1. Injury Prevention in Indian Country Protecting Yourself, Your Family, and Your Community Bridget Canniff Tribal Epidemiology Center Consortium Tam Lutz Native CARS

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)

9. 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

10. 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

11. Preventing Injuries at the Community Level What injury prevention efforts are priorities for YOUR communities? Who is involved?

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

13. 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. http://www.usa.safekids.org/tier3_cd.cfm?folder_id=540&content_item_id=1010

14. Community Action Bike rodeos Helmet give-aways or discounts Others?

15. Elder Safety and Falls Prevention Protecting Yourself, Your Family, and Your Community

16. 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

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

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

19. Potential Interventions Escape plans Emergency services Smoke/CO 2 detectors Home safety for Elders Youth programs and activities Environmental concerns Others?

20. Motor Vehicle Safety: Seat Belts Protecting Yourself, Your Family, and Your Community

21. 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 www.cdc.gov/ncipc/wisqars

22. Motor Vehicle Death Rates by Race, 2005 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 www.cdc.gov/ncipc/wisqars

23. 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

24. 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

25. 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”

26. ■ 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

27. 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

28. Motor Vehicle Safety: Child Safety Seats Protecting Yourself, Your Family, and Your Community

30. 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 www.cdc.gov/ncipc/wisqars

31. 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

32. Recommended Child Passenger Restraint Guidelines Source: National Highway Traffic Safety Administration, American Academy of Pediatrics. http://www.aap.org/policy/re0116.html

33. 4 Steps for Kids 1. Rear-facing 2. Forward-facing 3. Booster seats 4. Adult seat belts

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

35. 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

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

37. 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

38. 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

39. State Child Safety Seat Laws

40. 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?

41. 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

42. Preliminary Studies 2003 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

43. Results – Percent of children in restraint use categories Overall, 29% properly restrained, 30% incorrectly restrained, 41% unrestrained

44. 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

45. Promising Intervention What it happening in tribal communities? What is being used in non tribal communities?

46. 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

47. 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

48. 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 CARS 503-228-4185 x271 tlutz@npaihb.org Bridget Canniff Tribal EpiCenter Consortium 503-228-4185 x302 bcanniff@npaihb.org