ATV Safety Summit: Training the Next Generation - Barriers and Facilitators of Education and Training
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Robin D. Schier, Assistant Professor of Nursing at the University of Texas Health Science Center at Houston, presented this at CPSC’s ATV Safety Summit Oct. 11, 2012. ATV rider safety training, education and danger awareness has become the major focus on reducing the incidents of injuries and deaths in children under the age of 16 years. My doctoral project (currently in press with Journal of Trauma) at Vanderbilt University was dedicated to understanding what the barriers and facilitators were to youth under 16 years of age and ATV safety education and training. The aim of this project was to develop and implement a pilot-version, parent survey assessing barriers against and facilitators for youth under 16 years of age attending the ASI RiderCourse in Tennessee. This project examined the only national ATV safety course given by ASI to determine the low enrollment in this course. No previously validated survey instrument for parents was found, therefore, survey development for this project was based on injury prevention and survey development literature, and personal experience during the attendance of a RiderCourse. The knowledge gained from survey results will help guide the development of future projects that are needed to contribute to the body of knowledge concerning ATV safety and children. Many questions remain unanswered: Are there sufficient ATV safety training courses? Are there direct barriers to enrollment in these courses? Does the public feel the need for formal ATV education? Are the available classes effective for children? Is the RiderCourse student handbook written so children of all ages can understand and comprehend the material? Is it even appropriate to train and educate children on ATV use? Can ATV use ever become a safe, recreational activity for children under the age of 16 years?
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ATV Safety Summit: Training the Next Generation - Barriers and Facilitators of Education and Training
- 1. Robin D. Schier, DNP, APRN, CPNP AC/PC The University of Texas Health Science Center at Houston robin.schier@uth.tmc.edu
- 2. The purpose of this project was to identify the barriers and facilitators of enrollment in the ASI ATV Safety RiderCoursesm Copyright 2011 Robin D. Schier
- 3. Children under 16 years of age are using ATVs for high-adventure thrill and fun, sporting, and family- oriented activities ATV operators under the age of 16 are nearly four times more likely than older ATV operators to experience injuries requiring emergency treatment The escalating popularity is associated with increasing morbidity and mortality Copyright 2011 Robin D. Schier
- 4. From 1982 to 2006, the number of children killed in ATV crashes was equivalent to… Five 747 jumbo jets full of children Copyright 2011 Robin D. Schier
- 5. In 2008… There were 135,100 ATV-related ER visits across the United States 37,000 (28%) were children under 16 years of age This is the equivalent of 2 school buses full of children that are injured or killed every day while riding an ATV Copyright 2011 Robin D. Schier
- 6. Children under 16 years of age lack the strength, physical motor skills, coordination and judgment to safely maneuver these high-powered vehicles Copyright 2011 Robin D. Schier
- 7. Voluntary standards agreed to by the industry have not worked Legislative efforts have not proven successful ATV danger awareness, education, and rider safety training has become the major focus on reducing the incidents of injuries and deaths in children under the age of 16 years Copyright 2011 Robin D. Schier
- 8. Historically, there is only a 4-7 % participation in ATV education and safety training courses, including the ASI RiderCoursesm Numerous studies and organizations have recommended an increase in ATV safety training and education for children To date, no studies have identified what effective ATV education and safety training looks like or why there is such a low attendance and involvement in these classes Copyright 2011 Robin D. Schier
