ATV Safety Summit: Consumer Awareness: Getting the Message Out - Education and Training for All-terrain Vehicle Safety

Education and Training for All-terrain Vehicle Safety
Mary E. Aitken, MD MPH
Injury 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 Summit
US Consumer Product Safety Commission, October 2012

archildrens.org arpediatrics.org
arpediatrics.org uams.edu

ATV Injury Admissions,
Arkansas Children's Hospital Trauma Service
100
by Year and Age, 1998-2011
90
80
70
60 15 to 18
Count

10 to 14
50
5 to 9
40 0 to 4
30
20
10
0
1998

2011
1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010
Year

ATV Safety Activities
• 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


Arkansas ATV Research Group
• Arkansas • West Virginia
– Mary Aitken, Pediatrics – Maria Brann, Mass
– James Graham, Pediatric Communications
Emergency Medicine • Denver
– Beverly Miller, Education – Jim Helmkamp, Epidemiology
– Hope Mullins, Public Health • Baltimore
– Chandra Thorbole, – Steve Bowman, Health
Engineering Services Research
• Oklahoma
– Mike Klumpp, 4-H/Agriculture


ATV 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 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 County
ATV Use and Behavior by County and Time
Intervention Comparison
Pre Post Pre Post
Exposure 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%

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


Targeted 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 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 Project
Change in Correct Response, Safe ATV Use,
Baseline and Video Intervention (%)
21.6
Baseline Intervention

15.9

11.2
10.3

6.5 6.5
5.7
4.4
3 3.2
2.6 2.4
0.5

Children as Children Children <16 Children <16 Children <16 Training Alcohol Unloaded
-1.4
-3.3 -3.5
passengers experience child Supervised No ATVS Weapon
vehicles only
Williams et al, J Rural Health, 2010


ATV Safety Toolkit Distribution by State
Through June 2012

ATV Toolkit
Distribution

0

1-5

6-25

26-50

51-100

100+

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

Training on proven strategies
• 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
Bowman, Injury Prevention, 2009

• Despite effectiveness, helmet use among ATV riders is
very low


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 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 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 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 Research


Simulation Factorial Study

ATV Speed 10mph
Slope 30 degrees
Slope length 2m


Simulation 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
• 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 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 All-terrain Vehicle Safety