Demographic determinants of chemical safety information recall in workers and consumers in South Africa: A cross sectional study

BackgroundChemical hazard communication is intended to alert users of the potential hazards of chemicals. Hazard information needs to be understood and recalled. Recall of hazard communication is critical when the written form of the information is not available at the time it is required.MethodsA cross-sectional study investigating associations between recall of chemical safety information on labels amongst 402 participants including 315 workers and 87 consumers in two provinces of South Africa.ResultsRespondents were predominantly male (67.7%), the median age was 37 years (IQR: 30-46 years) and less than half of the participants completed high school (47.5%). Multivariate analysis identified the following positive associations with the recall of all the label elements listing the strongest association: call appropriate services and industrial vs consumer sector (OR = 2.4; 95% CI: 1.2; 4.6 ); call appropriate services and transport vs consumer sector (OR = 4.4; 95% CI: 1.2; 16.0); flammable symbol and male vs female gender (OR = 2.3; 95% CI: 1.0; 5.3); flammable symbol and home language English vs African languages (OR = 6.6; 95% CI: 2.1; 21.2); any hazard statement and home language Afrikaans vs African languages (OR = 14.0; 95% CI: 3.6; 54.2), any first aid statement and further education vs none (OR = 3.3; 95% CI: 1.3; 8.0), correct chemical name and industry blue collar workers vs non-industry blue collar workers (OR = 2.6; 95% CI: 1.1; 6.1), correct chemical name and non-industry white collar occupations vs non-industry blue collar workers (OR = 2.7; 95% CI: 1.0; 7.1).ConclusionThe study found a number of potential positive associations which influence recall of label elements of which some (e.g., sector, gender, occupation) suggest further research. Relevant policies in South Africa should ensure that the safety information on chemical labels is clearly visible to read and understandable which aids recall and the reduction in harmful chemical exposures.     

Cultural and socio-demographic predictors of car accident involvement in Norway,Ghana, Tanzania and Uganda

The prevalence of road traffic accidents is increasing towards endemic proportions in developing countries. The present study investigated cultural and demographic predictors of car accident involvement in a developed country in Europe and three developing countries in Sub-Saharan Africa. The comparison was carried out with questionnaires among a randomly obtained representative sample of the Norwegian population (n = 247) as well as stratified samples in Accra and Cape-Coast in Ghana (n = 299), Dar-es-Salaam and Arusha areas in Tanzania (n = 599), and the central Kampala and the Mbarara district in Uganda (n = 415). Measurement instruments of culture as symbol exchange and destiny orientation were used to predict self-reported road traffic accident involvement by car among the respondents. Demographic characteristics, such as gender, age and education, were also included as predictors of car accidents. The results showed that male gender was the only significant predictor of accident involvement in Norway. Introverted and extroverted culture, destiny orientation and written culture were associated with accident involvement in the African countries. Male gender also predicted accidents in these countries. Non-technical injury preventive countermeasures in developing countries could focus on cultural practice and fatalistic beliefs. Countermeasures in both developed and developing countries should target male drivers.     

Assessing the impact of risk-taking behavior on road crash involvement among University students residing in two Mediterranean countries

Surveillance systems are indispensable for injury prevention; yet, detailed electronic records are rarely available. The “Student’s Health Card” is a self-reporting electronic tool addressing health issues of University students, while aiming to actively involve them in preventive practices and health promotion. Utilizing data from the injury prevention related section, this study sought to investigate the impact of risk-taking behavior on road crash involvement among University students residing in two Mediterranean countries. A total of 978 University students, 451 Greek and 527 Italian, provided information on prior road crash involvement, as well as on eight behavioral variables, comprising a risky behavior score. Multiple logistic regression analysis was performed. The already known tendency for clustering of risky behaviors was evident. One degree increment in the risky behavior score was found to increase the risk of road crash involvement by 35%. Driving after drinking (OR = 2.55, CI = 1.53–4.26), riding with a drunk driver (OR = 2.19, CI = 1.08–4.45) and tobacco smoking (OR = 1.95, CI = 1.18–3.22) significantly multiplied the risk. Despite their better compliance with safety measures, Italian students, compared with Greek, reported worse alcohol-related driving habits and engaged more frequently in mobile phone use while driving. Clustering of risky behaviors was found to be an important predictor of road crash involvement. Screening and awareness of risk-taking propensity of University students could guide early intervention. The “Student’s Health Card” could provide, at minimal cost, reliable risk-taking and road crash involvement information, which is needed for both personal risk assessment and surveillance purposes.     

