{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T22:05:41Z","timestamp":1778364341923,"version":"3.51.4"},"reference-count":49,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T00:00:00Z","timestamp":1647388800000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2022,2,22]]},"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u20132019). 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\u2019s home county. Relationships between helmet use at the time of injury, demographics, and socioeconomic variables were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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&lt;0.001) and passengers (89.5%; p&lt;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&lt;0.0001), passenger status (OR=6.457; p&lt;0.0001), and older age (OR=1.219; p&lt;0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III\u2014retrospective comparative epidemiological study.<\/jats:p><\/jats:sec>","DOI":"10.1136\/tsaco-2021-000876","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T16:11:45Z","timestamp":1647447105000},"page":"e000876","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Socioeconomic factors associated with helmet use in pediatric ATV and dirt bike trauma"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9683-5242","authenticated-orcid":false,"given":"Kelly L","family":"Vittetoe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackson H","family":"Allen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Purnima","family":"Unni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katlyn G","family":"McKay","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron M","family":"Yengo-Kahn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owais","family":"Ghani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pradeep","family":"Mummidi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber L","family":"Greeno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher M","family":"Bonfield","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harold N \"Bo\"","family":"Lovvorn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,3,16]]},"reference":[{"key":"2024051312062128000_7.1.e000876.1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.amjsurg.2016.11.017","article-title":"Injuries from all-terrain vehicles: an opportunity for injury prevention","volume":"214","author":"Benham","year":"2017","journal-title":"Am J Surg"},{"key":"2024051312062128000_7.1.e000876.2","doi-asserted-by":"publisher","DOI":"10.1136\/ip.2008.019372"},{"key":"2024051312062128000_7.1.e000876.3","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/TA.0b013e3182a994ff","article-title":"Helmet use is associated with a decrease in intracranial hemorrhage following all-terrain vehicle crashes","volume":"76","author":"Rostas","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"key":"2024051312062128000_7.1.e000876.4","unstructured":"Topping J . 2020 report of deaths and injuries involving Off-Highway vehicles with more than two wheels. US Consum Prod Saf Comm 2020;20."},{"key":"2024051312062128000_7.1.e000876.5","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/TA.0000000000000266","article-title":"A prospective, multi-institutional study of pediatric all-terrain vehicle crashes","volume":"77","author":"Mazotas","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"key":"2024051312062128000_7.1.e000876.6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-1993"},{"key":"2024051312062128000_7.1.e000876.7","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1663"},{"key":"2024051312062128000_7.1.e000876.8","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.jemermed.2016.12.035","article-title":"All-Terrain vehicle injury in children and youth: examining current knowledge and future needs","volume":"53","author":"Doud","year":"2017","journal-title":"J Emerg Med"},{"key":"2024051312062128000_7.1.e000876.9","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1177\/000313481808400239","article-title":"Helmets matter: Kentucky All-Terrain vehicle crashes seen at a Tennessee trauma center","volume":"84","author":"Testerman","year":"2018","journal-title":"Am Surg"},{"key":"2024051312062128000_7.1.e000876.10","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000114922.46342.38"},{"key":"2024051312062128000_7.1.e000876.11","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1177\/000313480507101107","article-title":"All-terrain vehicle injuries: are they dangerous? A 6-year experience at a level I trauma center after legislative regulations expired","volume":"71","author":"Fonseca","year":"2005","journal-title":"Am Surg"},{"key":"2024051312062128000_7.1.e000876.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2006.00051.x"},{"key":"2024051312062128000_7.1.e000876.13","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000158252.11002.6E"},{"key":"2024051312062128000_7.1.e000876.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-017-0807-y","article-title":"Age and the risk of All-Terrain Vehicle-related injuries in children and adolescents: a cross sectional study","volume":"17","author":"McLean","year":"2017","journal-title":"BMC Pediatr"},{"key":"2024051312062128000_7.1.e000876.15","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jsr.2016.10.004","article-title":"Understanding risk factor patterns in ATV fatalities: a recursive partitioning approach","volume":"59","author":"Lagerstrom","year":"2016","journal-title":"J Safety Res"},{"key":"2024051312062128000_7.1.e000876.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2007.09.021"},{"key":"2024051312062128000_7.1.e000876.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2010.02.021"},{"key":"2024051312062128000_7.1.e000876.18","doi-asserted-by":"publisher","DOI":"10.1136\/ip.2003.002626"},{"key":"2024051312062128000_7.1.e000876.19","first-page":"135","article-title":"Youth personality factors as predictors of risky All-Terrain vehicle (ATV) driving behaviors","volume":"22","author":"Jinnah","year":"2016","journal-title":"J Agric Saf Health"},{"key":"2024051312062128000_7.1.e000876.20","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.91.11.1792"},{"key":"2024051312062128000_7.1.e000876.21","unstructured":"CPSC.gov . The consumer product safety improvement act (CPSIA). 