title: More fatal all-terrain vehicle crashes occur on the roadway than off: increased risk-taking characterises roadway fatalities.
abstract: BACKGROUND
  All-terrain vehicles (ATVs) have steadily increased in popularity, size and speed, characteristics that likely contribute to the alarming rise in ATV-related fatalities. One potentially high-risk activity is riding on the road.
  
  
  OBJECTIVE
  To compare fatal ATV crashes that occur on the roadway and off, to more fully understand factors that contribute to fatalities at each location.
  
  
  METHODS
  Fatality data from the US Consumer Product Safety Commission (CPSC) were used for descriptive and comparative analyses. Multivariate logistic regression analysis was performed to determine relative risk.
  
  
  RESULTS
  Over 60% of all fatalities (1985-2009) resulted from roadway crashes. After 1998, roadway fatalities increased at over twice the rate of off-road fatalities. Roadway crashes were more likely than off-road crashes to involve multiple fatalities, carrying passengers, alcohol use, collisions and head injuries. Roadway victims were less likely to be helmeted than off-road victims. Passengers and operators with passengers were also less likely to be helmeted than operators riding alone. Helmeted victims were half as likely to suffer a head injury.
  
  
  CONCLUSIONS
  Fatal roadway crashes were more likely than off-road crashes to involve risk-taking behaviours (eg, carrying passengers) that could exacerbate the inherent difficulty of operating ATVs on roadway surfaces. Higher crash forces from greater speed, and lower use of protective equipment, may also have contributed to higher roadway mortality rates. Eliminating non-essential ATV road use may be an effective way to reduce ATV-related fatalities. This will likely require a substantial investment in rider education and better enforcement of ATV road use restriction laws.
authors.affiliation: Department of Emergency Medicine, University of Iowa, Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa 52242, USA. gerene-denning@uiowa.edu
authors.forename: Gerene M
authors.initials: GM
authors.lastname: Denning
authors.forename: Karisa K
authors.initials: KK
authors.lastname: Harland
authors.forename: David G
authors.initials: DG
authors.lastname: Ellis
authors.forename: Charles A
authors.initials: CA
authors.lastname: Jennissen
mesh_terms: D000059:Accidents / Q000401:mortality*; D000063:Accidents, Traffic / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015541:Off-Road Motor Vehicles / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D014481:United States / Q000453:epidemiology; D055815:Young Adult