Presenter Profile
Charles Jennissen, MD
University of Iowa
Department of Emergency Medicine
Stead Family Department of Pediatrics
charles-jennissen@uiowa.edu
Charles Jennissen, MD, is a pediatric emergency medicine physician and a clinical professor in the Department of Emergency Medicine and the Stead Family Department of Pediatrics at the University of Iowa Carver College of Medicine. Dr. Jennissen is the Principal Investigator for IFCK at the University of Iowa Stead Family Children’s Hospital and presently serves on the IFCK National Board. He grew up on a dairy farm in central Minnesota and has been an advisory board member of I-CASH (Iowa Center for Agricultural Safety and Health) for 26 years. He feels honored to have received the National IFCK Principal Investigator of the Year Award in 2023.
Presentations
A National Study of FFA Adolescent Attitudes and Use of Helmets While Riding ATVs
Kareem Shoukih, BS
Brianna Iverson, MD
Parker Sternhagen, BS
Sarah Nichols, BS
Taeuk Kang, MBiotech, MSc
Kristel Wetjen, RN, BSN
Brenda Vergara
Pam Hoogerwerf, BA
Charles Jennissen, MD
Mishaps associated with all-terrain vehicles (ATVs), both during work and play, are common in rural areas and frequent causes of death and serious injury. Head injuries are the most common cause of death and helmet use can significantly decrease the risk. Our objective was to determine rural adolescents’ use of ATVs, attitudes regarding helmets while riding ATVs, the frequency of helmet use on these vehicles, and how demographic and other factors may be associated with wearing helmets and the support of helmet laws.
A convenience sample of 2025 National FFA (formerly Future Farmers of America) Convention & Expo attendees completed an anonymous survey at the University of Iowa Stead Family Children’s Hospital injury prevention booth. After compilation, data were imported into SAS (version 9.4). Descriptive and statistical analyses including bivariate (chi-square, Fisher’s exact test) and logistic regression were performed. To compare helmet importance score distributions, the Wilcoxon rank sum or Kruskal-Wallis test was used.
2,516 adolescents between 13-18 years participated. Nearly two-fifths (38%) lived on a farm, 38% lived in the country/not on a farm and 24% were from towns. The vast majority (91%) were non-Hispanic White. Over three-fifths (61%) of subjects’ families owned an ATV and two-thirds (66%) had ridden an ATV in the past year. Farm residents had the highest ATV ownership (77%) and having ridden in the past year (79%) proportions, both p<0.0001. Overall, less than one-half (46%) supported laws requiring ATV helmets. For riders, about one-third (35%) stated they always/mostly wore helmets when riding; over one-half said they never or rarely do. Those from farms (29%) and isolated rural areas (26%) had significantly lower proportions that always/mostly wore helmets as compared to peers, both p<0.001. The mean ratings for helmet use importance (from 1-10, 10 high) was 7.1 (SD 2.8). Females, town residents, less frequent riders and those supporting helmet laws all had higher median helmet use importance ratings compared to counterparts. Nearly one-third of respondents (31%) reported a strict “no helmet, no riding” rule in their family; these respondents had a higher mean importance rating for helmet use (10.0), higher proportions supporting ATV helmet laws (78%) and higher proportions that always/mostly wore a helmet (81%) when riding as compared to those without a rule, all p<0.001.Those with a strict “no helmet, no riding” rule had nearly 14 times greater odds of supporting helmet laws and 24 times greater odds of always/mostly wearing helmets compared to those without a rule.
ATV ownership and use by study rural adolescents were extremely common, especially those from farms. Helmet importance while riding ATVs was rated relatively low. Farm youth had lower proportions wearing helmets, lower helmet importance ratings, and less support for laws mandating helmet use. Our study indicates that the safety culture surrounding helmet use is poor among adolescents on farms and in rural areas and deserves targeted interventions to increase helmet use and potentially decrease ATV-related deaths and serious injuries.
