More Kids Killed on ATVs than Bikes

Charles A. Jennissen, MD Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City, IA Interview with:
Charles A. Jennissen, MD
Department of Emergency Medicine
University of Iowa Carver College of Medicine
Iowa City, IA 52242


MedicalResearch: Why did you perform this study? 

Dr. Jennissen: More youth 15 years and younger in the United States are killed in all-terrain vehicle (ATV) crashes than on bicycles. Since 2001, children represent nearly 30% of all ATV-related injuries and 20% of all ATV-related deaths.  Although previous studies have shown children to have high exposure to ATVs, these studies have been mostly limited to select rural and agricultural groups.  With this study, we wanted to investigate the epidemiology of ATV use and safety-related behaviors among a large cross-sectional sample of adolescents.

MedicalResearch: How was the study performed?

Dr. Jennissen: Prior to an in-classroom ATV safety education program, we administered a survey to 4,684 students aged 11 to 16 years at 30 schools across Iowa.

MedicalResearch: What are the main findings of the study?

Dr. Jennissen: Overall, 77% of the students had been on an ATV, with 38% of those riding daily or weekly.  Among ATV riders, 57% had been in a crash (defined as having rolled over, hit something, or fallen off the ATV) . 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 unsafe behaviors; only 2% reported that they 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, 3.73, and 3.24 times more likely to report a crash, respectively.

MedicalResearch: Were any of the findings unexpected?

Dr. Jennissen: Probably the biggest surprise was the high percentage of ATV exposed students who had experienced a crash.  Although many children do experience ATV-related injuries and deaths, our study suggests that a lot of youth are experiencing ATV mishaps without the consequences of significant injury.  Of course, not experiencing a serious consequence from a crash is a good thing. However, I worry that such events may lead to an increased sense of invulnerability in the adolescent mind and lead to even greater risk taking activity, rather than being a “wake-up call” for practicing safer riding behaviors.

The high ATV exposure was not really a big surprise to us, but what was a bit unexpected was that the percentage exposed to ATVs did not vary much between students in school districts in areas federally-designated as being isolated rural vs. rural vs. urban.  Granted, our study population did not include densely populated metropolitan school districts. However, Iowa’s pediatric ATV mortality rate is comparable to or lower than that of 21 other states, suggesting Iowa is not unique regarding ATV use. In addition, all states, even those with large metropolitan areas, have rural and suburban populations. In fact, the top ten states in number of pediatric ATV fatalities includes California, Texas, Pennsylvania, Florida, and New York. Therefore, ATV exposure beyond our state’s somewhat more rural communities should not be discounted.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Jennissen: A large percentage of youth are riding ATVs, practicing unsafe behaviors, and experiencing crashes. Primary care clinicians should determine whether their patients are exposed to ATVs and if so, should strongly consider injury prevention counseling. ATV use meets key criteria for guidance importance: high severity and frequency of injury, availability of environmental strategies to prevent injury, and evidence that the strategies are effective. Even children from urban localities could be exposed, particularly those from suburban acreages or who visit rural areas. In fact, non-rural youth may be at even greater risk of crash and injury if they lack ATV riding experience.

An American Academy of Pediatrics policy statement recommends that no child younger than 16 years of age ride an ATV. Although we support this recommendation, it is unlikely to be an effective message for many families. If youth are going to ride ATVs, they should do so as safely as possible.  This includes always wearing a helmet and using other protective equipment, staying off public roads, no passengers (unless designated seats), never riding an adult-size machine, getting safety training (preferably a hands-on certification course), limiting vehicle speed, and no alcohol or drug use. Routine counseling by clinicians could greatly increase the number of adolescents receiving ATV safety education and potentially decrease the number of pediatric ATV-related deaths and injuries. Of course, it is important for parents to be models of safe ATV use, and strictly enforce safe riding behaviors in their children.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Jennissen:  More study is needed to determine the most effective methods for increasing ATV safety knowledge, improving safe riding behaviors, and decreasing ATV-related injuries and deaths.  This includes evaluating safety education programs, such as we are presently doing in our school-based education program called STARs (Safety Tips for ATV Riders). Among anticipatory guidance interventions, safety counseling is supported by the best evidence, but ATV injury prevention counseling by clinicians has not yet been studied.


A School-Based Study of Adolescent All-Terrain Vehicle Exposure, Safety Behaviors, and Crash Experience
Charles A. Jennissen, Karisa K. Harland, Kristel Wetjen, Jeffrey Peck, Pam Hoogerwerf, and Gerene M. Denning

Ann Fam Med July/August 2014 12:310316; doi:10.1370/afm.1663



Last Updated on July 17, 2014 by Marie Benz MD FAAD