1. Injury Prevention in Indian Country Bridget Canniff Project Director Tribal Epidemiology Center Consortium Northwest Portland Area Indian Health Board

2. 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)

3. Key Unintentional Injury Topics Motor Vehicle Safety: Seat Belts Motor Vehicle Safety: Child Safety Seats Elder Safety & Falls Prevention Bike Safety & Helmet Use Home Safety & Fire Prevention

4. Motor Vehicle Safety: Seat Belts

5. Motor Vehicle Safety ■ On average, 2 AI/ANs are killed every day in crashes in the US 1 1 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 www.cdc.gov/ncipc/wisqars

6. Motor Vehicle Safety Make sure vehicles are safe and in working order Use car seats for children Ensure drivers and passengers wear seat belts Enforce speed limits and discourage aggressive driving Enforce laws against impaired driving

7. The traffic death rate for AI/ANs in Washington is ____ times higher than for non-Natives. 2 1. 1.7 2. 2.5 3. 3.3 4. 4.2 2 Washington Traffic Safety Commission. Tribal Traffic Safety [online]. (2010) [cited Feb 22 2010]. Available from URL: http://www.wtsc.wa.gov/programs/tribal.php

8. Five Ways Seat Belts Prevent Injury 1. Keep people in the vehicle 2. Contact the strongest parts of the body 3. Spread forces over a wide area of the body 4. Help the body to slow down 5. Protect the brain and spinal cord

9. “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”

10. How often do YOU wear your seatbelt? 1. Always 2. Usually 3. Sometimes 4. Occasionally 5. Never

11. The Message for Native Communities: Buckle Up for Every Ride ■ Wearing a seat belt is the easiest way to prevent injury or death ■ It only takes a few seconds to buckle up - you never know when you may be in a crash ■ Buckle up for every ride in the car, even short trips

12. Motor Vehicle Safety Resources Washington Traffic Safety Commission http://www.wtsc.wa.gov/programs/tribal.php http://www.wtsc.wa.gov/programs/tribal.php Washington Safety Restraint Coalition www.800bucklup.org/ www.800bucklup.org/

13. Motor Vehicle Safety: Child Safety Seats

15. 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 1-44). … making up one-third of all child deaths 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]. (2005) [cited Feb 17 2009]. Available from URL: www.cdc.gov/ncipc/wisqars www.cdc.gov/ncipc/wisqars

16. Five Ways Child Safety Seats Prevent Injury 1. Keep children in the vehicle 2. Contact the strongest parts of the body 3. Spread forces over a wide area of the body 4. Help the body to slow down 5. Protect the brain, spinal cord and abdomen

17. 4 Steps for Kids 1. Rear-facing 2. Forward-facing 3. Booster seats 4. Adult seat belts

18. How tall should a child be in order to use an adult seat belt? 1. 4’ 2. 4’6” 3. 4’9” 4. 5’

19. Minimum recommendations Rear-facing seats: Until age 1 AND at least 20 lbs Forward-facing seats: Until upper limit for specific seat, usually age 4 AND 40 lbs Booster seats: Until age 8 OR 4’9” tall Adult seat belts in back seat: Until age 13

20. Step 1: Rear-facing Infant Seats ■ Keep infants rear-facing until a minimum of age 1 and at least 20 pounds.

21. 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

22. Step 2: Forward-Facing Child Restraints ■ Convertible and Forward-facing only ■ Child must be: One year old AND 20+ pounds

23. 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 booster Belt-positioning backless booster

24. 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

25. 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

26. Tribal Child Safety Seat Laws Does your tribe 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?

27. Possible 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

28. Child Safety Seat Resources National Highway Traffic Safety Administration www.nhtsa.gov www.nhtsa.gov Washington State Booster Seat Coalition www.boosterseat.org www.boosterseat.org Washington Safety Restraint Coalition www.800bucklup.org/ www.800bucklup.org/

29. Elder Safety and Falls Prevention

30. 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 www.cdc.gov/ncipc/wisqars

31. Proven Interventions: What Works Comprehensive check- ups Medication management Vision care Home safety Regular exercise for balance & strength

32. Elder Falls Resources Fall Prevention Center of Excellence (CA) www.stopfalls.org www.stopfalls.org CDC National Center for Injury Prevention and Control www.cdc.gov/homeandrecreationalsafety/falls

33. Bike Safety and Helmet Use Protecting Yourself, Your Family, and Your Community

34. Why Wear Helmets? Native American children die from injuries twice as often as children from other races 4 Helmets can reduce head injuries by 85% and brain injuries by 88% 5 4 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 5 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. http://www.usa.safekids.org/tier3_cd.cfm?folder_id=540&content_item_id=1010

35. Bike and Helmet Safety Resources Pedestrian and Bicycle Information Center www.bicyclinginfo.org www.bicyclinginfo.org National Bike Safety Coalition www.cdc.gov/HomeandRecreationalSafety/ bikeinjuries.html www.cdc.gov/HomeandRecreationalSafety/ bikeinjuries.html

36. Home Safety and Fire Prevention Protecting Yourself, Your Family, and Your Community

37. Keeping Homes Safe Escape plans Emergency services Smoke/CO 2 detectors Home safety for Elders Youth programs and activities Environmental concerns

38. Home and Fire Safety Resources FireSafety.gov Home Safety Council www.homesafetycouncil.org

39. Preventing Injuries at the Community Level What injury prevention efforts are priorities for YOUR communities? Who is involved, or could be involved?

40. Injury Prevention in Indian Country 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 Tribal EpiCenters

41. Assessing the Need in Your Community Who is being injured? How are these people being injured? How many of these injuries have occurred, and over what time period? Are they increasing or decreasing in frequency? Which of these injuries is most significant in terms of:  personal impact  economic costs  social consequences 

42. Assessing the Need in Your Community Are local injury rates higher or lower than the national or state rate? How does it compare to other health problems? What are community issues (cultural, attitudes, beliefs, behaviors) that could be contributing to injuries? What is involved in decreasing injuries? Are there strategies other communities have used that have proven effective or promising? What are community strengths (cultural, attitudes, beliefs, behaviors) that could help reduce injuries?

43. General Injury Prevention Resources Indian Health Service Portland Area Injury Prevention www.ihs.gov/MedicalPrograms/portlandinjury www.ihs.gov/MedicalPrograms/portlandinjury CDC National Center for Injury Prevention and Control (NCIPC) www.cdc.gov/injury www.cdc.gov/injury

44. This presentation is a collaboration between the Tribal Epidemiology Center Consortium (with materials coming from the consortium’s Injury Prevention in Indian Country toolkit) and the Native CARS Study. 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: Bridget Canniff Tribal EpiCenter Consortium 503-228-4185 x302 bcanniff@npaihb.org Tam Lutz, Native CARS 503-228-4185 x271 tlutz@npaihb.org