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Since 1985, one-third of all US all-terrain vehicle (ATV)-related injuries and one-quarter of deaths involved victims16 years of age. ATV safety education of youth could help reduce these tragedies.To assess the efficacy of the Safety Tips for ATV Riders (STARs) school-based programme targeting adolescents.A survey was anonymously administered before and after the programme to determine demographics, knowledge and reported likelihood of using the information learned.Over 4600 students in 30 Iowa schools participated from November 2010 to April 2013. Initially, 52% knew most ATVs are designed for one rider, 25% knew the recommended vehicle size for their age range and 42% knew riding on Iowa's roads was legal only for agricultural purposes. After the programme, this increased to 92%, 82% and 76%, respectively (p0.0001 in each case), with 61% of students correct on all three. Better preintervention scores were associated with being males, higher riding frequency and being from isolated rural communities. After the programme, 48% and 32% said they were likely/very likely versus unlikely/very unlikely to use the safety information learned, respectively; younger students, females and infrequent riders reported higher likelihoods.STARs increased short-term ATV safety knowledge and almost half the participants reported they would use the safety information presented. Males and frequent riders seemed more resistant, but some groups that may be more vulnerable to potential ATV crash and injury appeared amenable to the training with higher increases in postprogramme scores and greater intention of improving safety behaviours.

Background All-terrain vehicle (ATV)-related deaths and injuries are a growing public health concern, particularly in rural and suburban communities. More engineering approaches that address vehicle safety and promote injury prevention are critically needed. Objectives Our study was designed to determine the variability in seat characteristics among 2012 model-year, adult-size ATVs. Methods Measurements of 67 models were performed using an image-based method. Seat characteristics were compared by manufacturer and by ATV type (sport vs utility). Results There were significant differences in seat length and seat placement among manufacturers and between sport and utility ATVs. Seat lengths ranged from 19.8 to 37.0 inches, with sport models significantly longer than utility models. Longer seats resulted from the back of the seat extending further beyond the rear axle and/or the seat front extending closer to the handle grips. Seat front to handle grip distances ranged from 3.25 to 16.5 inches. Combined data showed a strong inverse correlation between seat length and the distance from the seat front to the handle grips, but no significant correlation with wheelbase or engine size. Conclusions We found wide variability in seat length and placement for adult-size ATVs. However, existing seat specifications were identified that may be a good starting point for improved seat design. Optimal design would allow for safe operation while reducing the likelihood of multiple riders and use by underaged operators, both major risk factors for ATV-related deaths and injuries. Ultimately, regulations may be needed to ensure standardised seat design is incorporated throughout the ATV industry.

Background All-terrain vehicles (ATVs) have steadily increased in popularity, size and speed, characteristics that likely contribute to the alarming rise in ATV-related fatalities. One potentially high-risk activity is riding on the road. Objectives To compare fatal ATV crashes that occur on the roadway and off, to more fully understand factors that contribute to fatalities at each location. Methods Fatality data from the US Consumer Product Safety Commission (CPSC) were used for descriptive and comparative analyses. Multivariate logistic regression analysis was performed to determine relative risk. Results Over 60% of all fatalities (1985–2009) resulted from roadway crashes. After 1998, roadway fatalities increased at over twice the rate of off-road fatalities. Roadway crashes were more likely than off-road crashes to involve multiple fatalities, carrying passengers, alcohol use, collisions and head injuries. Roadway victims were less likely to be helmeted than off-road victims. Passengers and operators with passengers were also less likely to be helmeted than operators riding alone. Helmeted victims were half as likely to suffer a head injury. Conclusions Fatal roadway crashes were more likely than off-road crashes to involve risk-taking behaviours (eg, carrying passengers) that could exacerbate the inherent difficulty of operating ATVs on roadway surfaces. Higher crash forces from greater speed, and lower use of protective equipment, may also have contributed to higher roadway mortality rates. Eliminating non-essential ATV road use may be an effective way to reduce ATV-related fatalities. This will likely require a substantial investment in rider education and better enforcement of ATV road use restriction laws.

