@misc{attarian_2015, title={Waterfall Mortality and Morbidity in North Carolina, 2001-2013}, volume={26}, ISSN={["1545-1534"]}, DOI={10.1016/j.wem.2014.07.005}, abstractNote={Few locations like Western North Carolina have high concentrations of documented, easily accessible waterfalls and large numbers of visitors.1Adams K. North Carolina Waterfalls: A Hiking and Photography Guide. John F. Blair Publisher, Winston-Salem, NC2005Google Scholar Because of these characteristics, waterfalls are popular places for outdoor recreation and play an important role in the state’s tourism industry. Unfortunately, despite preventive measures by emergency management and resource managers, injuries and fatalities occur. This research analyzed the frequency of North Carolina waterfall injuries and fatalities over a 13-year period and identified the root cause of waterfall accidents. Data were gathered by conducting an Internet search using a set of keyword phrases (eg, North Carolina waterfall accidents, North Carolina waterfall injuries, North Carolina waterfall deaths) for years 2001 to 2013. The content of each source was reviewed, and the following information was documented for analysis: year, month, and day of incident; waterfall name; sex and age of victim; and victim’s place of residence. The root cause for each incident was also recorded. Root cause is the initial factor in the chain of events leading to an incident. For use in this study, 2 categories for root cause were used: unsafe acts and unsafe conditions. Unsafe acts relate to the actions, behaviors, and attitudes of the waterfall visitor. Unsafe conditions are hazards related to the waterfall environment that, if not addressed, can result in an incident. Data were collated and coded, and then analyzed using Microsoft Excel for Mac, version 14.0.0 (Microsoft, Redmond, WA). Between the years 2001 and 2013, 39 cases, or an average of 3.0 incidents per year, were recorded. Reported incidents involved 42 victims at 27 different waterfalls. Eighty-three percent of victims were male. More than half (54%) of the victims were between the ages of 19 and 29 years (mean 27 years). Twenty-eight incidents (66%) resulted in a fatality (mean 2.1 deaths per year). Content analysis identified the place of residence for 34 of the 42 victims and found more than half (n = 22; 69%) lived outside the region. More than half (59%) of the incidents occurred during the years 2010 to 2013. Seasonal distribution showed incidents peaked during the summer months of June, July, and August (62%), followed by spring (23%), and were equally distributed between weekdays (46%) and weekends (51%). Eight of 10 victims (81%) fell from the waterfall, and 62% of these falls resulted in a fatality. Drowning accounted for 18% of all fatalities reported. The primary unsafe condition leading to injury or death (66%) involved victims losing their footing on slippery, wet rock or trail. Unsafe acts leading to injury or death usually involved an activity above the waterfall (eg, wading, swimming) and made up 15% of incidents and 21% of fatalities. Jumping into or swimming in a plunge pool produced 12% of victims and 11% of fatalities. Ignoring a safety barrier was a factor in death or injury to 12% of victims. Engaging in photography (ie, getting in a better position for a photograph) accounted for 7% of incidents. “Would-be rescuers” and “reaching for a dropped object” made up a small percentage (5%) of the unsafe acts recorded. Alcohol or drugs may have played a role in 5% of fatalities. The 2 primary risk groups identified in this study were males and young adults aged 19 to 29 years. This finding is similar to the morbidity and mortality statistics noted for other outdoor recreation activities and may be explained by higher risk acceptance of males.2Demirhan G. Mountaineers’ risk perception in outdoor-adventure sports: a study of sex and sports experience.Percept Motor Skill. 