Attendees will be able to:
1. List at least three youth demographic factors associated with higher proportions having ridden ATVs in the past year.
2. Describe rural youth’s attitudes related to helmet use on ATVs.
3. State which rural adolescents might be at greater risk for lack of helmet use on ATVs.
Rural Adolescent Attitudes and Use of Helmets While Riding Dirt Bikes: A National Study
John Drey, BS
Parker Sternhagen, BS
Sarah Nichols, BS
Brianna Iverson, MD
Kareem Shoukih, BS
Taeuk Kang, MBiotech, MSc
Kristel Wetjen, RN, BSN
Brenda Vergara
Pam Hoogerwerf, BA
Charles Jennissen, MD
Dirt bikes are common in rural areas, especially on farms and ranches. Mishaps can result in serious injury with head injuries being the most common cause of death. Helmet use can significantly reduce the risk. Our objective was to determine rural adolescents’ attitudes regarding helmets, their frequency of helmet use while riding dirt bikes, and to identify demographic and other factors affecting helmet use and the support of helmet laws.
A convenience sample of 2025 National FFA (formerly Future Farmers of America) Convention & Expo attendees in Indianapolis, Indiana, completed an anonymous survey. After compilation, data were imported into SAS version 9.4. Descriptive, bivariate (Chi-square, Fisher’s exact test) and logistic regression analyses were performed. The Wilcoxon rank sum or Kruskal-Wallis test was used to determine differences in helmet importance score distributions.
2,516 adolescents (13-18 years) participated. Almost two-fifths (38%) lived on a farm, 38% lived in the country/not on a farm, and 24% were from towns. Nearly one-third (31%) stated their family owned a dirt bike with those from farms having a higher ownership percentage (39%) than those living elsewhere, p<0.0001. Over one-third (36%) had ridden dirt bikes in the past year. Males, dirt bike owners, those from farms or from the country/not a farm, and individuals from rural Rural Urban Commuting Area (RUCA) codes all had higher proportions having ridden dirt bikes. Respondents from the Northeast and West census regions had higher proportions having ridden a dirt bike in the past year versus the Midwest and South. Average helmet importance rating (1-10, 10 high) was 8.9 (SD1.9). Those with lower median helmet importance included males, those from farms, and those that had ridden dirt bikes, all p<0.0001. Helmet use was: Always 51%, Mostly 21%, Sometimes 11%, Rarely 8%, Never 10%. Midwesterners had about twice the odds of wearing helmet always/mostly as compared to those from the South and West. Overall, 70% supported laws requiring dirt bike helmet use with those from farms with lower endorsement percentages, p<0.0001. Those living in states with universal helmet laws had odds 2.7x higher, and those in states with helmet laws covering younger drivers had odds 1.8x higher of supporting helmet laws than those without laws. Over three-fifths (61%) reported their family had a “no helmet, no riding” rule; these respondents had a 10.6x higher odds of always/mostly wearing a helmet compared to those without a rule.
Dirt bike ownership and use by study adolescents was common, especially those from farms. Respondents rated wearing a helmet while riding dirt bikes as being very important, but much lower by farm residents. Farm youth also had lower proportions wearing helmets. The safety culture surrounding dirt bike helmet use is poor among farm adolescents and deserves targeted interventions. However, families with “no helmet, no riding” rules had a much higher likelihood of supporting helmet laws and always/mostly wearing helmets.
Attendees will be able to:
1. List at least three youth demographic factors associated with higher proportions having ridden dirt bikes in the past year.
2. Describe rural youth’s attitudes related to dirt bike helmet use and how it differs among motorized vehicles.
3. State which rural adolescents might be at greater risk for lack of helmet use on dirt bikes.
Snowmobile Helmets: A National Study of FFA Adolescent Attitudes and Use
Brianna Iverson, MD
Kareem Shoukih, BS
Sarah Nichols, BS
Parker Sternhagen,, BS
Taeuk Kang,, MBiotech, MSc
Kristel Wetjen, RN, BSN
Brenda Vergara
Pam Hoogerwerf, BA
Charles Jennissen, MD
Snowmobiling is a common recreational activity in rural areas of northern climes. Head injuries are a common while snowmobiling, and helmet use can significantly decrease the risk. Our objective was to determine rural adolescents’ use of snowmobiles, their attitudes toward helmets, the frequency of their use while riding snowmobiles, and the demographic and other factors associated with helmet use and support for helmet laws.