Background All-terrain vehicle (ATV) crashes have long been recognised as a public health concern, with >800 deaths and more than 400,000 injuries each year in the U.S. alone. Recreational off-highway vehicles (ROVs) have more recently been growing in popularity, but little is currently known about the impact of their use. Our objective was to determine the epidemiology, mechanisms and risk factors for ROV crashes and injuries. Methods Descriptive and comparative analyses were performed using data from the Consumer Product Safety Commission ROV database (2003–2011). Results The database contained 428 crashes (899 occupants). Occupants were 68% male, 31% Conclusions These data provide important insights into ROV use and related crashes. Although likely to be more stable than ATVs, ROV rollovers, including at low speeds, appear to be the major crash mechanism, most often in a turn. Being unrestrained in a rollover with subsequent ejection and pinning by the ROV were the most significant risk factors for severe injury and death.

Background All-terrain vehicle (ATV) crashes are common in agricultural communities, but few studies have reported on who is being exposed and may be at greatest injury risk. This study was performed to determine the epidemiology of ATV exposure and crashes in a rural county. Methods Data was analysed from the Keokuk County Rural Health study which is a prospective population-based, longitudinal study of residents in Keokuk County, Iowa. Descriptive and comparative analyses were performed on 2006 Round 3 survey data which included ATV-related questions. Results Of 1,123 respondents, 38% reported having ridden an ATV in the previous year. Respondents who were male, younger, currently working on a farm, had higher income, or owned/rented more acres had a greater likelihood of recent ATV exposure. Adults with children in the home were more likely to have ridden an ATV in the past year than those with none (53% vs. 28%, p Conclusions Study respondents had a high exposure to ATVs, particularly young people and those who lived or worked on farms. Safety training efforts should be focused on demographic groups identified with higher exposure and greater likelihood of ATV crash, including agricultural workers and their families.

Background Snowmobiling is a popular form of winter recreation, but adverse events can lead to significant injury. Our objective was to determine the demographics and risk factors for snowmobile-related injuries seen in Emergency Departments (EDs). Methods ED visits related to snowmobile operation were identified in the National Electronic Injury Surveillance System (NEISS) database, which collects information from a national probability sample of U.S. hospitals. Descriptive and statistical analyses were performed. Results From 2002–2013, 1,944 snowmobile-related injuries were identified in the NEISS database. This corresponds to a national estimate of 135,032 snowmobile-related ED visits during the study period. There was a trend of decreasing injuries over time with a national estimate of 12,862 in 2002 and 9,270 in 2013 (average decrease of 499 per year, 95% CI: 89.9–907.7). Most commonly injured were 19–29 year olds, accounting for 30% of the total; 19% were paediatric patients. About three-fourths were male. The most common mechanisms of injury involved falling off (22%), striking a stationary object (16%), and rolling the vehicle (13%). Mechanisms that had the greatest admission rates included events involving a drop-off (50%), ejections (25%) and motorised vehicle collisions (22%). Helmets were reported as being used in 11.4%. Patients wearing a helmet had a 63% reduced odds of requiring inpatient admission compared to those without (p = 0.03). Speed was reported in only 7% of cases. A higher proportion of those operating at speeds estimated ≥35 mph were admitted (24%) as compared to those with lower speeds (15%). Conclusions Snowmobilers without helmets were more likely to require hospital admission. Snowmobilers should be especially wary of terrain changes, other vehicles in the area, and being ejected, as these mechanisms had injuries requiring higher rates of inpatient treatment.

Background Previous studies showed that Iowa all-terrain vehicle (ATV) crash victims from off-highway vehicle (OHV) parks practiced safer riding behaviours than off-road crash victims outside the parks. The objective of this study was to determine the effect of regulations and enforcement on the prevalence of safety behaviours among Iowa OHV park users. Methods From May to September of 2014, motion-activated cameras captured photos of users at the entrances of Iowa’s eight OHV parks. Riders were coded by vehicle type, estimated age, sex, and safety behaviours. Descriptive and multivariable logistic regression analyses were performed. Results A total of 6,718 vehicles and 9,083 riders were analysed. Among OHV park users, 44% were on ATVs, 51% on dirt bikes and 5% on side-by-sides (SxSs). Helmet use was 94% overall. Just 6% of single-rider ATVs and 0.8% of dirt bikes had passengers. While only 11% of park users on ATVs were Conclusions Regulated safety behaviours (helmet use and riding without passengers) were highly common among OHV park users. However, unregulated behaviours (SxS restraint use and children driving youth-sized ATVs only) had lower compliance. Moreover, regulated safety behaviours were significantly increased when the parks were patrolled. This study shows that a combination of regulation and enforcement is effective in ensuring safety behaviour compliance in OHV parks. Similar efforts outside parks could have a substantial effect on decreasing off-road vehicle-related deaths and injuries.