2005; 100: 1155-1160Crossref PubMed Google Scholar Research also noted that men 22 to 40 years of age fall from heights at a higher rate than women.3Warner K.G. Demling R.H. The pathophysiology of free-fall injury.Ann Emerg Med. 1986; 15: 1088-1093Abstract Full Text PDF PubMed Scopus (96) Google Scholar Data also revealed that more than half of North Carolina victims lived outside the region. Previous research suggested tourists are involved in accidents because they are unfamiliar with their surroundings, are of a holiday mindset, and are more willing to take risks.4Bentley T.A. Page J.P. Scoping the extent of adventure tourism accidents.Ann Tourism Res. 2001; 28: 705-726Crossref Scopus (63) Google Scholar The high number of waterfall accidents may also be related to the large number of easily accessible waterfalls throughout western North Carolina. These factors, coupled with inexperienced visitors unfamiliar with the dangers associated with waterfall environments, can lead to the unexpected consequences identified in this study. The root cause for falling from a waterfall is rarely a single unsafe act or condition, but more often a combination of the two. Most falls from waterfalls happen when victims lose their footing by slipping on wet or algae-covered rock. Waterfall visitors can mitigate the possibility of slipping by being more aware of slippery surfaces and wearing appropriate footwear. Drowning was also associated with waterfall incidents, occurring exclusively in the plunge pools formed by hydraulic erosion at the base of waterfalls that make great “swimming holes.” Swimmers new to an area should observe or talk to local residents or officials who are familiar with the site or should reconnoiter the area above and below the plunge pool for hidden dangers. A small number of visitors ignore safety barriers. Similar behavior was reported by Heggie and Heggie,5Heggie T.W. Heggie T.M. Viewing lava safely: an epidemiology of hiker injury and illness in Hawaii Volcanoes National Park.Wilderness Environ Med. 2004; 15: 77-81Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar who noted that many tourists hiked beyond posted warning signs near active lava flows, exposing themselves to dangerous conditions. Barriers are erected to protect the public from harm. Many waterfalls in North Carolina do not have safety barriers, however, because of their location. Despite safety information, warning signs, and barriers designed to protect the public, falls from a waterfall can result in serious, often fatal accidents. Both direct and indirect management approaches—including posted warning signs; working with landowners, resource managers, and local businesses near waterfalls; providing online access to information about stream flow (with instructions how to use the information to prevent injuries); developing a public awareness campaign; and enhanced monitoring—could be implemented to make visitors more aware of the risks involved with recreation around waterfalls. Preventive efforts focused on males and adults aged 19 to 29 years that address issues of judgment, preparation, and experience should also be considered. Future research should incorporate observations at various waterfalls to document visitor behavior and how it contributes to waterfall accidents. Investigations into the types and severity of injuries sustained by waterfall victims will also enhance the knowledge base for waterfall education.}, number={1}, journal={WILDERNESS & ENVIRONMENTAL MEDICINE}, author={Attarian, Aram}, year={2015}, pages={105–107} }
 @article{serenari_bosak_attarian_2013, title={Cross-cultural efficacy of American low-impact programs: A comparison between Garhwal guide beliefs on environmental behavior and American outdoor travel norms}, volume={34}, ISSN={["1879-3193"]}, DOI={10.1016/j.tourman.2012.03.010}, abstractNote={In America, recreationists on public lands are expected to follow behavioral norms codified through low-impact programs. Such programs have been exported to countries all over the world with little or no critical thought about their efficacy in other cultural contexts. The present study examined the normative assumptions of the Leave No Trace program in the context of adventure tourism guides in the Garhwal Himalaya of India to determine the efficacy of implementing such programs in a different cultural context. We identified what salient beliefs prompt whitewater rafting and trekking guides' intention to perform pro-environmental behavior. We then compared the results with the belief system used for the basis of Leave No Trace. Results revealed that an American appeal to personal responsibility in Garhwal may not succeed for a variety of reasons. This study helps lay a foundation for much needed research on pro-environmental behavior and improved resource management techniques in the Indian Himalaya.}, journal={TOURISM MANAGEMENT}, author={Serenari, Christopher and Bosak, Keith and Attarian, Aram}, year={2013}, month={Feb}, pages={50–60} }
