In 2005, there was an average of two ATVs per household in the State. Between 2000 and 2004, 26 residents died in ATV crashes each year. This number increased to 45 per year for the period 2005-2007. At the time of their crash, approximately one-third of the victims had a revoked, suspended, or surrendered driver's license. From 2005 to 2007, nearly two-thirds of fatal ATV crashes occurred on paved roads. Just over 60 percent of the deaths resulted from head injuries caused by ATV collisions on public roads. Children under 18 years old constituted 15 percent of the deaths. Eighty percent of those killed were males, and approximately 10 percent were passengers on the ATVs. Since 2005, only 6 percent of adult fatality victims and 29 percent of child victims were wearing helmets. The cost of ATV deaths in West Virginia in 2004 was estimated at $120 million. Of the significantly injured ATV riders treated at level I, II, and III trauma centers in West Virginia in 2006, only 19 percent were reported to be wearing a helmet. In 2006, the average hospital length of stay doubled if the victim was not wearing a helmet. This report recommends the promotion of further limits on the operation of ATVs on paved roads, a requirement that ATV riders wear helmets, required registering of ATVs with the State Division of Motor Vehicles, the promotion of reduced alcohol/drug use while operating an ATV, prohibition of the use of ATVs as a substitute for licensed motor vehicles by persons with a suspended driver's license, and the establishment of a central clearinghouse for information and education resources. 29 references, 8 tables, 4 graphs, and appended data forms and relevant West Virginia statutes