It is conducted annually in conjunction with the HealthStyles survey, which assesses health related beliefs and behaviours among adults. The HealthStyles survey methods are described in greater detail elsewhere. 6 ,7 Briefly, panel members for an online, consumer research panel are randomly recruited using an addressed based probability sampling method that covers approximately 97% of US households. 7 The panel is continuously replenished and maintains about 55 000 panellists. A total of 8110 adults completed the spring survey for a response rate of 56%. Then, from 16 July to 3 August 2011, the YouthStyles survey was sent to a random sample of 1614 potential respondents aged 12–17 years living in households in which a parent had participated in the 2011 spring HealthStyles survey; 840 52% youth participated. Seven participants did not answer the ATV riding question and were excluded, leaving 833 respondents. Porter Novelli provided the Centers for Disease Control and Prevention CDC with both unweighted and weighted data from the 2011 YouthStyles survey; the data were weighted to match the 2010 US Census benchmarks for age, race, gender, household income, number of youth aged 12–17 years in household, education, census region, metropolitan statistical area MSA status and internet access personal communication, Deanne Weber of Porter Novelli, 2012. 7 Institutional review board approval was not required for this study because Porter Novelli provided the CDC with a final, de identified data set. Respondents who rode an ATV at least once during the past 12 months were then asked, “How often do you wear a helmet when you ride or drive an ATV?” Response options included ‘always’; ‘nearly always’; ‘sometimes’; ‘seldom or rarely’ or ‘never’. Responses were first grouped into the following four categories: always; nearly always or sometimes; seldom or rarely; and never, and helmet use among all riders was reported using all four categories.

Maxxis Bighorn 2.0 Radial ATV Tire 26x9-12 ARCTIC CAT BOMBARDIER CAN-AM etc Maxxis Bighorn 2.0 Radial ATV Tire 24x10-11 HONDA KAWASAKI POLARIS SUZUKI Open Trail 105014 54in. Rubber Flap Plow Accessory Pair 4FT Lighted Spiral RGB LED Whip Light Antenna w/Flag & Remote ATV UTV BUGGY TRI ROW 630W 20" LED Work Light Bar Spot Flood Offroad for Polaris ATV UTV 22" Kenda Bear Claw ATV Tire 25x10-11 HONDA KAWASAKI POLARIS SUZUKI YAMAHA 12" 360W +4" 90W Tri-Row LED Work Light Bar Spot Flood Beam Offroad ATV UTV SUV Pair 4" 324W QUAD-ROW Flood Beam LED Work Light Pods Offroad for Polaris ATV UTV Quad-Row 9" 888W LED Work Light Bar Spot Flood Offroad for Polaris Sportsman ATV 22" 420W LED Light Bar Dual Row Combo Offroad Driving 4X4WD for Polaris ATV UTV 4x137 Wheel 14" Inch Rim XD ATV XS135 GRENADE 14x10 +0mm Black 5" 308W LED Work Light Bar Pods Side Shooter Combo Offroad for Polaris ATV UTV 2X 5" 308W LED Work Light Bar Pod Side Shooter Combo Offroad for Polaris ATV UTV Nilight 2x 6FT Spiral RGB Led Whip Light for for Can-Am ATV UTV RZR Polaris Cars Kimpex 2500 lb Winch Kit - Steel, Polaris Sportsman X2 800 2007-09 Kimpex 2500 lb Winch Kit - Steel, Polaris Sportsman 400 2005 Kimpex 2500 lb Winch Kit - Steel, Arctic Cat Prowler XTZ 1000 2010-11, 13-14 Kimpex 2500 lb Winch Kit - Steel, Polaris RZR S 570 2017 Kimpex 2500 lb Winch Kit - Steel, Polaris RZR XP 4 900 2013 Kimpex 2500 lb Winch Kit - Steel, Polaris RZR 900 2014 Kimpex 2500 lb Winch Kit - Steel, Bombardier Outlander Max 650 2006 Kimpex 2500 lb Winch Kit - Steel, Can-Am Outlander Max 500 2007-12 Kimpex 2500 lb Winch Kit - Steel, Yamaha Big Bear 400 2012 Kimpex 2500 lb Winch Kit - Steel, Yamaha Grizzly 600 1998-01 Kimpex 2500 lb Winch Kit - Steel, Honda FourTrax Foreman 400 1995-96 Kimpex 2500 lb Winch Kit - Steel, Arctic Cat Prowler XTX 700 2010-11, 13-14 Kimpex 2500 lb Winch Kit - Steel, Arctic Cat 400 2002-05 Kimpex 2500 lb Winch Kit - Steel, Polaris Sportsman 400 2001-03 Kimpex 2500 lb Winch Kit - Steel, Polaris RZR 4 XP 900 2012 Kimpex 2500 lb Winch Kit - Steel, Bombardier Outlander Max 400 2004-06 Kimpex 2500 lb Winch Kit - Steel, Can-Am Outlander Max 400 2007-14 Kimpex 2500 lb Winch Kit - Steel, Yamaha Kodiak 700K 2016 Kimpex 2500 lb Winch Kit - Steel, KYMCO MXU 450i 2012-13 Kimpex 2500 lb Winch Kit - Steel, John Deere Gator XUV 855D 2011-14 Kimpex 2500 lb Winch Kit - Steel, Honda Foreman 450 2002-04 Kimpex 2500 lb Winch Kit - Steel, Polaris RZR 800 2008-14 Kimpex 2500 lb Winch Kit - Steel, Kawasaki Brute Force 650 2005-13 Kimpex 2500 lb Winch Kit - Steel, Bombardier Outlander 800 2006 Kimpex 2500 lb Winch Kit - Steel, KYMCO MXU 375 2009-13 Kimpex 2500 lb Winch Kit - Steel, Arctic Cat 375 2002 Kimpex 2500 lb Winch Kit - Steel, Polaris Magnum 500 1999-02 Kimpex 2500 lb Winch Kit - Steel, Kawasaki Mule 610 2005-07, 09-16