School Violence

School Violence

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In the United States, an estimated 55 million students are enrolled in pre-kindergarten through twelfth grade. Another 15 million students attend colleges and universities across the country. While U.S. schools remain relatively safe, any amount of violence is unacceptable. Parents, teachers, and administrators expect schools to be safe havens of learning. Acts of violence can disrupt the learning process and have a negative effect on students, the school itself, and the broader community.

School violence is a subset of youth violence, a broader public health problem. Youth violence refers to harmful behaviors that may start early and continue into young adulthood. It includes bullying, slapping, punching, weapon use, and rape. Victims can suffer serious injury, significant social and emotional damage, or even death. The young person can be a victim, an offender, or a witness to the violence-or a combination of these. Detailed information about youth violence is available online.

Data Sources for School Violence

Indicators of School Crime and Safety
CDC contributes to the Department of Education's annual report on school crime and student safety. This report provides the most recent data available from many independent sources.

School Associated Violent Death Study
Since 1992, CDC has collaborated with the Departments of Education and Justice to monitor school-associated violent deaths at the national level. Information is collected from media databases, police, and school officials. A case is defined as a fatal injury (e.g., homicide or suicide) that occurs (1) on school property; (2) on the way to/from school; or (3) during or on the way to/from a school sponsored event. Only violent deaths associated with U.S. elementary and secondary schools are included. Data obtained in this study have identified trends and helped to inform preventive measures.

School Health Policies and Programs Study
The School Health Policies and Programs Study (SHPPS) is the largest, most comprehensive assessment of school health policies and programs. It is conducted at state, district, school, and four classroom levels across the country. The study, sponsored by CDC, provides data to help improve school health policies and programs. SHPPS is conducted every six years; the first administration was in 1994 and the most recent, in 2006. The study assesses eight components of school health programs at the elementary, middle/junior, and senior high school levels that are related to adolescent risk behaviors, including violence. These components are health education; physical education; health services; mental health and social services; school policy and environment; food services; faculty and staff health promotion; and family and community involvement.

Youth Risk Behavioral Surveillance System
CDC monitors risk behaviors, such as violence, that contribute to the leading causes of death among youth in the United States. A nationwide survey is administered every two years in public and private high schools so that investigators can examine behaviors related to fighting, weapon carrying, dating and sexual violence, and suicide.

Risk and Protective Factors for Youth Violence

Research on youth violence has helped us better understand the factors that make some populations more likely to commit violent acts. Such risk factors increase the likelihood that a young person will become violent, but they may not be the direct cause of youth or school violence. Detailed information about the risk and protective factors associated with youth violence is available on-line.

Related CDC Research:

• Bullying and Sexual Violence Project
  The Bullying and Sexual Violence Project, funded by CDC and conducted at the University of Illinois at Urbana-Champaign, is designed to assess the association between bullying (e.g., from the perspective of both the bully and the victim) and co-occurring and subsequent sexual violence. The Project also tests associations between these forms of violence and potentially modifiable risk and protective factors from multiple levels of the social ecology (i.e., individual, family, peer, and community factors). Participants in the three-year study will include 3,500 middle school students (sixth through eighth grade) in 140 classrooms and their teachers, drawn from two school districts. Students and teachers will complete surveys at multiple time points to assess bullying attitudes and behaviors; frequency of bullying and victimization; sexual harassment victimization and perpetration; measures of proposed risk (e.g., anger, attitudes toward violence); and protective factors (e.g., empathy). Data from this project should enable researchers to determine whether certain risk and protective factors are shared or unique to bullying experiences and the perpetration of sexual violence.

• Crime Prevention Through Environmental Design
  CDC supported the development of a tool to measure environmental design principles in schools to better understand how the physical environment may contribute to fear and violence among students. Work is now underway to determine the extent to which scores on this tool are associated with fighting, carrying weapons, substance abuse, and fear in schools.

