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PEDIATRICS Vol. 104 No. 6 December 1999, pp. 1397-1399
AMERICAN ACADEMY OF PEDIATRICS:
The Prevention of Unintentional Injury Among American Indian and
Alaska Native Children: A Subject Review
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ABSTRACT |
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Among ethnic groups in the United States, American Indian and Alaska Native (AI/AN) children experience the highest rates of injury mortality and morbidity. Injury mortality rates for AI/AN children have decreased during the past quarter century, but remain almost double the rate for all children in the United States. The Indian Health Service (IHS), the federal agency with the primary responsibility for the health care of AI/AN people, has sponsored an internationally recognized injury prevention program designed to reduce the risk of injury death by addressing community-specific risk factors. Model programs developed by the IHS and tribal governments have led to successful outcomes in motor vehicle occupant safety, drowning prevention, and fire safety. Injury prevention programs in tribal communities require special attention to the sovereignty of tribal governments and the unique cultural aspects of health care and communication. Pediatricians working with AI/AN children on reservations or in urban environments are strongly urged to collaborate with tribes and the IHS to create community-based coalitions and develop programs to address highly preventable injury-related mortality and morbidity. Strong advocacy also is needed to promote childhood injury prevention as an important priority for federal agencies and tribes.
More than 700 000 American Indian and Alaska Native
(AI/AN) children younger than 19 years old live in the United
States.1 These AI/AN children experience higher rates of
morbidity and mortality from unintentional injuries than do other US
children. The 881 injury deaths to AI children between 1992 and
1994 translate to an overall rate of 52.3 deaths per 100 000 children
per year. This rate is almost twice the US rate of 28.3 per 100 000
children for all races (1993).2 Rates of injury deaths are
high for rural and urban AI/AN populations.3
Although rates of injury death have dropped considerably during the
past 25 years, they remain disproportionately high among AI/AN children
for the most common causes of injury. Fatality rates for motor vehicle
occupant injuries are 3 times higher for AI/AN children than for white
and black children.1 Pedestrian-motor vehicle collision
deaths are almost 4 times that for all US races combined, and drowning,
the second leading cause of injury death, occurs at rates almost 2 times higher than those for white and black children. Native American
children also die as a result of fire and burn injury at 2.8 times the
rate of white children.
Some of the recognized important risk factors for unintentional injury
mortality among AI/AN children include poverty, alcohol abuse,
substandard housing, limited access to emergency medical services,
rural residences, and low seat belt use
rates.24-8 The high rates of injury-related death and
disability make it especially important to emphasize and intensify
injury prevention efforts within this population.
Injury prevention specialists use media campaigns, targeted education,
safety technology, environmental modification, and passage of laws and
regulations to achieve their aims. Each of these approaches has been
used successfully by the tribes, often working in close partnership
with the Indian Health Service (IHS) Injury Prevention Program. Some
examples of successful injury prevention programs for AI/AN communities
include a program promoting winter coats with flotation devices in
Alaska to prevent drowning9; a livestock control program
to reduce motor vehicle collisions with large animals10;
and the Navajo Nation motor vehicle occupant safety program to boost
seat belt use.11
The sovereignty of tribes provides special challenges to the regulatory
and legislative approach to injury control in AI/AN communities. Safety
laws vary considerably among the 550 federally recognized tribes.
Although some tribes fall under the jurisdiction of state laws (eg,
California, Oklahoma, and Alaska), many enact their own laws and tribal
codes. According to a recent inventory of tribal laws relating to
occupant safety, only 14% of the responding tribes had passed their
own laws requiring seat belt use, 46% had adopted state laws, and the
remainder had no relevant law.12 The regulatory and
legislative approach is complex and may often require working with each
tribe separately, similar to the enactment of laws in states.
The AI/AN groups are culturally and linguistically diverse with more
than 200 native languages still spoken. Although similarities exist
among some tribes, such as the Pueblo tribes, most tribes have unique
cultural practices. Intervention strategies should account for these
differences. For example, the promotion of the use of child safety
seats is a well-accepted form of prevention for motor vehicle crash
injury, but the method used to promote them may need to be tailored to
the cultural beliefs of the specific tribe. In some tribes, discussions
of mortality, risk, and harm are forbidden.13 For example,
health care professionals should not warn that death is a potential
outcome if certain protective measures are not taken. One strategy used
by the IHS Injury Prevention Program was to conduct a crash test
using a cradle board to demonstrate the inadequacy of this device as a
child vehicle restraint. Video footage of this test was sufficient to
communicate the risk without having to predict risk of harm to the
child.
Pediatricians can increase their understanding of tribal cultures in
many ways. In many tribes, traditional healers, tribal elders, or
community health workers can be approached respectfully and asked to
provide guidance; in other tribes it may be more appropriate to work
directly with the tribal health director. Many tribes have or are
developing cultural centers to assist nonmembers to gain a greater
understanding of the tribe.
Some general strategies also can be used to communicate with AI/AN
patients. First, avoid comparisons between AI/AN people and people of
other cultures. Second, providers should take extra time to convey
information in a clear nonjudgmental style that is free of jargon.
Common cultural attributes of the AI/AN people include cooperation and
patience. They may respond quietly or ask few questions because of
their beliefs about respect and consideration.
