Injuries among American Indians/Alaska Natives (AI/AN): Fact Sheet

How big is the problem?

• Injuries are the leading cause of death for AI/AN ages 1 to 44 and the third leading cause of death overall. ¹   
• Motor vehicle crashes are the leading cause of unintentional injury for AI/AN ages 1 to 44. Adult motor vehicle-related death rates for AI/AN are more than twice that of whites and almost twice that of blacks.¹  
• Among infants less than one year of age, AI/AN have consistently higher total injury death rates than other racial/ethnic populations and the highest rate of motor-vehicle traffic deaths.²
• Among AI/AN 19 years and younger, motor vehicle crashes are the leading cause of injury-related death, followed by suicide, homicide, drowning, and fires.³  

Who is most at risk?

• Children: Among ethnic groups in the United States, AI/AN children experience the highest rates of injury mortality and morbidity. AI/AN ages 19 years and younger are at greater risk of preventable injury-related deaths than others in the same age group in the United States. Compared with blacks and whites, this group has the highest injury-related death rates for motor vehicle crashes, pedestrian events, and suicide. Rates for these causes are two to three times greater than rates for whites the same age.³
• Males: AI/AN as a group are at increased risk of injury, but AI/AN males are at especially high risk for many types of injuries. Compared to their female counterparts, AI/AN males ages 20 years and older are twice as likely to die from a motor vehicle crash and nearly four times more likely to die from pedestrian-related injury. ¹  

What are the major risk factors?

Low seat belt use

• According to the National Highway Traffic Safety Administration (NHTSA), the overall rate of seat belt use on reservations is relatively low (55.4%). Belt use varies greatly across reservations, ranging from a low of 8.8 percent to a high of 84.8 percent. Reservations with primary seat belt laws have the highest use rates, followed by reservations with secondary seat belt laws; reservations with no seat belt laws have the lowest use rates.⁴ 
• More than 3 out of every 4 (76 %) of passenger vehicle occupants who died in motor vehicle crashes on reservations were unrestrained at the time of the fatal crash.⁵

Low child safety seat use

• Though child safety seat use rates for AI/AN communities vary greatly, rates are generally much lower than national rates.⁶ In 2008, the national child safety seat use rate for children from birth to age 7 was 87 percent.⁷ In one study of three Northwest tribes, car seat use rate ranged from 12%–21% for children from birth to age 4. ⁸

Alcohol Impaired Driving

• AI/AN have a relatively high prevalence of alcohol-impaired driving and the highest alcohol-related motor vehicle mortality rates among racial/ethnic populations.^9,10

• Among crashes on reservations from 1982 to 2002, an estimated 65 percent were alcohol-related. Nationally, during this same time period, 47 percent of total crashes were alcohol-related.⁵

How can injuries be prevented?

Proven and effective strategies to reduce motor vehicle crash-related injuries and deaths are well established; these include use of occupant restraints, primary laws, high visibility enforcement, and strict blood alcohol content laws. Although each AI/AN community is politically and culturally unique, effective strategies can be tailored to meet the specific needs of tribes.

Child safety seats

• Child safety seats reduce the risk of death in passenger cars by 71% for infants, and by 54% for toddlers ages 1 to 4 years.¹¹

• There is strong evidence that child safety seat laws, safety seat distribution and education programs, community-wide education and enforcement campaigns, and incentive-plus-education programs are effective in increasing child safety seat use.¹²

Seat belt use

• There is strong evidence that seat belt use laws, especially primary enforcement laws, and enhanced enforcement campaigns are effective in increasing seat belt use.¹³

Impaired driving

Proven measures to reduce alcohol-impaired driving include:

• Aggressively enforcing 0.08% BAC laws, minimum legal drinking age laws and zero tolerance laws for drivers younger than 21 years old.¹⁴

• Utilizing sobriety checkpoints. DUI checkpoints are effective in reducing alcohol-related crashes and death by approximately 17-25%.¹⁵

• Using multi-faceted community-based approaches to alcohol control and DUI prevention.^16,17

Teen drivers

• There are proven methods to helping teens become safer drivers. Research suggests that the most comprehensive graduated drivers licensing (GDL) programs are associated with reductions of 38% and 40% in fatal and injury crashes, respectively, among 16-year-old drivers.¹

• Graduated driver licensing (GDL) systems are designed to delay full licensure while allowing teens to get their initial driving experience under low-risk conditions. For more information about GDL systems, see the Teens Behind the Wheel: Graduated Drivers Licensing fact sheet.

References

1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-Based Injury Statistics Query and Reporting System (WISQARS)(online)(2009) {cited 2009 October 2}.
2. Bernard SJ, Paulozzi LJ, Wallace LJD. Fatal Injuries Among Children by Race and Ethnicity – United States, 1999-2002. MMWR 2007:56(No. SS-5)
3. 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.
4. Department of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Safety Belt Use Estimate for Native American Tribal Reservations. February 2006. DOT HS 809 921.
5. Department of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Fatal Motor Vehicle crashes on Indian Reservations 1975-2002. April 2004. DOT HS 809 727.
6. LeTourneau RJ, CE Crump, Bowling JM, Kuklinski DM, Allen CW. Ride Safe: A Child Passenger Safety Program for American Indian and Alaska Native Children. Maternal Child Heath 2008. DOI 10.1007/s10995-008-0332-6
7. Department of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts: Child Restraint Use in 2008-Overall Results. May 2009 DOT HS 811 135
8. Smith ML, Berger LR. Assessing community child passenger safety efforts in
   three Northwest Tribes. Injury Prevention 2002;8;289-292
9. Voas RB, Tippets AS, Fisher DA. Ethnicity and Alcohol related fatalities: 1990 to 1994. Landover, MD: Pacific Institute for Research and Evaluation; 2000. Report no. DOT HS 809 068
10. Naimi TS, Cobb N, Boyd D, Jarman DW, Espey D, Snesrud P, Chavez P. Alcohol-Attributable Deaths and Years of Potential Life Lost Among American Indians and Alaska Natives – United States, 2001-2005. MMWR 2008;57(34):938-941.
11. Department of Transportation (US), National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts 2008: Children. Washington (DC): NHTSA; 2009. [cited 2009 Nov 9].
12. Zara S, Sleet DA, Thompson RS, et al. Task Force on Community Preventive Services. Reviews of evidence regarding interventions to increase use of child safety seats. American Journal of Preventive Medicine. 2001;21(4S):31-47
13. Motor-Vehicle Occupant Injury: Strategies for Increasing Use of Child Safety Seats, Increasing Use of Safety Belts, and Reducing Alcohol-Impaired Driving. A Report on Recommendations of the Task Force on Community Preventive Services. MMWR. 2001;50 (no.RR-7) (2)
14. Shults RA, Sleet DA, Elder RW, Ryan GW, Sehgal M. Association between state-level drinking and driving countermeasures and self-reported alcohol-impaired driving. Injury Prevention 2002;8:106—10.
15. Elder RW, Shults RA, Sleet DA, et al. Effectiveness of sobriety checkpoints for reducing alcohol-involved crashes. Traffic Injury Prevention 2002;3:266-74.
16. DeJong W. Hingson R. Strategies to reduce driving under the influence of alcohol. Annual Review of Public Health 1998;19:359-78.
17. Holder HD, Gruenewald PJ, Ponicki WR, Treno AJ, Grube JW, Saltz RF, et al. Effect of community-based interventions on high-risk drinking and alcohol-related injuries. Journal of the American Medical Association 2000;284:2341-7.