Presenter Profile
Charles Jennissen, MD
Department of Emergency Medicine
University of Iowa Healthcare
charles-jennissen@uiowa.edu
Charles Jennissen, MD, is a pediatric emergency medicine physician and a Clinical Professor in the Departments of Pediatrics and Emergency Medicine at the University of Iowa Carver College of Medicine. Dr. Jennissen grew up on a dairy farm in central Minnesota. This plays a large part in his interest in safety and injury prevention, particularly regarding children and teens, and those who work and live on farms. Most of his research projects have addressed injury-related issues, especially those involving off-road vehicles.
Presentations
You Want to Know What?!—Farmer Parents’ Attitudes Regarding Healthcare Providers Discussing Firearm Storage and the Asking Saves Kids Program
Marc Doobay, MPAS MC
Nicholas Stange, MD MPH
Pam Hoogerwerf, BA (Presenter)
Cassidy Branch, MA
Victor Soupene, PhD MS
Charles Jennissen, MD
Firearm-related deaths and injuries can often be prevented with safe firearm storage. The American Academy of Pediatrics (AAP) recommends clinicians discuss firearm storage with families as part of their injury prevention routine. The AAP also advocates through their Asking Saves Kids (ASK) campaign for parents/caregivers to ask about firearms and their storage in the homes where their children visit. Our study objective was to evaluate the attitudes held by Iowa parents on farms regarding healthcare providers asking about and discussing firearm storage and also about the ASK campaign.
Focus group sessions (in-person and on-line) were performed in 2024. Participants were recruited through emails to Iowa FFA club advisors who informed member parents, a mass email distributed to University of Iowa faculty/staff, and personal distribution of invites to 2024 Farm Progress Show attendees. Requirements included: (1) Must live on and actively farm/ranch in Iowa, (2) Must have at least one child between 10-19 years old, and (3) Must have at least one firearm in the home. Major themes were identified from the focus group moderator guide. Sub-themes were based on the conversations of subjects. Dedoose, a software package that facilitates qualitative analysis, was utilized to analyze transcript content. Additional coding was conducted by three research members, and coding discrepancies were discussed with a consensus achieved via an iterative process.
Thirty-two parents participated. Some deemed it appropriate for clinicians to discuss firearm storage to help ensure children’s safety and to identify families needing safety information. However, others felt it only appropriate to ask about firearms if there were mental health concerns. A few stated providers were a trusted source and that it would be easier to have firearm safety conversations with them than others, and recognized firearms were another safety issue to be addressed. The majority had negative opinions regarding clinicians discussing firearms. Many would be surprised, offended, defensive, and even stop going to the provider if asked. Specific reasons included that it was an invasion of privacy and none of their business, it was not healthcare provider’s job/responsibility, being asked was threatening and made them feel targeted, and it would not be helpful for providers to ask. Regarding the ASK campaign, many stated they would be annoyed, that asking them was offensive like they didn’t trust them or were judging them as bad parents, and asking would not change their storage behaviors.
Most study participants were not comfortable with clinicians asking about firearm storage, and in many cases, felt it had nothing to do with their family’s health. Similarly, they had negative attitudes regarding being asked about their firearm storage by other children’s parents. Healthcare providers may encounter unique barriers when addressing safe firearm and ammunition storage with rural families.
Attendees will be able to:
1) State at least three positive things that some farm parents relayed to focus group moderators regarding healthcare providers discussing firearm storage with them.
2) Identify at least three negative things that some farm parents discussed said to focus group moderators regarding healthcare providers discussing firearm storage with them.
3) Discuss at least three opinions shared by some farm parents to focus group moderators about parents of their children’s friends asking them about their firearm storage.
Lawnmower-Related Eye Injuries in the U.S.
Nicholas Stange, MD MPH (Presenter)
Charles Jennissen, MD
Power lawnmowers pose significant ocular hazards and understanding these injuries can inform prevention strategies. The study objective was to determine the epidemiology, mechanisms, and trends of lawnmower-related eye injuries in the U.S., focusing on national estimates, injury types, and high-risk populations.