 @article{attarian_siderelis_2013, title={Injuries in Commercial Whitewater Rafting on the New and Gauley Rivers of West Virginia}, volume={24}, ISSN={["1545-1534"]}, DOI={10.1016/j.wem.2013.04.003}, abstractNote={To describe the rates, patterns, and likelihood of injuries in commercial whitewater rafting on the New and Gauley rivers, West Virginia.Standardized injury report forms developed by the West Virginia Whitewater Commission were reviewed for years 2005-2010 to provide a statistical account of injuries reported by licensed commercial rafting outfitters operating on the New and Gauley rivers.Overall, musculoskeletal injuries (sprains/strains, 21.1%; dislocations, 13.8%; fractures, 12.2%) comprised the majority (47.4%) of incidents followed by injuries to soft tissue (lacerations, 29.0%; abrasions, 13.3%; contusions, 2.3%). Almost one half (44.3%) of injuries were to the head, neck, and shoulders followed by the lower extremities (foot/ankle/leg/knee/hip, 33.9%) and upper extremities (hand/wrist/arm, 14.3%). Data analyzed using the Somers' D statistic revealed the likelihood of an injury occurring inside the raft is P = .55, and P = .39 when passengers are ejected from the raft into the river. The most likely injuries to occur to passengers are a laceration (P = .51) or a sprain (P = .20). The main probabilities for the risks of injuries were found to be to the head (P = .24), shoulder (P = .16), and face (P = .13) of the passenger.By knowing what injuries are common, their likelihood of occurrence, and the settings in which they happen, commercial outfitters can initiate practices to reduce injury rates.}, number={4}, journal={WILDERNESS & ENVIRONMENTAL MEDICINE}, author={Attarian, Aram and Siderelis, Christos}, year={2013}, pages={309–314} }
 @book{attarian_2012, title={Risk management in outdoor and adventure programs: scenarios of accidents, incidents, and misadventures}, publisher={Champaign, IL: Human Kinetics}, author={Attarian, A.}, year={2012} }
 @article{serenari_leung_attarian_franck_2012, title={Understanding environmentally significant behavior among whitewater rafting and trekking guides in the Garhwal Himalaya, India}, volume={20}, ISSN={["0966-9582"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84861512853&partnerID=MN8TOARS}, DOI={10.1080/09669582.2011.638383}, abstractNote={Garhwal, Uttarakhand, India, is planning for large-scale sustainable mountain tourism. However, current tourism practices have resulted in waste accumulation and vegetation loss. This paper explores the possibility of increasing the role of whitewater rafting and adventure tour guides to reduce tourists’ environmental impacts. Earlier studies on guides acquiescent with this role have found it to be effective in altering client behavior and minimizing environmentally destructive behavior. However, only limited research focuses on guides from developing countries outside an ecotourism context. This exploratory research in Garhwal, India, helps explain adventure guide intentions to perform pro-environmental behavior. The theory of planned behavior was applied to identify factors leading to a sample of 68 whitewater and trekking guides to perform three environmentally significant behaviors – packing out rubbish, burying their human waste and cutting living trees for firewood. Results suggest that the theoretical antecedents of the theory of planned behavior can predict intentions to perform pro-environmental behavior among non-western guides. Possible impediments to consistent performance of pro-environmental behavior among guides were noted, including lack of social pressure to change, abhorrence of contact with excreta, caste issues, effort expended to dig burial holes, etc. Managerial possibilities to encourage change are discussed.}, number={5}, journal={JOURNAL OF SUSTAINABLE TOURISM}, author={Serenari, Christopher and Leung, Yu-Fai and Attarian, Aram and Franck, Chris}, year={2012}, pages={757–772} }
