Original Article

Using a Resident-Led School Outreach Program to Improve Knowledge of All-Terrain Vehicle Safety

Authors: Kristyn Jeffries, MD, A. Reid Burks, MD, Michele Nichols, MD, Julie Farmer, RN, Nipam Shah, MBBS, MPH, Charles A. Jennissen, MD, Gerene M. Denning, PhD, Kathy Monroe, MD, MSQI


Background: During the past decade, all-terrain vehicle (ATV)–related injuries treated in US emergency departments decreased by 33%, down to approximately 100,000 injuries in 2016. In comparison, the number of children evaluated for ATV injuries in the Children’s of Alabama emergency department more than doubled between 2006 and 2016, counter to the national trend. The American Academy of Pediatrics guidelines state that ATV operators should be at least 16 years old; however, children younger than 16 continue to represent almost one-third of all ATV-related injuries nationwide, and nearly all of the injuries to children in Alabama.

Methods: Using surveillance data from the Children’s of Alabama hospital electronic medical record database, several Alabama counties near Birmingham were identified as having an increased number of children with ATV-related injuries in 2016. The Safety Tips for ATV Riders (STARs) program, developed in Iowa, was provided to middle school students in these counties by pediatric residents. Surveys were anonymously administered to children before and after the program and included information about demographics, knowledge of safe ATV practices, and the likelihood of using the education afterward.

Results: In total, 525 students participated in January 2019; their ages ranged from 11 to 15 years and the proportion of males and females was equivalent. More than 50% of the children reported riding ATVs in the last 12 months, and of these riders, 47% reported never wearing a helmet when riding. Initially, only 20% of the overall participants knew ATVs were not intended for passengers, 20% knew the recommended engine size for their age, and 57% knew that Alabama law prohibits riding on public roads. After education, this increased to 91%, 90%, and 89%, respectively. Before the STARs program, only 6% knew all three correct answers, whereas 80% answered all of the questions correctly on the postprogram survey. After the program, 34% reported they were very likely/likely to use this information in the future.

Conclusions: The STARs program dramatically improved short-term ATV safety knowledge, and many participants reported they were likely to subsequently use the safe practices presented. School-based programs, such as STARs, may help increase ATV safety awareness and change behaviors in high-risk age groups. This training may be successfully provided by various motivated individuals, including medical residents.

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1. Consumer Product Safety Commission. 2016 annual report of ATV-related deaths and injuries. https://www.cpsc.gov/content/2016-annual-report-of-atv-related-deaths-and-injuries. Published 2017. Accessed June 1, 2019.
2. Helmkamp JC, Aitken ME, Lawrence BA. ATV and bicycle deaths and associated costs in the United States, 2000-2005. Public Health Rep 2009;124:409–418.
3. American Academy of Pediatrics Committee on Injury and Poison Prevention. All-terrain vehicle injury prevention: two-, three-, and four-wheeled unlicensed motor vehicles. Pediatrics 2000;105:1352-1354.
4. Jennissen CA, Peck J, Wetjen K, et al. The Safety Tips for ATV Riders (STARs) programme: short-term impact of a school-based educational intervention. Inj Prev 2015;21:166–172.
5. Jennissen CA, Harland KK, Wetjen K, et al. All-terrain vehicle safety knowledge, riding behaviors and crash experience of Farm Progress Show attendees. J Safety Res 2017;60:71–78.
6. Brann M, Mullins SH, Miller BK, et al. Making the message meaningful: a qualitative assessment of media promoting all-terrain vehicle safety. Inj Prev 2012;18:234–239.
7. Burgus SK, Madsen MD, Sanderson WT, et al. Youths operating all-terrain vehicles–implications for safety education. J Agromedicine 2009;14:97–104.
8. Novak JA, Hafner JW, Aldag JC, et al. Evaluation of a standardized all-terrain vehicle safety education intervention for youth in rural central Illinois. J Prim Care Community Health 2013;4:8–13.
9. Denning GM, Harland KK, Jennissen CA. Age-based risk factors for pediatric ATV-related fatalities. Pediatrics 2014;134:1094–1102.
10. Denning GM, Harland KK, Ellis DG, et al. More fatal all-terrain vehicle crashes occur on the roadway than off: increased risk-taking characterises roadway fatalities. Inj Prev 2013;19:250–256.
11. Office of the Attorney General, State of Alabama. Archived opinion 86-00033. https://www.alabamaag.gov/Documents/opin/8600033.pdf. Published 1985. Accessed August 6, 2019.
12. Consumer Federation of America. ATVs on roadways: a safety crisis. https://consumerfed.org/reports/atvs-on-roadways-a-safety-crisis. Published March 1, 2014. Accessed August 8, 2019.
13. Rodgers GB. The effectiveness of helmets in reducing all-terrain vehicle injuries and deaths. Accid Anal Prev 1990;22:47–58.
14. House T, Schwebel DC, Mullins SH, et al. Video intervention changes parent perception of all-terrain vehicle (ATV) safety for children. Inj Prev 2016;22:328–333.
15. Rezet B, Risko W, Blaschke GS. Competency in community pediatrics: consensus statement of the Dyson Initiative Curriculum Committee. Pediatrics 2005;115(suppl 3):1172–1183.
16. Kaczorowski J, Aligne CA, Halterman JS, et al. A block rotation in community health and child advocacy: improved competency of pediatric residency graduates. Ambul Pediatr 2004;4:283–288.
17. University of Iowa Stead Family Children’s Hospital. Safety tips for ATV riders. https://uichildrens.org/sites/default/files/atv-safety-booklet.pdf. Accessed July 15, 2020. 18. University of Iowa Stead Family Children’s Hospital. All terrain vehicle (ATV) safety. https://uichildrens.org/health-library/all-terrain-vehicle-atvsafety. Accessed July 15, 2020.