A retrospective cross-sectional study of U.S. lawnmower-related eye injuries from 2004-2023 was performed using the Consumer Product Safety Commission’s National Electronic Injury Surveillance System. Periorbital injuries were not included. The mechanism of injury and several other variables were coded using the database narratives. Descriptive and comparative analyses (chi-square and Fisher’s exact test) were performed.
An estimated 120,613 lawnmower-related eye injuries occurred in the U.S. from 2004-2023 (N=2,467 NEISS cases). Those injured were 82% males, 95% adults and 82% non-Hispanic Whites. Ninety-nine percent of injuries occurred at home. Most injuries (77%) were from projectiles (predominately grass, dirt and rocks), 12% non-projectile injuries during mowing, 8% maintenance/repair-related and 2% from chemical exposures (primarily gasoline). Common diagnoses included eye abrasions/contusions (55%) and foreign bodies (27%). Severe injuries included retinal detachment, iris sphincter tear, corneal erosion, lens dislocation and globe rupture. Only 2% of projectile injuries were documented in narratives as using eye protection including eyeglasses. The average annual estimate for lawnmower-related eye injuries was 33% lower when comparing 2018-2023 to 2004-2017 (n=4,502 vs. n=6,686, p<0.001). Injuries decreased more in males than in females, (35% vs. 23%, p<0.001) and in adults aged 18-65 (35%) as compared to youth <18 yrs (26%) and adults >65 yrs (23%), p<0.001. Whereas injuries decreased in non-Hispanic Whites by 41%, they increased in Blacks (18%) and other racial/ethnic groups, including Hispanics (42%), p<0.001. Youth <18 years were a higher proportion of bystander (50%) versus operator (5%) injuries, p<0.001. As compared to adults, a greater proportion of injured children were African American and Hispanic (p=0.003) and were injured somewhere other than at home (p=0.023). Bystanders, as compared to operators, had higher rates of severe injuries requiring hospital admission, p=0.002.
Lawnmower-related eye injuries remain a serious risk, especially from projectiles. The risk could be significantly lessened if proper safety glasses/goggles were utilized both while operating mowers and when performing maintenance/repair. Though less frequent, bystander injuries also occur with half of these being children and with a greater proportion requiring admission. Other individuals should not be in the vicinity of a mower’s operation, especially children.
Attendees will be able to:
1) Describe the trend in overall and pediatric lawnmower-related eye injuries over time.
2) Identify at least three mechanisms for lawnmower-related eye injuries.
3) State at least three comparative differences between lawnmower-related eye injuries in youth versus adults.
Off-Road Vehicle-Related Eye Injuries in the U.S.
Nicholas Stange, MD MPH
Charles Jennissen, MD
Off-road vehicles remain a public health concern in the U.S. and are associated with approximately 700 deaths and 100,000 emergency department visits per year. Our study objective was to determine the epidemiology of eye injuries related to off-road vehicles, including all-terrain vehicles (ATVs), dune buggies and utility task vehicles (UTVs), with determination of the mechanisms of injury and associated diagnoses and the trend of injuries over time.
Off-road vehicle-related eye injuries were identified from 2004-2023 using the nationally representative National Electronic Injury Surveillance System which is maintained by the Consumer Product Safety Commission. Periorbital injuries were not included. The database narratives were utilized to code the mechanism of injury. Descriptive and comparative analyses (chi-square and Fisher’s exact test) were performed.
An estimated 20,076 ORV-related eye injuries (yearly average 1,004 cases) occurred, but incidents decreased significantly over time. Greater decreases in eye injuries were seen among youth, males, and those occurring at home or on farms/ranches. Injured victims were 77% males, 76% adults, and 90% non-Hispanic White. Nearly half (46%) occurred at home and 32% at a place of recreation/sports. Primary injury mechanisms included being hit by a foreign body/projectile (52%), hit by a branch (17%), and vehicle collisions/ejections (13%). The most common diagnoses were eye abrasions/contusions (55%) and foreign bodies (19%). Severe injuries included lacerations, hyphemas, traumatic uveitis, retinal detachments and ruptured globes. The vast majority (97%) were able to be discharged. Debris in foreign body/projectile injuries were 70% grass/dirt/dust/rocks, 20% insects and 5% sticks/wood. Only 1.4% of operators/passengers injured were documented as using safety glasses/goggles, with few using helmets. Injury mechanisms varied significantly between adult males and females, p=0.002. Higher proportions of injured youth were females and required admission for their injuries as compared to adults, p=0.002 and p=0.043, respectively.
