TI Grantee Update: Arkansas

Grant Recipient:   Arkansas Children’s Hospital Research Institute
Title: Development and Evaluation of Targeted ATV Safety Educational Strategies for Rural Children 
Project Period: October 1, 2007 to September 30, 2010
Project Team: Primary Investigator Mary Aitken, MD, MPH, gathered an unique and far reaching team of 13 professionals for both collaboration and implementation of her TI project.  They include: co-investigators from Arkansas Children’s James Graham, MD, and Steve Bowman, PhD, and from the West Virginia University Injury Control Research Center, James Helmkamp, PhD, and Maria Brann, PhD.  Additional team members from Arkansas Children’s include: Beverly Miller, Med, S. Hope Mullins, MPH, Shane Eoff, and John Nixon.  Other key collaborators include: Robert Williams, MD, Arkansas Children’s Hospital Research Institute, Karen Ballard, EdD, University of Arkansas Division of Agriculture Cooperative Extension Service, Chandra Thorbole, PhD, Engineering Institute, Joe Huggins, Arkansas Game and Fish Commission, and Mike Klumpp, University of Arkansas Division of Agriculture Cooperative Extension Service.
Background: From 2000-2004, children younger than 16 accounted for 21% of ATV deaths and 32% of emergency department (ED)-treated ATV injuries. This five-year period identified an increase in deaths by 12% and injuries by 40%, with an economic cost in the hundreds of millions of dollars.  The purpose of this project is to develop, evaluate, and disseminate tailored ATV safety educational materials and delivery strategies for children in rural areas.
Project Progress:
2010-2011 Input from high school students is used to improve visual materials in the ATV safety education toolkit. Project staff then work with Louisiana and South Carolina 4-H youths and their parents to finalize the toolkit. The toolkit is disseminated through established state, regional, and national networks. In addition, project staff begin to evaluate the effectiveness of digital simulation of an ATV crash in influencing attitudes and beliefs about risks related to ATVs. Simulations of crash scenarios for educational purposes are in production.
ATV simulation model
Dr. James Graham (left) and Dr. Chandra Thorbole (center) assess the computational modeling of a six year old child on an ATV of size and power that is typical for recreational use. The modeling was completed through an independent engineering testing center. 
2009-2010 In November 2009, project collaborators meet to explore strategies for disseminating ATV safety messages in rural communities. Project staff begin testing feasibility of disseminating these messages through movie theaters.  A theater in a rural area of Arkansas allows a number of dissemination strategies to be conducted during an eight-week period, including airing public service announcement during advertising, lobby displays, and distributing brochures.  Trained high school volunteers from an adjacent county conduct exit interviews under the supervision of project staff. Data from the movie theater activity is currently being analyzed. In addition, production begins on the development of a digital model of an ATV crash.  
2008-2009 Focus group results are used to develop an ATV safety education toolkit, which includes a facilitator guide, supplemental print materials, and classroom curriculum guides. Project staff work with physical education teachers in a rural high school to conduct an ATV safety education campaign using the toolkit. Additional focus groups are held with these high school students to  evaluate and refine targeted messages within the toolkit. A brochure and poster are created to reinforce key messages.
2007-2008 Project staff catalog and assess existing ATV safety materials. They then conduct focus groups in Arkansas to assess sample materials for messages to which ATV riders would be receptive. In addition, project staff collaborate with the Arkansas Game and Fish Commission on the production of a video on ATV safety for hunters.  The 20-minute video, titled A Trip Unplanned, relates the story of two teens riding an ATV who ignore both ATV and gun safety recommendations.
Pictured above is the jacket for A Trip Unplanned, the ATV safety video created by Arkansas Children's Hospital in collaboration with the Arkansas Game and Fish Commission, among others.  
Dissemination and Sustainability: The following manuscripts have been published:
  • SM Bowman, ME Aitken, JC Helmkamp, SA Maham, CJ Graham. Impact of helmets on injuries to riders of all-terrain vehicles.  Injury Prevention. 2009;15:3-7.
  • Helmkamp JC, Aitken ME, Lawrence BA.  ATV- and bicycle-related deaths and associated costs in the United States, 2000-2005.  Public Health Reports.  2009:124;409-418.
Additional manuscripts are under development. In addition, project staff have published articles on ATV safety in the June 2010 issue of City and Town, a state publication for elected officials in Arkansas, and in the April 2010 issue CSN, a monthly newsletter of the Children's Safety Network.
Invited presentations as well as posters have also been provided at numerous professional meetings including:
  • “Conducting injury prevention in rural communities:  Tailoring messages for booster seat and all-terrain vehicle safety (Poster Presentation),” - American Public Health Association, Denver, CO, November, 2010.