- 9. The 4-H ATV Safety and ASI ATV RiderCoursesm grants are offered to 4-H communities to increase ASI’s ATV RiderCoursesm participation Tennessee was challenged to educate 150 persons (adults and youth) in the ASI ATV RiderCoursesm Only 62 youth completed the course Copyright 2011 Robin D. Schier
- 10. Copyright 2011 Robin D. Schier
- 11. A 26 – question multiple choice and short answer pilot survey was distributed to 180 parents of youth associated with the Tennessee 4-H Extension residing in one of the top 9 Central Region Tennessee counties with the highest ATV morbidity and mortality identified by the trauma database at Monroe Carell Jr. Children’s Hospital at Vanderbilt 22.2% of the surveys were returned Copyright 2011 Robin D. Schier
- 12. Copyright 2011 Robin D. Schier
- 13. Copyright 2011 Robin D. Schier
- 14. 70% of the parents in this sample do not feel that ATVs are dangerous for children under 16 to ride and consider their child a “good” or “expert” driver Copyright 2011 Robin D. Schier
- 15. Only 3% of parents report that a medical professional has talked to them about ATV safety 100% of parents feel that the Tennessee 4-H Extension is trustworthy Copyright 2011 Robin D. Schier
- 16. 92% percent of the children in this study would not be able to attend a RiderCoursesm because they ride vehicles exceeding course and manufacturer engine size recommendations of 90 cc or less Copyright 2011 Robin D. Schier
- 17. 50% of parents state they WILL NOT have their child take the RiderCoursesm in the future because they have never heard of the program Of the parents who purchased their vehicle new through an authorized ATV dealership, only 7% received any information on hands-on safety training Copyright 2011 Robin D. Schier
- 18. 93% of parents feel ATV training will reduce ATV related injuries and deaths AND 96% of parents feel that ATV training is NOT a waste of time HOWEVER More than 80% of these parents said they would not enroll their child in the RiderCoursesm Copyright 2011 Robin D. Schier
- 19. Over 85% of parents who were self-taught or learned to drive ATVs from a friend or family member also had used this method with their own children creating a cross-generational pattern Copyright 2011 Robin D. Schier
- 20. Only 7% of parents said their children completed the RiderCoursesm Copyright 2011 Robin D. Schier
- 21. Copyright 2011 Robin D. Schier
- 22. Free cost Belief ATV training will reduce injuries “Not a waste of time” Parents’ concern for child’s safety Parents want children to learn something new about ATV safety and driving skills Previous ATV-related accident Trust in the TN 4-H Extension and community Copyright 2011 Robin D. Schier
- 23. Lack of awareness of RiderCoursesm Lack of ATV safety training information given at time of vehicle purchase (New and Used) Large market for previously-owned ATVs Parents’ desire to teach their own children Copyright 2011 Robin D. Schier
- 24. Parents’ scheduling conflicts with time/day courses are offered Parents’ uncertainty of who teaches the course Parents’ belief that child is an experienced driver Not having the correct-sized ATV to attend training courses Copyright 2011 Robin D. Schier
- 25. Copyright 2011 Robin D. Schier
- 26. Explore and identify beliefs and attitudes about the dangers of operating ATVs and about safety training to both parents and youth Revise survey instrument or conduct focus groups with parents and youth Increase awareness and anticipatory guidance related to the dangers of ATVs and children by medical professionals Copyright 2011 Robin D. Schier
- 27. Further explore trust/distrust issues with parents and youth about ATV safety information Promote health policy legislative efforts in conjunction with educational and training opportunities Explore vehicle loaner program for youth who need correct-sized ATVs for course enrollment Copyright 2011 Robin D. Schier
- 28. Evaluate RiderCoursesm course handbook and materials for age appropriateness and reading comprehension level Evaluate ASI’s ATV booklet “Parents, Youngsters and All-Terrain Vehicles” for reliability in determining rider “readiness” for children Investigate opportunities to increase parental involvement in ATV safety training courses and consider a “train your child how to ride” course for parents Copyright 2011 Robin D. Schier
