Injury Prevention in Indian Country

Protecting Yourself, Your Family, and Your Community

Bridget CanniffTribal Epidemiology Center

Consortium

Tam LutzNative CARS

What are Unintentional Injuries?

• Efforts to prevent or reduce the severity of bodily injuries before they occur

• Programs that advance the health of the population by preventing injuries and improving quality of life

What is Injury Prevention?

• Damage or harm caused to the body by an outside agent or force

• Does not include injuries related to violence (assault, abuse, homicide, suicide)

Injury Prevention Toolkit

• Designed for those interested in starting or expanding Tribal Injury Prevention Programs

• Full Toolkit or CD only

• Fact sheets, presentations, brochures

• Developed jointly by Northwest, California and Southern Plains EpiCenters

Injury Prevention Toolkit Topics

• Bike Safety & Helmet Use

• Elder Safety & Falls Prevention

• Home Safety & Fire Prevention

• Motor Vehicle Safety: Seat Belts

• Motor Vehicle Safety: Child Safety Seats

Preventing Injuries at the Community Level

• What injury prevention efforts are priorities for YOUR communities?

• Who is involved?

Bike Safety and Helmet Use

Protecting Yourself, Your Family, and Your Community

Why Wear Helmets?

• Native American children die from injuries twice as often as children from other races 1

• Helmets can reduce head injuries by 85% and brain injuries by 88% 2

1 National Center for Health Statistics. Centers for Disease Control and Prevention. National Vital Statistics System. 2000-2004 mortality statistics. Hyattsville (MD): National Center for Health Statistics, 2007. Accessed 3/6/08

2 National SAFE KIDS Campaign (NSKC). Bicycle Injury Fact Sheet. Washington (DC): NSKC, 2004. http://www.usa.safekids.org/tier3_cd.cfm?folder_id=540&content_item_id=1010. Accessed 2/7/2008.

Community Action

• Bike rodeos• Helmet give-aways or

discounts• Others?

Elder Safety and Falls Prevention

Protecting Yourself, Your Family, and Your Community

Impact of Elder Falls

In the Northwest, falls are responsible for up to 25% of unintentional injury deaths for American Indians/Alaska Natives aged 55 and over 3

3 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (1999-2007) [cited Feb 18 2009].  Available from URL: www.cdc.gov/ncipc/wisqars

Proven Interventions: What Works

• Comprehensive check-ups• Medication management• Vision care• Home safety• Regular exercise for

balance & strength• Others?

Home Safetyand Fire Prevention

Protecting Yourself, Your Family, and Your Community

Potential Interventions

• Escape plans• Emergency services• Smoke/CO2 detectors• Home safety for Elders• Youth programs and activities• Environmental concerns• Others?

Motor Vehicle Safety:

Seat BeltsProtecting Yourself, Your

Family, and Your Community

Why Wear a Seat Belt?

■ Motor vehicle crashes are the leading cause of death for AI/AN people ages 1-44 4

■ On average, two American Indians are killed every day in crashes in the US 4

4 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited Feb 18 2009].  Available from URL: www.cdc.gov/ncipc/wisqars

Motor Vehicle Death Rates by Race, 2005

0

5

10

15

20

25

30

Dea

ths

per 1

00,0

00

AI/AN White Black Asian

N=295,895,897 Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited Feb 17 2009].  Available from URL: www.cdc.gov/ncipc/wisqars

If Seat Belts Were the Cure…

■ If a disease killed as many people as car crashes, people would demand the government take action

■ SEAT BELTS are the cure!■ Last year approximately 10,000

people could have been saved by wearing a seat belt

Five Ways Seat Belts Prevent Injury

1. Keep people in the vehicle2. Contact the strongest parts of the body3. Spread forces over a wide area of the

body4. Help the body to slow down5. Protect the brain and spinal cord

We Don’t Buckle Up!

“We don’t get tickets out here on the Rez”

“I am only going down the street”

“I just don’t think about it”

“I let the kids get out of their belts once we are on our Rez roads”

■ This teenage girl walked away from this crash on the Lac Courte Oreilles Reservation

■ She survived because she was wearing a seat belt!

Seat Belts Save Lives

Buckle Up for Every Ride

■ There is no good excuse for not being safe and buckling up!

■ If you decide not to wear a seat belt, you increase the chance that you will injure yourself or others

■ Wearing a seat belt is the easiest way to prevent serious injury or death in a collision

■ It only takes a few seconds to buckle a seat belt, and you never know when you may get in a crash

■ Buckle up for every ride in the car, even short trips

Motor Vehicle Safety:

Child Safety Seats

Protecting Yourself, Your Family, and Your Community

Why use Child Safety Seats?

Motor vehicle crashes are the LEADING CAUSE OF DEATH for AI/AN children between ages 1-9 (as well as AI/ANs 1-45).

… making up one-third of all child deaths 5

5 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited Feb 17 2009].  Available from URL: www.cdc.gov/ncipc/wisqars

Five Ways Child Safety Seats Prevent Injury

1. Keep children in the vehicle2. Contact the strongest parts of the body3. Spread forces over a wide area of the

body4. Help the body to slow down5. Protect the brain, spinal cord and

abdomen

Recommended Child Passenger Restraint Guidelines Buckle Everyone. Seat children age 12 and under in the back seat.

Infants (Birth – 1 Year)

Toddlers (1 – 4 Years)

School-Age Children (4 – 8 Years)

Recommended Weight Requirements

Up to 20 pounds; if an infant is >20 pounds, use a seat that is labeled for rear-facing use up to 30 pounds.