 @misc{attarian_2010, title={A Review of Lightning Safety Education for Outdoor Adventure Programs}, volume={21}, ISSN={["1078-1439"]}, DOI={10.1016/j.wem.2009.12.011}, abstractNote={As an outdoor leader and educator for over 30 years and lightning strike survivor, I decided to conduct an exploratory study into the content of outdoor adventure program lightning education procedures with the primary purpose of identifying commonalities, omissions, and misconceptions based on currently accepted lightning safety education practices. A secondary purpose was to suggest a set of lightning safety education criteria for use by outdoor adventure programs to educate staff and participants on lightning safety. A summary of the investigation is presented herein. Given the nature of the environment in which outdoor adventure programs operate, lightning is a common objective danger recognized by providers of outdoor adventure programs. Therefore, those responsible for conducting these activities assume a special responsibility to ensure that adequate and continuous precautions are taken to prevent injuries. While lightning safety programs have been created for the general public, recreation, athletic programs, and outdoor activities,1National Oceanic and Atmospheric AdministrationNational Weather Service.http://www.noaa.gov/Google Scholar no such “curriculum” or nationally accepted standards on lightning awareness and safety education for outdoor adventure programs exists. Instead, individual adventure programs have made an attempt (some better than others) to create their own lightning safety education procedures based on lightning safety information available from comparable outdoor adventure programs, the National Oceanic and Atmospheric Administration (NOAA), National Lightning Safety Institute, and other nationally recognized meteorological organizations. For this report, the content of 22 lightning safety education procedures was reviewed from a variety of outdoor adventure programs. Lightning safety information for each organization was gathered by contacting program administrators through the World Wide Web via the Association for Outdoor Recreation and Education (AORE) list serve (aore@list.aore.org) and asking each to voluntarily e-mail me their program's lightning safety procedures for review. Content for the lightning safety education program was determined by reviewing the NOAA website on lightning and identifying a set of appropriate criteria for a lightning safety education program.2Paulcke W. Dumler H. Hazards in Mountaineering.in: Oxford University Press, New York1973: 12Google Scholar Based on this review the following lightning safety education categories were recognized: lightning facts, lightning science, lightning safety, and lightning first aid.1National Oceanic and Atmospheric AdministrationNational Weather Service.http://www.noaa.gov/Google Scholar I added an additional category “lightning misconceptions.” A content analysis was conducted for each of the lightning safety education procedures submitted by the 22 adventure programs and compared to the 5 a priori categories to identify any commonalities, omissions, and misconceptions. I was surprised to find that adventure program lightning safety education tended to rely primarily on variations of the 30/30 rule (for instance, one program required that when the storm/lightning is approximately 3 miles [15 seconds between flash and thunder] or less from the group's location, trip leaders were to instruct group members to disperse and prepare for a lightning drill). Many of the programs provided information on areas to avoid during a thunderstorm (54%), described the use of the lightning crouch position (45%), and noted the appropriate actions to take when caught in a thunderstorm (40%). Three programs listed a single lightning misconception as fact in their safety information. Findings also indicated that programs could do more to educate their staff on lightning facts and the physics of lightning. Well-developed adventure program lightning safety education should be consistent with current and acceptable practices, provide important background information (eg, lightning facts, lightning science, lightning safety), detailed information for both land (eg, backpacking, rock climbing, etc), and water-based activities (eg, canoeing, whitewater paddling, sea kayaking, etc), specifics on first aid treatment for victims of lightning strike, and the misconceptions of lightning. These recommendations are supported in part by Paulcke and Dumler who stated that the “sole protection against objective hazards is the observation and understanding of these natural phenomena, combined with suitable equipment and tactics.”2Paulcke W. Dumler H. Hazards in Mountaineering.in: Oxford University Press, New York1973: 12Google Scholar Roeder3Roeder WP. Teaching lightning safety—a five level method. International Conference on Lightning and Static Electricity Paper IC07-ABKM05; August 28–31, 2007.Google Scholar noted that choosing content for a lightning safety program is crucial, and should focus on increasing awareness about the threats of lightning and developing a