atv safety summit: training the next generation - barriers and facilitators of education and...

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Barriers and Facilitators of All-Terrain Vehicle Education and Safety Training for Youth Under 16 Years of Age Robin D. Schier, DNP, APRN, CPNP AC/PC The University of Texas Health Science Center at Houston r [email protected]

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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?

TRANSCRIPT

Page 1: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Barriers and Facilitators of All-Terrain Vehicle Education and Safety Training

for Youth Under 16 Years of Age

Robin D. Schier, DNP, APRN, CPNP AC/PCThe University of Texas Health Science Center

at [email protected]

Page 2: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Purpose

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

Page 3: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Background and Significance

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

Page 4: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Background and Significance

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

Page 5: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Background and Significance

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

Page 6: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Background and Significance

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

Page 7: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Background and Significance

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

Page 8: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Review of Literature

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

Page 9: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Review of Literature

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

Page 10: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Copyright 2011 Robin D. Schier

Page 11: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Data Collection

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

Page 12: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

The Socio-Ecological Model and Approach to Public Health Initiatives

Copyright 2011 Robin D. Schier

Page 13: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Copyright 2011 Robin D. Schier

Page 14: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Results

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

Page 15: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Results

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

Page 16: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Results

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

Page 17: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Results

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

Page 18: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Results

93% of parents feel ATV training will reduce ATV related injuries and deaths

AND96% 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

Page 19: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Results

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

Page 20: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Results

Only 7% of parents said their children completed the

RiderCoursesm

Copyright 2011 Robin D. Schier

Page 21: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Copyright 2011 Robin D. Schier

Page 22: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Identified Facilitators to Course Enrollment

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

Page 23: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Identified Barriers to Course Enrollment

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

Page 24: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Indentified Barriers to Course Enrollment

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

Page 25: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Copyright 2011 Robin D. Schier

Page 26: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Future Research

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

Page 27: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Future Research

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

Page 28: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Future Research

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

Page 29: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Future Research

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

Page 30: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Copyright 2011 Robin D. Schier

Page 31: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

Conclusion

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

Page 32: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

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

Page 33: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

References

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

Page 34: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

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 HealthDr. Mary Aitken

Arkansas Children’s HospitalMartin Koon

TN 4-H Extension Hope Mullins

Arkansas Children’s HospitalPurnima Unni

Monroe Carell Jr. Children’s Hospital at Vanderbilt

Copyright 2011 Robin D. Schier

Page 35: ATV Safety  Summit: Training the Next Generation - Barriers and Facilitators of Education and Training

For additional information, please contact:

Robin D. Schier, DNP, APRN, CPNP AC/PCAssistant Professor of Nursing

The University of Texas Health Science Center

at [email protected]

(832) 434 - 7426

Copyright 2011 Robin D. Schier