• The Student Health and Safety Survey
  The Student Health and Safety Survey is a crosssectional, self-administered, 174- item survey designed to assess the overlap between different types of violent behavior (dating violence, same-sex peer violence, and suicide). In addition to examining the extent to which youth engage in these different types of violent behaviors, the Survey also assessed potential risk and protective factors for these behaviors. The Survey was administered to a sample of seventh-, ninth-, eleventh-, and twelfth-grade students from a public school district in a high-risk community ("risk" is based on several community level indicators such as poverty, unemployment, and the prevalence of serious crimes). Data were collected from 4,131 students. Survey results will help researchers determine whether certain risk and protective factors are shared or if they are unique to different types of violence.

Prevention Resources

Academic Centers of Excellence on Youth Violence Prevention
CDC funds 10 Academic Centers of Excellence (ACE) on Youth Violence Prevention to bring together academic and community resources to study and create lasting ways to prevent youth violence. ACEs are unique compared to traditional research centers because they work with community members and many educational, judicial, and social work partners to develop action plans, partnerships, and priorities to prevent youth violence and to learn about effective preventive strategies. Some ACE projects are directly related to school violence prevention, such as the evaluation of school-wide systems for enhancing positive social behaviors.

Best Practices of Youth Violence Prevention: A Sourcebook for Community Action
CDC's Best Practices of Youth Violence Prevention: A Sourcebook for Community Action is the first of its kind to look at the effectiveness of specific violence prevention practices in four key areas: parents and families; home visiting; social and conflict resolution skills; and mentoring.

Blueprints for Violence Prevention
CDC provided some funding for the Blueprints for Violence Prevention, which identified 11 model prevention programs that meet a strict scientific standard of program effectiveness. This standard is based upon an initial review by the Center for the Study and Prevention of Violence at the University of Colorado and a final review by a distinguished advisory board comprised of seven experts in the field of violence prevention. The 11 model programs, called "Blueprints," have been effective in reducing adolescent violent crime, aggression, delinquency, and substance abuse. To date, more than 600 programs have been reviewed. The Blueprints project has currently identified another 18 programs that show promise.

Early Warning, Timely Response: A Guide to Safe Schools
Early Warning, Timely Response: A Guide to Safe Schools, available from the U.S. Department of Education, Office of Special Education and Rehabilitative Services, offers research-based practices designed to help school communities identify early warning signs and develop prevention, intervention, and crisis response plans. It is based on the work of an independent panel of experts from the fields of education, law enforcement, and mental health. This document provides a better understanding of the causes of violence and effective prevention strategies that will lead to safer schools.

Multisite Violence Prevention Project
CDC is collaborating with four universities to explore whether the largest reductions in school-based violence in middle schools result from a universal prevention program to change school norms related to aggression and violence that includes all middle school students and teachers in a specific grade; a selective program that is implemented only with students at the highest risk for perpetrating violence; or a program that combines both approaches.

School Health Guidelines to Prevent Unintentional Injuries and Violence
CDC's School Health Guidelines to Prevent Unintentional Injuries and Violence includes information about preventing adolescent violence, suicide, and unintentional injury; why it is important to focus on schools; and what schools do to prevent injuries and violence.

School Health Index
CDC's School Health Index (SHI) is a self-assessment and planning guide that enables schools to identify the strengths and weaknesses of their health promotion policies and programs. It also helps them develop an action plan for improving student health, and involves teachers, parents, students, and the community in improving school policies, programs, and services. The SHI covers five health topics: physical education and activity, healthy eating, tobacco use prevention, unintentional injuries and violence prevention, and asthma.

Effectiveness of Universal School-Based Programs for Preventing Violence
During 2004-2006, the Task Force on Community Preventive Services reviewed published scientific evidence on the effectiveness of universal school-based programs to reduce or prevent violent behavior. These programs have been shown to decrease rates of violence and aggressive behavior among school-age children. The effectiveness of the programs was demonstrated at all grade levels, and an independent meta-analysis confirmed and supplemented these findings.

