results of rural middle and high school students displayed that other than riding with passengers, youth know the appropriate behavior for riding ATVs including appropriate size of ATV, appropriate helmet size, and appropriate location to ride. Unfortunately, the improved knowledge had little to no effect on safe-riding behaviors or number of crashes. 14 Focused education efforts may prove to be more effective on crash populations, and formalized education efforts on crash victims may decrease repeat crash offenders. Focused education efforts on adolescents may also help decrease morbidity and mortality, as ATV safety training certification courses among adolescents reported higher helmet use, less riding with passengers, and less driving on public roads in Iowa. 17 Our institution has expanded its ATV education and safety program across the state to provide education at schools, camps, and other activities at the end of 2021. 18 Future data will provide insight as to whether the education was successful in decreasing risky behaviors associated with severe injury or death.
CONCLUSION
ATVs continue to cause a significant number of hospitalizations and deaths in both the pediatric and adult age groups. Low helmet use and high substance use are contributors to severity of injury. ATV use in children will continue, and widespread educational efforts are needed to target the pediatric population and parents. Helmet law legislation has been passed in WV for children, but private land continues to be exempt from these laws. Anticipatory guidance at well-child checks to assess for ATV use and to target ATV safety behaviors may be beneficial. These educational efforts may yield progress toward decreasing risky behaviors associated with severe injury and death. Increased awareness and public service announcements may be effective first steps in addressing this problem.
REFERENCES
1. US motorcycle and ATV sales from 2013 to 2017. Statista; Feb 22, 2023. https:// www. statista. com / statistics / 252261 / us-motorcycle-salesin-units /. Accessed 27 July 2023.
2. Topping J. 2018 Annual Report of ATV Related Deaths and Injuries. CPSC: February 2020. https:// www. cpsc. gov / s3fs-public / 2018AnnualReportofATVR elatedDeathsandInjuries. Accessed 15 December 2022.
3. United States Census Bureau. State Population Totals and Components of
Change: 2020-2022. UCSB; 2022. https:// www. census. gov / data / tables / timeseries / demo / popest / 2020s-state-total. html. Accessed 27 July 2023.
4. Number of units sold, retail price paid vary by state. PowerSports Business; April 2, 2012. https:// powersportsbusiness. com / columns / 2012 / 04 / 02 / number-of-unitssold-retail-price-paid-vary-by-state /. Accessed 15 December 2022.
5. Humphries RL, Stone CK, Stapczynski JS, Florea S. An assessment of pediatric all-terrain vehicle injuries. Pediatr Emerg Care. 2006; 22( 7): 491-494. doi: 10.1097 / 01. pec. 0000227383.69014.36
6. Denning GM, Harland KK, Jennissen CA. Age-based risk factors for pediatric ATV-related fatalities. Pediatrics. 2014; 134( 6): 1094-1102. doi: 10.1542 / peds. 2014-1993
7. McLean L, Russell K, McFaull S, Warda L, Tenenbein M, McGavock J. Age and the risk of All-Terrain Vehicle-related injuries in children and adolescents: a cross sectional study. BMC Pediatr. 2017; 17( 1): 81. Published 2017 Mar 17.
18 • www. wvsma. org