Reducing Risk for Tribal Communities

Key points

  • Proven strategies exist to reduce motor vehicle crashes, injuries, and deaths.
  • Prevention strategies include car seat and booster seat use, seat belt use, and reducing impaired and distracted driving.
  • These strategies can be successfully tailored to tribal communities.

Overview

Proven strategies to reduce motor vehicle crashes, injuries, and deaths are well established. Strategies to prevent crashes include graduated drivers licensing laws, blood alcohol concentration (BAC) laws, sobriety checkpoints, and ignition interlocks for those convicted of driving while intoxicated. Increasing car seat and booster seat use through child passenger restraint laws that require car seat and booster seat use for all children until at least age 9 years, increasing seat belt use through primary enforcement seat belt laws that cover all seating positions, and high visibility enforcement are proven ways to prevent crash-related injuries and deaths. These strategies can be successfully tailored to tribal communities.

Indigenous Knowledge‎

In evaluating strategies for tribal road safety, it is important to include Indigenous Knowledge, which is "a body of observations, oral and written knowledge, innovations, practices, and beliefs developed by Tribes and Indigenous Peoples through interaction and experience with the environment." Indigenous Knowledge is "applied to phenomena across biological, physical, social, cultural, and spiritual systems" and includes "extensive observations, lessons, and skills passed from generation to generation."



A Memorandum for Heads of Federal Departments and Agencies in November 2022 stated that "Indigenous Knowledge is a valid form of evidence for inclusion in Federal policy, research and decision making. Indigenous Knowledge and other forms of knowledge do not depend on each other for validation, and each system can support the insights of the other."

Source: Guidance for Federal Departments and Agencies on Indigenous Knowledge

Prevention steps and strategies

Car seat and booster seat use

  • Car seat use reduces the risk for injury in a crash by 71–82% for children, when compared with seat belt use alone.12
  • Booster seat use reduces the risk for serious injury by 45% for children ages 4–8 years, when compared with seat belt use alone.3
  • Car seat and booster seat distribution plus education programs can increase restraint use.456 These programs help parents and caregivers get new, unused car seats or booster seats and learn how to properly install and use them.456 These programs often include hands-on demonstrations which can help increase proper installation and use.
    • Incentive and education programs reward parents or children with coupons or other prizes for correctly using car seats and offer educational print materials and videos for parents and caregivers.457
  • Child restraint laws require children riding in vehicles to be buckled up in approved restraints such as car seats, booster seats, or seat belts appropriate for their age, weight, and height. These laws are effective for increasing restraint use and reducing child deaths and injuries.478
    • Strengthening current laws with booster seat provisions that require children who have outgrown car seats to use booster seats until at least age 9 helps reduce injuries and deaths.9101112131415
    • Short-term, high-visibility enforcement programs can enhance the effectiveness of child restraint laws, especially if they include broad media coverage.47 These programs are often similar to or conducted in combination with seat belt use programs like Click It or Ticket; however, they should be conducted in an equitable and culturally centered manner (see example below).

Safe Native American Passengers (SNAP) Course‎

Example from the Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide: Several Tribes in California and Arizona, as well as the California Highway Patrol, have used a modified version of the Safe Native American Passengers (SNAP) Course to educate law enforcement personnel about the importance of child safety seat use and enforcing child safety seat use laws. This gives officers the tools to address CPS during traffic safety stops.

Seat belt use

  • Seat belt use reduces the risk for death and serious injury by about half for older children and adults.16
  • There is strong evidence that primary enforcement seat belt laws that cover all seating positions and high visibility enforcement are effective at increasing seat belt use.717 Prior work has explored how to conduct this in a culturally centered manner in some tribal communities.