Statement of purpose Traditional all-terrain vehicles (ATVs) are designed for one rider only. The study objective was to better understand the effect passengers have on the mechanisms and injuries seen in ATV crashes. Methods/approach A retrospective chart review and analysis was performed of trauma registry patients with ATV-related injuries at the University of Iowa from 2002–2013. Results 537 cases were included in the analysis of which 20% were passengers or drivers with passengers. Both children and females were more likely to be passengers (p Conclusions Passengers on ATVs may be at greater risk for fall/ejection to the rear which appears to increase the risk of head injury. ATV operators who self-eject receive extremity injuries but may be more able to protect their heads; passengers limit the ability of a driver to self-eject when losing vehicle control. Significance and contributions This study provides insight on how passengers on ATVs may contribute to crash likelihood and injury severity. A strict no rider rule could reduce risk of some ATV crashes.

Statement of purpose Side-by-sides (SxSs), which includes utility task vehicles (UTVs) and recreational off-highway vehicles (ROVs), have become increasingly popular over the past few years. The study objective was to evaluate SxS crashes with respect to demographics, crash mechanisms, and associated risk factors. Methods/approach A retrospective chart review and analysis was performed of SxS vehicle trauma victims at the University of Iowa from 2008–2013. Results Thirty-three patients with SxS-related injuries were identified. Two-thirds were males. Over half (55%) were children Conclusions Although most current SxS models have roll bars, lack of safety belt use is reducing their benefit. Youth suffer a high percentage of the SxS injuries, often while driving. Significance and contributions No previous reports specifically address the epidemiology of SxS crashes. Study results support prohibiting children from operating SxSs. Certain adult populations appear at risk and may require targeted interventions.

Statement of purpose A previous study found that trauma patients from Iowaoff-highway vehicle (OHV) parks were significantly more likely to be in compliance with all-terrain vehicle safety regulations and behaviours than those injured elsewhere. This study’s purpose was to determine the types of enforcement performed by state Department of Natural Resources (DNR) patrol officers in OHV parks, and which specific code regulations they enforce. Methods/approach Patrol officer time logs and enforcement activities were obtained through a cooperative agreement with the DNR. Enforcement activitiesand variables regarding to whomenforcement activities were directed were analysed. Results During 751 enforcement hours over 160 days, patrol officers recorded 359 separate enforcement activities. Of these, 52% were verbal warnings, 31% written warnings, and 17% written citations. About 89% of enforcement activities was directed at males; no significant difference in type of violation was found by offender’s sex (p = 0.11). Individuals 16 to Conclusions Enforcement by patrol officers at OHV parks in this study was primarily through warnings; violators were allowed to correct their regulatory deficiencies. A smaller number received written citations. Significance and contributions This is the first study to examine enforcement activities related to OHVpark regulations. Further study is needed to determine if safety behaviour compliance is better when patrol officers are performing on-site enforcement as compared to when they are not.

Statement of purpose Safety behaviours of off-highway vehicle (OHV) park users may be better than those riding elsewhere, and census data is required to determine if differences among OHV parks in injuries can be explained by higher use or if other factors are involved. This study’s purpose was to ascertain the photographic capture rate of riders entering OHV parks with motion-activated cameras, and to determine study variable concordance between on-site evaluations and photo appraisement. Methods/approach Panoramic motion-activated cameras were placed at the entrances of all eight public OHV parks in Iowa. On-site assessment and photo image analysis was performed for demographic, vehicle, and safety behaviour variables, and then compared. Results On-site data collection was performed for 114 h for 17 cameras during which 493 off-road vehicles entered the OHV parks. A total of 251 vehicles entering the parks were identified on photos for an overall capture rate of 50.9%. For cameras with at least 5 vehicles noted during on-site evaluation, the capture rate ranged from 38–81%. The number of vehicles entering the parks was segmented by 15 min intervals, and there was no significant variance or decrease in photo capture rate until there were more than 15 vehicles entering a park during a quarter hour period. Variable concordance between on-site and photo derived data ranged from 91–100% which included sex of rider, estimated age group of rider, vehicle type, number of wheels, number of vehicle riders, helmet use, and restraint use for side-by-side vehicles. Conclusions About one-half of riders entering Iowa OHV parks were captured by motion-activated cameras. Concordance of study variables was high between that collected on-site and from photo assessment. Significance and contributions The study validated the use of photo-derived data to determine OHV park users and safety behaviours. Results will also assist in park census estimation.

