ATV Safety Summit: Consumer Awareness: Getting the Message Out - Education and Training for...

archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org

Education and Training for All-terrain Vehicle Safety

Mary E. Aitken, MD MPHInjury Prevention Center, Arkansas Children’s Hospital

Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences

Arkansas ATV Research Group

Presented to ATV Safety SummitUS Consumer Product Safety Commission, October 2012

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ATV Injury Admissions, Arkansas Children's Hospital Trauma Service

by Year and Age, 1998-2011

15 to 18

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• ATV Safety Workgroup (2001):– Multidisciplinary group: healthcare, public health, community– Activities: Planning, research, education, and advocacy– Practical and evidence-based solutions sought

• Arkansas ATV Safety Research Group (2009):– Epidemiology – Educational program development and evaluation – Advocacy and policy research– Engineering and vehicle factors

ATV Safety ActivitiesATV Safety Activities


Arkansas ATV Research GroupArkansas ATV Research Group

• Arkansas– Mary Aitken, Pediatrics– James Graham, Pediatric

Emergency Medicine– Beverly Miller, Education– Hope Mullins, Public Health– Chandra Thorbole,

Engineering

• Oklahoma– Mike Klumpp, 4-H/Agriculture

• West Virginia– Maria Brann, Mass

Communications

• Denver– Jim Helmkamp, Epidemiology

• Baltimore– Steve Bowman, Health

Services Research


ATV EducationATV Education• Doing education directed toward children is

complicated and controversial • Little formal evaluation of ATV training and education

has been published• What has been published largely examines

knowledge gains, rather than intended or actual behavior

• Methods to assess behavior in actual use exist but are challenging


Educational StudiesEducational Studies

• Community Education Campaign– Non-randomized, controlled design– Worked with health coalition in AR counties with

high ATV injury rates– Pre/post knowledge, self-reported behavior

surveys in secondary schools

• Revealed very high levels of ATV exposure and risk taking behaviors


Intervention Results by CountyIntervention Results by County

Pre Post Pre PostExposure to ATV 85% 91% 74% 75%Passenger Exposure 23% 20% 22% 22%Helmet Use 15% 14% 17% 16%Parent Awareness of ATV Use 63% 66% 57% 54%Recall of ATV Safety Message 49% 63%* 35% 44%Participation in ATV Safety Training 12% 29%* 21% 22%

Intervention Comparison ATV Use and Behavior by County and Time

* p<0.05 Aitken et al, J Invest Med, 2007


Targeted ATV Education ProgramTargeted ATV Education Program

• Aims: – To develop and evaluate educational materials for use in

general community based ATV injury prevention– To develop and evaluate more targeted educational

strategies for use in populations at high risk for ATV injury– To explore innovative message delivery strategies for ATV

injury prevention for children and adolescents

EMSC Targeted Issues Grant # H34MC08514-01-00: Development and Evaluation of Targeted ATV Education Strategies for Rural Children, 9/1/07-8/31/11)


Hunter Safety InterventionHunter Safety Intervention

• More focused educational program targeting youth and adults taking AR hunter safety class

• Pre/post knowledge surveys• Baseline Cycle (N=3015 surveys) and

Intervention Cycle (1402 surveys)• Very popular with Hunter Safety Instructors

Williams, J of Rural Health, 2010


Hunter Safety Education ProjectHunter Safety Education Project

Date: 6-21-12Source: Injury Prevention Center at Arkansas Children’s Hospital

ATV Safety Toolkit Distribution by StateThrough June 2012

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• Little study of protective gear or helmet effectiveness• reduction of 42% for mortality; 62% reduction in head injury

Rodgers, Accident Anal Prev 1990

• Among ATV riders of all ages admitted to trauma centers, unhelmeted riders are: • > 60% increased risk for any TBI and 3X more likely to sustain severe TBI• more than twice as likely to die in hospital

• Despite effectiveness, helmet use among ATV riders is very lowBowman, Injury Prevention, 2009

Training on proven strategiesTraining on proven strategies


Why Low Helmet use?Why Low Helmet use?

• What are barriers and facilitators to ATV helmet use?– Focus groups of ATV riders (adult and youth)– Helmet wearers and non wearers– Presumed barriers and facilitators explored– Cost, comfort, and style less frequently cited

factors than lack of perceived risk


Focus Group CommentsFocus Group Comments• Teen: “I’ve been known to have pretty quick reflexes, so I

would probably jump off soon enough to not cause much damage to my head.”

• Adult: “I’m not gonna be going fast enough, I’m not gonna be doing anything that’s gonna give me a reason to need it.”

• Adult: “…they are so much safer today that when we were children that we just don’t see the importance.”

• Adult: “I’m really more afraid of her breaking and arm and a leg than I am hitting her head.”

• Adult: “…a lot of people just think that 4 wheelers are relatively stable, unlike a motorcycle.”


Engineering studies as a tool in educationEngineering studies as a tool in education

• Educational directions may be clearer if ATV performance and stability better understood

• Limited research on ATV dynamics with child riders

• Some studies on anthropomorphics (Bernard, 2010) emerging but other evidence is lacking


Engineering projectsEngineering projects• Co-investigators at UAMS, ACH, University of AR, UA

Cooperative Extension, private engineering firm• Use advanced computer simulation technology to

simulate ATV performance with children on board• Potential applications

– Education (short term)– Improved ATV and helmet design


Engineering ResearchEngineering Research


Simulation Factorial StudySimulation Factorial Study

ATV Speed 10mph Slope 30 degrees Slope length 2m


Simulation videosSimulation videos

• Animation added to computer simulations to use in educational interventions

• Status: draft form for suggestions and edits• http://www.enginst.org/files


Planned Studies Planned Studies • Engineering studies--next steps

– Tire and road surface characterization– Grip strength testing– Multiple passengers—in progress

• Educational intervention– Grant application planned for early 2013:

intervention to modify risk perception

• Helmet and TBI studies– TBI characterization under varying scenarios– Helmet strength requirements– Other helmet design issues/barriers (visual field,

comfort, etc.)


Challenges and Next StepsChallenges and Next Steps

• Improve and expand training/educational evaluation

• Short term: Use novel and more sophisticated methods to convey ATV risk to families

• Longer term: Engineering modifications to improve vehicle design and stability as well as reduce child access and passenger use


Acknowledgements

• Arkansas Biosciences Institute• Children’s University Medical Group Fund• HRSA Emergency Medical Services for Children

Targeted Issues Grant program• Center for Translational Neuroscience

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ATV Safety Summit: Consumer Awareness: Getting the Message Out - Education and Training for...

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