Rural adolescent attitudes and use of helmets while riding ATVs, motorcycles and dirt bikes.

BACKGROUND: Head injuries are the most common cause of death in some motorized vehicles for which helmet use can significantly decrease the risk. Our objective was to determine rural adolescents' attitudes regarding helmets and their use while riding ATVs, motorcycles and dirt bikes. METHODS: A convenience sample of 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees were surveyed. After compilation, data were imported into the statistical program, R ( https://www.R-project.org/ ). Descriptive statistics, contingency table, logistic regression and non-parametric alternatives to ANOVA analyses were performed. RESULTS: 1331 adolescents (13-18 years) participated. One half lived on a farm, 21% lived in the country/not on a farm and 28% were from towns. Nearly two-thirds (65%) owned an ATV with 77% of all having ridden one in the past year. Farm residents had the highest ATV ownership (78%) and having ridden (80%) proportions, both p < 0.001. Overall, ownership and ridership for motorcycles (22% and 30%, respectively) and dirt bikes (29% and 39%, respectively) was significantly less than ATVs, all p < 0.001. Of ATV riders, those living on farms or in the country/not on a farm rode them more frequently than those from towns, p < 0.001. Higher percentages always/mostly wore helmets when riding dirt bikes (51%) and motorcycles (57%) relative to ATVs (21%), p < 0.001. Those from farms had lower proportions wearing helmets versus those living elsewhere for all vehicles. Helmet use importance ratings (1-10, 10 high) were not different for motorcycles (mean 8.6, median 10) and dirt bikes (mean 8.3, median 10), but much lower for ATVs (mean 6.1, median 6). Females, non-owners, and helmet law supporters all had higher helmet use importance ratings. Males, those from farms, and owners and riders of the vehicles all had lower proportions that supported helmet laws. Support for helmet laws was significantly lower for ATVs (30.7%) than dirt bikes (56.3%) or motorcycles (72.3%), both p < 0.001. Those whose families had strict ATV "No Helmet, No Riding" rules had much higher helmet use and helmet importance ratings. CONCLUSIONS: Our study indicates that the safety culture surrounding helmet use is relatively poor among rural adolescents, especially on farms, and deserves targeted interventions.

A national study of firearm exposure and safety training among rural youth.

BACKGROUND: Data regarding rural youths' experience with firearms, including safety training, is highly limited despite their frequent presence in homes. Our objective was to investigate rural adolescents' use of firearms and whether they had received formal firearm training. METHODS: A convenience sample of 2021 National FFA (formerly Future Farmers of America) Convention & Expo attendees were given an anonymous survey at the University of Iowa Stead Family Children's Hospital injury prevention booth. The survey explored their use of rifles/shotguns and handguns and whether they had completed a certified firearm safety course. Descriptive and comparative analyses, including multivariable logistic regression analyses, were performed on compiled data. RESULTS: 3206 adolescents ages 13-18 years participated with 45% reporting they lived on a farm or ranch. The vast majority of participants (85%) had fired a rifle/shotgun; 43% reported firing them > 100 times. Of those that had fired rifles/shotguns, 41% had done so before 9 years old. Most had also fired a handgun (69%), with 23% having fired handguns > 100 times. Of those that had fired handguns, 44% had done so before 11 years. Average age for first firing rifles/shotguns was 9.5 (SD 3.1) years, and 11.1 (SD 3.0) years for handguns. Males, non-Hispanic Whites, and those living on farms or in the country had significantly greater percentages who had fired a rifle/shotgun or a handgun. Significant differences were also seen by U.S. census region. Over half (64%) reported having gone hunting. Of those that had used a firearm, 67% had completed a firearm safety training course. Overall, 23% were/had been members of a school or club shooting team and of these, 87% had taken a safety course. CONCLUSIONS: Most FFA member participants had fired both rifles/shotguns and handguns, many at very young ages. Significant differences in firearm use were noted by demographic factors including the home setting (i.e., farms and ranches) and their U.S. census region. Nearly one-third of adolescent firearm users had not received formal safety training. Promoting firearm safety should include advising families on when it is developmentally appropriate to introduce youth to firearms and on the importance of firearm safety training.