An anonymous survey was given to a convenience sample of attendees of the 2025 National FFA (formerly Future Farmers of America) Convention & Expo in Indianapolis, Indiana. Descriptive, bivariate, and multivariable logistic regression analyses were performed after data compilation and importation into SAS version 9.4. The Wilcoxon rank sum test or Kruskal-Wallis test, depending on the number of groups compared, was used to determine differences in medians.
2,516 adolescents between 13-18 years completed the survey with 38% living on farms, 38% in the country but not on a farm and 24% from towns. Snowmobile ownership varied significantly by U.S. census region: Northeast 32% > Midwest 18% = West 16% > South 4% (p=0.018 and p<0.001). Overall, 18% had ridden a snowmobile in the past year which varied significantly by census region. Snowmobile owners, males, non-Hispanic Whites, farm residents and those from rural areas indicated by Rural-Urban Commuting Area (RUCA) codes all had higher proportions having ridden a snowmobile in the past year (all p<0.02). Helmet use importance (from 1-10, 10 high) while riding snowmobiles was rated relatively high (mean 8.5, SD 2.2) and significantly higher than that for all-terrain vehicles (6.4, 3.0). Overall, 69% stated there should be a law requiring snowmobile helmets. Helmet use was: 58% always, 14% mostly, 6% sometimes, 5% rarely, 17% never. Owners, non-Hispanic White individuals, and those that supported helmet laws had greater proportions that wore a helmet always/mostly as compared to peers (all ? p=0.02). In addition, participants living in states that had snowmobile laws had higher proportions (85%) that always/mostly wore helmets as compared those without laws (68%), p<0.0001. Over three-fifths (63%) stated their family had a strict “no helmet, no riding” rule for snowmobiles; these respondents had a higher median importance rating for helmet use (10.0), higher proportions supporting ATV helmet laws (81%) and higher proportions that always/mostly wore a helmet (91%) when riding as compared to those without a rule, all p<0.001. Those with a rule also had 13 times greater odds of always/mostly wearing a helmet compared to those without a rule.
Respondents rated helmet wearing while snowmobiling as very important and over two-thirds supported laws mandating use. Still, over two-fifths of riders reported not always wearing a helmet. Demographics were identified for which interventions could be targeted. Youth whose families had “no helmet, no riding” rules placed higher importance on riding with helmets and had higher likelihood of supporting helmet laws and always/mostly wearing a helmet. More rural adolescent helmet use would likely decrease the number of snowmobile-related deaths and serious injuries.
Attendees will be able to:
1. List at least three youth demographic factors associated with higher proportions having ridden a snowmobile in the past year.
2. Describe rural adolescents’ use of helmets and the importance they ascribe to helmet use while riding snowmobiles.
3. State which youth might be at greater risk for not wearing a helmet while riding snowmobiles.
A National Study of Rural Adolescent Attitudes and Use of Helmets While Riding Motorcycles
Sarah Nichols, BS
Kareem Shoukih, BS
Parker Sternhagen, BS
Brianna Iverson, MD
Taeuk Kang, MBiotech, MSc
Pam Hoogerwerf, BA
Kristel Wetjen, RN, BSN
Brenda Vergara
Charles Jennissen, MD
Motorcyclists have six times the fatality rate of occupants in passenger car crashes. While motor vehicle fatalities have decreased, motorcycle deaths are nearly three times greater than in 1997. Although crashes often result in traumatic head injuries, helmet use can significantly decrease the risk. Our objective was to determine rural adolescents’ attitudes regarding helmets while riding motorcycles, their frequency of helmet use on these vehicles, and to determine how demographic and other factors may be associated with helmet use and support for helmet laws.
