Introduction

Annually, several hundred million people worldwide enjoy alpine skiing and snowboarding.1 Besides the well-known beneficial effects related to exercise, these snow sports are also associated with a certain risk of injury. Head injuries account for 9–19% of all winter sport injuries reported by ski patrols and emergency departments.1 ,2 However, the use of ski helmets has been shown to reduce the head injury risk up to 60% among children and adults.1 ,2 While in recent years ski helmet use has become mandatory for children in Italy and in most Austrian provinces,3 ,4 the worldwide first mandatory ski helmets for all ages was introduced in Nova Scotia (East Canada) in 2011.5 Although over the last 10 years ski helmet use has steadily increased worldwide, for example, up to 70% in Canada, Austria and Switzerland in 2010,4 ,5  there is an ongoing debate in various countries about the introduction of mandatory ski helmets.4 ,6 Therefore, question arises as to whether ski helmet legislation is more effective regarding an increasing helmet use than education.