The association between county ordinances allowing off-road vehicles on public roads and crash rates.

BACKGROUND: Legislative bodies across the country have increasingly allowed off-road vehicles (ORVs) including all-terrain vehicles (ATVs) and utility task vehicles (UTVs) on public roads, an environment for which they are not designed. In 2004, Iowa gave individual counties the discretion to pass ordinances allowing ORVs on public roadways. The objective of this study was to evaluate the relationship between the passage of ORV ordinances and ORV crash rates, especially on public roads. METHODS: An Iowa ORV roadway ordinance database and an Iowa ORV crash database (2002-2018) for all 99 counties were compiled. Crashes for which county location could not be determined were excluded. Utilizing a zero-inflated Poisson model, correcting for background crash frequency trends and population, investigators compared the relative rates of crashes after ordinance passage to time points before ordinance implementation and to counties without such ordinances. Sub-analyses, including that focused on more recent years (2008-2018), were also performed. RESULTS: Forty-five county ORV roadway ordinances went into effect between 2011 and 2018 and 2,347 crashes (69%) met inclusion criteria. Adjusted for year, there was a 58% greater ORV crash rate in counties after passing an ORV roadway ordinance (incidence rate ratio (IRR) 1.58, 95% CI 1.32-1.90). Roadway crashes (n = 834) increased 48% after ordinance passage (IRR 1.48, 95% CI 1.14-1.94). This roadway crash association remained statistically significant when analysis was limited to the years 2008-2018 (IRR 1.39, CI 1.06-1.83, n = 544); to ATV crashes only (IRR 1.70, CI 1.20-2.40, n = 683); and to ATV crashes excluding counties with UTV-only ordinances (IRR 1.74, CI 1.40-2.15, n = 2,011). CONCLUSIONS: ORV roadway and total crashes increased significantly after implementation of county ordinances allowing ORVs on public roadways and when compared to counties without such ordinances. It is likely that these increased crashes have resulted in more injuries and possibly deaths. Results from this study may help inform policymakers as they consider legislation regarding ORV usage on public roads.

Firearm exposure and safety training of rural Iowa youth.

PURPOSE: Our objective was to investigate rural adolescents' use of firearms and whether they had received firearm training. METHODS: 2019 Iowa FFA Leadership Conference attendees were surveyed. Descriptive and comparative analyses were performed. RESULTS: One thousand three hundred and eighty-two FFA members aged 13-18 years participated. The vast majority (85%) had fired a rifle/shotgun; 58% reported firing them >20 times. Of those who had fired rifles/shotguns, 32% had done so before 9 years old; 79% before 13 years. Most had also fired a handgun (62%), with 30% having fired handguns >20 times. Of those who had fired handguns, 34% had done so before 11 years old. The average age for first firing rifles/shotguns was 10.1 (SD 2.9) years, and 11.9 (SD 2.8) years for handguns. Males, older teenagers, and those living on farms or in the country had significantly greater percentages that had fired a rifle/shotgun or a handgun. Greater proportions of males had used firearms >20 times and started firing them at younger ages. Over half (55%) reported having gone hunting. Of those, 24% first hunted before 9 years old; 48% before 11 years. Of those who had used a firearm, 61% had completed a firearm safety training course. For hunters, 80% had taken a course. CONCLUSIONS: Most participants had used firearms, and many did so at very young ages. Substantial numbers had not received formal training. The authors believe that families should be counseled when it is developmentally appropriate to introduce youth to firearms, and all should take firearm safety training before using them.

Pre- and postnatal safe sleep knowledge and planned as compared to actual infant sleep practices.

