What influences youth to operate all-terrain vehicles safely?

Developing messages to encourage healthy, sustainable dietary substitutions: A qualitative study with US emerging adults

Prior research shows that adopting simple dietary substitutions (e.g., replacing beef with poultry or plant-based entrees) can improve dietary quality and reduce the negative environmental consequences of food production, but little is known about how to encourage people to adopt these substitutions. This study aimed to examine reactions to messages encouraging healthy, sustainable dietary substitutions among emerging adults ages 18-25. We conducted four online focus groups with a diverse sample of US emerging adults (n = 28; 61% female). Focus groups explored emerging adults' reactions to messages encouraging them to adopt three target dietary substitutions: replacing beef and pork with poultry and plant-based entrees; replacing juice with whole fruit; and replacing dairy milk with non-dairy milk. We transcribed discussions verbatim and adopted a thematic approach to analyzing the transcripts. Results showed that participants perceived messages to be most effective at encouraging the target dietary substitutions when the messages: encouraged specific, achievable dietary changes; linked these dietary changes to clear consequences; included personally relevant content; included statistics; were succinct; and used a positive tone. Across the target dietary substitutions, two message topics (small changes, big benefits, which emphasized how small dietary changes can have large positive health and environmental impacts, and warning, which discussed the negative health and environmental impacts of dietary choices) were generally perceived to be most effective. A few participants expressed doubt that the target dietary substitutions would have meaningful environmental impacts. Results suggest that campaign messages to encourage healthy, sustainable dietary substitutions may be more effective if the messages make the target dietary substitutions seem achievable and use statistics to clearly describe the positive impacts of making these changes.

Effective factors of improved helmet use in motorcyclists: a systematic review

BACKGROUND

Road traffic injuries (RTI) are one of the most prominent causes of morbidity and mortality, especially among children and young adults. Motorcycle crashes constitute a significant part of RTIs. Policymakers believe that safety helmets are the single most important protection against motorcycle-related injuries. However, motorcyclists are not wearing helmets at desirable rates. This study systematically investigated factors that are positively associated with helmet usage among two-wheeled motorcycle riders.

METHODS

We performed a systematic search on PubMed, Scopus, Web of Science, Embase, and Cochrane library with relevant keywords. No language, date of publication, or methodological restrictions were applied. All the articles that had evaluated the factors associated with helmet-wearing behavior and were published before December 31, 2021, were included in our study and underwent data extraction. We assessed the quality of the included articles using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies.

RESULTS

A total of 50 articles were included. Most evidence suggests that helmet usage is more common among drivers (compared to passengers), women, middle-aged adults, those with higher educations, married individuals, license holders, and helmet owners. Moreover, the helmet usage rate is higher on highways and central city roads and during mornings and weekdays. Travelers of longer distances, more frequent users, and riders of motorcycles with larger engines use safety helmets more commonly. Non-helmet-using drivers seem to have acceptable awareness of mandatory helmet laws and knowledge about their protective role against head injuries. Importantly, complaint about helmet discomfort is somehow common among helmet-using drivers.

CONCLUSIONS

To enhance helmet usage, policymakers should emphasize the vulnerability of passengers and children to RTIs, and that fatal crashes occur on low-capacity roads and during cruising at low speeds. Monitoring by police should expand to late hours of the day, weekends, and lower capacity and less-trafficked roads. Aiming to enhance the acceptance of other law-abiding behaviors (e.g., wearing seat belts, riding within the speed limits, etc.), especially among youth and young adults, will enhance the prevalence of helmet-wearing behavior among motorcycle riders. Interventions should put their focus on improving the attitudes of riders regarding safety helmets, as there is acceptable knowledge of their benefits.

Risk factors associated with quadbike crashes: a systematic review

Background

Quadbikes or all-terrain vehicles are known for their propensity for crashes resulting in injury, disability, and death. The control of these needless losses resulting from quadbike crashes has become an essential contributor to sustainable development goals. Understanding the risk factors for such injuries is essential for developing preventive policies and strategies. The aim of this review was to identify the risk factors associated with quadbike crashes at multiple levels through a systematic review of a wide range of study designs.

Methods

The study incorporated a mixed-method systematic review approach and followed the PRISMA 2020 guidelines for reporting systematic reviews, including a peer reviewed  protocol. This systematic review included observational studies investigating the risk factors associated with quadbike crashes, injuries, or deaths. Seven electronic databases were searched from inception to October 2021. Studies were screened and extracted by three researchers. Quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). Due to extensive heterogeneity, meta-analysis was not conducted. All the risk factors have been presented in a narrative synthesis for discussion following the guidelines for Synthesis without Meta-analysis (SWiM).