ORV-related eye injuries are typically due to mechanisms that could have been avoided or have their severity decreased with the use of eye protection. The promotion and use of helmets with face shields or safety googles when riding ORVs are critical for preventing these injuries, especially among youth who had greater proportions of severe eye injuries requiring admission.
Attendees will be able to:
1) Describe the trend in overall and pediatric off-road vehicle-related eye injuries over time.
2) Identify at least three mechanisms for off-road vehicle-related eye injuries.
3) State two comparative differences between off-road vehicle-related youth versus adults and how most of these injuries could be prevented.
Rural Iowa Adolescents’ Use, Knowledge and Attitudes Regarding UTVs on Public Roads
Parker Sternhagen, Undergraduate (Presenter)
Brooke Askelsen, Undergraduate
Cole Wymore, MD
Junlin Liao, PhD
Pam Hoogerwerf, BA
Brenda Vergara, AA
Charles Jennissen, MD
Manufacturers warn against the use of utility task vehicles (UTVS) on public roads as they are not designed for roadway use. In fact, most UTV-related deaths occur on public roads with the majority not involving another vehicle. Despite this, legislative bodies across the U.S. are passing laws allowing increased UTV use on public roads. The study objective was to examine rural adolescent’s use, knowledge and attitudes regarding UTVs on public roads.
An anonymous survey was performed of 2024 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees. Descriptive, bivariate (chi-square) and logistic regression analyses were performed using Stata 15.1 (StataCorp, College Station, TX).
1,029 FFA members participated. Respondents were 13-18 years with 67% being 14-17 years. One-half were from a farm, one-fifth lived in the country/not a farm, and 30% were from a town. Almost all (96%) were non-Hispanic White. Over half (53%) of respondents’ families owned a UTV and over two-thirds (69%) had driven/ridden one. Of those who had driven/ridden a UTV, 94% had driven/ridden on an unpaved public road (51% reported doing so at least weekly) and 87% had been on a paved road (41% reported doing so at least weekly). Males and owners of UTVs had greater odds of having driven on both unpaved (2.2x and 30.7x, respectively) and paved (1.7x, 13.4x, respectively) public roads at least weekly as compared to their peers. Overall, 64% and 63% stated it was safe to drive UTVs on unpaved and paved public roads, respectively, while 62% and 54% stated UTVs were designed for unpaved and paved roads, respectively. Males (2.8x), owners of UTVs (2.1x) and those that had ridden on public roads (3.1x) all had greater odds of stating it was safe to drive UTVs on both unpaved and paved roads than their comparative peers. Less than half (44%) agreed that most UTV deaths occur on public roads. Over half agreed to assertions that UTV manufacturers state UTVs are safe on unpaved (54%) and paved (52%) public roads. Generally, males, UTV owners, UTV riders, those who had ridden on public roads and more frequent riders all had greater proportions that held these misconceptions. The vast majority (82%) incorrectly believed one could be under 18 years to legally drive UTVs on Iowa county roads.
A majority of study participants had driven/ridden a UTV and almost all of these had been on public roads. The majority agreed it was safe to drive UTVs on both unpaved and paved public roads and were unaware that most UTV-related deaths occur on roads. They also believed the falsehood that manufacturers state UTVs are safe on unpaved and paved public roads. Targeted education and enforced legislation prohibiting use on public roads may be critical in decreasing UTV-related deaths and injuries.
Attendees will be able to:
Describe present practices of rural adolescents regarding driving UTVs on public roads.
Discuss the attitudes rural adolescents have related to the driving of UTVs on public roads.
State at least three demographic groups that had higher proportions who held misconceptions and falsehoods related to UTVs on public roads.
On-line Marketing of Chinese Youth ATVs: Are Dealers Following Mandatory Federal Standards?