BACKGROUND: Our objectives were to compare safe sleep knowledge, attitudes and planned vs. actual infant sleep practices among expectant mothers before and after their infant's birth and to determine whether differences (if present) were associated with any demographic variables. METHODS: Study participants were surveyed at their 28-week prenatal and 6-week postpartum obstetric clinic visits from November 2019-February 2021. Due to COVID-19 pandemic cancellation of in-person postpartum visits, many participants received text messaging encouraging them to take the follow-up survey online. Frequency and comparative analyses were performed. RESULTS: 355 women (44%) completed both pre- and postnatal surveys. Many participants increased their safe sleep knowledge during the study. For example, of those who were unsure or thought it safe for a baby to sleep in a baby swing/bouncy seat, two-thirds (67/102, 66%) stated it was unsafe on the postnatal survey. In addition, many who were unsure or planned sleep practices considered unsafe prenatally reported utilizing safe sleep practices on their postnatal survey. For example, of those unsure or planning to use a crib bumper (17% of the total), almost all (88%) were not using one postnatally. Conversely, some participants who reported they would be following safe sleep practices prenatally were not doing so postpartum. For example, 13% of those stating they would place their child on their back reported using another sleep position on the postnatal survey. Certain demographics had higher proportions reporting this reversal for specific safe sleep practices. For example, non-Hispanic Whites (19%) as compared to other races/ethnicities (5%) and those with incomes ≥ $75,000 (21%) as compared with those with less income (9%) had higher proportions stating their infant would sleep in the same room but then reported postnatally they were sleeping in a different room, p = 0.0094 and p = 0.0138, respectively. CONCLUSIONS: We observed increases in safe sleep knowledge and that some participants followed safer sleep practices than they had planned. However, there were also participants who planned to use safe sleep practices prenatally who were not doing so after their baby's birth. Our study identified demographics for which targeted safe sleep education and more effective interventions may be needed.

Pediatric lawn mower-related injuries and contributing factors for bystander injuries.

BACKGROUND: Riding lawn mower injuries are the most common cause of major limb loss in young U.S. children. Our study objective was to investigate the circumstances surrounding pediatric riding lawn mower injuries and to identify potential contributing risk factors and behaviors leading to these events. METHODS: Followers/members of both a public and a private lawn mower injury support and prevention Facebook page who had or were aware of children who had suffered a lawn mower-related injury were invited to complete an electronic survey on Qualtrics. Duplicate cases and those involving push mowers were removed. Frequencies and chi-square analyses were performed. RESULTS: 140 injured children were identified with 71% of surveys completed by parents and 19% by an adult survivor of a childhood incident. The majority of injured children were Caucasian (94%), male (64%), and ≤ 5 years of age at the time of the incident (63%). Bystanders were 69% of those injured, 24% were lawn mower riders, and mower operators and others accounted for 7%. The lawn mower operator was usually male (77%), being the father/stepfather in almost half. Overall, 59% of injuries occurred while traveling in reverse, 29% while moving forward. Nearly all (92%) had an amputation and/or permanent disability. Subgroup analysis (n = 130) found injured bystanders were younger than injured passengers with 71% versus 45% being < 5 years of age, respectively (p = 0.01). Over three-quarters of bystander incidents occurred while moving in reverse as compared to 17% of passenger incidents (p < 0.01). Amputations and/or permanent disabilities were greater among bystanders (97%) as compared to passengers (79%, p = 0.01). Only 3% of bystanders had an upper extremity injury as compared to 21% of passengers (p = 0.01). Seventy-three percent of bystander victims had received at least one ride on a lawn mower prior to their injury incident. CONCLUSIONS: Child bystanders seriously injured by riding lawn mowers were frequently given prior rides likely desensitizing them to their inherent dangers and leading them to seek rides when mowers were being used. Engineering changes preventing blade rotation when traveling in reverse and not giving children rides (both when and when not mowing) may be critical in preventing mower-related injuries.

Recreational off-highway vehicle exposure, safety behaviors and crash experiences among adolescents.