Medical Record Abstraction Form for Domestic Bombing Events

Data capture regarding the diagnosis and treatment of injuries is important to quantify the true impact of a disaster. This one-page form allows public health personnel, at the city, county, state, or federal level, to quickly extract basic medical information from hospital and emergency medical services’ records in order to advise officials as to the immediate impact of the event and the potential need for special resources (e.g., blood products, types of medical personnel, etc.). The form contains data elements regarding when and how injured persons arrived for hospital care, who administered their initial care, basic details regarding individuals’ location at the time of the blast if present in the chart documentation, basic categories of type of injury a person may have sustained, medical resources needed for initial treatment (such as x-rays or blood transfusions), types of physicians involved in initial care (such as trauma surgeons, orthopedic surgeons, etc.), and disposition, i.e., treated and released, admitted to the hospital, deceased. The form is designed to be used for chart extraction purposes only. No interviews are needed to obtain data.

Download the printable form

Brain Injuries and Mass Casualty Events:

Traumatic brain injuries can occur during mass casualty events. If you think you or someone you know has a brain injury, contact your health care provider.

What is a traumatic Brain Injury?

A traumatic brain injury (TBI) is defined as a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.. Not all blows or jolts to the head result in a TBI. The severity of such an injury may range from “mild,” that is, a brief change in mental status or consciousness to “severe,” that is, an extended period of unconsciousness or amnesia after the injury. A TBI can result in short or long-term problems with an individual’s ability to function independently, or changes that affect thinking, memory, sensation, language, and emotions.

Why Are TBIs a Problem in Mass Casualty Events?

In mass casualty events, such as the World Trade Center attack or the Oklahoma City bombing, TBIs were caused by flying debris or by a person falling and hitting their head. A blast from an explosion can also cause a TBI even when there is no direct contact with an object.

What Are Some Common Signs and Symptoms of a TBI?

The signs and symptoms of a TBI can be subtle. Symptoms of a TBI may not appear until days or weeks following the injury or may even be missed as people may look fine even though they may act or feel differently. The following are some common signs and symptoms of a TBI:

• Headaches or neck pain that do not go away;
• Difficulty remembering, concentrating, or making decisions;
• Slowness in thinking, speaking, acting, or reading;
• Getting lost or easily confused;
• Feeling tired all of the time, having no energy or motivation;
• Mood changes (feeling sad or angry for no reason);
• Changes in sleep patterns (sleeping a lot more or having a hard time sleeping);
• Light-headedness, dizziness, or loss of balance;
• Urge to vomit (nausea);
• Increased sensitivity to lights, sounds, or distractions;
• Blurred vision or eyes that tire easily;
• Loss of sense of smell or taste; and
• Ringing in the ears.

What Can You Do to Get Help?

If you think you or someone you know has a TBI, contact your health care provider. Your health care provider can refer you to a neurologist, neuropsychologist, neurosurgeon, or specialist in rehabilitation (such as a speech pathologist). Getting help soon after the injury by trained specialists may speed your recovery.

For More Information, Contact:

The Brain Injury Association of America (BIAA)

• Call the toll-free help line at 1-800-444-6443 for help in English or Spanish
• Visit the website at www.biausa.org

The Defense and Veterans Brain Injury Center (DVBIC)

• Call Toll Free for information 1-800-870-9244
• Visit the website at www.dvbic.org

The Centers for Disease Control and Prevention (CDC)

• Learn about CDC’s TBI-related activities and products online at: http://www.cdc.gov/node.do?id=0900f3ec8000dbdc.
• Download a free copy of CDC’s “ Facts about traumatic Brain Injury” fact sheet.
• Download or order the free brochure, Facts about Concussion and Brain Injury, (in English and Spanish) online at: www.cdc.gov/ncipc/tbi/default.htm.