The self-defensive attribution hypothesis in the work environment: Co-workers’ perspectives

The study explored the possible influences of situational, personal and non-relevant perception on causality attributions and responsibility assignment in Ghana’s work environment. Ghanaian industrial workers (co-workers) who were witnesses to industrial accidents (n = 117) assigned causality for the mishap and their responses were compared. Analyses were based on the co-workers’ responses to open-ended questions. Three categories of co-workers were identified and labelled as situationally relevant (n = 34), personally relevant (n = 43) and non-relevant co-workers (n = 40). The results showed that co-workers (witnesses) who had some perception of situational and or personal relevance with the accident victims attributed less responsibility to the accident victims than did their counterparts who had no perception of relevance. This observation, like other motivated attributional distortions, seems to reflect a tendency towards self-protection from the three categories of co-workers. It confirms the self-defensive attribution hypothesis in causal attributions about accidents in the work environment.     

The correlation between gradients of descending roads and accident rates

The traffic accident rate on descending roads on mountainous highways is quite high. To study the effects of vertical gradient and length of road on traffic accidents on continuous descending roads, data from 1413 traffic accidents over an 85.43 km section of road were collected. By taking parameters such as the gradients in accident sites, and taking the average gradient in N km (N = 1, 2, 3, 4, 5) just prior to the accident sites as the profile parameter, scatter diagrams were drawn to explore the effects of the profile parameters on the distribution of traffic accidents. Analysis of the exponential regression and correlation analysis between accident rates and profile parameters was carried out as well. The research results show that the accident rate increases with average vertical gradient exponentially; the differences between accident rate and different profile parameters are significant; the accident rate has a good exponential relationship with average gradients when a section has a 2 km or 3 km slope just prior to the accident sites i.e. the accident rate at a specific section on a continuous descending road is related to the average gradient in 2–3 km descending sections just prior to the accident site. The findings indicate that a steep gradient alone is not the reason for an accident, but we also have to take into consideration the presence of a “continuous long” descent prior to it.     

Occupational accidents model based on risk–injury affinity groups

This article sets outs a generalized utility model for the diagnosis and prediction of accidents among the Spanish workforce. Based on observational data classified into a risk–injury contingency table (19 × 19), we have summarized the accident rate of all Spanish companies over an 11-year period (75,19,732 accidents). By using correspondence analysis a structure composed of three axes can be obtained, the combination of which identifies three separate risk and injury groups, which we use as a general Spanish pattern. The relationships of greater affinity or likelihood amongst the risks and injuries identified in the pattern facilitate decision-making at the risk-assessment stage in Spanish companies. Each risk–injury group has its own characteristics, interpretable within the phenomenological framework of the accident.The main advantage of this model is its potential application to any other country and the feasibility of contrasting results from different countries. One limiting factor, however, is that the model currently lacks a common classification frame for risks and injuries which would enhance this contrast. The aim of this model is to automatically manage work-related accidents at a national level.     

Evaluation of an in-vehicle monitoring system (IVMS) to reduce risky driving behaviors in commercial drivers: Comparison of in-cab warning lights and supervisory coaching with videos of driving behavior

ProblemRoadway incidents are the leading cause of work-related death in the United States.MethodsThe objective of this research was to evaluate whether two types of feedback from a commercially available in-vehicle monitoring system (IVMS) would reduce the incidence of risky driving behaviors in drivers from two companies. IVMS were installed in 315 vehicles representing the industries of local truck transportation and oil and gas support operations, and data were collected over an approximate two-year period in intervention and control groups. In one period, intervention group drivers were given feedback from in-cab warning lights from an IVMS that indicated occurrence of harsh vehicle maneuvers. In another period, intervention group drivers viewed video recordings of their risky driving behaviors with supervisors, and were coached by supervisors on safe driving practices.ResultsRisky driving behaviors declined significantly more during the period with coaching plus instant feedback with lights in comparison to the period with lights-only feedback (ORadj = 0.61 95% CI 0.43–0.86; Holm-adjusted p = 0.035) and the control group (ORadj = 0.52 95% CI 0.33–0.82; Holm-adjusted p = 0.032). Lights-only feedback was not found to be significantly different than the control group's decline from baseline (ORadj = 0.86 95% CI 0.51–1.43; Holm-adjusted p > 0.05).ConclusionsThe largest decline in the rate of risky driving behaviors occurred when feedback included both supervisory coaching and lights.Practical applicationsSupervisory coaching is an effective form of feedback to improve driving habits in the workplace. The potential advantages and limitations of this IVMS-based intervention program are discussed.     