Over 20 pounds and up to 40 pounds; if a toddler is <20 pounds, use a rear-facing child safety seat.

Over 40 pounds and up to 80 pounds, under 4’9”; if a school-age child is <40 pounds, use a forward-facing child safety seat.

Type of Seat Infant only or rear-facing convertible

Convertible or forward-facing harness seat

Belt positioning booster seat

Seat Position Rear-facing only Can be rear-facing until 30

pounds if seat allows; generally forward-facing

Forward-facing

Notes

Children should use rear-facing seat until one year of age AND at least 20 pounds. Harness straps should be at or below shoulder level.

Harness straps should be at or above shoulder level. Most seats require harness straps to be in top slots for forward-facing use.

Belt positioning booster seats must be used with both lap and shoulder belt. Shield booster seats are not recommended.

Key safety tips

Never place an infant in the front seat of a vehicle with a passenger air bag. A rear-facing seat spreads crash forces over an infant’s entire body, minimizing injury to the delicate brain and spinal cord.

Children in forward-facing child safety seats should never sit in the front of a vehicle with a passenger air bag. Properly installed forward-facing CSSs minimize the risk of head and brain injury by reducing head movement in a crash.

The purpose of a belt-positioning booster is to position the child so that the adult seat belt will fit optimally across the child’s hips and chest. The lap belt must fit low and tight across the hips, and the shoulder belt must fit over the shoulder and snug across the chest to avoid abdominal injuries.

Source: National Highway Traffic Safety Administration, American Academy of Pediatrics. http://www.aap.org/policy/re0116.html

4 Steps for Kids

1. Rear-facing

2. Forward-facing

3. Booster seats

4. Adult seat belts

Step 1: Rear-facing Infant Seats

■ Keep infants rear-facing until a minimum of age 1 and at least 20 pounds.

Step 1 & 2: Rear-Facing / Forward-Facing Convertibles■ Rear and forward facing

■ Reclined for rear-facing and upright for forward-facing

■ Can be used for larger infants less than one year old and 20-35 pounds

Step 2: Forward-Facing Child Restraints

■ Convertible and Forward-facing only

■ Child must be: One year old AND 20+ pounds

Step 3: Booster Seats■ Booster seats are for

children from 40 to 80 pounds

■ Lap/shoulder belt only

■ Head restraint

■ Use shoulder belt positioners

High back

Belt-positioning Backless Booster

Step 4: Seat Belts

■ Vehicle seat belts are made for adults and older children 4’9” or taller

■ Most children reach this height at 8 years old and 80+ pounds

■ All children under the age of 13 should still sit in the back seat

State Child Safety Seat Laws

Tribal Child Safety Seat Laws

• Tribes are sovereign nations and enact laws for their own lands

• Enforcement depends on tribes’ agreements with local and state authorities

• Does your tribal nation have a current law for on reservation?

• Do you know what that law mandates?• What are your impressions of community

compliance with state or tribal laws?

Incorrect Restraint Use• Children using adult seat belt face 3.5

times greater risk for serious injury• Child restraints reduce risk of death by

28% compared to adult seat belt• 51-82% of infant car seats and 30% of

booster seats are used incorrectly • incorrect installation • incompatible with child’s height, weight, or age • straps are too loose

www.boosterseat.org

Preliminary Studies2003 NT Child Safety Seat Study

Surveys conducted June – July 2003• All vehicles entering or leaving each site:

Approached while occupants would most likely be restrained

• Driver estimated children’s age, weight and distance from home

• Trained observer evaluation: Seating location Restraint use by each child age 8 or younger Driver restraint use

• Driver survey Opinions about child restraint use Awareness of local passenger restraint laws

Robert Davidson

Results – Percent of children in restraint use categories

63

41

1116

22

41

21

37

49

0

100

Infant seat-eligible (n=88) Child seat-eligible (n=316) Booster seat-eligible (n=370)

Proper use

Restrainedincorrectly

Unrestrained

Overall, 29% properly restrained, 30% incorrectly restrained, 41% unrestrained

Discussion• Infants had highest use• Booster-age children had lowest use• Parents more likely to have kids properly

restrained• Drivers who wear a seat belt more likely to

restrain other passengers• Being subject to a state or tribal seat belt

law was associated with restraint use

Promising Intervention

• What it happening in tribal communities?

• What is being used in non tribal communities?

Potential Interventions• Certified Child Passenger Safety (CPS) technician • Free or low cost child seats• Loaner program• Enact child passenger restraint law / Increased

enforcement of existing laws• Health care providers ask about car seat use &

reinforce the importance of seats• View crash test videos• Have wrecked vehicle at community events• Training on proper use• Have children design seat covers

Native CARS (Children Always Ride Safe) Study

• Will work with six existing tribal partners• Will assess child safety seat use• Will determine knowledge of child safety

seat use, barriers and facilitators• Will utilize a community base approach to

develop tailored interventions• Will implement and evaluate intervention

programs

This presentation was a collaboration between the Native CARS Study and Tribal Epidemiology Center Consortium (with some materials coming from the consortium’s Injury Prevention in Injury Country toolkit)

This publication was supported by Award Number U50 MN024133 from the Centers for Disease Control and Prevention through a Cooperative Agreement with the Tribal Epidemiology Center Consortium. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

CONTACTS:

Tam Lutz, Native CARS503-228-4185 x271tlutz@npaihb.org

Bridget CanniffTribal EpiCenter Consortium

503-228-4185 x302bcanniff@npaihb.org