A convenience sample of 2025 National FFA (formerly Future Farmers of America) Convention & Expo attendees completed an anonymous survey at the University of Iowa Stead Family Children’s Hospital injury prevention booth. Data was compiled and imported into SAS (version 9.4). Descriptive and statistical analyses including bivariate (Chi-square, Fisher’s exact test) and logistic regression analyses were performed. To evaluate differences in the distribution of helmet importance scores, the Wilcoxon rank sum or Kruskal-Wallis test was used.
2,516 adolescents participated. Over half (56%) were female; 56% were 16-18 years. About 38% reported that they lived on a farm, 38% lived in the country/not on a farm, and 24% lived in town. One-fifth of respondents’ families owned a motorcycle; a quarter (24%) had ridden one in the past year. Farm and country/not farm residents had higher proportions owning and having ridden motorcycles than those from town, both p<0.001. Average helmet importance was 9.3 (SD 1.6) out of 10. Those with lower helmet importance ratings included older teens, males, those from farms and non-owners, all p<0.01. Helmet use was: Always 58%, Mostly 15%, Sometimes 10%, Rarely 9%, Never 9%. Urban respondents and owners had higher proportions that wore helmets always/mostly than their peers, both p<0.04. Overall, 89% endorsed motorcycle helmet laws with lower support from farm respondents, p<0.001. Those living in states with universal motorcycle helmet laws had greater support for laws than other states, p?0.001. Over three-fifths (62%) reported their family had a “no helmet, no riding” rule; these respondents had higher importance ratings for helmet use, higher proportions supporting motorcycle helmet laws (90% vs 69%) and higher proportions that always/mostly wore a helmet (88% vs 51%) as compared to those without a rule, all p<0.0001. Those with a strict “no helmet, no riding” rule had 4.4x greater odds of supporting a helmet law and 6.9x greater odds of always/mostly wearing a helmet compared to those without a rule.
Study respondents from farms and the country/not a farm had greater motorcycle ownership and use than those from towns. Teenagers in the study rated helmet importance highly and most wore a helmet always/mostly when riding. However, nearly a fifth rarely/never wore them with those from farms having lower importance ratings and helmet use. Adolescents from farms may deserve targeted interventions and all parents should be encouraged to implement and enforce strict “no helmet, no riding” rules for their families.
Attendees will be able to:
1. List at least three youth demographic factors associated with higher proportions having ridden motorcycles in the past year.
2. Describe rural youth’s attitudes related to motorcycle helmet use and how it differs among motorized vehicles.
3. State which rural adolescents might be at greater risk for lack of helmet use on motorcycles.
Rural Farm Parents’ Attitudes on Firearm Storage and Suicide Prevention
Charles Jennissen, MD
Victor Soupene, PhD, MS
Marc Doobay, DMSc, PA-C, DFAAPA
Nicholas Stange, MD, MPH
Pam Hoogerwerf, BA
Cassidy Branch, MA
Firearm suicides rates are higher in rural US areas compared to urban US areas. However, less is known regarding how rural, farm parents address suicide risk and how this affects firearm safe storage practices. We sought to answer the following questions regarding rural, farming parents: 1) How do they understand their responsibility as gatekeepers in regulating firearm access to youth? 2) What strategies do they use to manage home firearm access? 3) How do parents see firearm access affecting rural suicide risk? and 4) How do they view safe storage laws in relation to preventing suicide?
Focus group sessions (in-person and online) were conducted. Participants were recruited through emails to Iowa FFA club advisors who informed member parents and a mass email distributed to University of Iowa faculty/staff. Participants had to : (1) live on and actively farm/ranch in Iowa, (2) have at least one child 10-19 years old, and (3) have at least one firearm in the home. Thematic analysis was conducted through inductive, consensus coding of focus group transcripts involving four research team members.
