BACKGROUND All-terrain vehicles' (ATVs) popularity and associated injuries among children are increasing in the United States. Currently, most known ATV use pattern data are obtained from injured youth and little documented data exist characterizing the typical ATV use patterns and safety practices among American children in general. OBJECTIVE To describe the typical ATV safety and use patterns of rural youth. METHODS A cross-sectional anonymous mail survey was conducted of youth participants (ages 8-18) in the 4-H Club of America in four Central Illinois counties. Questions examined ATV use patterns, safety knowledge, safety equipment usage, crashes, and injuries. RESULTS Of 1,850 mailed surveys, 634 were returned (34% response rate) with 280 surveys (44% of respondents) eligible for analysis. Respondents were principally adolescent males from farms or rural locations. Most drove < or =1 day per week (60.2%) and used ATVs for recreation (36%) or work (22.6%) on farms and/or private property (53.4%). Most never used safety gear, including helmets (61.4%), and few (14.6%) had received safety education. Of the 67% who experienced an ATV crash, almost half (44%) were injured. Children with safety training had fewer crashes (P= .01), and those riding after dark (P= .13) or without adult supervision (P= .042) were more likely injured. CONCLUSIONS ATV use is common in a rural 4-H population. Most child ATV users were adolescent boys, had little safety training and did not use safety equipment or helmets. ATV injury prevention efforts should focus on these areas.