BACKGROUND: Recreational off-highway vehicles (ROVs), often called utility task vehicles (UTVs), are designed to be driven by those ≥ 16 years and manufacturers recommend passengers be at least 12 years old. This study's objective was to determine Iowa adolescents' exposure to ROVs, riders' use of restraint devices, and crash prevalence. METHODS: Adolescents participating in the Safety Tips for ATV Riders (STARs) program at their schools were anonymously surveyed by the Iowa Off-Road Vehicle Safety Task Force from Fall 2014-Fall 2019. Frequency, bivariate (chi square and Fisher's exact test) and logistic regression analyses were performed using SAS software, V.9.4. RESULTS: A total of 4,023 students (9-18 years) from 18 school districts participated. Overall, 68% reported having ridden in an ROV. The proportions having ridden an ROV by where participants lived were farm (85%) > country/not farm (73%) > town (60%), p < 0.0001. Of those asked additional ROV questions (n = 2152), 39% of ROV riders reported riding at least weekly in the previous 12 months. Of those riding ROVs in the past year, 29% reported having at least one crash. Males and respondents living on farms had higher percentages reporting crashes, as compared to females (31% vs. 24%, p = 0.005) and those living elsewhere (35% vs. 24%, p = 0.0003). Thirty-seven percent of ROV riders never or almost never wore their seatbelt. Seatbelt use was inversely proportional to age, p < 0.001. A higher proportion of females reported always or almost always wearing a seat belt (42% vs. 36%, p = 0.0016). Percentages never or almost never wearing seatbelts by residence were farm (47%) > country/not farm (38%) > town (32%), p = 0.0005. Almost daily riders and those reporting having been in a crash were both 1.7 times more likely to never or almost never wear a seatbelt as compared to infrequent riders and those without a crash, respectively. CONCLUSIONS: Iowa adolescents frequently ride ROVs and often without a seatbelt, putting them at greater risk for serious injury or death in a crash. Almost 30% of riders reported an ROV-related crash in the past year. Our study identified a high-risk population that could be targeted for ROV safety education and other injury prevention efforts.

All-terrain vehicle exposure and the association of certified training on adolescent safety behaviors and crash experiences.

BACKGROUND: Certified training courses in all-terrain vehicle (ATV) operation are recommended, but little has been published regarding how they affect riding behaviors. Our objectives were to determine adolescents' ATV riding exposures, crashes and injuries, and the association of completing certified ATV training on riding behaviors. METHODS: Respondents completed an anonymous paper survey at 30 school districts approximately one year after participating in the Safety Tips for ATV Riders (STARs) program. Survey data were compiled using Qualtrics™. Frequency, chi-square, Fisher's exact test, and logistic regression analyses were performed using SAS, V.9.4. RESULTS: 4,891 students completed the survey from Fall 2012-Fall 2019. Respondents were 10-18 years old, and similar numbers of participants were male and female. Fifty-nine percent lived in town, 18% on a farm, and 22% in the country but not on farm. Forty-two percent reported their families owned an ATV. Seventy-seven percent had ridden an ATV, 40% of whom reported riding at least weekly. The vast majority (94%) used ATVs for recreation and 49% used them for work purposes. In the previous year, 22% of riders reported having been in a crash, with 7% of crash victims requiring medical attention for injuries. Greater crash likelihood was seen in males, recreational riders, more frequent riders, competitive racers and those who had ridden with passengers or on roads. Only 8% of riders had completed certified ATV safety training (note, STARs is not a certification program). Those whose families owned ATVs, more frequent riders, and public park users had greater likelihoods of course completion. Relative to their peers, respondents who completed a certification course had higher proportions that always/almost always wore helmets (39% vs. 20%, p < 0.0001) and lower proportions that never/almost never wore helmets (29% vs 58%, p < 0.0001), had ridden with passengers (63% vs. 96%, p < 0.0001), and had driven on public roads (41% vs 50%, p = 0.0065). CONCLUSIONS: ATV safety training certification among Iowa adolescents in the study was infrequent but those that received training reported higher helmet use, less riding with passengers, and less driving on public roads. These data suggest completing safety training certification may promote safer riding behaviors among youth.

American Academy of Pediatrics Recommendations for the Prevention of Pediatric ATV-Related Deaths and Injuries.

Since all-terrain vehicles (ATVs) were introduced in the mid-1970s, regulatory agencies, injury prevention researchers, and pediatricians have documented their dangers to youth. Major risk factors, crash mechanisms, and injury patterns for children and adolescents have been well characterized. Despite this knowledge, preventing pediatric ATV-related deaths and injuries has proven difficult and has had limited success. This policy statement broadly summarizes key background information and provides detailed recommendations based on best practices. These recommendations are designed to provide all stakeholders with strategies that can be used to reduce the number of pediatric deaths and injuries resulting from youth riding on ATVs.

