This research compares state-level rollover protective structure (ROPS) prevalence rates from the early and mid-1990s to those observed in the years 2001 and 2004. In addition, state-level ROPS prevalence rates are compared to state-level tractor overturn fatality rates. Tractor data for 1993-1995 and for 2001 and 2004 for all tractors and ROPS-equipped tractors in use on U.S. farms were derived from surveys conducted for NIOSH by the USDA-NASS. Changes in ROPS prevalence rates at the state level between the two time periods were assessed using a two-sample paired t-test with unequal sample sizes. Poisson regression was used to assess the association between ROPS prevalence rates and tractor overturn fatality rates at the state level. Overall, 49 of the 50 states had an observed increase in the percentage of farm tractors equipped with ROPS from 1993-1995 to 2001 and 2004. This increase was statistically significant for 34 states. Large shifts in ROPS prevalence were found within individual states and in clusters of states. These include a major increase in the southeastern U.S. and some western states. However, a core of states in the northeast (many of them in or near the Appalachian Mountains) through the upper midwest remain in the bottom quartile for ROPS prevalence. For the years 1992 through 2004, the highest fatality rates were observed in many of the same states that were identified previously as having persistently low ROPS prevalence rates. There is a clear relationship between low state-level ROPS prevalence rates and high state-specific tractor overturn fatality rates. While progress has been made in increasing the percentage of ROPS-equipped farm tractors, it is projected that ROPS prevalence rates will not reach a protective level nationally until after 2015. Regionally, the northeast and midwest will not reach protective levels of ROPS-equipped tractors until after 2020. Based on the adoption rates observed, tractor overturn rates will likely continue to be a more localized, but significant, public health issue for several states beyond the year 2020. The results of this study show the geographic areas of the U.S. where the greatest need exists, and where a greater emphasis should be placed on ROPS promotion activities. However, addressing this public health issue on a large scale will require resources and an organized commitment, which have historically been lacking.