CDC Acute Injury Care Research Agenda: Guiding Research for the Future

CDC Acute Injury Care Research Agenda: Guiding Research for the Future

In 2003, the National Center for Injury Prevention and Control—CDC’s Injury Center—identified gaps in the area of acute injury care and updated the CDC Injury Research Agenda (2002) to clearly state CDC’s highest priorities for acute care research. That same year, the Injury Center began to update its Research Agenda by focusing on research that will ultimately make a difference in improving acute injury care systems and the care individuals receive when they are injured. After a two-year process of engaging injury care and public health experts, the revised Acute Injury Care Research Agenda was released at the National Injury Prevention and Control Conference in Denver on May 11, 2005.

Caring for the acutely injured is a public health issue. It encompasses pre-hospital care through the provision of land- or air-based emergency medical services; emergency department assessment, treatment, and stabilization of injured patients; and in-hospital care for the surgical and medical management of acute injuries among all age groups.

Implementing this Agenda will be a challenge, but improved infrastructure among our nation’s trauma systems is vital to public health. This Agenda identifies priorities and will help guide research efforts to prevent needless deaths, lessen adverse health effects from injuries, and potentially reduce the cost of medical care to the injured. The Agenda is also intended as a reference for policy makers, educators, service providers and others interested in learning more about the impact of acute injury care.

Current Research
Learn more about CDC's support of current research in acute injury care.

Order your free copy.
To order a free copy of this Acute Injury Care Research Agenda, complete the publications order form.

Download the PDF

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Acute Injury Care

Acute Injury Care

The care of the acutely injured is a public health issue that involves bystanders and community members, health care professionals, and health care systems. It encompasses prehospital emergency medical services; emergency department assessment, treatment, and stabilization; and in-hospital care surgery and medical management among all age groups. The importance of acute injury care became increasingly clear in the aftermath of the events of 9/11 and subsequent mass casualty events.

Because CDC recognizes that injuries continue to occur, despite our best efforts at prevention, the Division of Injury Response (DIR) at CDC’s Injury Center seeks to improve outcomes for those who have survived severe injuries and to improve acute injury care practices. To meet this challenge, DIR works with national and international organizations spanning the continuum of injury prevention and acute injury care, including those responsible for emergency medical services and emergency medicine and trauma surgery, other public health organizations, other federal agencies, and the corporate sector.

Playground Injuries: Fact Sheet

Overview

Each year in the United States, emergency departments treat more than 200,000 children ages 14 and younger for playground-related injuries (Tinsworth 2001).

Occurrence and Consequences

• About 45% of playground-related injuries are severe—fractures, internal injuries, concussions, dislocations, and amputations (Tinsworth 2001).
  

• About 75% of nonfatal injuries related to playground equipment occur on public playgrounds (Tinsworth 2001). Most occur at schools and daycare centers (Phelan 2001).
  

• Between 1990 and 2000, 147 children ages 14 and younger died from playground-related injuries. Of them, 82 (56%) died from strangulation and 31 (20%) died from falls to the playground surface. Most of these deaths (70%) occurred on home playgrounds (Tinsworth 2001).

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Cost

In 1995, playground-related injuries among children ages 14 and younger cost an estimated $1.2 billion (Office of Technology Assessment 1995).

Groups at Risk

• While all children who use playgrounds are at risk for injury, girls sustain injuries (55%) slightly more often than boys (45%) (Tinsworth 2001).

• Children ages 5 to 9 have higher rates of emergency department visits for playground injuries than any other age group. Most of these injuries occur at school (Phelan 2001).

Risk Factors

• On public playgrounds, more injuries occur on climbers than on any other equipment (Tinsworth 2001).
  
• On home playgrounds, swings are responsible for most injuries (Tinsworth 2001).
  
