focus on education and awareness around collisions, including the causes of collisions and awareness of the objects and people (e.g., young inexperienced skiers) that are most likely to be collided into by an adolescent skier out of control on the hill. Youth may need to be continually reminded to watch their speed to avoid injury, especially from colliding with objects and people.

V Parental influence

Parents are one of the most important influences on youths’ behaviour (Morrish, Kennedy & Groff, 2011) and therefore play a role in the decisions that youths make while on the hill.One area in which parents influence their teens’ behaviours is through their own behaviours. Researchers have found that adolescents mimic the safety behaviours their parents demonstrate and that parental safety behaviours (or lack thereof) translate into those children will demonstrate (Bianchi & Summala, 2004; Morrongiello, Corbett & Bellissimo, 2008; Morrongiello & Lasenby-Lessard, 2007). Parents need to be vigilant about “practising what they preach” and ensuring that they are modelling safe behaviours to their children around ski hill safety.

Researchers have found that one important area for parents to exert their influence in is ensuring that their children have been taught the appropriate skills for the ski hill activities they plan to engage in (Meyers et al., 2007). Additionally, parents should make sure that youth have been educated on their responsibilities around the safety of everyone else on the hill (Meyers, et al., 2007). To ensure their children have an appropriate ability level in order to ski and snowboard safely, parents can talk with them about ski hill safety before the activities, enrol their children in classes and spend time with their children on the hill before allowing them to ski or snowboard alone.

Some researchers have demonstrated that certain parental behaviours around ski hill activities may lead to increased risk-taking and injuries among youth. Specifically, Ackery and Detsky (2011) report that some parents may push their adolescents to be riskier in winter sports due to hopes that their children may become pro athletes or simply because they are living vicariously though their children’s actions. These parents may overestimate their children’s abilities and see education and prevention tools as not pertaining to them. As such, multifaceted programming and awareness campaigns that involve parents, children, and ski hill workers, coupled with rules around behaviours on the hill and constant reminders of the alpine responsibility code, may be effective strategies forreducing adolescent risks that may result in injury to themselves and others.

Another area parents can play a key role in ski hill safety is around how seriously they take ski hill injuries. Research demonstrates that programming needs to educate parents to maintain reasonable and consistent levels of vigilance around their children’s behaviours on the hill, so as to not become overprotective, nor to become lackadaisical about safety.

VI Lessons learned for programming and prevention efforts

Several programs are already in place incorporating some of these key lessons, such as the Heads Up program in the United States, which uses social marketing techniques to remind skiers and snowboarders of their responsibility to ride safely and in control.To keep younger children safe, the PACE Penguin Children’s Ski Safety Program in Canada has implemented a campaign in which children are made more visible to others through wearing colourful bibs. This initiative would benefit from additional awareness materials targeted at adolescents on the ski hill who are more prone to colliding with and injuring the younger riders.

The literature review summarized here led to the conclusion that SNOWSMART should build upon and incorporate the successful programming already begun into one multi-faceted campaign targeting all ski hill participants. SNOWSMART’s aim is to reduce injuries from collisions among children and adolescents due to risky behaviours on the hills, such as excessive speed and riding out of control. It will include education and awareness components directed at the adolescents who are taking the most risks and therefore presumably causing a great deal of the collision-related injuries.

The visibility of children on the hill will be increased through the messaging and bibs used by the PACE Penguin Children’s Ski Safety Program. Additionally, messages will be targeted at all levels of experience. Materials will remind participants that it is everyone’s job to keep the hills safe.

VII Conclusions and next steps

The full literature review on childhood and adolescent ski and snowboard injuries is available at www.oninjuryresources.ca.

Targeting issues of excessive speed, loss of control and collisions, SNOWSMART will launch at five ski hills in Canada this winter: Poley Mountain, N.B., Mt. Sima, Yukon, Brimacombe, Ont., Mount St.Louis Moonstone, Ont., and Snow Valley, Alta. Parents with children between two and eight years of age will be given PACE Penguin kits for their children to use. SNOWSMART Days will provide positive reinforcement in the way of prizes to skiers and boarders “caught” following the Alpine Responsibility Code. Finally,a nationwide competition will be launched in which youths will be invited to compete to create a winning public service announcement video dealing with these issues. Find out more at http://www.snowsmart.ca.

