Jim Helmkamp, Senior Epidemiologist for the National Institute for Occupational Safety and Health Western States Office, presented this at CPSC's ATV Safety Summit Oct. 12, 2012. State-specific ATV fatality rates were compared between 1990-1999 and 2000-2007 grouping states according to helmet, and training and licensure requirements (per SVIA state ATV requirement charts). 2,226 deaths occurred from 1990-1999 at a rate of 0.09 deaths per 100,000 population and 7,231 deaths from 2000-2007 at a rate of 0.32. Male rates were at least six times higher than female rates. Males accounted for about 86% of the deaths overall. Children under 17 years accounted for over one-third of the deaths in the earlier period decreasing to about 17% in the latter. The number of deaths increased 225% from the earlier period to the latter with a three-fold increase in the death rate. There was little collective difference between rates for states with or without helmet requirements and between states with or without training and licensure requirements. Policy-oriented prevention strategies over the past decade seem to have largely failed. This failure may be due to lack of enforcement and the casual attitude of many ATV riders to not wear a helmet or take training.