• A study in New York City found that playgrounds in low-income areas had more maintenance-related hazards than playgrounds in high-income areas. For example, playgrounds in low-income areas had significantly more trash, rusty play equipment, and damaged fall surfaces (Suecoff 1999).

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References

Mack MG, Sacks JJ, Thompson D. Testing the impact attenuation of loose fill playground surfaces. Injury Prevention 2000;6:141–4.

Office of Technology Assessment, U.S. Congress. Risks to Students in School. Washington (DC): U.S. Government Printing Office; 1995.

Phelan KJ, Khoury J, Kalkwarf HJ, Lanphear BP. Trends and patterns of playground injuries in United States children and adolescents. Ambulatory Pediatrics 2001;1(4):227–33.

Suecoff SA, Avner JR, Chou KJ, Crain EF. A Comparison of New York City Playground Hazards in High- and Low-Income Areas. Archives of Pediatrics & Adolescent Medicine 1999;153:363–6.

Tinsworth D, McDonald J. Special Study: Injuries and Deaths Associated with Children’s Playground Equipment. Washington (DC): U.S. Consumer Product Safety Commission; 2001.

Poisoning in the United States: Fact Sheet

Overview

A poison is any substance that is harmful to your body when ingested (eaten), inhaled (breathed), injected, or absorbed through the skin. Any substance can be poisonous if enough is taken. This definition does not include adverse reactions to medications taken correctly.

Poisonings are either intentional or unintentional. If the person taking or giving a substance did not mean to cause harm, then it is an unintentional poisoning. Unintentional poisoning includes the use of drugs or chemicals for recreational purposes in excessive amounts, such as an “overdose.” It also includes the excessive use of drugs or chemicals for nonrecreational purposes, such as by a toddler. Intentional poisoning is the result of a person taking or giving a substance with the intention of causing harm. Suicide and assault by poisoning fall into this category. When the distinction between intentional and unintentional is unclear, poisonings are usually labeled “undetermined” in intent.

Information about both lead and carbon monoxide poisoning can be found on other CDC web pages; see sources of additional information for the relevant websites. Statistics below include poisoning from all substances, including lead and carbon monoxide.

Occurrence

Unintentional

• In 2005, 23,618 (72%) of the 32,691 poisoning deaths in the United States were unintentional, and 3,240 (10%) were of undetermined intent (CDC 2008). Unintentional poisoning death rates have been rising steadily since 1992.
• Unintentional poisoning was second only to motor vehicle crashes as a cause of unintentional injury death in 2005 (CDC 2008). Among people 35 to 54 years old, unintentional poisoning caused more deaths than motor vehicle crashes.
• In 2006, unintentional poisoning caused about 703,702 emergency department (ED) visits (CDC 2008).
• Almost 25% of these unintentional ED visits resulted in hospitalization or transfer to another facility (CDC 2008).
• In 2006, poison control centers reported about two million unintentional poisoning or poison exposure cases (Bronstein et al. 2007).

Intentional

• In the United States in 2005, 5,833 (18%) of the 32,691 poisoning deaths were intentional; 5,744 were suicides and 89 were homicides (CDC 2008).
• In 2006, intentional poisoning led to about 220,924 emergency department (ED) visits; 216,358 involved self-harm and 3,982 were assaults (CDC 2008).
  • Among the self-harm poisoning ED visits, 162,096 (75%) resulted in hospitalization or transfer to another facility.
• Self-harm poisoning was the second-leading cause of ED visits for intentional injury in 2006 (CDC 2008).
• That same year, poison control centers reported 198,578 cases where the reason for poison exposure was a suspected suicide attempt (Bronstein et al. 2007).

Most common poisons

Unintentional

• In 2004, 95% of unintentional and undetermined poisoning deaths were caused by drugs (WONDER 2007). Opioid pain medications were most commonly involved, followed by cocaine and heroin (Paulozzi et al. 2006).
• Among those treated in EDs for nonfatal poisonings involving intentional, nonmedical use (such as misuse or abuse) of prescription or over-the-counter drugs in 2004, opioid pain medications and benzodiazepines were used most frequently (SAMHSA 2006).

