Arkansas — Targeted Issue
Development and Evaluation of Targeted ATV Safety Educational Strategies for Rural Children
Sept. 1, 2007 - Aug. 31, 2011


Arkansas Children's Hospital Research Institute
Principal Investigator(s)
Grant Number
Award Amount


HRSA Region


EMSC Region

Red River

HPP Region





Name Roles Agency Mailing Address Office Phone Email
Mary Aitken, MD
  • Principal Investigator
Arkansas Children's Hospital Research Institute


Title Published Description Format Availability
All-terrain Vehicle Safety ToolKit 2011 The ATV Safety Tool Kit contains valuable safety information that when utilized can save lives and stop preventable injuries from harming ATV riders. The information is presented in multiple formats for the facilitator to use as he or she pleases. It includes: - A Trip Unplanned, an engaging 20-minute video about the risks of ATV use; - discussion guide to facilitate discussion of key safety points for ATV riders; - posters to reinforce key safety messages; - an ATV safety brochure to reinforce key safety messages; - public service announcments; and - a PowerPoint presentation on ATV safety. Toolkit Available Online


Title Published Author Abstract Publication PMID
ATV and Bicycle Deaths and Associated Costs in the United States, 2000-2005 2009 Helmkamp JC, Aitken ME, Lawrence BA OBJECTIVE: We determined the rate and costs of recent U.S. all-terrain vehicle (ATV) and bicycle deaths. Methods: Fatalities were identified from the National Center for Health Statistics Multiple Cause-of-Death public-access file. ATV and bicycle deaths were defined by International Classification of Diseases, 10th Revision codes V86.0-V86.9 and V10-V19, respectively. Lifetime costs were estimated using standard methods such as those used by the National Highway Traffic Safety Administration. Results: From 2000 through 2005, 5,204 people died from ATV crashes and 4,924 from bicycle mishaps. A mean of 694 adults and 174 children died annually from ATV injuries, while 666 adults and 155 children died from bicycle injuries. Death rates increased among adult ATV and bike riders and child ATV riders. Males had higher fatality rates for both ATVs and bicycles. Among children, total costs increased 15% for ATV deaths and decreased 23% for bicycle deaths. In adults, ATV costs increased 45% and bike costs increased 39%. Conclusions: Bicycle- and ATV-related deaths and associated costs are high and, for the most part, increasing. Promotion of proven prevention strategies, including helmet use, is indicated. However, enforcement of helmet laws is problematic, which may contribute to observed trends.
Public Health Reports 19445417
Foot injuries associated with all-terrain vehicle use in children and adolescents 2008 Thompson TM, Latch R, Parnell D, Dick R, Aitken ME, Graham J OBJECTIVES: Children can suffer serious foot injuries while riding or driving an all-terrain vehicle (ATV). The purpose of this study was to describe this injury pattern.
METHODS: A search of the trauma registry of the Arkansas Children's Hospital for the years 1998 through 2006 was conducted to find cases of children admitted for treatment of foot injuries related to ATV use. The cases were deidentified and summarized. The study was reviewed and deemed to be exempt by the local institutional review board.
RESULTS: Ten cases of foot injury were identified. The median age was 3 years. Eight had forefoot injuries, including 6 who had amputation of the great toe. All but one patient had multiple open foot fractures. Seven required skin grafting. Complications included infection, scar formation, disfigurement, and gait disturbance. The mean length of stay on initial hospitalization was 6 days, and the mean hospital charge was $12,890.
CONCLUSIONS: Children, particularly young children, on an ATV can suffer serious foot injuries resulting in disfigurement and disability. The recommendation that young children not ride on ATVs is emphasized by these findings.
Pediatric Emergency Care 18633307
A trial of an all-terrain vehicle safety education video in a community-based hunter education program 2011 Williams RS, Graham J, Helmkamp JC, Dick R, Thompson T, Aitken ME PURPOSE: All-terrain vehicle (ATV) injury is an increasingly serious problem, particularly among rural youth. There have been repeated calls for ATV safety education, but little study regarding optimal methods or content for such education. The purpose of this study was to determine if an ATV safety video was effective in increasing ATV safety knowledge when used in a community-based statewide hunter education program. METHODS: During the baseline phase, surveys focusing on ATV safety were distributed to students in the Arkansas hunter safety program in 2006. In the intervention phase a year later, an ATV safety video on DVD was provided for use in required hunter education courses across Arkansas. The same survey was administered to hunter education students before and after the course. FINDINGS: In the baseline phase, 1,641 precourse and 1,374 postcourse surveys were returned and analyzed. In the intervention phase, 708 precourse and 694 post-course surveys were completed. Student knowledge of ATV safety after watching the video was higher than in preintervention classes. Knowledge of appropriate helmet usage increased from 95% to 98.8% (P < .0001). Awareness of the importance of not carrying a passenger behind the driver increased from 59.5% to 91.1% (P < .0001). Awareness of importance of hands-on ATV rider training increased from 82.1% to 92.4% (P < .0001). CONCLUSIONS: A brief ATV safety video used in a hunter education course increased ATV safety knowledge on most measures. A statewide hunter education program appears to be a useful venue for ATV safety education. Journal of Rural Health 21729152
