title: Barriers and facilitators to all-terrain vehicle helmet use.
abstract: BACKGROUND
  The burden of all-terrain vehicle (ATV)-related injuries and deaths in the pediatric population has increased dramatically during the past decade. Brain injuries represent a large proportion of these injuries and are the leading cause of death among those injured. Despite the risk involved in operating these vehicles, helmet use remains low. The aim of this study was to identify and understand common barriers and facilitators to helmet use among ATV users.
  
  
  METHODS
  Focus groups were conducted in Arkansas with adolescent and adult ATV users to discuss ATV and safety equipment use. Standard methods of qualitative research were used to interpret focus group data. Moderator guides were framed using the Health Belief Model of behavior change. Transcript-based analysis was used, and data were managed using HyperRESEARCH (version 2.8.3). The transcribed data were coded to identify important themes.
  
  
  RESULTS
  Eleven focus groups were conducted with 58 participants, who discussed ATV use patterns, current safety practices, and barriers to helmet use. Major themes were a lack of perceived risk with operating an ATV and lack of perceived severity of injury resulting from ATV crashes. Participants discussed other barriers to helmet use including helmet discomfort and inconvenience. Suggested solutions included passage of helmet laws for riders younger than 18 years, helmet redesign, and development of visual aids/crash simulations to convey the dangers of ATV use.
  
  
  CONCLUSIONS
  This study identifies a gap in risk perception among ATV users. Injury prevention should focus on education about risks of engaging in unsafe ATV behaviors and the danger of the vehicles themselves.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Adams
authors.forename: Mary E
authors.initials: ME
authors.lastname: Aitken
authors.forename: Samantha Hope
authors.initials: SH
authors.lastname: Mullins
authors.forename: Beverly K
authors.initials: BK
authors.lastname: Miller
authors.forename: James
authors.initials: J
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001131:Arkansas; D001930:Brain Injuries / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D005260:Female; D017144:Focus Groups; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009042:Motivation; D015541:Off-Road Motor Vehicles; D012307:Risk Factors; D055815:Young Adult