Intentional

• In 2004, 75% of poisoning suicides were caused by drugs—both legal and illegal. The most commonly used drugs identified in drug-related suicides were psychoactive drugs, such as sedatives and antidepressants, followed by opiates and prescription pain medications (WONDER 2007).
• Most (93%) nonfatal, poison-related suicide attempts involved pharmaceuticals. Among the 132,582 drug-related suicide attempts in the United States in 2005, sedatives and hypnotics, pain medications, and antidepressants were the most common drugs taken. Among pain medications, opioids were the most widely used, while benzodiazepines were the most common sedatives (SAMHSA 2007).

Costs

• In 2000, poisonings led to $26 billion in medical expenses and made up 6% of the economic costs of all injuries in the United States.
• Males accounted for 75% of the total costs of poisoning injuries ($19 billion).
• Females accounted for 25% of the total costs of poisoning injuries (almost $7 billion) (Finkelstein et al. 2006).

Groups at Risk

Unintentional

Among those who died from unintentional poisoning in 2005:

• men were 2.1 times more likely than women;
• Native Americans had the highest death rate;
• whites and blacks had comparable rates;
• the peak age was 45-49 years of age; and
• the lowest mortality rates were among children less than 15 years old (CDC 2008).

Among people who unintentionally poisoned themselves, received treatment in emergency departments and survived in 2006:

• men were 1.5 times more likely than women;
• the highest rates were in the 40-49 year old age group (CDC 2008).

Intentional

Among those who committed suicide by poisoning in 2005:

• men were 1.3 times more likely than women;
• whites were 3.6 times more likely than blacks; and
• the peak age was 45-49 years old (CDC 2008).

Among those who intentionally harmed themselves with poison, received treatment in emergency departments, and survived in 2006:

• women were 1.6 times more likely than men; and
• the peak age was 15-19 years old, with a secondary peak in the 40-44 age group (CDC 2008).

Sources of Additional Information

Organizations

American Association of Poison Control Centers, Inc. *

National Center for Environmental Health: Carbon monoxide poisoning

National Center for Environmental Health: Lead Poisoning Prevention Program

Substance Abuse and Mental Health Services Administration

Publications

Centers for Disease Control and Prevention. Unintentional and undetermined poisoning deaths -– 11 states, 1990-2001. MMWR 2004;53:233-8.

Centers for Disease Control and Prevention. Nonfatal, unintentional medication exposures among young children --- United States, 2001—2003. MMWR 2006;55:1-5.

Centers for Disease Control and Prevention. Unintentional poisoning deaths --- United States, 1999—2004. MMWR 2007;56:93-96.

References

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2008) [cited 2008 Feb 19]. Available from URL: www.cdc.gov/ncipc/wisqars.

Centers for Disease Control and Prevention. Wide-ranging OnLine Data for Epidemiologic Research (WONDER) [online]. (2007) [cited 2008 Feb 19]. Available from URL: http://wonder.cdc.gov/mortsql.html.

Finkelstein E, Corso P, Miller T. The incidence and economic costs of injury in the United States. New York: Oxford University Press; 2006.

Bronstein AC, Spyker DA, Cantilena LR, Green G, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS). Clinical Toxicology 2007;45:815-917.

Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology and Drug Safety 2006;15:618-27.

Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies. Drug Abuse Warning Network, 2005: national estimates of drug-related emergency department visits. DAWN Series D-29, DHHS Publication No. (SMA) 07-4256. Rockville, MD, 2007.

Water-Related Injuries: Fact Sheet

How big is the problem?