Thirty-two parents participated. Few participants reported positive remarks toward being considered a “gatekeeper” of firearms in the home, but many provided negative comments-- particularly surrounding this terminology. They considered their role more of monitoring firearm use rather than of being a gatekeeper. In fact, most parents described keeping firearms readily available within the household with most youth in the home having as much access as anyone else. Several parents described firearm accessibility as consistent with how they themselves were raised and believed children simply needed education. Although many participants expected their children to ask for permission to access and, for some, anticipated firearms would be operated under their supervision only, firearms were still readily available to all. Many felt safe storage practices were primarily relevant for young children and that once youth started using firearms, reducing access was considered impractical. Many participants expressed skepticism about statistics indicating higher suicide rates in rural communities. Others were not surprised given the social isolation of rural living and the high firearm availability. Additional explanations included exposure to social media with bullying as a contributor. Several noted they rarely heard about suicide in public discourse. Most participants believed suicide was influenced more by mental health problems than by firearm access and some explicitly rejected the idea that reducing firearm access would meaningfully reduce suicide risk. They had negative views toward safe storage laws as a suicide prevention strategy and perceived such laws would be ineffective due to noncompliance and were concerned about law enforcement in private homes.
Farm parents in the study had not embraced the role of being the gatekeepers of firearms in the home and had not considered how that might contribute to increased suicide risk of rural youth. Addressing rural community attitudes toward firearm storage and the factors contributing to firearm suicide may lead to improvements in secure firearm storage.
Attendees will be able to:
1. Examine the unique perspectives of farm parents regarding their role as gatekeepers of firearms in the home.
2. Identify key factors discussed by farm parents suicides in rural communities.
3. Analyze the range of opinions expressed by farm parents about suicide prevention through safe storage practices and safe storage laws.
Rural Adolescent Attitudes and Use of Equestrian Helmets
Brianna Iverson, MD
Sarah Nichols, BS
Kareem Shoukih, BS
Parker Sternhagen, BS
Taeuk Kang, MBiotech, MSc
Pam Hoogerwerf, BA
Kristel Wetjen, RN, BSN
Brenda Vergara
Charles Jennissen, MD
Horses are still common in rural areas, including farms and ranches, and are used for both recreation and some work-related activities. Equestrian helmets reduce the risk and severity of head injuries yet may be underutilized. Our study objective was to evaluate the frequency of equestrian helmet use among rural adolescents, their attitudes regarding helmets, and to identify demographic and other factors associated with wearing helmets and support for helmet laws.
A convenience sample of 2025 National FFA (formerly Future Farmers of America) Convention & Expo attendees was anonymously surveyed. Data was compiled and imported into SAS version 9.4. Descriptive and statistical analyses were performed, including bivariate (chi-square, Fisher’s exact test) and multivariable logistic regression analyses. Helmet importance score distributions were compared using the Wilcoxon rank sum test or the Kruskal-Wallis test.
2,516 adolescents (13-18 years of age) participated; 38% lived on a farm, 38 % in the country/not on a farm and 24% lived in towns. Over one-fourth (27%) of participants’ households owned horses with those from farms having the highest ownership proportion (42%), p<0.0001. Overall, 42% had ridden a horse in the past year. Females (49%) and those whose families owned horses (83%) had higher proportions having ridden a horse in the past year, both p<0.0001. Midwest respondents had lower percentages that had ridden a horse (39%) than those from other U.S. census regions (46%), p=0.004. Less than a third (31%) supported equestrian helmet laws. Helmet use was: 22% always, 13% mostly, 12% sometimes, 14% rarely, 39% never. Females (40%) had higher helmet use as compared to males (25%), p=0.0001. Those from farms (29%) had lower helmet use than those from elsewhere (40%), p=0.002. Percentages that always/mostly wore a helmet varied by region: Northeast 61%, South 41%, Midwest 32%, West 22%, p<0.0001. Helmet importance (rated 1-10, high 10) was a mean of 6.4 (SD 3.0). Males, those from farms, frequent riders, and horse owners had lower median ratings of helmet importance than their peers. Respondents who had participated in activities requiring equestrian helmet use had higher percentages that reported wearing helmets (54% vs 22%), viewed helmets as more important, and supported laws mandating helmet use (36% vs 20%), all p <0.001. Those whose families had a strict “no helmet, no riding” rule had higher importance ratings for helmet use, higher proportions supporting equestrian helmet laws (59% vs 14%) and greater proportions that always/mostly wore a helmet (78% vs 20%) compared to those without rules, all p<0.001. Respondents with strict helmet rules had 8 times greater odds of supporting helmet laws and 11 times higher odds of always/mostly wearing a helmet compared to their peers.
