Injuries Among American Indians/Alaska Natives (AI/AN): CDC Activities

Programs

Tribal Motor Vehicle Injury Prevention Programs

American Indians and Alaska Natives (AI/AN) are at increased risk of motor-vehicle related injury and death with rates 1.5 to 3 times higher than rates for other Americans. To address this disparity, CDC's Injury Center funded four Tribes from 2004-2009 to tailor, implement, and evaluate evidence-based interventions to reduce motor vehicle-related injury and death in their communities.  The four piloted programs were successful at increasing seat belt use, increasing child safety seat use, and decreasing alcohol-impaired driving, as seen in the sample of accomplishments below:

• The Tohono O’odham Nation (TON) passed a primary seat belt law in 2005.  To support the new law, the TON Motor Vehicle Injury Prevention Program staff and Securing Tohono O’odham People (STOP) Coalition members have focused on increasing seat belt use on the Reservation with a comprehensive media campaign and working with Tribal Police to enforce the new law.  To determine the impact of their program activities, they conducted observations of seat belt use among both drivers and passengers. They found that driver seat belt use increased 47% and passenger seat belt use increased 62% from 2005 to 2008.         

• The Ho-Chunk Nation Motor Vehicle Prevention Program (MVPP) also set goals to increase seat belt use and child safety seat use. Through a number of activities—including partnering with local County police departments, implementing a comprehensive media campaign, and conducting targeted education and training for police officers—the Program, from 2005 to 2009, has seen driver seat belt use increase 38%, passenger seat belt use increase 94%, and child safety seat use increase from a baseline of 26% in Fall 2005 to 76% in Spring 2009. 

• The White Mountain Apache Tribe Motor Vehicle Injury Prevention Program focused on increasing seat belt use and decreasing alcohol-impaired driving by conducting DUI sobriety checkpoints, enhanced police enforcement, and a comprehensive media campaign.  In 2008 they conducted 24 sobriety checkpoints and stopped 13,408 vehicles. To examine the effects of their program activities, they also tracked rates of seat belt use among drivers and passengers. They found that driver seat belt use increased from 13% to 54% and passenger seat belt use increased from 10% to 32% from 2004 to 2008.

• The San Carlos Apache Tribe Motor Vehicle Injury Prevention Program focused on reducing alcohol-impaired driving and increasing seat belt use among their tribal members.  Media campaigns, sobriety checkpoints, enhanced police enforcement, and local community events were important components of their program.  Since 2004, total DUI arrests increased 52%, driver seat belt use increased 46%, and motor vehicle crashes decreased 29%.  In 2007, the San Carlos Tribal Council passed a primary seat belt law and a .08 blood alcohol concentration (BAC) law.

These multi-component programs have produced a model for use in other tribes. Lessons learned from these programs will allow for improved implementation as strategies are disseminated to other AI/AN communities. 

CDC-IHS Interagency Agreement

Since 1985, CDC and the Indian Health Service (IHS) have had an interagency agreement. This agreement focuses on surveillance, risk factor identification, technical assistance, and prevention measures which will reduce injuries among AI/AN. This successful partnership was established in response to high rates of injury among AI/AN populations. It has become one of the longest-lived partnerships for CDC’s Injury Center. CDC's Injury Center activities that fall under this partnership include:

• Providing technical assistance to the Indian Health Service's Tribal Injury Prevention Cooperative Agreements Program (IHS TIPCAP) through service as an IHS TIPCAP Project Officer.

• Mentoring and instructing IHS Injury Prevention fellowship program and providing short course trainings.

• Developing and maintaining a federal partnership between National Highway Traffic Safety Administration (NHTSA), Bureau of Indian Affairs (BIA), Indian Health Service (IHS), and the Centers for Disease Control and Prevention's (CDC) Injury Center. This partnership is a joint initiative between federal agencies to address the high rates of motor vehicle crash injuries and death in Indian Country.

Research

Injury mortality among AI/AN 19 years and younger

AI/AN 19 years and younger are at greater risk of preventable injury-related deaths than other children in the United States in the same age group. Three out of four (75%) deaths among AI/AN in this age group are attributable to injuries and violence, according to a 2003 CDC MMWR study. This is a rate about twice that of all children and youth in the United States. Motor vehicle crashes were the leading cause of injury-related death, followed by suicide, homicide, drowning, and fires. Between 1989 and 1998, more than 3,300 AI/AN age 19 or younger living on or near reservations died as a result of injuries or violence (Wallace 2003).

Wallace LJD, Patel R, Dellinger A. Injury mortality among American Indian and Alaska Native Children and Youth — United States, 1989–1998. MMWR 2003;52(30):697–701.

Traumatic brain injury among AI/AN

Traumatic brain injuries (TBI) are a major cause of disability among AI/AN. CDC scientists found that from 1992 to 1996, Indian Health Service (IHS), tribal, or contract-care hospitals recorded nearly 4,500 TBI–related hospitalizations among AI/AN, of which 5% were fatal. Rates of TBI among males were two and one-half times greater than that of females. Injuries resulted in more than 21,000 hospital days, and the average length of stay for a TBI hospitalization was 4.7 days. Prevention strategies should focus on the leading causes of hospitalizations for TBI:  motor vehicle crashes (24%), assaults (17%), and falls (16%).

Adekoya N, Wallace LJD. Traumatic brain injury—American Indians and Alaska Natives—United States, 1992–1996. MMWR 2002;51(14):303–5.

AI/AN Childhood Injury Mortality Atlas, 1989-1998

CDC staff developed a color atlas that details, by IHS regional area, eight major causes of injury-related death among AI/AN ages 0 to 19 during 1989–1998. The causes included motor vehicle-related, pedestrian-related, firearm-related, suicide, homicide, drowning, fire and burns, and suffocation. For each cause of injury, composite maps of the IHS Area rates as well as individual maps are shown to allow for rate comparisons among Areas and with national all-race rates. In addition, trends in death rates by race, age-sex-specific rates, and subcategories of cause are provided for each of the eight causes of injury.

Patel R, Wallace LJD, Paulozzi L. Centers for Disease Control and Prevention. Atlas of Injury Mortality among American Indian and Alaska Native children and youth, 1989–1998. Atlanta (GA): CDC, 2005.  (Also available in HTML).