Craniofacial Injuries: Community-Based Interventions to Encourage Use of Helmets, Facemasks, & Mouthguards in Contact Sports
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine the effectiveness of community-based interventions to encourage the use of helmets, facemasks, and mouthguards to prevent craniofacial injuries in contact sports. This finding is based on a small number of heterogeneous studies with inconsistent results. These inconsistent results may be due, in part, to variations in the use and effectiveness of helmets, facemasks, and mouthguards in different sports.
The limited evidence highlights the need for research to further establish the efficacy of safety equipment for different sports and the effectiveness of community-based interventions to increase the use of equipment proven to reduce craniofacial injuries.
The full CPSTF Finding and Rationale Statement and supporting documents for Oral Health: Preventing Craniofacial Injuries, Community-Based Interventions to Encourage Use of Helmets, Facemasks, and Mouthguards in Contact Sports are available in The Community Guide Collection on CDC Stacks.
Intervention
Community-based interventions can encourage people involved in contact sports to use helmets, facemasks, and mouthguards to prevent craniofacial injuries. These interventions include at least one of the following:
- Educational approaches designed to influence knowledge, attitudes, or behaviors among health professionals, parents, coaches, players, and officials engaged in organized sports
- Promotional activities (e.g., raising awareness or providing equipment at reduced or no cost or offering incentives for their use)
- Environmental or policy approaches (e.g., establishing and enforcing rules of play that require use of protective equipment)
Contact sports are defined as team or combat sports where full or limited contact occurs between players or between a player and an object. Craniofacial injuries are defined as injuries to the skull (cranium), upper jaw (maxilla) or face and include oral and dental injuries.
About The Systematic Review
The CPSTF finding is based on evidence from a systematic review of 8 studies (search period 1946-November 2012). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to oral health.
Study Characteristics
- Included studies were associated with six different contact sports
- Studies evaluated three broad categories of interventions including legislative mandates, provision of safety equipment, and health promotion and education
- Seven of the included studies were conducted in high-income countries
Summary of Results
Eight studies were included in the review.
- Study results were inconsistent
- The diversity in sports, potential injuries, and population characteristics across the studies limited the ability to pool data and draw any general conclusions about intervention effectiveness
Summary of Economic Evidence
An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.
Applicability
Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.
Evidence Gaps
- More research is needed on the efficacy of various protective equipment devices in preventing injuries in different contact sports.
- Further research is required to establish the effectiveness of community-based interventions that provide and promote the use of protective equipment. Ideally, researchers will use consistent outcome measures and definitions.
- Finally, research should examine potential harms of the intervention, especially with regard to risk compensation behavior.
Implementation Considerations and Resources
Despite the finding of insufficient evidence, the following are considerations for implementation drawn from studies included in the evidence review, the broader literature, and expert opinion.
- The use of helmets, facemasks, and mouthguards may raise players’ concerns regarding comfort and athletic performance.
- Helmets, facemasks, and mouthguards vary in quality, fit and comfort, and their individual properties have the potential to inhibit or facilitate their use as well as affect their protective properties.
- The wider literature includes concerns about potential harms associated with the use of helmets, facemasks, and mouthguards, such as impaired breathing, speech, peripheral vision, and hearing.
- An additional concern is risk compensation, meaning players using protective equipment may take greater risks because they perceive themselves to be better protected.