ATV Safety Summit: Consumer Awareness: Getting the Message Out - Education and Training for All-terrain Vehicle Safety
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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
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archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
• 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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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)
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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.”
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
Engineering ResearchEngineering Research
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
Simulation Factorial StudySimulation Factorial Study
ATV Speed 10mph Slope 30 degrees Slope length 2m
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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.)
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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
archildrens.org uams.eduarpediatrics.org uams.eduarpediatrics.org
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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