Nearly 80% of study adolescents did not always wear helmets when riding horses. However, structured activities requiring helmet use and strict familial helmet rules were strongly associated with increased ratings of helmet importance and greater helmet wearing. Expanding equestrian helmet mandates and targeted education to parents may improve the safety culture and increase youth helmet use.
Attendees will be able to:
1. List at least two youth demographic factors associated with higher proportions having ridden a horse in the past year.
2. Describe rural youth equestrian helmet use and the importance youth ascribe to wearing helmets while riding horses.
3. State what effect required helmet use at training centers, competitions, club events, and group rides may have on adolescents’ use of and attitudes regarding equestrian helmets.
Infant Safe Sleep Knowledge of Rural Iowa Adolescents
Kynan Renshaw
Nicholas Stange, MD, MPH
Cole Wymore
Parker Sternhagen, BS
Brooke Krueger, BS
Sarah Nichols, BS
Kareem Shoukih, BS
Alec Marticoff, BS
Mikayla Gibson, BS
Jiayi Sun, BS
Brenda Vergara
Pam Hoogerwerf, BA
Charles Jennissen, MD
Adolescents frequently take care of young infants who are relatives or as babysitters. Lack of infant safe sleep knowledge may place infants in their care at greater risk. Few studies have been conducted examining infant safe sleep knowledge in non-parent adolescents. Our objective was to determine rural adolescents’ knowledge regarding infant safe sleep location and positioning as well as other aspects of infant safe sleep practices.
An anonymous survey was performed of a convenience sampling of 2025 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees at the Stead Family Children’s Hospital safety booth. Surveys were completed either electronically on Qualtrics via phone or on paper which were later entered into Qualtrics. Data were exported and descriptive and bivariate (chi-square) analyses were performed using R, version 4.4.1.
1633 adolescents 13-18 years of age participated. Nearly three-fifths (59%) were 16-18 years old and over three-fifths (62%) were female. The vast majority (96%) were non-Hispanic White. Most respondents agreed that locations considered safe for babies to sleep were safe: baby’s own crib (94%), bassinet (87%) and Pack and Play/portable crib (87%). However, significant proportions also believed some unsafe locations for babies to sleep were safe including baby swing/bouncy seat (43%), in bed with an adult (41%), car seat in the house (38%) and on a couch, sofa, or recliner/armchair (31%). Overall, 91% named at least one unsafe sleep location as being safe or at least one safe location as being unsafe. Those with higher proportions with at least one error in the safety of potential sleep locations included males, younger teenagers, those from the country/not on a farm, and those who had never placed an infant <1 year of age down to sleep. Just two-thirds (67%) agreed that it was safe to place a baby down to sleep on their back, and only half or less disagreed with statements that it was safe to place a baby down to sleep on their side (50%) or on their stomach (46%). Lack of knowledge was notable for other safe sleep principles including about half (49%) agreeing it was safe for a baby to sleep with a crib bumper and only about three-fifths or less disagreeing with statements that it was safe for a baby to sleep with stuffed animals (54%), blankets (60%) or a pillow (58%). In general, male’s infant safe sleep knowledge was significantly less than females, p<0.0001 for most queries. Overall, 42% reported having heard, seen or read something about infant safe sleep in the past. The most frequently mentioned places respondents stated they heard, seen or read something about infant safe sleep was in school (22%), from parents (19%), social media (16%) and from a babysitting course (9%).
Infant safe sleep knowledge in study rural adolescents was low and the majority had not heard, seen or read anything about infant safe sleep. Our study supports adolescents being targeted for infant safe sleep education, for example, in school and during babysitting classes.
Attendees will be able to:
1) Discuss at least three areas of safe sleep knowledge for which rural adolescents lack knowledge.
2) State the proportion of study adolescents that report having heard, seen or read anything about infant safe sleep
3) Identify at least two ways in which adolescents could be educated regarding infant safe sleep practices.