• In 2005, there were 3,582 fatal unintentional drownings in the United States, averaging ten deaths per day. An additional 710 people died, from drowning and other causes, in boating-related incidents.^{1, 2}



• More than one in four fatal drowning victims are children 14 and younger.¹ For every child who dies from drowning, another four received emergency department care for nonfatal submersion injuries.¹



• Nonfatal drownings can cause brain damage that may result in long-term disabilities including memory problems, learning disabilities, and permanent loss of basic functioning (i.e., permanent vegetative state).

Who is most at risk?

• Males: In 2005, males were four times more likely than females to die from unintentional drownings in the United States.¹

• Children: In 2005, of all children 1 to 4 years old who died, almost 30% died from drowning.¹ Although drowning rates have slowly declined,^{1, 3} fatal drowning remains the second-leading cause of unintentional injury-related death for children ages 1 to 14 years.⁴

• Minorities:
  • Between 2000 and 2005, the fatal unintentional drowning rate for African Americans across all ages was 1.3 times that of whites. For American Indians and Alaskan Natives, this rate was 1.8 times that of whites.¹
  • Rates of fatal drowning are notably higher among these populations in certain age groups. The fatal drowning rate of African American children ages 5 to 14 is 3.2 times that of white children in the same age range. For American Indian and Alaskan Native children, the fatal drowning rate is 2.4 times higher than for white children.¹
  • Factors such as the physical environment (e.g., access to swimming pools) and a combination of social and cultural issues (e.g., valuing swimming skills and choosing recreational water-related activities) may contribute to the racial differences in drowning rates. If minorities participate less in water-related activities than whites, their drowning rates (per exposure) may be higher than currently reported.⁵

What are the major risk factors?

• Lack of barriers and supervision. Children under one year most often drown in bathtubs, buckets, or toilets.⁶ Among children ages 1 to 4 years, most drownings occur in residential swimming pools.⁶ Most young children who drowned in pools were last seen in the home, had been out of sight less than five minutes, and were in the care of one or both parents at the time.⁷ Barriers, such as pool fencing, can help prevent children from gaining access to the pool area without caregivers’ awareness.⁸



• Age and recreation in natural water settings (such as lakes, rivers, or the ocean). The percent of drownings in natural water settings increases with age. Most drownings in those over 15 years of age occur in natural water settings.⁹



• Lack of appropriate choices in recreational boating. In 2006, the U.S. Coast Guard received reports for 4,967 boating incidents; 3,474 boaters were reported injured, and 710 died. Among those who drowned, 9 out of ten were not wearing life jackets. Most boating fatalities from 2006 (70%) were caused by drowning; the remainder were due to trauma, hypothermia, carbon monoxide poisoning, or other causes. Open motor boats were involved in 45% of all reported incidents, and personal watercraft were involved in another 24%.²



• Alcohol use. Alcohol use is involved in up to half of adolescent and adult deaths associated with water recreation and about one in five reported boating fatalities.^{10, 11} Alcohol influences balance, coordination, and judgment, and its effects are heightened by sun exposure and heat.¹²



• Seizure disorders. For persons with seizure disorders, drowning is the most common cause of unintentional injury death, with the bathtub as the site of highest drowning risk.¹³

What has CDC research found?

A CDC study about self-reported swimming ability¹⁴ found that:

• Younger respondents reported greater swimming ability than older respondents;



• Self-reported ability increased with level of education (i.e., high school graduate, college graduate, etc.);



• Among racial groups, African Americans reported the most limited swimming ability; and



• Men of all ages, races, and educational levels consistently reported greater swimming ability than women.

Details about additional studies and their findings are highlighted in the Water-Related Injuries: CDC Activities fact sheet.

How can water-related injuries be prevented?

To help prevent water-related injuries:^{1, 8, 9, 12, 13}

• Designate a responsible adult to watch young children while in the bath and all children swimming or playing in or around water. Adults should not be involved in any other distracting activity (such as reading, playing cards, talking on the phone, or mowing the lawn) while supervising children.
  
  

• Always swim with a buddy. Select swimming sites that have lifeguards whenever possible.
  