- 29. Further investigate and encourage increased distribution of ATV safety information from new and used dealers, as well as to those who sell vehicles privately Develop collaborative/interdisciplinary partnerships to promote ATV safety within community settings Copyright 2011 Robin D. Schier
- 30. Copyright 2011 Robin D. Schier
- 31. This pilot survey can serve as a catalyst for developing theory-driven interventions and research questions addressing the problem of low enrollment and participation in ATV safety training for children Copyright 2011 Robin D. Schier
- 32. If no one attends the classes, the ASI RiderCoursesm is an ineffective solution to preventing ATV-associated injuries and deaths Copyright 2011 Robin D. Schier
- 33. Aitken, M.E. Graham, C.J., Killingsworth, J.B., Mullins, S.H., Parnell, D.N. & Dick, R.M. (2004). All-terrain vehicle injury in children: Strategies for prevention. Injury Prevention, 303-307. doi: 10.1136/ip.2003.004176 Allegrante, J.P., Marks, R. & Hanson, D.W. (2006). Ecological models for the prevention and control of unintentional injury. In A.S. Gielen, Injury and Violence Prevention (pp.105-126). San Francisco: Jossey-Bass. ATV Safety Institute (2009). ATV RiderCourse Student Handbook. Irvine: Specialty Vehicle Institute of America. ATV Safety Institute (2009). Parents, Youngsters & All-Terrain Vehicles. Irvine: Specialty Vehicle Institute of America. Bowman, S.M. & Aitken, M.E. (2010). Still unsafe, still in use: Ongoing epidemic of all-terrain vehicle injury hospitalizations among children. The Journal of Trauma, Injury, Infection, and Critical Care, 20 (20), 1-6. doi:10.1097/TA.0b013e3181ea283d. Bronfenbrenner, U. (1993). Ecological models of human development. In M. Gauvain & M. Cole, Readings on the Development of Children, (pp. 37-43). New York: Freeman. Burgus, S.K., Madsen, M.D., Sanderson, W.T. & Rautiainen, R.H. (2009). Youths operating all-terrain vehicles-implications for safety education. Journal of Agromedicine, 124 (3), 409-418. doi: 10.1080/10599240902751047. Burr, J.F. Jamnik, V.K., Shaw, J.A. & Gledhill, N. (2010). Physical demands of off-road vehicle riding. American College of Sports Medicine, 42(7), 1345-1354. doi:10.1249/MSS.0b013e3181cd3. Collins, C.L., Smith, G.A. & Comstock, R.D. (2007). Children plus all nonautomobile motorized vehicles (not just all-terrain vehicles) equals injuries. Pediatrics, 120 (1), 134- 141. doi: 10.1542/peds.2006-3612. Keenen, H.T. & Bratton, S.L. (2004). All-terrain vehicle legislation for children: A comparison of a state with and a state without a helmet law. Pediatrics, 113 (4), e330- e334, doi:101542/peds. 113.4.e330. Kelleher, C.M., Metze, S.L., Dillon, P.A., Mychaliska, G.B., Keshen, T.H. & Foglia, R.P.. (2005). Unsafe at any speed-Kids riding all-terrain vehicles. Journal of Pediatric Surgery, 40 (6), 929-935. doi: 10.1016/j.jpedsurg.2005.03.007. Kellum, E., Creek, A., Dawking, R., Bernard, M. &Sawyer, J.R. 2008). Age-related patterns of injury in children involved in all-terrain vehicle accidents. Journal of Pediatric Orthopedics, 28 (8), 854-858. Murphy, N. & Yanchar, N.L. (2004). Yet more pediatric injuries associated with all-terrain vehicles:: Should kids be using them? The Journal of Trauma, Injury, Infection and Critical Care, 56 (6), 1185-1190. doi 10.1097/01. T.A. 0000123038.94864.E2. Scutchfield, S. (2003). All-terrain vehicles: Injuries and prevention. Clinical Orthopaedics and Related Research, 409, 61-72. doi:10.1097/01.glo.0000060441.40507.3e. Specialty Vehicle Institute of America. (2010). About the ATV Safety Institute. Retrieved October, 2010, from ATV Safety Institute: http://www.atvsafety.org/infosheets/about_ASI.pdf. Specialty Vehicle Institute of America (2010). State all-terrain vehicle requirements. Retrieved October 28, 2010, from ATV Safety Institution: http:// www.atvsafety.org./infosheets/summary_chart_August _2010.pdf. Stolz, U., McKenzie, L.B., Mehan, T.J. & Smith, G.A. (2009). Assessing public opinion regarding potential ATV-related policies. Journal of Safety Research, 40, 149-155. doi: 10.101016/j.jsr.2009.02.005. Su, W. Hui, T. & Shaw, K. (2006). All-terrain vehicle injury patterns: Are current regulations effective? Journal of Pediatric Surgery, 41, 931-934. doi:10.1016/j.jpedsurg.2006.01.011. Testerman, G. (2009). 