Jens Strand, High School Student (Presenter)
Charles Jennissen, MD
There are federally mandated Specialty Vehicle Institute of America (SVIA)/American National Standards institute (ANSI) standards that apply to all all-terrain vehicles (ATVs) including youth models. Youth models are presently categorized by maximum restricted and unrestricted speeds. The maximum speed for Y6+ models (for youth ?6 years) is 15 mph and for Y10+ and Y12+ models (for youth ?10 years and ?12 years) is 30 mph. Prior to 2009, youth models were based on engine displacement with models for youth ?6 years having engine sizes less than 70cc and those for youth ?12 years being 90cc or less. There are no models approved for children under 6 years. The youth ATV market in recent years has been dominated by less expensive Chinese models. The objective of this study was to examine how Chinese youth ATVs are marketed by on-line dealers and whether they comply with federal standards.
Internet searches were conducted from August 2024-March 2025 with various search terms regarding youth ATVs and Chinese models to identify dealers on-line. The websites were reviewed to determine the youth models available and how they were marketed including the ages for which the model was recommended, the engine displacement and maximum speed, as well as dimension specifications. Descriptive analyses were performed.
201 Chinese youth ATVs advertised by eighteen dealers on-line were identified. There were 23 youth models on two websites that were advertised for children <6 years (22 models for as young as 3 years). Most engine sizes for these vehicles ranged from 107-125cc, except one was 40cc; maximum speeds for the six models where stated were 10-45 mph, average 27 mph. Of the remaining 177 youth ATVs, 76 models at ten on-line sites had age recommendations and/or stated maximum speed such that one could determine whether they followed federal regulations. Fifty-two (68%) did not meet speed standards for age. For models not meeting the standard, speeds ranged from 25-37 mph for Y6+ (6 models), 32-45 mph for Y10+ (4 models), 32-45 mph for Y12+ (7 models), and 31-45 mph for those with no age specified (35 models). All 18 sites advertised youth models for which federal standards were not met or did not provide age recommendations or the maximum speed so that this could be determined. Of models recommended for children ?6 years, 173/177 provided the engine displacement. All of them exceeded previous engine size standards for youth models. Engines ranged from 107-135cc for Y6+ (8 models), 107-125c for Y10+ (25 models), 107-125c for Y12+ (22 models) and 107-250cc for ATVs with no specific age designation (122 models).
Dealers marketing Chinese manufactured youth ATVs are generally not following federally mandated standards and/or not providing the recommended age ranges for the youth ATVs they are selling on-line. This is potentially leading to more children riding ATVs that are not designed for them and potentially leading to increased crashes and injuries.
Attendees will be able:
1. To state how youth ATV models are categorized now and how that differs from the past.
2. To discuss the present marketplace regarding the sale of youth ATVs in the U.S.
3. To identify at least three ways in which on-line dealers of Chinese youth ATVs are not following mandatory federal standards and luring customers to purchase ATVs for younger children.
Infant Safe Sleep Practices of Rural Iowa Adolescents
Ky Renshaw, Undergraduate
Nicholas Stange, MD MPH
Cole Wymore, MD
Parker Sternhagen, Undergraduate
Brooke Askelsen, Undergraduate
Sarah Nichols, BS
Kareem Shoukih, BS
Alec Marticoff, BS
Mikayla Gibson, BS
Brenda Vergara, AA
Pam Hoogerwerf, BA
Charles Jennissen, MS
The number of infants <1 year of age that die of Sudden Unexpected Infant Death (SUID) in the U.S. each year is similar to that of the number of motor vehicle-related deaths in those <20 years. By following safe sleep practices, the risk of SUID can be decreased. Our study objectives were to: 1) determine the proportion of rural Iowa adolescents that take care of infants <1 year of age and in what capacity, and 2) identify the proportion that have placed infants <1 year of age to sleep and whether they always followed basic infant safe sleep practices.
An anonymous survey was performed of 2025 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees at the University of Iowa 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 Excel and Vassarstats (http://vassarstats.net/).