A Comprehensive Report on All-Terrain Vehicles and Youth: Continuing Challenges for Injury Prevention.

All-terrain vehicles (ATVs) represent a serious and ongoing public health and safety concern for children and adolescents. Survey studies indicate that high proportions of youth ride ATVs in both rural and nonrural populations. The significant human and economic costs of pediatric ATV-related deaths and injuries result from a number of major risk factors that are highly common in pediatric ATV crashes: operating adult-size vehicles, riding with or as passengers, lack of protective equipment, and riding on public roads. Other less well-studied but potentially significant risk factors are speed, riding at night, alcohol use among older teenagers, and lack of training and supervision. Although potentially safer than adult ATVs, youth models present a number of safety concerns that have not been addressed with rigorous study. The most common ATV crash mechanism is a noncollision event-for example, a rollover. Common injury mechanisms include ejection from the vehicle, resulting in extremity and head injuries, and being pinned or crushed by the vehicle with resulting multiorgan trauma and/or compression asphyxia. Traumatic brain injury and multisystem trauma are the 2 most common causes of death and disabling injury. Taken together, a large multidecade body of evidence is the basis for the American Academy of Pediatrics policy statement recommendation that no child younger than 16 years of age ride on an ATV. Because children continue to be allowed to ride these vehicles, however, efforts to prevent pediatric ATV-related deaths and injuries require multipronged strategies, including education of both youth and parents, safety-based engineering, and enforcement of evidence-based safety laws.

Rural youth's exposure to firearm violence and their attitudes regarding firearm safety measures.

BACKGROUND: In the wake of an epidemic in firearm-related deaths and injuries, youth have become leading voices of concern. This study's objective was to investigate rural youth's personal experiences with firearm-related violence, and their attitudes towards firearms and gun violence prevention strategies. METHODS: Attendees of the 2019 Iowa FFA Leadership Conference were surveyed about personal experiences with firearm-associated deaths and injuries, and their attitudes regarding firearm-related issues. Descriptive (frequencies), bivariate (chi square, Fisher's exact test) and multivariable logistic regression analyses were performed utilizing Stata 15.1 (StataCorp, College Station, Texas). RESULTS: Responses from 1382 FFA members 13-18 years of age were analyzed. About 5% had personally seen someone threatened with a firearm. Over one-third (36%) stated they knew someone who had been killed or injured by gunfire. Of these, over two-thirds knew of someone who had died or was injured unintentionally and 30% knew of someone killed or injured intentionally (e.g. suicide). Nearly all agreed or strongly agreed that the right to use firearms for hunting and shooting sports should be legal (94%), that a firearm safety course should be required to get a hunting license (89%), and that there should be a required background check before purchasing a firearm (89%). Over three-fifths (61%) agreed or strongly agreed that there should be laws requiring safe storage of firearms in homes. Although still high, lesser support for firearm safety policies was seen among males, older youth, participants living on farms or in the country, and youth who hunted, had firearms in their homes, and/or were in homes with unsafe firearm storage. CONCLUSIONS: The majority of youth in this study supported firearm safety measures including required training, background checks, and safe firearm storage in homes. These findings are consistent with the national youth-led call for firearm safety. Additionally, over one-third of respondents personally knew someone who was killed or injured by a firearm and 5% had seen someone or been personally threatened with firearm violence. Our study did not investigate the effects of firearm violence on participants' mental health and wellbeing, but future studies addressing this question seem highly justified.

The dark side of nighttime all-terrain vehicle use.