course of action through lightning education. In addition, all content should be reviewed to eliminate any misconceptions about lightning, which may compromise safety and contribute to a false sense of security.4Gookin J. NOLS Backcountry Lightning Safety Guidelines.http://rendezvous.nols.edu//content/view/1718/803/Google Scholar The “cone of protection” was the single lightning misconception identified during the analysis and is an “arguable concept that has no place in lightning safety education . . .”4Gookin J. NOLS Backcountry Lightning Safety Guidelines.http://rendezvous.nols.edu//content/view/1718/803/Google Scholar Providers of outdoor adventure programs and activities deliberately encourage their participants to engage in activities containing risks in unique and unfamiliar environments. Given the nature of the environment in which outdoor adventure programs operate, lightning is a recognized risk and, therefore, those responsible for conducting these programs assume a special responsibility to ensure that their staff are educated on the risks associated with lightning. Effective field response to lightning requires a thorough understanding of lightning physics and acceptable options, and this requires training and judgment. All reasonable options and their pros and cons should be part of lightning education and action guidelines. Finally, comprehensive lightning safety education for outdoor adventure programs should include consistent, relevant, and up-to-date information that provides valuable background and foundational information for instructor decision-making, and for educating both staff and participants on lightning safety and preventing lightning injury.}, number={2}, journal={WILDERNESS & ENVIRONMENTAL MEDICINE}, author={Attarian, Aram}, year={2010}, pages={176–177} }
 @article{siderelis_attarian_2004, title={Trip response modeling of rock climbers' reactions to proposed regulations}, volume={36}, ISSN={["2159-6417"]}, DOI={10.1080/00222216.2004.11950011}, abstractNote={Study results contribute to the recreation benefits literature for the sport of rock climbing. Also, reported is an application of a hybrid or trip response modeling approach. Respondent reactions (intended behavior) to regulatory changes in management plans at Crowder's Mountain State Park, North Carolina, are assessed. The proposed regulations address (a) the quality of rock climbing conditions, (b) variations in climbing areas to accommodate the different skill levels, (c) limiting the number and size of groups, (d) rationing of rock climbing at certain areas, involving either area modifications, restrictions or closures, and (e) requiring users to attend education programs and perform park service projects. Intended changes in annual climbing participation, attributable to the proposed regulations, are displayed along with losses in recreation benefits. Our point estimate of consumer surplus is $125 per trip, which compares favorably with other reported estimates. Finally, an on-site climbing choice model is estimated and the resulting distributions of demanded state park trips among the seven climbing areas resulting from four regulatory change are evaluated.}, number={1}, journal={JOURNAL OF LEISURE RESEARCH}, author={Siderelis, C and Attarian, A}, year={2004}, pages={73–88} }
 @article{leung_attarian_2003, title={Frontcountry visitor information/education programs: Are there lessons for wilderness?}, volume={9}, number={1}, journal={International Journal of Wilderness}, author={Leung, Y.-F. and Attarian, A.}, year={2003}, pages={32–33} }
 @article{wirsching_leung_a._2003, title={Swatting little bugs: What agencies can do to decrease depreciative visitor behavior}, volume={38}, number={11}, journal={Parks & Recreation}, author={Wirsching, A. and Leung, Y.-F. and A., Attarian}, year={2003}, pages={16–22} }