300 all-terrain vehicles crashes: An east Tennessee trauma center’s experience. Tennessee Medicine, 108 (8), 45-7. United States Consumer Product Safety Commission (2010). 2008 Annual Report of ATV-Related Deaths and Injuries. Bethesda: Division of Hazard Analysis. United States Government Accountability Office Reports to Congressional Committee. (2010). All-terrain vehicles: How they are used, crashes, and sales of all-sized vehicles for children’s use. Washington, D.C. Upperman, J.S.. Shulz, B. Gaines, B.A. Hackam, D., Cassidy, L.D., Ford, H.R. & Helkemp, J.. (2003). All-terrain vehicle rules and regulations: Impact on pediatric mortality. Journal of Pediatrics, 38 (9), 1284-1286. doi: 10.1016/s0022-3468(03)00383-x. Williams, R. S., Graham, J. Helmkamp, J.C., Dick, R., Thompson, T. & Aitken, M.E. (2010). A trial of all-terrain vehicle safety education video in a community-based hunter education program. The Journal of Rural Health, 00, 1-8. doi: 101111/j.1748-0361.2010.00327.x. Copyright 2011 Robin D. Schier
- 34. Special acknowledgement and appreciation for offering their time and expertise with this project to… Dr. Tom Cook Vanderbilt University School of Nursing Dr. Patti Scott Arkansas Department of Health Dr. Mary Aitken Arkansas Children’s Hospital Martin Koon TN 4-H Extension Hope Mullins Arkansas Children’s Hospital Purnima Unni Monroe Carell Jr. Children’s Hospital at Vanderbilt Copyright 2011 Robin D. Schier
- 35. Robin D. Schier, DNP, APRN, CPNP AC/PC Assistant Professor of Nursing The University of Texas Health Science Center at Houston robin.schier@uth.tmc.edu (832) 434 - 7426 Copyright 2011 Robin D. Schier
Editor's Notes
- My scholarly project is titled “Barriers and Facilitators of All-Terrain Vehicle Education and Safety Training for Youths Under 16 Years of Age”
- (slide)It has been almost 40 years since Honda Motor Company introduced the first recreational all-terrain vehicle (ATV) in the United States.These ATVs were initially designed to assist in farming, ranching, logging, snow-plowing, forestry, agriculture and transportation in rural and remote areas because they were small, durable and able to handle a variety of terrains. ATVs are also used in a variety of occupations such as search-and-rescue units, law enforcement and military.However, the recreational use has now surpassed the industrial utilization.A recent survey found that 80% of ATV owners use them for family recreational activities such as trail riding, exploring and sightseeing, compared to only 21% who use them for work, chores or transportation
- The international marketing and manufacturing of ATVs is widespread. (slide)It is estimated that somewhere between 8 to 10 million ATVs are currently in use in the United States. There is an enormous, established market for the resale of ATVs, using a variety of methods such as retailer/dealer trade-ins for new sales, person-to-person sales, and sales through internet sites. This unregulated market increases the chances of ATVs landing in the hands of children, without proper safety education or danger warnings. (slide)
- The United States Consumer Product Safety Commission’s 2008 Annual Report of ATV-related deaths and injuries recorded nearly 10,000 deaths between 1982 and 2008. Of those fatalities, over 2,5000 or 27% were children under 16 years of age and more than 1,000 or 11% of them were under the age of twelve This is equivalent to 5 jumbo jets full of children
- In the year 2008, over 135,000 persons visited an emergency room for their ATV-related injuries. Of those treated, children under 16 years of age accounted for over 37,000 visits, about 28%. (Slide)- This is equivalent to 2 school busses full of children that are injured or killed every day while riding an ATVMany of these young riders share similar patterns of injury as children riding off-road motorcycles.The severity and patterns of ATV-related injuries vary greatly .Some common injuries typically involve the head, neck, face, chest, abdomen and extremities.A large number of injuries associated with ATVs occur when either the driver loses control, the vehicle rolls over, flipping on embankments or inclines, the driver or passenger is thrown off the vehicle; or there is a collision with a fixed object such as a tree or gate.Often times, the heavy ATV rolls over, causing crushing injuries.