Stochastic modeling of accident risks associated with an underground coal mine in Turkey

In this study, a methodology is proposed towards development of an uncertainty model that includes randomness in the occurrence of days-lost accidents in a coal mine. The accident/injury data consists of 1390 days-lost accident cases recorded at GLI-Tuncbilek underground lignite mine from January 1994 to December 2002. In the first step of proposed methodology, the frequency and the severity of the accidents have been modeled statistically by fitting appropriate distributions. The test done by BestFit software yields a chi-square value of 21.53 (p = 0.089) with 14 degrees of freedom and estimates the parameter of lambda for Poisson distribution as 12.87 accidents/month. For the severity component, a lognormal distribution is fitted to days-lost data and chi-square goodness-of-fit test calculates a value of 40.44 (p = 0.097) with 30 degrees of freedom. The parameters of lognormal distribution are estimated as a mean of 14.3 days and standard deviation of 23.1 days, respectively. Then, two distributions are basically combined by Monte Carlo simulation in order to construct relative risk levels in yearly base referring to the final cumulative distribution. Finally, a simple forecasting modeling is carried out in order to quantitatively predict the expected risk levels by using decomposition technique in time series analysis. Stochastic model estimates that although, there would be substantial reduction in the expected number of accidents in the near future, the higher level of risks still should be a concern for the mine management.     

Using a cluster randomized controlled trial to determine the effects of intervention of battery and hardwired smoke alarms in New South Wales,Australia: Home fire safety checks pilot program

IntroductionIn 2014, Fire & Rescue New South Wales piloted the delivery of its home fire safety checks program (HFSC) aimed at engaging and educating targeted top “at risk” groups to prevent and prepare for fire. This pilot study aimed to assess the effectiveness of smoke alarms using a cluster randomized controlled trial.MethodsSurvey questionnaires were distributed to the households that had participated in the HFSC program (intervention group). A separate survey questionnaire was distributed to the control group that was identified with similar characteristics to the intervention group in the same suburb. To adjust for potential clustering effects, generalized estimation equations with a log link were used.ResultsMultivariable analyses revealed that battery and hardwired smoking alarm usage increased by 9% and 3% respectively among the intervention group compared to the control group. Females were more likely to install battery smoke alarms than males. Respondents who possessed a certificate or diploma (AOR = 1.31, 95% CI 1.00–1.70, P = 0.047) and those who were educated up to years 8–12 (AOR = 1.32, 95% CI 1.06–1.64, P = 0.012) were significantly more likely to install battery smoke alarms than those who completed bachelor degrees. Conversely, holders of a certificate or diploma and people who were educated up to years 8–12 were 31% (AOR = 0.69, 95% CI 0.52–0.93, P = 0.014) and 24% (AOR = 0.76, 95% CI 0.60–0.95, P = 0.015) significantly less likely to install a hardwired smoke alarm compared to those who completed bachelor degrees.ConclusionsThis pilot study provided evidence of the benefit of the HFSC in New South Wales. Practical Applications: Fire safety intervention programs, like HFSC, need to be targeted to male adults with lower level of schooling even when they are aware of their risks.     

Better effect of the use of a needle safety device in combination with an interactive workshop to prevent needle stick injuries

ObjectivesThis study compares the effectiveness of two types of interventions with no intervention on the prevention of needle stick injuries (NSIs).MethodsHealth care workers, who were at risk for NSIs, were eligible for this three-armed cluster randomized controlled trial. In total, 23 hospital wards were randomly assigned to 1 of 2 intervention groups, which were given either a needle safety device and a workshop (NW; 7 wards, n = 267) or a workshop only (W; 8 wards, n = 263), or to a control group (C; 8 wards, n = 266). The primary outcome was the half-year incidence of NSIs, which was measured through questionnaires and official notification at the occupational health service at baseline (T0), 6 months (T1) and 12 months (T2) after baseline. Analysis were done by intention to treat. This study is registered as a prospective randomized trial, number NTR1207.ResultsA statistically significant difference was found between the groups for the half-year incidence of NSIs (p = 0.046) on the basis of questionnaire data with ORs for reported NSIs for the NW group compared with the control group of 0.34 (95% CI: 0.13–0.91) and 0.45 (95% CI: 0.19–1.06) for the W group compared with the control group. The officially registered NSIs during the study period showed no statistical differences between the groups.ConclusionsThe combined intervention of the introduction of needle safety devices and an interactive workshop led to the highest reduction in the number of self-reported NSIs compared to a workshop alone or no intervention.     

Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004–2012

Introduction: Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers. Methods: Self-reported weight, height, and injuries within the previous three months were collected annually for U.S. workers in the National Health Interview Survey (NHIS) from 2004–2012. Participants were categorized as normal weight (BMI: 18.5–24.9 kg/m²), overweight (BMI: 25.0–29.9), obese I (BMI: 30.0–34.9), and obese II (BMI: 35 +). The prevalence of injury and prevalence ratios from fitted logistic regression models was used to assess relationships between obesity and injury after adjusting for covariates. Sampling weights were incorporated using SUDAAN software. Results: During the 9-year study period from 2004 to 2012, 1120 workers (78 workers per 10,000) experienced a work-related injury during the previous three months. The anatomical sites with the highest prevalence of injury were the back (14.3/10,000 ± 1.2), fingers (11.5 ± 1.3), and knees (7.1 ± 0.8). The most common types of injuries were sprains/strains/twists (41.5% of all injuries), cuts (20.0%), and fractures (11.8%). Compared to normal weight workers, overweight and obese workers were more likely to experience work-site injuries [overweight: PR = 1.25 (95% CI = 1.04–1.52); obese I: 1.41 (1.14–1.74); obese II: 1.68 (1.32–2.14)]. These injuries were more likely to affect the lower extremities [overweight: PR = 1.48, (95% CI = 1.03–2.13); obese I: 1.70 (1.13–2.55); obese II: 2.91 (1.91–4.41)] and were more likely to be due to sprains/strains/twists [overweight: PR = 1.73 (95% CI = 1.29–2.31); obese I: PR = 2.24 (1.64–3.06); obese II: PR = 2.95 (2.04–4.26)]. Conclusions: Among NHIS participants, overweight and obese workers were 25% to 68% more likely to experience injuries than normal weight workers. Practical applications: Weight reduction policies and management programs may be effectively targeted towards overweight and obese groups to prevent or reduce work-site injuries.     

Investigation of affecting parameters on treating high-strength compost leachate in a hybrid EGSB and fixed-bed reactor followed by electrocoagulation–flotation process

In this research, treatability of high-load compost leachate in a hybrid expanded granular sludge bed (EGSB) and fixed-bed (FB) bioreactor followed by electrocoagulation–flotation (ECF) system was examined. The operational factors in EGSB–FB were influent chemical oxygen demand (COD), hydraulic retention time (HRT) and COD/nitrogen ratio (COD/N). And, their interactive effects on the efficiency of COD removal and biogas production rate (BPR) as responses were analyzed and correlated by response surface methodology (RSM). The optimum conditions of the hybrid EGSB–FB reactor were acquired at COD = 7800 mg/L, HRT = 35 h, COD/N = 70, in which COD removal efficiency was 83% and BPR 94 mL/h. The amount of confidence interval was 95%. COD (relevant coefficient = 9.8) and HRT (relevant coefficient = −24) were resulted respectively as the most effective parameters on COD removal and BPR. Yet, COD/N parameter imposed negative effect on COD removal and BPR in values less than about 100. The outcomes indicated that operated ECF as post-treatment in constant conditions (electrolysis time = 75 min, electrodes distance = 3 cm, voltage = 20 V) successfully satisfied discharge criteria in the most part of experimental domains.     

Educational status and organizational safety climate: Does educational attainment influence workers’ perceptions of workplace safety?