2016. https:\/\/www.cpsc.gov\/Regulations-Laws-Standards\/Statutes\/The-Consumer-Product-Safety-Improvement-Act (27 Jul 2021)."},{"key":"2024051312062128000_7.1.e000876.22","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-1164","article-title":"Age legislation and Off-Road vehicle injuries in children","volume":"140","author":"Flaherty","year":"2017","journal-title":"Pediatrics"},{"key":"2024051312062128000_7.1.e000876.23","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jsr.2016.12.001","article-title":"All-terrain vehicle safety knowledge, riding behaviors and crash experience of farm progress show Attendees","volume":"60","author":"Jennissen","year":"2017","journal-title":"J Safety Res"},{"key":"2024051312062128000_7.1.e000876.24","doi-asserted-by":"crossref","first-page":"S277","DOI":"10.1097\/TA0b013e31826b00d7","article-title":"Analysis of pediatric all-terrain vehicle trauma data in middle Tennessee: implications for injury prevention","volume":"73","author":"Unni","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"2024051312062128000_7.1.e000876.25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2010.00327.x"},{"key":"2024051312062128000_7.1.e000876.26","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/j.amjsurg.2007.05.049","article-title":"A 21-year history of all-terrain vehicle injuries: has anything changed?","volume":"195","author":"Bansal","year":"2008","journal-title":"Am J Surg"},{"key":"2024051312062128000_7.1.e000876.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2007.09.016"},{"key":"2024051312062128000_7.1.e000876.28","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e31820942f8"},{"key":"2024051312062128000_7.1.e000876.29","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1097\/TA.0000000000001828","article-title":"Prevention of all-terrain vehicle injuries: a systematic review from the eastern association for the surgery of trauma","volume":"84","author":"Rattan","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2024051312062128000_7.1.e000876.30","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-2890"},{"key":"2024051312062128000_7.1.e000876.31","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-1585"},{"key":"2024051312062128000_7.1.e000876.32","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.jpedsurg.2016.09.003","article-title":"Injuries and outcomes associated with recreational vehicle accidents in pediatric trauma","volume":"52","author":"Linnaus","year":"2017","journal-title":"J Pediatr Surg"},{"key":"2024051312062128000_7.1.e000876.33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/2021.6.PEDS21225","article-title":"The impact of helmet use on neurosurgical care and outcomes after pediatric all-terrain vehicle and dirt bike crashes: a 10-year single-center experience","volume":"29","author":"Allen","year":"2022","journal-title":"J Neurosurg Pediatr"},{"key":"2024051312062128000_7.1.e000876.34","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2013-041138"},{"key":"2024051312062128000_7.1.e000876.35","doi-asserted-by":"crossref","first-page":"913","DOI":"10.5811\/westjem.2017.6.34404","article-title":"Using Geospatial mapping to determine the impact of All-Terrain vehicle crashes on both rural and urban communities","volume":"18","author":"Qin","year":"2017","journal-title":"West J Emerg Med"},{"key":"2024051312062128000_7.1.e000876.36","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.4.e330"},{"key":"2024051312062128000_7.1.e000876.37","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181f1e9fe"},{"key":"2024051312062128000_7.1.e000876.38","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/j.surg.2017.10.070","article-title":"Evolution of a level I pediatric trauma center: changes in injury mechanisms and improved outcomes","volume":"163","author":"Schlegel","year":"2018","journal-title":"Surgery"},{"key":"2024051312062128000_7.1.e000876.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2024051312062128000_7.1.e000876.40","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040296"},{"key":"2024051312062128000_7.1.e000876.41","unstructured":"Data.census.gov . Explore Census Data. https:\/\/data.census.gov\/cedsci\/ (27 Nov 2021)."},{"key":"2024051312062128000_7.1.e000876.42","doi-asserted-by":"publisher","DOI":"10.1080\/15389588.2011.561455"},{"key":"2024051312062128000_7.1.e000876.43","doi-asserted-by":"publisher","DOI":"10.1136\/ip.2003.004176"},{"key":"2024051312062128000_7.1.e000876.44","doi-asserted-by":"crossref","first-page":"S190","DOI":"10.1097\/TA.0000000000001521","article-title":"A multiyear assessment of a hospital-school program to promote teen motor vehicle safety","volume":"83","author":"Unni","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2024051312062128000_7.1.e000876.45","doi-asserted-by":"crossref","first-page":"83","DOI":"10.2307\/1602826","article-title":"Community-based injury prevention interventions","volume":"10","author":"Klassen","year":"2000","journal-title":"Future Child"},{"key":"2024051312062128000_7.1.e000876.46","doi-asserted-by":"publisher","DOI":"10.1136\/ip.2010.028126"},{"key":"2024051312062128000_7.1.e000876.47","doi-asserted-by":"crossref","first-page":"i49","DOI":"10.1136\/ip.2006.012872","article-title":"A conceptual framework for reducing risky teen driving behaviors among minority youth","volume":"12 Suppl 1","author":"Juarez","year":"2006","journal-title":"Inj Prev"},{"key":"2024051312062128000_7.1.e000876.48","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyu016"},{"key":"2024051312062128000_7.1.e000876.49","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40621-020-00253-2","article-title":"Parental attitudes and family helmet use for all-terrain vehicles and bicycles","volume":"7","author":"Wymore","year":"2020","journal-title":"Inj Epidemiol"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2021-000876","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T19:11:05Z","timestamp":1715627465000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2021-000876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,3,16]]},"published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1136\/tsaco-2021-000876"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2021-000876","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3]]}}}