- (Slide)ATVs are “rider-active” and designed for only one rider because of the precise, quickly executed, weight-distribution adjustments necessary to maintain balance and control of the vehicle.ATV operators must have the ability to anticipate, recognize, and react to potential hazards on the road.Driving any type of motorized vehicle requires mature cognitive and intellectual development.The driver must also have superior reasoning and decision-making skills.ATV riding requires good judgment to act responsibly and minimize risks. Physical size, strength, coordination, visual perception, emotional maturity, are important considerations.Operators must understand what can result from improper ATV operation.They must understand that unsafe actions can result in injury or death, such as the danger of mimicking the extreme stunts professional riders exhibit on TV and in video games Riders must be able to problem solve and readily express what causes accidents and how to avoid them. Poor decision-making skills and reckless operation creates increased risk for injury and can result in serious consequences. The social and emotional development of an ATV operator is very important. Understanding and following rules are critical for the safe operation of an ATV. Young riders must demonstrate safety-conscious attitudes and obey rules set by adults and guardians. Operating an ATV also commands excellent visual motor perception and good peripheral vision. One must have the ability to judge speeds and distances while riding and react with proper hand and foot actions.Children are often lack many of these necessary requirements to safely operate ATVs.They are often unable to judge distances or speeds. Their gross and fine motor coordination immature. And good balance and endurance does not typically mature until the age of 13 or 14 or sometimes later. Children often feel immortal and are willing to engage in high risk, adventurous activities and they may adopt behaviors that they think will lead to peer acceptance.So they take risks, because they lack judgment. They will test their skills, their adult supervisors, and their environment in their quest for independence.
- Despite the substantial increase of ATV-related injuries in children under the age of 16 years, there are no uniform driver’s age restrictions, mandatory training, education, or requirements for adult supervision.SlideSlide – Also each state legislation regulates ATV use individuallyAnd the real impact legislation and regulation has on reducing ATV-related injuries still remains unclear.Slide
- Until laws, regulations and their implementation plans are created to protect and prevent children under 16 years of age from riding an ATV, it is crucial that adequate educational and training opportunities exist and are utilized by youths and parents in order to learn proper ATV safety and handling. SlideSlideSlide
- SlideThis new initiative was first implemented in Louisiana, Arkansas, Mississippi, Nebraska, Texas and most recently, Tennessee. SlideDespite 14 newspaper articles, 2 radio interviews, 17 exhibits, and more than 50 professional conference presentations, numerous promotional and marketing outreach efforts throughout the state, the required ATV RiderCoursesm attendance goal of 150 students was not met by the Tennessee 4-H Extension. Slide -Only 62 youths completed the course.
- This is a photo compliments of Martin Koon of the TN 4-H Extension. Agents begin each stage of learning sitting and discussing the topic or skill before the kids mount the vehicle to practice
- Slide
- The socio-ecological model was used as a map for inquiry to understand the community indicators and potential barriers of ATV safety training participation. Socio-ecological models provide a useful integrative framework for achieving a better understanding of the multiple determinants that affect enrollment and participation in ATV education and safety training, and therefore can provide guidance for developing appropriate intervention strategies.This model describes the interwoven relationships between the individual and the environment acting at five levels or layers.These layers include the interpersonal level (parents, family members and peer groups), organizational level (Children’s Hospital at Vanderbilt and ASI), community level (TN 4-H Extension) and public level (county/state/regional/national components).Individual behavior is determined largely by the interaction between the multiple layers of the social environment.The most successful programs are comprehensive that focus on the individual while encouraging long-term support from families, peers and communities in an effort to increase public awareness and influence social policy.