BACKGROUND: Driving at night is considered a risk factor for all-terrain vehicle (ATV) crashes and injuries but few studies have addressed this issue. Our objective was to compare daytime and nighttime ATV crashes to better understand the potential risk factors associated with riding at night. METHODS: A retrospective study was conducted on Iowa ATV-related crashes and injuries from January 1, 2002 through December 31, 2019 using four statewide datasets: the Iowa Department of Transportation (2002-2019), the Iowa Department of Natural Resources (2002-2019), the Iowa State Trauma Registry (2002-2018) and Iowa newspaper clippings (2009-2019). A standardized coding system was developed, and matching records were identified using Link Plus®. Descriptive (frequencies) and bivariate (chi-square, Fisher's exact test) analyses were performed using VassarStats (Statistical Computation Website). RESULTS: Among crash victims where light conditions were documented (2125/3752, 57%), about one-quarter (485/2125, 23%) were injured at night. Nighttime crash victims were less likely youth (14% vs. 30%, p < 0.0001), less likely to be wearing helmets (11% vs. 18%, p = 0.003), and less frequently involved in motor vehicle crashes (7% vs. 14%, p < 0.0001) as compared to daytime victims. Nighttime victims were also more likely to be passengers (22% vs. 15%, p = 0.002), to test positive for alcohol (44% vs. 13% in adults, p < 0.0001), and to be injured on a roadway (53% vs. 45%, p = 0.007) and on weekends (76% vs. 63%, p < 0.0001). Numerous differences between daytime and nighttime characteristics were observed for males, females, and adults, whereas most characteristics were similar for youth. The severity of injuries and proportion of fatalities were similar among daytime and nighttime crash victims. CONCLUSIONS: Nighttime crash victims, particularly adults, were characterized by more frequent risky behaviors like carrying passengers, roadway riding, alcohol use, and lack of helmets. Whereas the frequency of risky behaviors among youth was similar for daytime and nighttime crashes, these behaviors put children at potential risk for injury. Multi-factorial, targeted injury prevention strategies are needed, including improved vehicle design, education about the dangers of nighttime operation, and passage and enforcement of ATV safety laws. Particularly relevant to our study are laws that prohibit nighttime riding.

Firearm Exposure and Storage Practices in the Homes of Rural Adolescents.

INTRODUCTION: Rural areas have higher rates of firearm-related unintentional and suicide deaths. Having access to a firearm greatly increases suicide risk. Safe firearm storage can be a major factor in preventing these tragedies. In this study we evaluated firearm exposure and storage practices in rural adolescents' homes. METHODS: An anonymous survey was administered to a convenience sample of attendees at the 2019 Iowa FFA (formerly Future Farmers of America) Leadership Conference. We performed descriptive, bivariate and multivariable logistic regression analyses. RESULTS: A total of 1,382 adolescents participated; 51% were males and 49% were females. Respondents were 13-18 years old, and 53% lived on a farm, 18% in the country/not on a farm, and 29% in town. Almost all (96%) self-identified as White/Caucasian. In their homes, 84% reported having rifles/shotguns, 58% reported having handguns, and 56% reported having both rifles/shotguns and handguns. Males were significantly more likely than females to report having firearms in their home (P<0.001). The likelihood of having rifles/shotguns was greater if living on a farm (odds ratio (OR) 4.19, 95% confidence interval (CI), 2.99-5.88) or in the country/not a farm (OR 2.74, 95% CI, 1.78-4.24) compared to those in town. Similarly, the presence of handguns in the home was increased if living on a farm compared to in town (OR 1.70, 95% CI 1.32-2.18). Rifles/shotguns and handguns were stored unlocked and/or loaded at least some of the time in 62% and 58% of homes, respectively. Those who lived on farms compared to in towns were more likely to have rifles/shotguns (OR 1.83, 95% CI 1.35-2.46) and handguns (OR 1.58, 95% CI 1.10-2.27) stored unlocked. For homes with unlocked rifles/shotguns, 46% stored ammunition unlocked. For homes with unlocked handguns, 38% stored ammunition unlocked. Among those aware of firearm storage in their home, 82% (802/974) reported at least one firearm stored either unlocked and/or loaded at least some of the time. CONCLUSION: The vast majority of rural adolescents we surveyed live in homes with firearms, and a large proportion of those firearms are not stored safely. Widespread efforts are needed to educate rural families about the importance of proper firearm and ammunition storage.

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

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.

Recreational off-highway vehicle crashes resulting in victims being treated at a regional trauma center: mechanisms and contributing factors.