Results

Thirty-nine studies combining an aggregate of 65,170 participants were included in this systematic review. The results indicate that modifiable risk factors, such as the increasing age of driving initiation, reducing substance use, and the use of organized riding parks, could reduce quadbike injuries. Riding practices such as avoiding passengers, avoiding nighttime riding, and using helmets could significantly reduce crashes and injuries among riders. Vehicle modifications such as increasing the wheelbase and limiting engine displacement could also help reduce crash incidence. Traditional interventional methods, such as legislation and training, had a weak influence on reducing quadbike injuries.

Conclusion

Multiple risk factors are associated with quadbike injuries, with most of them modifiable. Strengthening policies and awareness to minimize risk factors would help in reducing accidents associated with quadbikes.

PROSPERO registration number CRD42020170245

Socioeconomic factors associated with helmet use in pediatric ATV and dirt bike trauma

Objectives

Recreational off-road vehicle crashes can produce severe injury and death among children, often from head trauma sustained while riding unhelmeted. Although required for competition, recreational riders commonly forego helmets. This study aimed to identify socioeconomic factors associated with unhelmeted injuries among children riding all-terrain vehicles (ATVs) and dirt bikes recreationally, thus informing injury prevention efforts.

Methods

A retrospective review was completed of patients younger than 18 years who presented after recreational ATV or dirt bike crash to a single American College of Surgeons-verified level 1 pediatric trauma center (2010-2019). Demographic, injury, and outcome data were collected. US Census data regarding median and per capita income, poverty prevalence, and scholastic graduation rates were recorded for each patient's home county. Relationships between helmet use at the time of injury, demographics, and socioeconomic variables were examined.

Results

The cohort comprised 680 injured recreational ATV (n=510; 75%) and dirt bike (170; 25%) riders. Unhelmeted riders (n=450) were significantly older (median age 13 vs 11 years; p=0.008) and more often rode ATVs (n=399). Significantly greater percentages of females (77.9%; p<0.001) and passengers (89.5%; p<0.001) were unhelmeted at the time of injury. Residents of counties with lower median and per capita income, higher poverty prevalence, and lower high school and college graduation rates were significantly more likely to be unhelmeted at the time of their crash (p=0.003). In multivariable analysis, unhelmeted injuries were independently associated with ATV use (OR=6.757; p<0.0001), passenger status (OR=6.457; p<0.0001), and older age (OR=1.219; p<0.0001).

Conclusion

In children, ATV use, passenger status, and older age associated independently with unhelmeted riding in recreational vehicle crash. Residence in a county with both lower median income and scholastic graduation rates associated with unhelmeted crashes, and lower median income significantly predicted unhelmeted crashes. This study revealed socioeconomic factors that identify communities with greatest need for injury prevention initiatives.

Level of evidence

III-retrospective comparative epidemiological study.

Trauma Surgeon-Led and Funded Injury Prevention Program Decreases Number of All-Terrain Vehicle-Related Admissions

Background

All-terrain vehicle (ATV) laws regarding helmet use, alcohol involvement, and roadway riding are poorly enforced or largely ignored. We hypothesized that direct surgeon funding and leadership in injury prevention would decrease ATV crashes. To focus prevention efforts, we reviewed a rural level 1 trauma center 11-year experience with ATV crashes comparing helmeted and unhelmeted rider outcomes.

Methods

For the latter 6 years of the study period, a trauma surgeon sponsored an injury prevention fund promoting ATV safety using simulators and discussions for area high school students. Helmet use, alcohol avoidance, and safe ATV operating were emphasized. A trauma registry review of ATV admissions from 2009 through 2020 examined demographics, helmet use, and clinical outcomes using chi-square, t-test, and regression analysis.

Results

Unhelmeted ATV riders suffered more severe head and neck injuries (OR 19, CI 1.5-1.8, P < .001), worse overall Injury Severity Score (ISS), (OR 25, CI 12.1-14.2, P < .001), and higher mortality rates (OR 4.0, CI .02-.05, P < .001). Helmet use corresponded with an average decrease in AIS and increase in GCS status. Although only 15% of riders were helmeted, ATV crash admissions have decreased in the last 5 years ( P < .001).