VIII References

Ackery, A. D. and Detsky, A. S. (2011). Reducing lifelong disability from sports injuries in children. Canadian Medical Association Journal, 183, 11, 1235.doi:10.1503/cmaj.110634

B.C. Injury Research and Prevention Unit. (2006a). Downhill Skiing Injuries. Vancouver, BC: B.C. Injury Research and Prevention Unit.

B.C. Injury Research and Prevention Unit. (2006b). Snowboarding Injuries. Vancouver, BC: B.C. Injury Research and Prevention Unit.

Bianchi, A. &Summala, H. (2004). The “genetics” or driving behaviour: parents’ driving style predicts their children’s driving style. Accident Analysis and Prevention, 36, 655-659.

Bridges, E. J., Johnston, K. M. and Rouah, F. (2003). Snowblading injuries in Eastern Canada.British Journal of Sports Medicine, 37, 511-515.

Canadian Ski Council. (2009). Helmets and Ski Safety Facts and Stats. Collingwood, ON: Canadian Ski Council.

Cauffman, E., Steinberg, L. and Woolard, J. (2002). Age differences in capacities underlying competence to stand trial. Presented at the Biennial Meeting of the Society for Research on Adolescence, New Orleans, April 13.

Dahl, R. D. (2004). Adolescent brain development: A period of vulnerabilities and opportunities. In R. E. Dahl & L. P. Spear (Eds.), Annals of the New York Academy of Sciences. Vol. 1021.Adolescent brain development: Vulnerabilities and opportunities (pp. 1–22). New York: New York Academy of Sciences. doi: 10.1196/annals.1308.001

Hoshizaki, B., Vassilyadi, M., Post, A., and Oeur, A. (2012). Performance analysis of winter activity protection headgear for young children.Journal of Neurosurgery.Pediatrics, 9, 113-138.

Lids on Kids. (2011). If you wear a helmet, ski or snowboard as if you’re not wearing one. Lakewood, CO: Shealy, J. E.

Maffulli, N. and Baxter-Jones, A. D. (1995). Common skeletal injuries in young athletes.Sports Medicine, 19, 137-49.

Meyers, M. C., Laurent, M. J., Higgins, R.W., and Skelly, W. A. (2007). Downhill ski injuries in children and adolescents. Sports Medicine, 37, 6, 485-499.doi: 0112-1642/07/0006- 0485/$44.95/0

Morrish, J., Kennedy, P. and Groff, P. (2011). Parental influence over teen risk-taking: A review of the literature. SMARTRISK: Toronto, ON.

Morrongiello, B., Corbett, M. and Bellissimo, A. (2008). “Do as I say, not as I do”: Family influences on children’s safety and risk behaviours. Health Psychology, 27 (4), 498-503.

Morrongiello, B. and Lasenby-Lessard, J. (2007). Psychological determinants of risk taking by children: an integrative model and implications for interventions. Injury Prevention, 13, 20-25.doi: 10.1136/ip.2004.011296.

PACE Penguin Children’s Ski Safety Program . (2011). The PACE Penguin Children’s Ski Safety Program. Retrieved from: http://www.pacepenguin.com/

Xiang H., Stallones L. & Smith G.A (2004). Downhill skiing injury fatalities among children. Injury Prevention. 10, 99-102.

Xiang H. &Stallones L. (2003). Deaths associated with snow skiing in Colorado 1980–1981 to 2000–2001 ski seasons. Injury. 34, 12, 892-6.

Skokan E.G., Junkins E.P. &Kadish H. (2003).Serious winter sport injuries in children and adolescents requiring hospitalization.American Journal of Emergency Medicine.21, 2, 95-9.

Steinberg, L. (2004). Risk taking in adolescence. What changes and why? Annals of the New York Society for Sciences, 1021, 51-58.doi: 10.1196/annals.1308.005

IX Resources

Related Resources

  • For more information on any of the research articles cited in the literature review, we encourage you to go to the source, as listed in the References section.
  • Find the full literature review at http://www.oninjuryresources.ca/
  • Learn more about the SNOWSMART campaign at www.snowsmart.ca

Organizations