BACKGROUND: Recreational off-highway vehicles (ROVs) have become increasingly popular in recent years; however, crash epidemiology is not well described. ROVs travel at least 30 mph, and unlike all-terrain vehicles, have a rollover protective structure (ROPS) and seat belts or a harness system for occupants. This study's objective was to evaluate the demographics, mechanisms, injuries, and associated risk factors of ROV crashes. METHODS: A retrospective chart review was performed for patients of all ages with ROV-related injuries presenting to a Level 1 trauma center from 2004 to 2017. Cases were identified by ICD-9/10 codes and narrative searches. Person- and crash-related variables were examined in relation to injury outcomes including body area injured, injury severity score, and disposition (e.g. hospitalization, intensive care unit admission). Descriptive, bivariate (chi-square, Fishers exact test), and linear regression analyses were performed. RESULTS: Seventy-two patients with ROV-related injuries were identified. The number of injured patients increased over the study period (p < 0.01). Patients were 49% youth < 16 years old, 63% males, and 99% Caucasian. Half of the injured (51%) were passengers, with a higher proportion of youth being passengers (70%) as compared to adults (35%) (p < 0.01). Nearly one-third (30%) of crash victims < 16 years old were ROV drivers. Twenty-nine percent of all crashes occurred on roadways. Almost 40% of injured adults crashed at night, while all youth were injured during the day (p < 0.01). The primary crash mechanism was a rollover (67%). Only one patient was documented as being helmeted, and approximately one-fourth (24%) sustained head injuries and/or loss of consciousness. Other documented injuries included those to the face (20%), chest (22%), abdomen (11%), extremities (58%), and skin (51%). Over 90% of narratives were consistent with victims being unrestrained. Nearly three-fourths (74%) of victims were hospitalized and 26% required ICU care, one-half (53%) of these being children. CONCLUSIONS: Although ROVs have ROPs, lack of helmet and safety belt use are reducing their benefit. Youth are a large proportion of those injured in ROV crashes, often while driving despite vehicle operation recommended only for those ≥16 years old. Increased public education is needed regarding proper safety measures while operating and riding ROVs.

Adult moped-related injuries treated in U.S. emergency departments.

Objective: Few studies have investigated U.S. emergency department (ED) moped-related injuries. Our objective was to determine the characteristics of moped crashes among adult riders and to identify associations between key variables.Methods: Data were obtained from the National Electronic Injury Surveillance System (NEISS) for 2002-2014. Descriptive and comparative analyses of the identified cases were performed.Results: Based on a probability sample of 2,453 cases, an estimated 108,229 U.S. adult moped-related ED visits occurred during the study period. Injuries increased 2.7-fold over time. Summer months and weekdays were the most common crash times. Three-fourths of injured riders were male, two-thirds were ages 23-59 years, and 77% were Caucasian. Among cases documented, one-half were helmeted, and almost two-thirds of crashes occurred at ≤20 mph. The predominant mechanism was a non-collision crash (60%). Skin-related and musculoskeletal diagnoses were most common. Almost one-fifth of patients were admitted or transferred. Regression analyses showed that males were less likely than females to be in crashes with multiple riders, and more likely to have used alcohol/drugs and to be in a crash with another motor vehicle (MVC). Older riders (≥40 years) were more likely than those younger to have used alcohol/drugs and to suffer torso injuries, and less likely to be in an MVC. As compared to other crash mechanisms, MVCs were more likely to involve injuries to the head/neck/face and torso. The likelihood of being admitted/transferred was higher for males, with increasing age, and for collision-related crashes. The higher likelihood of being admitted/transferred was also characterized by alcohol/drug use, by lower limb and torso injuries, and almost 8 times more likely for riders with serious head injuries.Conclusions: Moped injuries increased in all adult age groups during the study period. However, there were significant differences in contributing factors, crash mechanism, and outcomes by sex, race, and age. These findings suggest the need for targeted injury prevention interventions.

Social workers' determination of when children's access or potential access to loaded firearms constitutes child neglect.