Because of concern about the high rate of childhood injury
morbidity and mortality among AI/AN people, the American Academy of
Pediatrics (AAP) supports the continued implementation and expansion of a broad-based injury prevention program among these populations. Pediatricians and others caring for AI/AN children should:
RECOMMENDATIONS
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Pediatricians and others involved in child health care have an opportunity and a challenge to reduce injury-related morbidity and mortality among AI/AN children. If the challenge can be met, Native American children will be protected from injuries at least as well as other US children, who have seen a more favorable reduction in injury mortality in recent years.14
COMMITTEE ON NATIVE AMERICAN CHILD HEALTH, 1998-1999
Lance Chilton, MD, Chairperson
Joann Bodurtha, MD, MPH
Mark P. Butterbrodt, MD
Bernadette Freeland-Hyde, MD
Sheila Gahagan, MD
David Grossman, MD, MPH
Jonathan Jantz, MD
LIAISON REPRESENTATIVES
Jandel Allen-Davis, MD
American College of Obstetricians and Gynecologists
Joseph T. Bell, MD
Association of American Indian Physicians
Donald Bechtold, MD
American Academy of Child and Adolescent Psychiatry
George Brenneman, MD
Center for American Indian and Alaskan Native Health
William F. Green, MD
Indian Health Service
Brian Postl, MD
Canadian Paediatric Society
Barbara Zind, MD
Section on Community Pediatrics
COMMITTEE ON INJURY AND POISON PREVENTION,
1998-1999
Murray L. Katcher, MD, PhD, Chairperson
Phyllis Agran, MD, MPH
Danielle Laraque, MD
Susan H. Pollack, MD
Gary A. Smith, MD, DrPH
Howard R. Spivak, MD
Milton Tenenbein, MD
Susan B. Tully, MD
LIAISON REPRESENTATIVES
Ruth A. Brenner, MD, MPH
National Institute of Child Health and Human Development
Stephanie Bryn, MPH
Maternal and Child Health Bureau
Marilyn Bull, MD
Section on Injury and Poison Prevention
Victor Garcia, MD
Section on Surgery
Cheryl Neverman
National Highway Traffic Safety Administration
Richard A. Schieber, MD, MPH
Centers for Disease Control and Prevention
Richard Stanwick, MD
Canadian Paediatric Society
Deborah Tinsworth
US Consumer Product Safety Commission
William P. Tully, MD
Pediatric Orthopaedic Society of North America
CONSULTANTS
Sue Ann Jantz, JD
Emery A. Johnson, MD, MPH
Former Director, Indian Health Service
Richard J. Smith III, MS
Injury Prevention Specialist, Indian Health Service
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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AI, American Indian; AN, Alaska Native; IHS, Indian Health Service; AAP, American Academy of Pediatrics.
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REFERENCES |
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- US Census Bureau. Database C90STF3C. Available at http://venus.census.gov/cdrom/lookup/909450908. Accessed October 27, 1998
- Trends in Indian Health: 1996. Washington, DC: US Department of Health and Human Services, Public Health Service, Indian Health Service; 1997
- Grossman DC, Krieger J, Sugarman JR, Forquera R Health status of urban American Indians and Alaska Natives. JAMA. 1994; 271:205-210
- Sugarman JR, Warren CW, Oge L, Helgerson SD Using the behavioral risk factor surveillance system to monitor year 2000 objectives among American Indians. Public Health Rep. 1992; 107:449-456 [Medline]
- Baker SP, O'Neill B, Ginsberg MJ, Li G. The Injury Fact Book. 2nd ed. New York, NY: Oxford University Press; 1992:224
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Campos-Outcalt D,
Prybylski D,
Watkins AJ,
Rothfus G,
Dellapenna A
Motor-vehicle crash fatalities among American Indians and non-Indians in Arizona, 1979 through 1988.
Am J Public Health
1997;
87:282-285
[Abstract/Free Full Text] - Mahoney M-C Fatal motor vehicle traffic accidents among Native Americans. Am J Prev Med. 1991; 7:112-116 [Medline]
- Grossman DC, Sugarman JR, Fox C, Moran J Motor-vehicle crash-injury risk factors among American Indians. Accid Anal Prev. 1997; 29:313-319 [CrossRef][Medline]
- Perkins RD. Community-based drowning intervention program. Proceedings of the National Fishing Industry Safety and Health Workshop, October 9-11, 1992. Washington, DC: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention; 1994:155-158
- Centers for Disease Control and Prevention Motor vehicle crashes and injuries in an Indian community: Arizona. MMWR Morb Mortal Wkly Rep. 1989; 38:589-590 [Medline]
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Centers for Disease Control and Prevention
Safety belt use and motor-vehicle-related injuries
Navajo Nation, 1988-1989.
MMWR Morb Mortal Wkly Rep.
1992;
41:705-708 [Medline] - Inventory of Tribal Traffic Laws. Rockville, MD: Indian Health Service; 1994
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Carrese JA,
Rhodes LA
Western bioethics on the Navajo reservation: benefit or harm?
JAMA.
1995;
274:826-829
[Abstract/Free Full Text] -
Rivara FP,
Grossman DC
Prevention of traumatic deaths to children in the United States: how far have we come and where do we need to go?
Pediatrics
1996;
97:791-797
[Abstract/Free Full Text]
Pediatrics (ISSN 0031 4005). Copyright ©1999 by the American Academy of Pediatrics
Statements of reaffirmation:
- AAP Publications Retired and Reaffirmed
- American Academy of Pediatrics
Pediatrics 2006 117: 1846-1847.[Extract] [Full Text] [PDF]
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AAP Publications Retired and Reaffirmed
Pediatrics 2009 123: 1421-1422.[Extract] [Full Text] [PDF]
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