 @article{attarian_2002, title={Rock climbers' self-perceptions of first aid, safety, and rescue skills}, volume={13}, ISSN={["1080-6032"]}, DOI={10.1580/1080-6032(2002)013[0238:RCSPOF]2.0.CO;2}, abstractNote={Objective Rock climbing is a challenging and demanding sport that requires specialized equipment and training. One significant area of training involves being familiar with first aid and rescue skills. This study reports climbers’ self-perceptions of their first aid, safety, and rescue skill competencies. Actual technical skills were not measured. Methods Data were collected through a World Wide Web (WWW)-based questionnaire administered over a 15-month period. The questionnaire requested information on respondents’ climbing history, first aid training, personal safety practices, and partner and self-rescue skills. Results Two hundred forty-one climbers completed the Web-based survey. Findings showed that the majority of climbers reported receiving some form of first aid training, were attentive to personal safety practices, and perceived themselves to be confident in partner and self-rescue techniques. Conclusions On the basis of the results obtained in this study, it appears that training and specialized skills are considered by rock climbers to be important components of managing risk.}, number={4}, journal={WILDERNESS & ENVIRONMENTAL MEDICINE}, author={Attarian, A}, year={2002}, pages={238–244} }
 @article{kanters_bristol_attarian_2002, title={The effects of outdoor experiential training on perceptions of college stress}, volume={25}, DOI={10.1177/105382590202500203}, abstractNote={ Students in graduate school experience stress associated with a fear of failure. Heightened stress responses typically occur in situations where students are required to absorb a vast quantity of information in a limited time. Student reports of stress induced anxiety and depression are further exacerbated by an inability to satisfy basic social, recreational, family and financial needs. Outdoor experiential training (OET) activities as a component of student development initiatives have been designed to assist students with the stress caused by the demands of college. The purpose of this study was to examine the effect of a one-day OET experience on graduate students' perceptions of stress. Using a quasi-experimental design, the results of this study indicated that several mood states, including anxiety-tension, vigor-activity, and depression-dejection, were significantly reduced by a one-day OET experience. }, journal={Journal of Experiential Education}, author={Kanters, M. A. and Bristol, D. G. and Attarian, A.}, year={2002}, pages={257–267} }
 @book{aram attarian_pyke._2000, title={Climbing and natural resources management an annotated bibliography}, publisher={[Raleigh]: North Carolina State University, Dept of Parks, Recreation & Tourism Management and Access Fund}, author={Aram Attarian and Pyke., Kath}, year={2000} }
 @book{attarian_2000, title={Climbing and natural resources management: An annotated bibliography}, publisher={Raleigh: North Carolina State University, Dept. of Parks, Recreation & Tourism Management and  Access Fund}, author={Attarian, A.}, year={2000} }
 @article{attarian_1999, title={A collaboration in resource management: The Stone Mountain project}, volume={34}, number={7}, journal={Parks & Recreation}, author={Attarian, A.}, year={1999}, pages={74–79} }
 @inbook{attarian_1999, title={Artificial climbing environments}, booktitle={Adventure programming (2nd ed.)}, publisher={State College, Pa.: Venture Publishing, Inc.}, author={Attarian, A.}, editor={J. C. Miles and Priest, S.Editors}, year={1999}, pages={341–345} }
 @article{attarian_1998, title={Reducing Rock Climbing Risks}, volume={71}, number={5}, journal={Camping Magazine}, author={Attarian, A.}, year={1998}, pages={31–33} }
 @article{attarian_carus_1998, title={Stone Mountain rebolting project}, number={1998 Spring}, journal={Boulderdash}, author={Attarian, A. and Carus, F.}, year={1998}, pages={18} }
 @inproceedings{attarian_1997, title={Managing risk in outdoor programs: A case study approach}, number={1997}, booktitle={Southeast Region Association for Experiential Education Conference proceedings, King, NC, April 1997}, author={Attarian, A.}, year={1997} }
 @inbook{attarian_1997, title={Outdoor recreation and the environment}, booktitle={Introduction to leisure services in North Carolina (3rd ed.)}, publisher={Dubuque, Iowa: Kendall/Hunt Pub. Co.}, author={Attarian, A.}, year={1997}, pages={103–116} }
 @article{attarian_1996, title={Integrating values clarification into outdoor adventure programs and activities}, volume={67}, DOI={10.1080/07303084.1996.10604837}, abstractNote={(1996). Integrating Values Clarification into Outdoor Adventure Programs and Activities. Journal of Physical Education, Recreation & Dance: Vol. 67, No. 8, pp. 41-44.}, number={8}, journal={Journal of Physical Education, Recreation & Dance}, author={Attarian, A.}, year={1996}, pages={41} }
 @article{attarian_1989, title={The role of leisure in higher education}, volume={16}, number={2}, journal={Leisure Information Quarterly}, author={Attarian, A.}, year={1989}, pages={5} }