BACKGROUND: Pediatric firearm-related deaths and injuries are a serious societal problem. Our study's objective was to determine social workers' assessment of child neglect with respect to access or potential access to a loaded firearm. METHODS: Study invitations were delivered by e-mail to National Association of Social Workers members designating their practice as "Child/Family Welfare" (N = 4933) in October/November, 2015. Demographics, attitudes regarding child access prevention (CAP) laws, and the ages (4-14 years) at which social workers deemed several scenarios as child neglect were determined. Descriptive (frequencies) and bivariate (chi square) analyses were performed. RESULTS: 485 of 4933 social workers completed the survey (9.8%). Of these, most agreed or strongly agreed (≥92%) there should be laws in place requiring firearms to be stored so unwanted access cannot be obtained by a child, even up to 15 years of age. In a scenario where a child had potential access to a loaded firearm, but never gained access, the presence of a CAP law pertinent to the child in the scenario increased the likelihood respondents would find the situation child neglect for all ages (p < 0.0001 for each age comparison). Moreover, 10.3% felt they could not deem the situation child neglect without the presence of a CAP law, no matter the age of the child. In a scenario where a child gained access to a loaded firearm, the vast majority found this to be child neglect (82-99%, with the percentage varying by the age of the child involved), regardless of the presence or absence of a CAP law and/or an injury being sustained. In addition, when a CAP law was in place, social workers were more likely to find neglect if the child had sustained a firearm-related injury as well (p values ranged from 0.016-0.0081 for age comparisons). CONCLUSIONS: The vast majority of child/family welfare social workers surveyed found it to be child neglect when youth accessed or had potential access to a loaded, unsecured firearm. Results of the study provide support for the passage of universal CAP laws to help protect children equally across states and ensure the safe storage of firearms in homes.

Pediatric and adolescent injury in all-terrain vehicles.

All-terrain vehicles (ATVs) remain a significant source of death and injury among youth. The purpose of this review is to provide an overview of the scope of the problem, the risk factors involved, crash-related outcomes and costs, and injury prevention strategies. There are currently more than 100 pediatric ATV-related fatalities each year and over 30,000 emergency department visits, with a potential annual cost for deaths and injuries approaching $1 billion. Major risk factors include lack of training, operating adult-size ATVs, riding as or carrying passengers, riding on the road, and not wearing a helmet. Extremity injuries are highly common, and the leading causes of death include brain injuries and multi-organ trauma. The latter increasingly involves being crushed by or pinned under the ATV. Reducing ATV-related deaths and injuries will require multiple strategies that integrate approaches from education, engineering, and evidence-based safety laws and their enforcement.

Child abuse and neglect experts' determination of when a child being left home alone constitutes child neglect.

BACKGROUND: Only 14 states have laws or guidelines regarding the minimum age a child may be left home alone. These ages range from 6 to 14 years. Our objective was to identify factors that influence child neglect determination by experts with regards to parents leaving children home alone. METHODS: American Academy of Pediatrics Section on Child Abuse and Neglect members (N = 523) were surveyed from July-August, 2015. Respondents were asked whether scenarios involving a child of varying age knowingly left home alone for 4 h were neglect in the presence or absence of injury to the child and the legality of the situation. Comparisons were performed using the chi-square test. RESULTS: One hundred ninety-three members responded (36.9%). In the scenario where there were no relevant laws and the child was uninjured, nearly 100% of the child experts determined this as being child neglect when the child was 6 years old. For 8, 10, 12, and 14 year olds, this was 88, 48, 4, and 1%, respectively. However, a significantly higher percentage of experts considered it child neglect for most ages when there was a law making the scenario illegal as compared when there was no law, and when the child was injured versus when they were not. The only demographic variable that showed a difference in child neglect determination was that females were more likely to consider higher aged children as having been neglected when there were no laws but the child was injured. The vast majority of experts (85%) stated that leaving a child home alone for 4 h should be illegal if the child is < 9 years old, and nearly one-half (44%) said it should be illegal for children < 11 years old. CONCLUSIONS: A number of factors affect how experts view children being left home alone as potential child neglect. Our data suggests that such cases may be evaluated differently due to variations in state laws, even though the risk to the child is the same. These results call for child safety law reform to provide greater uniformity in the evaluation of potential child neglect cases and better protect the safety of children.