- This agent was actually fortunate enough to obtain youth sized loaners from a local dealer to conduct this particular class. The TN 4-H Extension has only 1 trailer to pull loaners so classes needed to be coordinated to facilitate sharing of trainer equipment. This was the only county who was able to get loaners, he was friends with the shop owner.
- Regardless of their child’s age, experience or size of vehicle reported, Almost 70% of the parents in this sample do not feel that ATVs are dangerous for children under 16 years of age to ride and consider their child a “good” or “expert” driver.
- (Slide)There were some parents who reported a lack of confidence in various professional organizations. For example, over 20% of parents find the AAP either unbelievable or very unbelievable.
- SlideSo even though the parents did not indicate on the survey that they would not be able to take the course because of wronged sized vehicles, they would be told so if they were to call and try to register their child for the course
- Slide
- Slide
- Slide
- This statistic is reflected in the literature as well
- All children in this photo appear to be wearing the required safety gear- long pants, long sleeved shirt, gloves, helmets, goggles or face mask, and shoes or boots that cover the ankles.The nice shirt the agents are wearing were donated by the VCH Injury Prevention Program.
- There were many reasons why parents had taken their child to the course. SlideNo parents marked “the child wanted to take the course” or “child’s friends were taking the course” or that “they made their child take the course”. It would be interesting to obtain the child’s perspective on this question. More than likely they would indicate either “because their friends were taking it” or because they were “made to take it” by their parent. This stresses the importance of asking both parents and youth in the next survey distribution to compare potential answers.
- Slide - Parents indicated that they never “heard” of the course. This question might need to be reworded on the revised survey in order to clarify what “heard” means. Does it mean that they do not know that the RiderCourse exists or does it mean to them that they do not know of a course near their home.Slide – very few parents received any information about ATV safety. Slide – parents indicated that 50% of the vehicles were used and 50 % were new
- SlideSlide – this question should be clarified on the next survey as well. Several parents marked this answer - not sure if this is also related to parental trust issues
- This is the “I am ready” signal to indicate to the course instructor that they have check all their engines and gears and are ready to participate in the next skill.
- Parents do not feel that they are dangerous according to this survey. Do they not know about the current literature or do they choose not to believe what they have read or have been told of the dangers of ATV riding and children. This is still unclear.Adding a youth component could potentially identify additional barriers or facilitators to course enrollment. Medical professionals should guide families to resources of local safety training opportunities
- Slide – most youth sized models are unavailable for purchase or repair because of the lead law. H.R. 412 “Kids Just Want to Ride Act” . This is a proposal to amend the Consumer Product Safety Improvement Act (CPSIA) of 2008 to exempt youth-sized off-highway vehicles from children’s product lead limits, also known as the “lead law”. It has been formally introduced to the House Committee on Energy and Commerce and referred to the Subcommittee on Commerce, Manufacturing, and Trade of the 112th Congress during its first session of the 2011-2012 year. On August 14, 2008, President George Bush signed the Consumer Product Safety Improvement Act into law. One of the provisions bans the sale of any product intended for children under 12 years of age that fails to meet lead restrictions and requires mandatory testing of children’s products by third party laboratories before products are sold at retail . Youth-sized ATVs, which include lead in batteries, brakes, engines, paint and other components, fall into this category. The CPSIA also bans many of the mechanical parts needed for ATV repair. Currently the sale of youth-model ATVs are illegal and violators can be prosecuted. The Commission has voted to stay enforcement of the CPSIA of 2008 until May 1, 2011. Already over 58 bipartisan legislatures have voted for this bill.
- Slide
- This proposed projects was designed to address the many unanswered questions surrounding the lack of enrollment in ATV education and safety training courses. However, many unanswered questions remainAre there sufficient ATV safety training courses?What are other direct barriers to enrollment in these courses? Are the barriers at the individual level or are they at the community or political level? Does the public feel the need for formal ATV education? Are the available classes effective for children? Is the RiderCoursesm student handbook written so children of all ages can understand and comprehend this difficult material?Is it even appropriate to train and educate children on ATV use? Can this ever become a safe, recreational activity for children under the age of 16 years? SlideSlide
- And as a final note,Slide