From a practical perspective, understanding the impact of education on perceptions of workplace safety would benefit management’s decisions regarding workers’ adaptability, general work effectiveness, accident frequency, implementation of safety management policies, and handling of education-related accident characteristics. The current study thus examined the relationship between educational attainment and (i) safety perception, (ii) job satisfaction, (iii) compliance with safety management policies, and (iv) accident frequency. Participants were Ghanaian industrial workers (N = 320) categorized into four educational groups based on their responses: basic education 50% (n = 159); secondary education, n = 98 (30%); vocational/professional education, 17% (n = 56); and university education, 3% (n = 7). Workplace safety perception was assessed with Hayes et al.’s 50-item Work Safety Scale (WSS): a scale that effectively captures the dimensions identified by safety experts to influence perceptions of workplace safety. Multivariate analysis (MANOVA) was used to test for differences of statistical significance. Posterior comparison with t-test consistently revealed significant differences between the two higher-educated cohorts and their lower-educated counterparts. The results indicated a positive association between education and safety perception. Higher-educated workers recorded the best perceptions on safety, indicated the highest level of job satisfaction, were the most compliant with safety procedures and recorded the lowest accident involvement rate.     

Prevention of occupational injuries: Evidence for effective good practices in foundries

IntroductionOccupational injuries are a relevant research and practical issue. However, intervention studies evaluating the effectiveness of workplace injury prevention programs are seldom performed. Method: The effectiveness of a multifaceted intervention aimed at reducing occupational injury rates (incidence/employment-based = IR, frequency/hours-based = FR, severity = SR) was evaluated between 2008 and 2013 in 29 Italian foundries (22 ferrous; 7 non-ferrous; 3,460 male blue collar workers/year) of varying sizes. Each foundry established an internal multidisciplinary prevention team for risk assessment, monitoring and prevention of occupational injuries, involving employers, occupational physicians, safety personnel, workers' representatives, supervisors. Targets of intervention were workers, equipment, organization, workplace, job tasks. An interrupted time series (ITS) design was applied. Results: 4,604 occupational injuries and 83,156 lost workdays were registered between 2003 and 2013. Statistical analysis showed, after intervention, a reduction of all injury rates (− 26% IR, − 15% FR, −18% SR) in ferrous foundries and of SR (− 4%) in non-ferrous foundries. A significant (p = 0.021) ‘step-effect’ was shown for IR in ferrous foundries, independent of secular trends (p < 0.001). Sector-specific benchmarks for all injury rates were developed separately for ferrous and non-ferrous foundries. Conclusions: Strengths of the study were: ITS design, according to standardized quality criteria (i.e., at least three data points before and three data points after intervention; clearly defined intervention point); pragmatic approach, with good external validity; promotion of effective good practices. Main limitations were the non-randomized nature and a medium length post-intervention period. In conclusion, a multifaceted, pragmatic and accountable intervention is effective in reducing the burden of occupational injuries in small-, medium- and large-sized foundries. Practical Applications: The study poses the basis for feasible good practice guidelines to be implemented to prevent occupational injuries, by means of sector-specific numerical benchmarks, with potentially relevant impacts on workers, companies, occupational health professionals and society at large.     

Workers' compensation loss prevention representative contact and risk of lost-time injury in construction policyholders

IntroductionInsurance loss prevention (LP) representatives have access and contact with businesses and employees to provide targeted safety and health resources. Construction firms, especially those smaller in size, are a high-risk population. This research evaluated the association between LP rep contact and risk for lost-time injuries in construction policyholders.MethodsWorkers' compensation data were utilized to track LP rep contact with policyholders and incidence of lost-time injury over time. Survival analysis with repeated events modeling calculated hazard ratios (HR) and 95% confidence intervals (CI).ResultsCompared no LP contact, one contact was associated with a 27% reduction of risk (HR = 0.73, CI = 0.65–0.82), two with a 41% (HR = 0.59, CI = 0.51–0.68), and three or more contacts with a 28% reduction of risk (HR = 0.72, CI = 0.65–0.81).ConclusionsLP reps appear to be a valuable partner in efforts to reduce injury burden. Their presence or contact with policyholders is consistent with reduction in overall incidence of lost-time injuries.Practical applicationsReduction in lost-time injuries, resulting in reduced workers' compensation costs for policyholders and insurance companies, builds a business-case for safety and injury prevention. LP reps are often a low or no-cost benefit for insurance policyholders and may be an important injury prevention resource for small firms and/or those with lack of safety resources and staff.     