  • “Developing a digital simulation of an ATV crash,” - Injury Free Coalition for Kids, Chicago, IL, November, 2010.

  • “ATVs and Children” - Safe Kids of Delaware, Dover, DE, June, 2010

  • “Injury Risk in Rural Communities:  Perception, Reality, and Prevention” – Children’s Safety Network, June, 2010.

  • “Developing a Focused Injury Prevention Message for ATV use for Adolescents,” – EMSC Annual Grantee Meeting, Bethesda, Maryland, May, 2010.

  • “Still unsafe, still in use:  The ongoing epidemic of all-terrain vehicle injury hospitalizations among children” - Pediatric Academic Societies, Vancouver, BC, Canada, May, 2010.

  • “Kids Driving ATVs: Towards a Higher Safety Standard”,   Society of Trauma Nurses Pediatric Pre-Conference, April, 2010.

  • “ATVs and children under 16” - Lifesavers Conference, Philadelphia, PA, April, 2010.

  • “Use of tool kits to improve ATV safety” - National Association of Children’s Hospitals and Related Institutes, San Diego, CA, March, 201.

  • “Cranial Impalement of an All-terrain Vehicle Brake Handle in a Helmeted Child” - Southern Society for Pediatric Research, New Orleans, LA, February, 2010.

  • “Increasing Public Awareness and Capacity through Injury Prevention Tool Kits” - Injury Free Coalition for Kids, Ft. Lauderdale, FL, December, 2009.

  • “Translating Injury Prevention Research in Rural Environments (Poster Presentation)” - Injury Free Coalition for Kids, Ft. Lauderdale, FL December, 2009.

  • ATV Injury Prevention:  Vulnerability, Resilience, and Resistance” - Farm Bureau of LA and Lady of the Lake Trauma Program, Baton Rouge, LA, October, 2009

  • “Children and ATVs” - 8th Annual Iowa Child and Injury Prevention Conference, September 2009.

  • “Rural Child Injury Prevention” - Children’s Safety Network, NE Regional COP on Rural Injury Prevention, Boston, MA, September 2009.

  • “The growing epidemic of all-terrain vehicle injury,” - National Association of State EMS Officials, Little Rock, AR, July 2009.

  • “ATV Safety – Arkansas Experiences”- Children’s Safety Network, NE Regional COP on Rural Injury Prevention, July 2009.

  • “Development and evaluation of targeted ATV safety educational strategies for rural children (Poster presentation)” - National Association of Children’s Hospitals and Related Institutes, Nashville, TN, March, 2009.
Two additional applications submitted by the Arkansas Children’s’ Hospital Foundation were funded by private foundations to further ATV safety education in two targeted counties in Arkansas.  A third project, an intramural-funded study, will conduct focus groups in Arkansas to determine barriers to helmet use.  All of these projects are underway.
Emerging Projects Two new studies collecting preliminary data on the role of media in ATV safety are underway. Media articles are being reviewed and catalogued for reporting of the use of safety gear in articles on ATV crashes (Bowman, PI).  Additionally, web-based comment boards and blogs are being reviewed and coded to determine whether or not social media can be used to determine public sentiment regarding ATV safety, especially policy (Aitken, PI).  
Recognitions On April 28, 2009, at the 25th Annual Healthcare Advertising Awards, Arkansas Children’s Hospital received a Gold Award in the special video category for A Trip Unplanned.  A national panel of judges was engaged to review 4,400 entries based on creativity, quality, message effectiveness, consumer appeal, graphic design, and overall impact.