Dr. Charles Jennissen, of the University of Iowa Department of Emergency Medicine presented this at CPSC's ATV Safety Summit Oct. 12, 2012. The study objective was to determine the ATV anticipatory guidance practices of primary care providers, as well as their attitudes, knowledge, and the barriers faced in educating families about the risk of ATV use. Methods: An electronic survey was administered to primary care providers belonging to Iowa state medical societies. Results: More than 60% of respondents (N=218) believed that providing ATV anticipatory guidance was important. However, 78% gave ATV safety counseling less than 10% of the time during regular pediatric exams, and only 12% did so greater than 25% of the time. Families rarely ask providers for advice on ATV safety issues; 84% of providers were asked once a year or less. ATV knowledge scores were low (median score 2 of 12); however, those with previous ATV exposure had significantly higher scores. Many respondents affirmed insufficient knowledge (47%) and inadequate resources (63%), but the most commonly identified barrier was that it was not a routine part of their practice.

1. The Anticipatory Guidance
Provided by Primary
Healthcare Providers With
Regards to ATV Safety and
Injury Prevention
Gerene Denning, PhD
Charles Jennissen, MD
Karisa Harland, PhD
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2. Background
ATVs continue to be a significant cause of injury and
deaths in children.
• Risk of ATV crash for children is over 12 times higher
than for adults.
More children die each year from ATV crashes than from
bicycle crashes.
 Education of families regarding ATV safety is considered
an important component in decreasing injuries.
Primary healthcare providers are the principal source of
health and safety advice in most communities.
Can they play an important role? 2

3. Objectives of the Study
To assess knowledge, attitudes, and practices
related to ATV safety anticipatory guidance
among primary care providers in Iowa.
Funding for these
studies was
generously
provided by:
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4. ATV Anticipatory Guidance Survey
 Distributed a solicitation letter with a link to an on-
line survey through health professional
organizations in Iowa:
• Iowa Chapter of the American Academy of
Pediatrics (AAP) IANP
• Iowa Academy of Family Physicians (IAAFP)
• Iowa Physician Assistant Society (IPAS)
•
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Iowa Association of Nurse Practitioners (IANP)
• Iowa Nurse Practitioner Society (INPS)
 Determined:
(1) Knowledge of ATV safety and laws
(2) Attitudes toward ATV injury prevention
counseling in the office
(3) Current ATV safety anticipatory guidance
being provided to children and their families.
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5. Survey Results: Demographics and ATV Exposure
 218 usable surveys
 52% Male; Median age 48, Range 26 to >70
 96% White, non-Hispanic ATV user status N Percent
Board certification: No exposure 104 47%
 Pediatrics 21% Ridden but do not 86 40%
Ridden and now own 29 13%
 Family Med. 56%
56% 40%
13%
13%
47%
8% 23%
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6. Survey Results: Provider Practices
I ask patients/families if they own/use an ATV during well checks
and physical exams about:
78%
• Almost 80% ask about ATVs less than
10% of the time.
%Respondents
• PAs were more likely ask. (p =0.06)
9.6%
4.6% 2.8% 3.2% 2.8%
%Time
Care providers are not asking about ATV exposure.
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7. Survey Results: Provider Practices
I provide ATV injury prevention anticipatory guidance to my
pediatric patients/families during well checks or physical exam
about:
81%
• Over 80% provide guidance less than
10% of the time.
%Respondents
• Only 8.8% reported providing ATV
safety anticipatory guidance more than
half the time.
7%
2.8% 3.7% 2.3% 2.8%
%Time
Care providers are not providing anticipatory guidance.
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8. Survey Results: Provider Practices
 Resources used:
• Verbal information from provider (28.4%).
• Pamphlets and handouts (5%).
• Other resources were used by 2% or less.
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9. Survey Results: Families
Patients or their families ask me about ATV safety on average:
54% • Only 15.8% of providers were
being asked by families about
ATV safety issues more than
%Respondents
once a year.
• Over half were never asked about
30% ATV safety issues.
14%
1.4% 0.5%
Families are NOT recognizing healthcare providers as a resource for ATV
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10. Survey Results: Provider Knowledge
 12 knowledge questions regarding ATV safety and
state laws (“I don’t know” answers were regarded as
incorrect).
Knowledge scores were very low.
Median score 2 out of 12.
No differences by age.
No differences by licensure.



