Injury Prevention in Indian Country

Protecting Yourself, Your Family, and Your Community Bridget Canniff Tribal Epidemiology Center Consortium Tam Lutz Native CARS

What are Unintentional Injuries?

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

not

include injuries related to violence (assault, abuse, homicide, suicide)

What is Injury Prevention?

• • 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

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 Safety and Fire Prevention

Protecting Yourself, Your Family, and Your Community

Potential Interventions

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

Motor Vehicle Safety: Seat Belts

Protecting 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

15 10 5 0 30 25 20 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.

2.

3.

4.

5.

Keep people in the vehicle Contact the strongest parts of the body Spread forces over a wide area of the body Help the body to slow down 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”

Seat Belts Save Lives

■ This teenage girl walked away from this crash on the Lac Courte Oreilles Reservation ■ She survived because she was wearing a seat belt!

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

deaths 5 of all child 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.

2.

3.

4.

5.

Keep children in the vehicle Contact the strongest parts of the body Spread forces over a wide area of the body Help the body to slow down Protect the brain, spinal cord and abdomen

Recommended Child Passenger Restraint Guidelines

Buckle Everyone. Seat children age 12 and under in the back seat.

Recommended Weight Requirements Type of Seat Seat Position Notes Key safety tips

Infants (Birth – 1 Year)

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

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. use.

(1 Toddlers – 4 Years)

Over 20 pounds and up to 40 pounds; if a toddler is <20 pounds, use a rear facing child safety seat. Convertible or forward facing harness seat Can be rear-facing until 30 pounds if seat allows; generally forward-facing Harness straps should be at or above shoulder level. Most seats require harness straps to be in top slots for forward-facing 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.

School-Age Children (4 – 8 Years)

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. Belt positioning booster seat Forward-facing Belt positioning booster seats must be used with

both

lap and shoulder belt. Shield booster seats are not recommended. 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.

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 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

Results – Percent of children in restraint use categories Overall, 29% properly restrained, 30% incorrectly restrained, 41% unrestrained 100 Proper use Restrained incorrectly Unrestrained 63 49 41 41 37 21 22 16 11 0 Infant seat-eligible (n=88) Child seat-eligible (n=316) Booster seat-eligible (n=370)

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)

CONTACTS:

Tam Lutz, Native CARS 503-228-4185 x271 [email protected]

Bridget Canniff Tribal EpiCenter Consortium 503-228-4185 x302 [email protected]

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.