BackgroundAll-terrain vehicles (ATVs) have steadily increased in popularity, size and speed, characteristics that likely contribute to the alarming rise in ATV-related fatalities. One potentially high-risk activity is riding on the road.ObjectivesTo compare fatal ATV crashes that occur on the roadway and off, to more fully understand factors that contribute to fatalities at each location.MethodsFatality data from the US Consumer Product Safety Commission (CPSC) were used for descriptive and comparative analyses. Multivariate logistic regression analysis was performed to determine relative risk.ResultsOver 60% of all fatalities (1985–2009) resulted from roadway crashes. After 1998, roadway fatalities increased at over twice the rate of off-road fatalities. Roadway crashes were more likely than off-road crashes to involve multiple fatalities, carrying passengers, alcohol use, collisions and head injuries. Roadway victims were less likely to be helmeted than off-road victims. Passengers and operators with passengers were also less likely to be helmeted than operators riding alone. Helmeted victims were half as likely to suffer a head injury.ConclusionsFatal roadway crashes were more likely than off-road crashes to involve risk-taking behaviours (eg, carrying passengers) that could exacerbate the inherent difficulty of operating ATVs on roadway surfaces. Higher crash forces from greater speed, and lower use of protective equipment, may also have contributed to higher roadway mortality rates. Eliminating non-essential ATV road use may be an effective way to reduce ATV-related fatalities. This will likely require a substantial investment in rider education and better enforcement of ATV road use restriction laws.

More than 1 in 3 on-road crashes involved a collision with another vehicle, suggesting that ATVs on the road represent a potential traffic safety concern. Of note, helmets were associated with reduced risk for the number and severity of brain injuries, providing further support for the importance of helmet use. Finally, even controlling for helmet use, on-road crash victims suffered more major trauma and severe brain injuries than those off-road. Overall, our data reinforce the importance of laws restricting ATV road use and the need for effective enforcement, as well as the need to increase user education about ATV road-use laws and the dangers of riding on the roads.

WHAT'S KNOWN ON THIS SUBJECT: Younger age has been identified as an independent risk factor for all-terrain vehicle (ATV)-related injuries. Since the mid-1980s, one-third of ATVrelated deaths have involved children younger than 18 years of age. WHAT THIS STUDY ADDS:Using national data, we found both similarities and differences between pediatric age groups in the contribution of known risk factors to ATV-related deaths. The observed differences suggest the importance of targeting injury prevention approaches to specific age ranges. . Ninety-five percent of all pediatric fatalities were on adult-size vehicles. Victims ,6 years old had the highest proportion of girls (24%) and passengers (76%), and the lowest helmet use (17%). More than half of 6-to 11-year-old children were vehicle operators; 1 in 4 were carrying passengers in their own age range. Over the study period, 12-to 15-year-old children accounted for more than half of all pediatric ATV-related fatalities. The proportion of youth riding on the road increased with age, as did the proportion of collisions with other vehicles. Older teens had the highest proportions of roadway fatalities (72%) and collision events (63%), and 19% of their crashes involved alcohol. Head injuries occurred in 63% of victims (the major determinant being roadway riding), and helmets reduced the likelihood of head injury among fatal crash victims by 58%.CONCLUSIONS: There were significant differences between pediatric age groups in the relative contribution of known risk factors for ATV-related fatalities. Future injury prevention efforts must recognize these differences and develop interventions based on the age range targeted.

Although differences were observed between paved and unpaved roads, our results show that riding on either represented significantly greater dangers than riding off the road. Many vehicle warnings specifically mention the risks of paved but not unpaved roads, yet we found 23 states with half or more of their roadway deaths on unpaved surfaces. Safety warnings should explicitly state the dangers of roadway riding regardless of surface type. These data further support laws/ordinances greatly restricting ATV riding on all types of public roadways.

PURPOSE 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. METHODSWe 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. RESULTSRegardless 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. 1 In fact, more children are killed in the United States each year from ATVs than from bicycle crashes. 2 Previous studies indicate that youth ATV operators have a 12 times greater risk of injury as compared with adults.3 This increased risk is likely due to a number of factors including physical and mental immaturity, lack of training and experience, riding adult-size machines, and a greater likelihood of being a passenger. [4][5][6][7][8][9][10] Despite the magnitude of the problem, there have been few published studies regarding ATV use, and these studies have mostly been limited to select rural and agricultural groups, 7,[11][12][13][14] or ATV-owning households. 15 To our knowledge, this is the first study to provide epidemiology of ATV use and safety-related behaviors among a large cross-sectional sample of adolescents. administrators. Because previous studies showed that youth aged 12 to 15 years were at highest risk, 8 we targeted classes with students in this age range. Schools participated from across the state, although most were from eastern Iowa. This report includes all 30 participating schools from November 2010 through April 2013. METHODS Study DesignBefore the safety program, an anonymous survey was electronically administered using TurningPoint technology (http://www.turningtechnologies.com/ polling-solutions/turningpoint). TurningPoint displ...