Statement of purpose Head trauma is the leading cause of death and serious injury from all-terrain vehicle (ATV) crashes. The study objective was to better understand the relationship between speed and ATV crash-related brain injuries. Methods/approach A retrospective chart review and analysis was performed of trauma registry patients with ATV-related injuries at the University of Iowa Hospitals and Clinics from 2002–2013. Results 560 cases were identified; 77% were male and 32% were children 20 mph were associated with higher Max Head Abbreviated Injury Scale (AIS) scores than those ≤20 mph (p = 0.05). Crashes with speeds >30 mph had higher Max Head AIS scores than those ≤30 mph (p = 0.014). Higher speeds were also associated with a trend towards lower patient Glasgow Coma Scale (GCS) scores. Only about 20% of victims overall were wearing a helmet. Competitive racers, although helmeted, had more severe head injuries than all other victims. Competitive racers had lower GCS scores than their helmeted non-racing peers (p Conclusions Higher speed appears associated with greater head injury risk in ATV crashes. Although helmets are protective, there may be ATV crash speeds or mechanisms of brain injury at higher speeds that reduce helmet effectiveness. Significance and contributions This study suggests that the present maximum speed limitations for many youth size ATVs (30 mph) is not safe and puts the child at increased risk for head injury. All ATVs should have a code-protected, tamper-proof speed governor. This would particularly assist parents and employers in protecting youth and employees from the serious risks associated with high operating speeds.

Background The increasing popularity of all-terrain vehicles (ATVs) has been accompanied by an alarming rise in ATV-related deaths. Aims/Objectives/Purpose To compare fatal ATV crashes on and off the road in order to more fully understand the contributing factors for deaths at each location. Methods A retrospective study was performed using national fatality data from the Consumer Product Safety Commission. Results/Outcomes Overall, 62% of US deaths from 1985 to 2009 resulted from on-road ATV crashes. After 1998, on-road deaths increased at a greater rate than off-road deaths (48+2.8 vs 20+1.8 deaths/year), and crashes on the road were three times more likely to result in multiple deaths (p Significance/Contribution to the Field The majority of US ATV-related deaths have resulted from on-road crashes. We hypothesise that risk factors, like passengers and alcohol, exacerbate the challenges of safely operating ATVs on road surfaces, and that higher crash forces from greater speed and lack of protective equipment on the road increase head injuries that result in death. Getting ATVs off the roads may be an effective way to reduce ATV-related deaths.

Background Most surveillance sources provide limited data on the sequence of events during ATV crashes. This limitation provides the rationale to investigate less traditional sources such as social media sites where video sharing has become very popular. Aims/Objectives/Purpose To better understand the mechanisms and contributing factors of ATV-related injuries. Methods A review of ATV-related injuries at the University of Iowa from 2002 to 2009 was performed and crash mechanisms were characterised. A retrospective search of ATV crash videos posted on YouTube was performed. Videos were compiled and analysed. Results/Outcome 345 ATV trauma patients were identified. Rollovers (42%), striking an object (20%), and ejection/fall (13%) were the most common mechanisms of injury. The victim was struck by their ATV in 21% and pinned in 9%. Rollovers were more likely when turning or spinning, and on sloped terrain with passengers. Backward rollovers were most likely with passengers. For those ejected, patients falling/ejected to the rear had the lowest Glasgow Coma Scale (GCS) scores. Patients who jumped off or were ejected off the side had the highest extremity injury scores. The greater the ATV speed, the lower were the patient's GCS scores. 183 ATV crash videos have been collected and characterised to date. Although some ATV crash circumstances were over-represented in the videos, most demonstrated mechanisms that were seen in actual trauma patients. Significance/Contribution to the Field Evaluation of crash videos from social media sites may shed light on injury mechanisms. Analysis of these videos yields significant details that are not available through other sources. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Background On-road all-terrain vehicle (ATV) crashes are frequent despite most US states having laws restricting road use. Aims/Objectives/Purpose To determine the demographics, and the mechanisms and outcomes of injuries of on-road versus off-road ATV crashes. Methods Data from our Iowa ATV injury surveillance database (2002–2009) was derived and statistically analysed. Results/Outcomes 976 records were studied, with 38% of injured individuals from on-road crashes. Demographics were similar at each location. Females and youths under 16 were over four times more likely to be passengers (p 15 (p Significance/Contribution to the Field On-road crashes were significantly more likely to involve collision with another vehicle, suggesting on-road ATVs represent a traffic safety concern. Even controlling for helmet use, on-road crash victims suffered more severe injuries than those off-road. Our data reinforces the importance of laws restricting ATV road use and their enforcement, and the need to increase ATV user education about the dangers of on-road riding.