'Click-It for a Movie Ticket'‎

Example from the TMVIP Best Practices Guide: At a regional health corporation in rural Alaska, the TMVIP program developed a 'Click-It for a Movie Ticket' campaign to increase occupant restraint use. In collaboration with the local movie theater (a popular destination in this rural Alaskan outpost), and local law enforcement, the TMVIP coordinator was able to promote important traffic safety messages, provide an opportunity for law enforcement to do more than issue tickets, and reward community members for safe driving behaviors. This approach to identify incentives that are locally valued can be applied in other tribal communities.

Reduce impaired driving

Proven measures to reduce alcohol-impaired driving include:

  • Implementing The Community Guide supported strategies that can reduce binge drinking.18
  • Enforcing blood alcohol concentration (BAC) laws, minimum legal drinking age laws, and zero tolerance laws for drivers younger than 21 years old.719 These should be conducted in an equitable and culturally centered manner.
  • Using publicized sobriety checkpoints. Checkpoints can reduce alcohol-related crash deaths by 9%.20
  • Requiring ignition interlock use for all people convicted of alcohol-impaired driving, starting with their first offense21. Additionally, incorporating alcohol use disorder assessment and treatment into interlock programs shows promise in reducing repeat offenses once interlocks are removed.22
  • Providing Drug Recognition Expert or Advanced Roadside Impaired Driving Enforcement program training to law enforcement.7

Sobriety Checkpoints‎

Example from the TMVIP Best Practices Guide: Previously, the San Carlos Apache Tribe conducted sobriety checkpoints and a comprehensive media campaign. A total of 38 public service announcements and 21 community media events were conducted, combined with 21 sobriety checkpoints. They observed a 20% reduction in MVCs involving injuries or deaths, a 33% reduction in night-time crashes, and a 27% reduction in overall police-reported crashes.

Prevent teen crashes

  • There are proven methods to help prevent teen crashes. Graduated driver licensing (GDL) systems enable new drivers to progressively gain driving experience and driving skills under lower risk conditions by granting driving privileges in 3 stages.
  • Research indicates that GDL systems are associated with reductions of about 19% for injury crashes and 21% for fatal crashes for 16-year-olds.23 Best practice GDL systems often include the following components:24252627
    • Stage 1: Learner's Permit
      • Minimum age of 16 to obtain a learner's permit
      • A requirement to have a learner's permit for at least 12 months
      • At least 70 supervised practice hours
    • Stage 2: Intermediate/Provisional License
      • No teen or young adult passengers
      • Restrictions on nighttime driving (from 9 or 10 pm until 5 am, or sometimes longer)
    • Stage 3: Full Licensure
      • Minimum age of 18 to obtain a full license