Impact of helmets on injuries to riders of all-terrain vehicles 2009 SM Bowman, ME Aitken, JC Helmkamp, SA Maham, CJ Graham BACKGROUND: Although helmet use has been shown to be effective in reducing traumatic brain injuries (TBIs) due to motorcycle and bicycle crashes, it is unknown whether helmet use is associated with different injury patterns and severity for users of all-terrain vehicles (ATVs).
OBJECTIVES: To compare the likelihood of injury and death between helmeted and unhelmeted riders of ATVs.
METHODS: The National Trauma Data Bank for years 2002-2006 was used to examine the records of 11 589 patients hospitalized for injuries resulting from ATV use. The likelihood of receiving a TBI diagnosis or a significant injury to other body regions and differences in injury severity and in-hospital mortality between helmeted and unhelmeted ATV riders were compared.
RESULTS: After multivariable adjustment, compared with helmeted riders, unhelmeted riders were significantly more likely to sustain any TBI (OR 1.62, 95% CI 1.49 to 1.76, p<0.001) and major/severe TBI (OR 3.19, 95% CI 2.39 to 4.25, p<0.001). Unhelmeted riders were significantly more likely to die while in hospital than were helmeted riders (OR 2.58, 95% CI 1.79 to 3.71, p<0.001). Significant injuries to the neck and face regions were also significantly more likely in unhelmeted riders (OR 3.53, 95% CI 1.28 to 9.71, p = 0.015, and OR 1.94, 95% CI 1.32 to 2.84, p = 0.001, respectively).
CONCLUSIONS: ATV riders who do not wear helmets are more likely to receive significant injuries to the head, face, and neck. Prevention strategies and enforceable policy interventions to increase helmet use among ATV riders appear warranted.
Injury Prevention 19190268
Making the message meaningful: a qualitative assessment of media promoting all-terrain vehicle safety 2012 Brann M, Mullins SH, Miller BK, Eoff S, Graham J, Aitken ME BACKGROUND: Millions of all-terrain vehicles (ATV) are used around the world for recreation by both adults and youth. This increase in use has led to a substantial increase in the number of injuries and fatalities each year. Effective strategies for reducing this incidence are clearly needed; however, minimal research exists regarding effective educational interventions.
Objective This study was designed to assess rural ATV riders' preferences for and assessment of safety messages.
METHODS: 13 focus group discussions with youth and adult ATV riders were conducted. 88 formative research participants provided feedback on existing ATV safety materials, which was used to develop more useful ATV safety messages. 60 evaluative focus group participants critiqued the materials developed for this project.
RESULTS: Existing ATV safety materials have limited effectiveness, in part because they may not address the content or design needs of the target population. ATV riders want educational and action-oriented safety messages that inform youth and adult riders about their responsibilities to learn, educate and implement safety behaviours (eg, appropriate-sized ATV, safety gear, solo riding, speed limits, riding locations). In addition, messages should be clear, realistic, visually appealing and easily accessible. Newly designed ATV safety materials using the acronym TRIPSS (training, ride off-road, impairment, plan ahead, safety gear, single rider) meet ATV riders' safety messaging needs.
CONCLUSIONS: To reach a target population, it is crucial to include them in the development and assessment of safety messages. Germane to this particular study, ATV riders provided essential information for creating useful ATV safety materials.
Injury Prevention 22101098
Still unsafe, still in use: ongoing epidemic of all-terrain vehicle injury hospitalizations among children 2010 Bowman SM, Aitken ME BACKGROUND: The injury risks to children who ride all-terrain vehicles (ATVs) are well documented and include increased risk of death or hospitalization. We identify pediatric hospitalization trends for ATV injuries, provide national benchmarks, and discuss policy and prevention implications.
METHODS: We used data (1997-2006) from the kid's inpatient database, the only all-payer inpatient care database for children in the United States. Children and adolescents aged 0 year to 17 years were included. We generate national estimates of hospitalizations.
RESULTS: Total pediatric hospitalizations for ATV injuries have increased 150% from an estimated 1,618 in 1997 to 4,039 in 2006. The overall ATV-related injury hospitalization rate increased 139% from 2.3 per 100,000 in 1997 to 5.5 per 100,000 in 2006. Rates increased for both males and females, although the rate for males remained much larger than for females in 2006 (8.1 per 100,000 vs. 2.7 per 100,000, p < 0.001). For all age groups, ATV hospitalizations increased significantly between 1997 and 2006, but this change was most pronounced among those aged 15 years to 17 years. ATV hospitalization rates also increased significantly for patients hospitalized with traumatic brain injuries.
CONCLUSIONS: ATVs are associated with a significant and increasing number of hospitalizations for children. Reexamination of previous federal policies, including the potential for a new consent decree between the Consumer Product Safety Commission and ATV industry representatives, should be considered to address this alarming trend and to adopt effective strategies to minimize the use by children. Enforceable state-level policy to promote helmet use among ATV riders seems to be critically needed.
J Trauma 20962681