Background The presence of extra riders increases the likelihood of an all-terrain vehicle (ATV) crash and injury. However, many ATVs have seats long enough to accommodate passengers. Aims/Objectives/Purpose To determine if ATV seats could be redesigned to limit use to only one rider. Methods A convenience sampling of 14 ATV models were measured and compared, and seat dimension requirements were analysed at a 26 degree incline/decline. Results/Outcomes Seat lengths varied from 22-35 inches. The seat backs ended fairly consistently at 38-45 inches away from the handlebar attachment. Most of the seat length differences were accountable by the distance from the handlebar attachment to the front of the seat, which varied from 9-19 inches. The incline/decline study revealed that when going downhill, a rider needs to fully extend their arms and move their bottom back to the seat edge in order to move their centre of gravity behind the front tires and avoid a front rollover. When going uphill, a forward lean is sufficient to keep the operator's centre of gravity ahead of the rear tires and prevent a backward rollover. Significance/contribution to the field Since a rider can adequately change their centre of gravity on an uphill incline without shifting their bottom forward, the seat is not required to be as close to the handles as many manufacturers design. We suggest that a shorter seat starting further from the handlebar is the preferred ATV seat design. This should discourage multiple passenger use by reducing the space available for additional riders.

Background Since April 2009, the US Consumer Product Safety Improvement Act requires that new ATVs be subject to an action plan prescribing steps makers and sellers must take to ensure safety, such as rider training, distribution of safety information, and appropriate age recommendation. Aims/Objectives/Purpose To determine the practice of dealers and salespersons with regards to promoting safe ATV use. Methods A 'secret buyer' method was utilised to evaluate ATV seller practices. Results/Outcomes 50 ATV dealerships from 4 states were studied. 35 subjects (70%) were willing to show and discuss selling an adult-sized ATV when told that the purchase was for a 12-year-old. Seven (14%) responded with comments that ATVs should have no extra riders when the investigator made statements about the adequacy of a seat being long enough for a child to give a sibling rides. Only one subject informed about the need for a 12-year-old to complete ATV safety training to drive in a public ATV park when prompted. Significance/Contribution to the Field In this study, most ATV sellers did not follow requirements regarding age recommendation or provide other safety information. Those that did often voiced concerns about possible negative repercussions from violations. Dealership regulation compliance may increase with on-going enforcement. However, a 'don't ask, don't tell' relationship between seller and buyer was alluded to during the study in which sellers don't ask and buyers don't tell they are purchasing a larger machine for a child. This practice would limit the impact of regulation enforcement. This abstract is from proceedings of the Safety 2012 World Conference.

Background Equestrian helmets are effective in preventing head injuries, but use remains low. The media can have a great impact on injury prevention both positively and negatively by their portrayal of protective safety equipment or lack thereof. Aims/Objectives/Purpose To determine the equestrian helmet use of individuals pictured in horse organisation promotional materials. Methods Literature was requested from horse organisations. Photographs in the materials received were reviewed for equestrian helmet use and analysed. Results/Outcomes 113 of 335 organisations responded and 95 sent publications. 2004 photos with 2738 people were evaluated. The highest equestrian helmet use was by children, and teen helmet use was generally portrayed more frequently than in adults. The lowest rate was in the elderly (14.6%). Helmet use was highest in photos that depicted competition-jumping (87.9%). Competition-riding and pleasure-riding helmet use was only 30.0% and 34.5%, respectively. No one who was pictured while working on, with or while on a horse was shown with an equestrian helmet; nor was anyone in a parade. Adults riding with children did have a higher rate of wearing an equestrian helmet than adults who were pleasure-riding in general (44.2% vs 23.2%). Significance/Contribution to the Field Photographs in horse organisation literature often show people not wearing helmets during equine-related activities. Horse organszations have the ability to define equestrian helmet use as normative behaviour by always portraying people with helmets in their published materials. Developing an equestrian safety culture of routine helmet use should decrease the number of serious head injuries experienced by horse enthusiasts.