1641 adolescents 13-18 years of age completed the survey. Nearly three-fifths (59%) were 16-18 years old and over three-fifths (61%) were female. Nearly half (48%) lived on a farm, 23% lived in the country, but not on a farm and 29% lived in a town. The vast majority (95%) were non-Hispanic White. Overall, nearly three-quarters (72%) had taken care of a child <1 year of age; of these, 55% had done so as a babysitter, 43% did so for a relative’s infant (not a sibling) and 35% had taken care of a sibling <1 year of age. Overall, 57% stated they had placed a baby <1 year of age down for a nap or nighttime sleep. Of adolescents that had placed a baby <1 year of age down for sleep, 45% only reported places that would be considered safe (i.e., bassinet, baby’s own crib, pack and play/portable crib). As far as the sleep position, 78% stated they only placed babies <1 year of age down to sleep on their back. There were no significant differences by sex regarding proportions that had taken care of a baby <1 year of age, that had babysat, taken care of a relative’s child or had taken care of a sibling, that had placed a baby <1 year of age down to sleep, or that had reported always placing a baby in a safe place and a safe position to sleep.
Most rural adolescents in the study had placed a baby <1 year of age down to sleep with most having placed an infant in an unsafe place and one-fifth having placed infants not on their back. Adolescents should be targeted for infant safe sleep education, for example, in school and during babysitting classes.
Attendees will be able to:
1) Discuss the proportion of rural adolescents that take care of babies less than 1 year of age and their relationship to those children.
2) State the proportion of adolescents that report always placing an baby less than 1 year of age for a nap or nighttime sleep in a safe place and in a safe position.
3) Identify at least two ways in which adolescents could be educated regarding infant safe sleep practices.
Locked and Loaded: Attitudes Regarding Firearm Storage Among Farming Parents in Iowa
Marc Doobay, MPAS PA-C
Nicholas Stange, MD MPH
Pam Hoogerwerf, BA
Cassidy Branch, MA
Victor Soupene, PhD MS
Charles Jennissen, MD
Suicides and unintentional death rates due to firearms are greater in rural areas as compared to those more urban, and the rates are increasing. The presence of firearms in the home increases the risk of firearm-related deaths and injuries, and rural households, especially farms, are more likely to have firearms. Safe firearm storage is a major factor in preventing these tragedies. However, a study of nearly 1400 adolescent Iowa FFA members found over four-fifths had at least one firearm stored unlocked or loaded at least some of the time in their home. Our study objective was to evaluate the attitudes held by farming parents in Iowa regarding home storage of firearms.
Rural parents participated in focus group sessions conducted in person or on-line in 2024. Participants were recruited through several methods: Iowa FFA (formerly Future Farmers of Amerca) club advisors were contacted by e-mail to inform member parents, a mass email was sent to University of Iowa faculty/staff, and invitations were distributed to 2024 Farm Progress Show attendees. Inclusion criteria were: (1) Must live on and actively farm/ranch in Iowa, (2) Must have at least one child between 10-19 years, and (3) Must have at least one firearm in the home. Dedoose, a qualitative analysis software package, was used for transcript content analysis. Further coding was performed by three team members. Major themes and subthemes emerged. Coding discrepancies were discussed by the team until consensus was achieved.
Thirty-two participated. A few felt safe storage best kept children safe, and that unsafe storage was dangerous. However, some felt it was important more so to prevent theft and maintain gun condition, and to appease others. The majority had views that unsafe storage was acceptable or even not required. In many cases, subjects felt safe storage was incompatible with their use including personal protection and protecting/euthanizing livestock (i.e., they use it as a tool and store it that way). Many felt unsafe storage was safe such as hiding firearms and educating children “not to touch” when younger and how to use properly when older. Some didn’t feel they needed to meet best practices to have safe storage including not having ammunition locked or locked separately, having firearms unlocked but not loaded, and having “most” locked or just temporarily not locked and/or unloaded.
Our study found that the majority of farming parent participants were comfortable with firearm storage that did not meet safe storage criteria (i.e., firearms unloaded and locked with ammunition locked and stored separately) for a variety of reasons. Healthcare providers and other stakeholders will need to address these attitudes/barriers and find compromises that would improve but not necessarily meet best firearm storage practices.
Learning Objectives:
Attendees will be able to:
1. State at least three reasons why safe storage is important as provided by some rural farm parents at focus group sessions.
2. Identify at least three reasons why safe storage is not required and is unnecessary as provided by some rural farm parents at focus group sessions.
3. Discuss how attitudes held by rural parents might be addressed by healthcare providers and other stakeholders to improve firearm storage.