Prevention Implications and Priorities
Despite decreases in Native American child and youth death rates for motor vehicle crashes, pedestrian events, drowning, and fire, the disparity in injury rates between Native Americans and whites persists. Native American children and youth have not benefited to the same degree as white children in many areas of injury prevention practice (i.e., traffic safety, water safety, and residential fire safety). However, there are several proven and promising injury interventions that could be tailored to local tribal settings. Additional information on the circumstances of these injuries is needed to effectively target prevention efforts. Some of these approaches are discussed below. Motor Vehicle-Related Native Americans have the highest alcohol-related motor vehicle death rates of all racial groups,10 putting their children and youth at an elevated risk when they ride with an impaired driver. Researchers estimate that in states with American Indian and Alaska Native reservations, 65% of motor vehicle-related deaths among Native Americans involve alcohol.11 Young drivers are at particular risk because of inexperience, nighttime driving, too many passengers in the car, and patterns of alcohol use. Many tribes have the authority to restrict driving privileges on the reservations, conduct sobriety checkpoints, and set curfew ordinances to help 8 reduce deaths related to motor vehicle crashes among teens. The highest rates of pedestrian-related death occurred in two age groups: 1 to 4 years and 15 to 19 years. Most deaths occurred on public roadways, but over half of the 1 to 4 year olds who were killed as pedestrians were killed in non-traffic settings, such as private driveways. More information is needed about the circumstances of these pedestrian-related deaths, but many involve young children being backed over by large vehicles such as pick-up trucks (Nancy Bill, IHS Headquarters, personal communication, 2004). Parents and caregivers of young children should be aware of the risk that children face when playing around vehicles.12,13,14 Prevention strategies might involve working with local housing authorities to install circular driveways in new homes to reduce the need to back up, installing fencing to separate play areas from vehicle driveways, and increasing the use of audible back-up warning systems.14 Violence The IHS provides technical assistance to suicide prevention programs and alcohol- and substance-abuse treatment centers.18 Individual tribes have launched a number of suicide prevention programs that stress cultural relevance and the need for community involvement,19 but none have been rigorously evaluated. The American Indian and Alaska Native Community Suicide Prevention Center and Network in New Mexico has shown promising results in the past in reducing Native American youth suicide; the organization uses a community-based approach involving school-based youth, mental health referral assistance, and family outreach.20 Native American children and youth have somewhat lower homicide than suicide rates, and their rates are well below those for blacks. However, in terms of nonfatal violence, results from the National Crime Victimization Surveys from 1993 to 1998 indicated that Native Americans 12 to 19 years old are assaulted at rates well above those for any other minority.21 Programs that show promise at preventing youth violence have been recently summarized22 and include specific violence-prevention practices in four key areas: parents and families, home visitation, social and conflict resolution skills, and mentoring. Homicide among Native American children (0�years) is also an important Native American issue. Such homicides are typically perpetrated by family members.23 One intervention that has shown effectiveness in preventing child maltreatment is the home visitation program conducted by nurses or other health professionals.24 Firearms Residential fires account for the
majority of fire-related deaths (93%) among Native American children and
youth in our study. Fire death rates were highest for Native American
children under five years of age. Dramatic improvements have been made in
reducing fire-related death among Native American children and youth, with
rates decreasing 64% from 1981 to 1998. Despite this decrease, the
Aberdeen, Bemidji, and Alaska Areas had substantially higher fire-related
death rates than all other IHS Areas, with rates more
Drowning Four-sided isolation fencing around swimming pools has proven to be effective at preventing drowning among young children. In-ground pools with four-sided fencing had 60% fewer incidents of drowning compared with pools without four-sided isolation fencing (www.CPSC.gov). Three Tragic Seconds is a multimedia drowning prevention education program aimed at parents and caregivers of young children. CDC is working with the Children's Hospital of Orange County, California, and the National SAFE KIDS Campaign to implement the Three Tragic Seconds program in two communities in Arizona and Florida (www.cdc.gov/ncipc/factsheets/drown-activities.htm). Once a child is in the water, it is very important that a parent or guardian provide supervision. Swimmers can further reduce their risk by choosing swimming pools with lifeguard services, although this 35 may not be feasible around natural bodies of water. Proper swimming instruction and water-safety training can prepare a participant to deal with potentially hazardous aquatic environments such as strong currents, waves, and riverbed rocks. Environmental modifications can also be made to prevent drowning in natural bodies of water (i.e. lakefront slope gradients to prevent sudden, unseen water drop-offs).35 Older children and teenagers are more likely to drown in natural bodies of water than in swimming pools. Alcohol is a risk factor for drowning and is involved in 25% to 50% of drowning incidents among teenage boys (www.cdc.gov/ncipc/factsheets/drown.htm). In indigenous communities in Canada, alcohol is a factor in half of all drowning related to boat travel. In Canada, only about 10% of victims of boating drowning were wearing a personal flotation device (PFD).36 Distribution of PFDs and programs to education and distribute float coats have been used to increase boaters' safety in Alaska Native villages (Ron Perkins, Alaska Injury Prevention Center, personal communication, 2003). These programs involve a public awareness campaign combined with sales of low-cost float coats. Another promising program being supported by the U.S. Coast Guard in Alaska is the Kids Don't Float Program. This is a PFD loaner program at village community beaches and boat launching areas combined with an educational component for children and teenagers (www.chems.alaska.gov/Injury_Prevention/KidsDontFloat.htm).
Suffocation and Choking
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