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ABSTRACT
From 1982 to 2007, Kentucky had 459 deaths related to all-terrain vehicles (ATVs), fifth highest among US states. By 2012, Kentucky ranked fourth highest, with 578 ATV-related deaths. Following the sentinel event of an ATV-related traumatic brain injury to an unhelmeted high school student, the authors developed a 19-item survey that collected data regarding rural Kentucky high school students’ years of ATV driving, second-rider frequency, typical duration of riding events, estimated weekly number of riding events, and frequency of helmet use. Of the 159 students involved, males scored significantly higher on each of these items, except frequency of any ATV driving and frequency of helmet use, which showed no gender differences. Overall, 9.3% of students reported always wearing a helmet when driving and/or riding; 61.2% reported never wearing a helmet; 132 (83.0%) reported that they either drove ATVs or rode as a second rider, and 72 of these (57.1%) reported having had an ATV incident, 33 (45.8%) of which resulted in an injury. Twenty-one of these were serious injuries, including concussions; unconsciousness; fractures to skull, nose, collarbones, arms, ribs, and legs; elbow and hip dislocations; lacerations to head, eyes, arms, legs, and back; and multiple contusions and sprains. Findings have implications for the design of responsibility to protect (R2P) interventions that will reduce exposure and prevent ATV injury and fatality. A method that leverages the relevance of a sentinel event as a community public-health surveillance opportunity is described. Study surveillance data showed higher exposure to ATV hazards than previously reported.