All-terrain vehicle (ATV) riding is a very popular recreational activity, which has experienced increased participation worldwide since the early 1990s. In the USA alone, the US Consumer Product Safety Commission (CPSC) estimates that nearly seven million four-wheel ATVs were in use in 2004 with some 23 million riders.1 A 2005 statewide random digit dial telephone survey of 1243 West Virginia households provided evidence that ATV riding is a very popular and family-based event in all regions of the state. With a population slightly less than two million, 30% of sampled households own an ATV, and an estimated 460 000 ATVs are in use throughout West Virginia.2

As ATV riding has become an immensely popular family-oriented activity, the availability and use of ATVs has led to increased exposure to hazardous and unsafe conditions that have resulted in hundreds of deaths and thousands of injuries nationally. In fact, the estimated number of deaths associated with ATVs has risen nearly 180% from 276 deaths in 1995 to 767 in 2004 (the most recent year for which annual fatality data are available from the CPSC). Estimated non-fatal injuries requiring emergency room treatment rose over 150% from 53 600 visits in 1996 to 136 700 in 2005.1 West Virginia’s 138 deaths during the period 2002–2005 accounted for over 6% of all ATV-related deaths in the country—second only to Kentucky’s 143 deaths.1 This proportion and ranking will probably increase with the 52 deaths recorded in the state in 2006 and an additional 19 through May 2007.

Recreational riding often involves not only the driver/operator but passengers as well. There has been little attention directed towards passengers, however. A title and abstract review of over 120 ATV peer-review papers worldwide over the past two decades indicates that there have been no studies that have focused solely …