Resources

CDC resources

Additional resources

Print
Content Source:
National Center for Injury Prevention and Control
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  2. Zaloshnja E, Miller TR, Hendrie D. Effectiveness of child safety seats vs safety belts for children aged 2 to 3 years. Arch Pediatr Adolesc Med. 2007;161(1):65–68. doi:10.1001/archpedi.161.1.65
  3. Arbogast KB, Jermakian JS, Kallan MJ, Durbin DR. Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics. 2009;124(5):1281–1286. doi:10.1542/peds.2009-0908
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  7. Venkatraman V, Richard CM, Magee K, Johnson K. Countermeasures That Work: A Highway Safety Countermeasures Guide for State Highway Safety Offices, 10th Edition, 2020 (Report No. DOT HS 813 097) [PDF – 641 pages]. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration; 2021.
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  9. Shaw KM, West B, Kendi S, Zonfrillo MR, Sauber-Schatz E. Urban and rural child deaths from motor vehicle crashes: United States, 2015–2019. J Pediatr. 2022;250:93–99. doi:10.1016/j.jpeds.2022.07.001
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  11. West BA, Dorigo LL, Mattick KA, Yellman MA, Sauber-Schatz EK. Booster Seat Planning Guide. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2021.
  12. Farmer P, Howard A, Rothman L, Macpherson A. Booster seat laws and child fatalities: a case-control study. Inj Prev. 2009;15(5):348–350. doi:10.1136/ip.2008.021204
  13. Brixey SN, Corden TE, Guse CE, Layde PM. Booster seat legislation: does it work for all children?. Inj Prev. 2011;17(4):233–237. doi:10.1136/ip.2010.029835
  14. Mannix R, Fleegler E, Meehan WP III, Schutzman SA, Hennelly K, Nigrovic L, Lee LK. Booster seat laws and fatalities in children 4 to 7 years of age. Pediatrics. 2012;130(6):996–1002. doi:10.1542/peds.2012-1058
  15. Eichelberger AH, Chouinard AO, Jermakian JS. Effects of booster seat laws on injury risk among children in crashes. Traffic Inj Prev. 2012;13(6):631–639. doi:10.1080/15389588.2012.660663
  16. Kahane CJ. National Highway Traffic Safety Administration (NHTSA). Lives Saved by Vehicle Safety Technologies and Associated Federal Motor Vehicle Safety Standards, 1960 to 2012 – Passenger Cars and LTVs – With Reviews of 26 FMVSS and the Effectiveness Of Their Associated Safety Technologies in Reducing Fatalities, Injuries, and Crashes (Report No. DOT HS 812 069). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration; 2015.
  17. Dinh-Zarr TB, Sleet DA, Shults RA, et al. Reviews of evidence regarding interventions to increase the use of safety belts. Am J Prev Med. 2001; 21(4 Suppl):48–65. doi:10.1016/s0749-3797(01)00378-6.
  18. Guide to Community Preventive Services. Excessive Alcohol Consumption. 2023.
  19. Guide to Community Preventive Services. CSPTF Findings for Motor Vehicle Injury: Reducing Alcohol-Impaired Driving. 2021.
  20. Bergen G, Pitan A, Qu S, Shults RA, Chattopadhyay SK, Elder RW, Sleet DA, Coleman HL, Compton RP, Nichols JL, Clymer JM, Calvert WB, Community Preventive Services Task Force. Publicized sobriety checkpoint programs: A Community Guide systematic review. Am J Prev Med. 2014;46(5):529–539. doi:10.1016/j.amepre.2014.01.018.
  21. Guide to Community Preventive Services. Motor Vehicle Injury – Alcohol-Impaired Driving: Ignition Interlocks. 2021.
  22. Voas RB, Tippetts AS, Bergen G, Grosz M, and Marques P. Mandating treatment based on interlock performance: evidence for effectiveness. Alcohol Clin Exp Res. 2016;40(9):1953–1960. doi:10.1111/acer.13149
  23. Masten SV, Thomas FD, Korbelak KT, Peck RC, Blomberg RD. Meta-analysis of GDL laws (Report No. DOT HS 812 211) [PDF – 93 pages]. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration. November 2015.
  24. Ouimet MC, Pradhan AK, Brooks-Russell A, Ehsani JP, Berbiche D, Simons-Morton BG. Young Drivers and Their Passengers: A Systematic Review of Epidemiological Studies on Crash Risk. J Adolesc Health. 2015;57(1 Suppl):S24–35.e6. doi:10.1016/j.jadohealth.2015.03.010
  25. Insurance Institute for Highway Safety (IIHS). Graduated Licensing Calculator. Arlington, VA: Insurance Institute for Highway Safety & Highway Loss Data Institute; 2022.
  26. Steadman M, Bush JK, Thygerson SM, Barnes MD. Graduated driver licensing provisions: an analysis of state policies and what works. Traffic Inj Prev. 2014;15(4):343–348. doi:10.1080/15389588.2013.822493
  27. Curry AE, Metzger KB, Williams AF, Tefft BC. Comparison of older and younger novice driver crash rates: Informing the need for extended Graduated Driver Licensing restrictions. Accid Anal Prev. 2017;108:66–73. doi:10.1016/j.aap.2017.08.015