title: A school-based study of adolescent all-terrain vehicle exposure, safety behaviors, and crash experience.
abstract: OBJECTIVE
  More youth are killed every year in the United States in all-terrain vehicle (ATV) crashes than on bicycles, and since 2001, one-fifth of all ATV fatalities have involved victims aged 15 years or younger. Effectively preventing pediatric ATV-related deaths and injuries requires knowledge about youth riding practices. Our objective was to examine ATV use, crash prevalence, and riding behaviors among adolescent students in a rural state.
  
  
  METHODS
  We administered a cross-sectional survey to 4,684 youths aged 11 to 16 years at 30 schools across Iowa from November 2010 to April 2013. Descriptive and comparative analyses were performed.
  
  
  RESULTS
  Regardless of rurality, at least 75% of students reported having been on an ATV, with 38% of those riding daily or weekly. Among ATV riders, 57% had been in a crash. Most riders engaged in risky behaviors, including riding with passengers (92%), on public roads (81%), or without a helmet (64%). Almost 60% reported engaging in all 3 behaviors; only 2% engaged in none. Multivariable modeling revealed male youth, students riding daily/weekly, and those reporting both riding on public roads and with passengers were 1.61 (95% CI, 1.36-1.91), 3.73 (95% CI, 3.10-4.50), and 3.24 (95% CI, 2.09-5.04) times more likely to report a crash, respectively.
  
  
  CONCLUSIONS
  Three-fourths of youths surveyed were exposed to ATVs. The majority of riders had engaged in unsafe behaviors and experienced a crash. Given this widespread use and the potentially considerable morbidity of pediatric ATV crashes, prevention efforts, including anticipatory guidance by primary care clinicians serving families at risk, should be a higher priority.
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa University of Iowa Children's Hospital, Iowa City, Iowa charles-jennissen@uiowa.edu.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Jennissen
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa University of Iowa Injury Prevention Research, Iowa City, Iowa.
authors.forename: Karisa K
authors.initials: KK
authors.lastname: Harland
authors.affiliation: University of Iowa Children's Hospital, Iowa City, Iowa Division of Pediatric Surgery, University of Iowa Hospitals and Clinic, Iowa City, Iowa.
authors.forename: Kristel
authors.initials: K
authors.lastname: Wetjen
authors.affiliation: US Army Corps of Engineers, Washington, DC.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Peck
authors.affiliation: University of Iowa Children's Hospital, Iowa City, Iowa.
authors.forename: Pam
authors.initials: P
authors.lastname: Hoogerwerf
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Gerene M
authors.initials: GM
authors.lastname: Denning
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D003617:Dangerous Behavior; D003625:Data Collection; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008297:Male; D015541:Off-Road Motor Vehicles / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012424:Rural Population / Q000706:statistics & numerical data; D012449:Safety / Q000706:statistics & numerical data*; D012574:Schools
keywords: accidents; adolescent behavior; all-terrain vehicle; helmet; injury prevention; prevention & control; rural; safety