A problem analysis dealing with the importance of behavioral risk factors for ski injuries is based on the results of a case-control study conducted among Dutch skiers. In this study, cases (N = 572) were a sample of those who filed insurance claims for medical costs incurred as the result of a ski injury that prevented them from skiing for more than one day. Controls (N = 576) were a sample of uninjured skiers who filed insurance claims for nonmedical reasons.
Not taking ski lessons appeared to be a risk factor among beginners (odds ratio [OR] = 2.5; etiologic fraction [EF] = 12%). Failure of bindings to release is associated with a higher risk (OR = 3.2) for lower extremity injury, indicating that optimal binding adjustment can have a substantial preventive effect. Surprisingly, binding adjustment in the Netherlands more often involved the use of a test device compared to the ski resorts involved. In the latter case, the injury risk was higher (OR = 1.6; EF = 17%). From our data and the available literature, it can be concluded that alcohol consumption is probably not an important risk factor for ski injury. Several findings from our study seem to indicate that risk underestimation may be a risk factor for ski injury, but further study is necessary on this point. Taken together, the empirical basis for behavioral risk factors other than those mentioned above is still rather weak and thus a restrictive policy with respect to health education for downhill skiers would seem appropriate.