Discussion

All-terrain vehicle trauma and mortality is still frequent, especially in unhelmeted riders. The recent decrease in area ATV crashes is encouraging. Trauma surgeons have an opportunity to make a difference in public awareness and education through comprehensive physician-funded and directed injury prevention and research efforts.

Increased risk of head injury in pediatric patients with attention deficit hyperactivity disorder

OBJECTIVE

The prevalence of attention deficit hyperactivity disorder (ADHD) in the general pediatric population is 7%, whereas the prevalence in trauma is unknown. We hypothesized pediatric patients with ADHD would have a higher risk of involvement in a mechanism of injury (MOI) requiring constant attention to surroundings, such as a bicycle collision.

METHODS

The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for patients with ADHD. Patients, less than 16 years of age, with ADHD were compared to those without ADHD.

RESULTS

The prevalence of ADHD was 2.5% (2,866). ADHD patients had higher risk for bicycle collision (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.59-2.15; p < .001). ADHD bicyclists were less likely to wear a helmet (9.4% vs. 18.2%, p = .003) and had a higher rate of traumatic brain injury (TBI; 55.6% vs. 39.7%, p < .001), compared to non-ADHD bicyclists.

CONCLUSIONS

Pediatric ADHD patients have a 60% higher risk of being involved in a bicycle collision. ADHD patients that are involved in a bicycle collision are less likely to wear a helmet with a higher rate of TBI. Increased public awareness, education, and supervision may help reduce risk of bicycle collisions and TBI in this population.

Helmets Matter: Kentucky All-Terrain Vehicle Crashes Seen at a Tennessee Trauma Center

All-terrain vehicle (ATV) safety laws, including helmet use, vary by state and are sporadically enforced. Kentucky state laws require safety helmets only for younger riders. We hypothesized that ATV riders injured in Kentucky and seen at a Tennessee trauma center would more likely be unhelmeted, have more severe head injuries, and have higher mortality rates than those injured in Virginia or Tennessee. A Trauma Registry review of 750 injured ATV riders from June 1, 2005, through June 1, 2015 examined state location of accident, helmet use, markers of injury severity, and outcomes. Multiple logistic regression analysis examined predictors of severe head injuries and death with P < 0.05 significant. Unhelmeted ATV rider status predicted more severe head injuries (relative risk 23.5, P < 0.001) and death (relative risk 4.6, P < 0.001). ATV riders injured in the state of Kentucky were twice as numerous. In addition, they were more likely than ATVriders injured in Tennessee or Virginia to be unhelmeted, to have severe head injuries, and to sustain fatal injuries (all P < 0.001). This single trauma center study lends support for maintaining and enforcing current universal helmet laws for ATVriders of all ages in states where they are in effect and highlights the need to upgrade helmet laws that apply only to some riders.

Age- and Gender-Based Patterns in Youth All-Terrain Vehicle (ATV) Riding Behaviors

Injuries to youth on all-terrain vehicles (ATVs) have been increasing exponentially in recent years. Youth under age 16 years are 4 times more likely to require emergency room treatments. This study explored the relationships and differences in ATV risk and safety behaviors based on age, gender, and age at ATV driving/riding initiation. Data were collected from 180 farm youth between 10 and 19 years of age. The study brought to light an important factor that influences risky ATV behaviors of youth, namely, their age at ATV driving and riding initiation. The sooner that youth (boys and girls) were exposed to ATVs, including riding with their family or friends, the sooner they started driving ATVs themselves, and the more likely they were to indulge in several ATV risk behaviors when older. This effect was more pronounced for boys than girls. Overall, girls in this study were equally likely to engage in many of the risky ATV behaviors, such as taking and giving rides on single-seat ATVs, driving adult-sized ATVs, driving ATVs on public roads, and driving ATVs really fast. However, they were less likely to wear protective attire, leaving them more vulnerable to injuries and fatalities during crashes. Implications of the findings and future directions are discussed.

Age-based risk factors for pediatric ATV-related fatalities

OBJECTIVES

To compare and contrast characteristics and determinants of fatal all-terrain vehicle (ATV) crashes among pediatric age groups.

METHODS

Retrospective descriptive and multivariable analyses of Consumer Product Safety Commission fatality data (1985-2009) were performed.

RESULTS

Relative to 1985-1989 (baseline), pediatric deaths over the subsequent 4-year periods were lower until 2001-2004, when they markedly increased. Also, the proportion of vehicles involved in fatalities with engine sizes >350 cubic centimeter increased, reaching ∼50% of crashes in 2007-2009. 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.