During the 14-year period from 1990-2003, West Virginia experienced 220 deaths related to All Terrain Vehicles (ATVs). Death rates in West Virginia however, were significantly higher than the national rate or those of any of the its five surrounding states. About 25% of the West Virginia deaths occurred in children less than 18 years of age. Ninety-five percent of the victims were not wearing helmets and 15% were passengers. Nearly one-third of the ATV crashes occurred on public roads, streets, and highways--surfaces on which ATVs are not designed nor recommended to be used. The cost of ATV-related deaths is estimated to be over dollar 100 million annually. The number of non-fatal injuries resulting from ATV crashes is difficult to ascertain because of a lack of a centralized and standardized state-based surveillance mechanism. The 44 states that have some level of ATV safety requirements have a collective death rate half that of states, like West Virginia, who do not have ATV safety requirements. Due to the continuing public health burden caused by ATV deaths and injuries, as well as their associated costs, it is important that West Virginia policymakers pass strong ATV safety legislation during the current session.