title: All-terrain vehicles (ATVs) on the road: a serious traffic safety and public health concern.
abstract: OBJECTIVE
  On-road all-terrain vehicle (ATV) crashes are frequent occurrences that disproportionately impact rural communities. These crashes occur despite most states having laws restricting on-road ATV use. A number of overall risk factors for ATV-related injuries have been identified (e.g., lack of helmet, carrying passengers). However, few studies have determined the relative contribution of these and other factors to on-road crashes and injuries. The objective of our study was to determine whether there were differences between on- and off-road ATV crashes in their demographics and/or mechanisms and outcomes of injuries.
  
  
  METHODS
  Data were derived from our statewide ATV injury surveillance database (2002-2009). Crash location and crash and injury mechanisms were coded using a modification of the Department of Transportation (DOT) coding system. Descriptive analyses and statistical comparisons (chi-square test) of variables were performed. Multivariate logistic regression analysis was used to determine relative risk.
  
  
  RESULTS
  976 records were included in the final analysis, with 38 percent of the injured individuals from on-road crashes. Demographics were similar for crashes at each location, with approximately 80 percent males, 30 percent under the age of 16, and 15 percent passengers. However, females and youths under 16 were over 4 times more likely to be passengers (P ≤ 0.0001), regardless of crash location. Compared to those off-road, on-road crash victims were approximately 10 times more likely to be involved in a vehicle-vehicle collision (P < 0.001), 3 times more likely to have a severe brain injury (P < 0.001), and twice as likely to have suffered major trauma (P < 0.001). Adult operators in on-road crashes were also twice as likely to test positive for alcohol as those off-road (P < 0.05). Helmet use significantly reduced the odds of sustaining a brain injury and on-road victims were only half as likely to be helmeted (P < 0.01).
  
  
  CONCLUSIONS
  More than 1 in 3 on-road crashes involved a collision with another vehicle, suggesting that ATVs on the road represent a potential traffic safety concern. Of note, helmets were associated with reduced risk for the number and severity of brain injuries, providing further support for the importance of helmet use. Finally, even controlling for helmet use, on-road crash victims suffered more major trauma and severe brain injuries than those off-road. Overall, our data reinforce the importance of laws restricting ATV road use and the need for effective enforcement, as well as the need to increase user education about ATV road-use laws and the dangers of riding on the roads.
authors.affiliation: Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA. gerene-denning@uiowa.edu
authors.forename: Gerene
authors.initials: G
authors.lastname: Denning
authors.forename: Charles
authors.initials: C
authors.lastname: Jennissen
authors.forename: Karisa
authors.initials: K
authors.lastname: Harland
authors.forename: David
authors.initials: D
authors.lastname: Ellis
authors.forename: Christopher
authors.initials: C
authors.lastname: Buresh
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008297:Male; D015541:Off-Road Motor Vehicles; D011634:Public Health; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D012449:Safety; D014947:Wounds and Injuries / Q000453:epidemiology*