Validation of the principles of injury risk zones for motorcycle protective clothing

IntroductionThe distributions of motorcycle crash impacts and injuries were compared to the four impact risk zones and protective performance specified in the European Standard for motorcycle clothing (EN 13595).MethodsCrashed motorcyclists' (n = 117) injuries and clothing damage were categorized by body area into the four risk zones. Three levels of protection were defined: protective clothing with impact protection, protective clothing only and non-protective clothing.ResultsThe distribution of impact/injury sites corresponded to the predictions of EN 13595, with the proportion of all injuries decreasing from 43.9% in Zone 1, to 18.0%, 16.7%, and 11.5% in Zones 2 to 4, respectively. Protective clothing modified the distribution of injuries with substantially more injuries (OR = 2.69, 95% CL: 20.1–3.59) at unprotected impact sites.Practical applicationThese findings support an appropriate framework for determining performance specifications for the manufacture of motorcycle clothing that will effectively reduce the risk of injury in crashes.     

How perceptions of experience-based analysis influence explanations of work accidents

IntroductionThis article looks into how perceptions of experience-based analysis (EBA) influence causal explanations of accidents given by managers and workers in the chemical industry (n = 409) and in the nuclear industry (n = 222).MethodThe approach is based on the model of naive explanations of accidents (Kouabenan, 1999, 2006, 2009), which recommends taking into account explanations of accidents spontaneously given by individuals, including laypersons, not only to better understand why accidents occur but also to design and implement the most appropriate prevention measures. The study reported here describes the impact of perceptions about EBA (perceived effectiveness, personal commitment, and the feeling of being involved in EBA practices) on managers' and workers' explanations of accidents likely to occur at the workplace.ResultsThe results indicated that both managers and workers made more internal explanations than external ones when they perceived EBA positively. Moreover, the more the participants felt involved in EBA, were committed to it, and judged it effective, the more they explained accidents in terms of factors internal to the workers. Practical Applications: Recommendations are proposed for reducing defensive reactions, increasing personal commitment to EBA, and improving EBA effectiveness.     

Differences in risk perception,priorities, worry and demand for risk mitigation in transport among Norwegians in 2004 and 2008

The present study aimed to investigate differences in risk perception, the demand for risk mitigation, priorities and worry related to transport among the Norwegian public in 2004 and 2008. Age, gender, education, driver licence and number of injuries in transport were controlled for. The comparison was carried out with questionnaire surveys among representative samples of the Norwegian public in 2004 (n = 1730) and 2008 (n = 1864). The results showed that the perceived probabilities of transport accidents decreased, whereas the perceived severity of consequences increased during this period. Both samples estimated higher probabilities of accidents by private means of transport. The demand for risk mitigation and priorities related to transport safety increased significantly in the same period. The 2008 sample also reported more worry regarding accidents by private transport. Results were discussed in relation to transport safety campaigns, safety measures and significant accidents which occurred in this period.     

Substance exposure and helmet use in all-terrain vehicle accidents: Nine years of experience at a level 1 trauma center

IntroductionThe surging popularity of all-terrain vehicles (ATV) in the United States has caused an “epidemic of injuries and mortality.” The U.S. Consumer Product Safety Commission reported 99,600 injuries and 426 fatalities from ATV accidents in 2013. The aim of this study was to examine the relationship between helmet use and positive toxicology screenings on outcomes in ATV accident victims.MethodsThis is a retrospective study of patients admitted to a Level 1 Trauma Center in southwestern West Virginia following an ATV accident between 2005 and 2013. Data were obtained from the institution's Trauma Registry.ResultsA total of 1,857 patients were admitted during the study period with 39 (1.9%) reported deaths. Positive serum alcohol and/or urine drug screens were obtained in 66.4% of the patients tested (n = 1,293). Those with positive screenings were 9.5% less likely to utilize a helmet (13.2% vs. 22.7%, p < 0.001); and the lack of helmet use was associated with an increase in traumatic brain injury (57.1% vs. 41.7%, p < 0.001). Positivity for substances or the lack of helmet use was significantly associated with higher morbidity. Lack of helmet use resulted in a 3.94-fold increase in the risk of discharge in a vegetative state or death.ConclusionsDrugs and alcohol use may predispose riders to be less likely to wear helmets and significantly increase the risk of a poor clinical outcome following an ATV accident. Rigorous efforts should be made to enhance safety measures through educational endeavors and amendment of current regulations to promote safe and responsible use of ATVs.Practical applicationsModification of regulatory requirements should be considered in order to mandate the wearing of helmets during ATV operation. In addition, expansion of safety programs should be considered in an effort to improve availability, affordability and awareness of safe ATV practices.