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11. Survey Results: Provider Knowledge
 There were significant differences in knowledge scores
based on ATV experience.
ATV User Status Mean Score P value
Never been on an ATV 1.9 <0.001
Operated or ridden on an ATV 3.7
Currently owned an ATV 6.2
 There were significant differences in knowledge scores
based gender.
Gender Mean Score P value
Male 3.5 <0.05
Female 2.5
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12. Survey Results: Provider Knowledge
Knowledge Questions
% Correct
#1-7 Multiple Choice, #8-12 True/False
(1) A traditional ATV is designed to carry how many people? 67.4 %
Answer: One
(9) Adults are required by Iowa law to wear an approved helmet while 46.8%
operating an ATV.
Answer: False
Highest percent correct = 67%
2 questions = Around half or more correct
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13. Survey Results: Provider Knowledge
Knowledge Questions
% Correct
#1-7 Multiple Choice, #8-12 True/False
(7) At what age are ATV operators subject to prosecution for violation 26.1%
of Iowa ATV laws? Answer: Any ATV operator regardless of age
(8) Children are required by Iowa law to wear an approved helmet while 22.0%
operating an ATV. Answer: False
(10)According to Iowa law, children 12-17 years of age must have a 26.1%
valid safety certificate to operate an ATV on private land.
Answer: False
(11)According to Iowa law, children 12-17 years of age must be 21.1%
supervised by an adult to operate an ATV on private land.
Answer: False
(12)According to Iowa law, failure to report an ATV accident resulting in 26.1%
injury or death to the proper authorities is a misdemeanor.
Answer: True
5 questions = 21-26% correct
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14. Survey Results: Provider Knowledge
Knowledge Questions
% Correct
#1-7 Multiple Choice, #8-12 True/False
(2) According to manufacturer guidelines, what is the largest ATV 15.1%
engine size recommended for use by children 6-11 years of age?
Answer: Under 70 cc
(3) According to manufacturer guidelines, what is the largest ATV 11.0%
engine size recommended for use by children 12-15 years of age?
Answer: 90 cc
(5) According to Iowa law, children 12 to 17 years of age may operate 14.7%
an ATV on public land…
Answer: If they have a valid safety certificate.
(6) According to Iowa law, under which circumstances can a private 13.8%
citizen operate an ATV on public roads?
Answer: Agricultural purposes
4 questions = 15% or less correct
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15. School Survey Results: Knowledge
1. According to guidelines, what is the largest ATV engine size recommended for use by
12-15 year olds?
Correct Answer: 90 cc
Primary Care Providers School Age Children
11% Correct 26% Correct
2. According to Iowa law, when can someone ride an ATV on a public road?
Correct Answer: For farming purposes
Primary Care Providers School Age Children
14% Correct 46% Correct
3. ATVs are designed to carry how many people?
Correct Answer: 1 Person
Primary Care Providers School Age Children
68% Correct 52% Correct
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16. Survey Results: Attitudes About Knowledge
I have adequate knowledge to provide ATV injury prevention
anticipatory guidance to my pediatric patients and their families.
•47% Disagreed or
26% Somewhat Disagreed.
23%
%Respondents
21% 22% •31% Agreed or Somewhat
Agreed.
•ATV owners > Non-owners
9%
1%
Mean
#Correct 1.5 2.3 3.3 4.2 6.6
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17. Survey Results: Attitudes About Resources
I have adequate resources to provide ATV injury prevention anticipatory
guidance to my pediatric patients and their families.
32% 31% • 63% Disagreed or
somewhat disagreed.
%Respondents
21% • Only 15% agreed or
somewhat agreed.
11%
4%
2%
A variety of educational resources were requested.
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18. Survey Results: Barriers
The major barriers to providing ATV injury prevention anticipatory
guidance to my pediatric patients and their families are:
Barriers encountered providing ATV injury prevention
N Percent
anticipatory guidance at well checks/physical exams
I do not have enough time. 88 18%
I lack specific knowledge concerning ATV safety. 81 16%
I do not have the necessary ATV injury prevention resources. 80 16%
It is not a routine part of my well checks/physical exams. 105 21%
I am unaware of my patients' use of ATVs. 80 16%
I am not familiar with the use of ATVs. 31 6.2%
I do not believe any barriers exist. 15 3.0%
Other 19 3.8%
Total Responses 499
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19. Survey Results: Attitudes About Importance
ATV injury prevention anticipatory guidance is important to
provide to my pediatric patients and their families.
33%
28%
27%
%Respondents
5% 6%
2%
Approximately 60% of providers think it is important.
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20. Conclusions
 Primary providers in Iowa have limited knowledge of
ATV safety and laws, and most provide little or no
anticipatory guidance on ATV injury prevention.
 Families do not recognize primary providers as
sources of ATV safety advice.
 However, providers indicated an importance and
interest in providing more guidance.
 The major barrier was “not part of their regular
practice”.
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21. Conclusions
Healthcare providers could play a more central
role in promoting ATV safety if armed with
increased knowledge and appropriate
resources.
Educational methods that help overcome
perceived barriers are likely to be most effective
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22. Deaths And Injuries From ATV Crashes
Are Preventable!
To prevent deaths and injuries and their accompanying
financial costs, we need:
• EDUCATION and Public Awareness
• ENGINEERING Safer Vehicles
• ENFORCEMENT of Evidence-Based Public Health and
Safety Laws
It takes all stakeholders working together.
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23. THANK YOU
When we have the power to save lives and health,
we have the responsibility to do so.
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