  

• Avoid drinking alcohol before or during swimming, boating, or water skiing. Do not drink alcohol while supervising children.
  
  

• Learn to swim. Be aware that the American Academy of Pediatrics does not recommend swimming classes as the primary means of drowning prevention for children younger than 4. Constant, careful supervision and barriers such as pool fencing are necessary even when children have completed swimming classes.
  
  

• Learn cardiopulmonary resuscitation (CPR). In the time it might take for paramedics to arrive, your CPR skills could make a difference in someone’s life. CPR performed by bystanders has been shown to improve outcomes in drowning victims.
  
  

• Do not use air-filled or foam toys, such as “water wings”, “noodles”, or inner-tubes, in place of life jackets (personal flotation devices). These toys are not designed to keep swimmers safe.

If you have a swimming pool at home:

• Install a four-sided, isolation pool fence that completely separates the house and play area of the yard from the pool area. The fence should be at least 4 feet high. Use self-closing and self-latching gates that open outward with latches that are out of reach of children. Also, consider additional barriers such as automatic door locks or alarms to prevent access or notify you if someone enters the pool area.



• Remove floats, balls and other toys from the pool and surrounding area immediately after use. The presence of these toys may encourage children to enter the pool area or lean over the pool and potentially fall in.

If you are in or around natural bodies of water:

• Know the local weather conditions and forecast before swimming or boating. Strong winds and thunderstorms with lightning strikes are dangerous.



• Use U.S. Coast Guard approved life jackets when boating, regardless of distance to be traveled, size of boat, or swimming ability of boaters.



• Know the meaning of and obey warnings represented by colored beach flags.



• Watch for dangerous waves and signs of rip currents (e.g. water that is discolored and choppy, foamy, or filled with debris and moving in a channel away from shore). If you are caught in a rip current, swim parallel to shore; once free of the current, swim toward shore.

References

¹Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2008) [cited 2008 March 23]. Available from: URL: www.cdc.gov/ncipc/wisqars.

²U.S. Coast Guard, Department of Homeland Security (US). Boating Statistics – 2006 [online]. 2008. [cited 2008 March 26]. Available from URL: www.uscgboating.org/statistics/Boating_Statistics_2006.pdf.

³Branche CM. What is happening with drowning rates in the United States? In: Fletemeyer JR and Freas SJ, editors. Drowning: New perspectives on intervention and prevention. Boca Raton (FL): CRC Press LLC; 1999.

⁴Centers for Disease Control and Prevention. Swimming and Recreational Water Safety. In: Health Information for International Travel 2005-2006. Atlanta: US Department of Health and Human Services, Public Health Service, 2005.

⁵ Branche CM, Dellinger AM, Sleet DA, Gilchrist J, Olson SJ. Unintentional injuries: the burden, risks and preventive strategies to address diversity. In: Livingston IL, editor. Praeger handbook of Black American health (2nd edition): Policies and issues behind disparities in health. Westport (CT): Praeger Publishers; 2004. p. 317-27.

⁶ Brenner RA, Trumble AC, Smith GS, Kessler EP, Overpeck MD. Where children drown, United States, 1995. Pediatrics 2001;108(1):85–9.

⁷Present P. Child drowning study. A report on the epidemiology of drowning in residential pools to children under age five. Washington (DC): Consumer Product Safety Commission (US); 1987.

⁸U. S. Consumer Product Safety Commission. Safety barrier guidelines for home pools [online]. [cited 2007 Mar 21]. Available from URL: www.cpsc.gov/cpscpub/pubs/pool.pdf.

⁹Gilchrist J, Gotsch K, Ryan GW. Nonfatal and Fatal Drownings in Recreational Water Settings—United States, 2001 and 2002. MMWR 2004;53(21):447–52.

¹⁰Howland J, Mangione T, Hingson R, Smith G, Bell N. Alcohol as a risk factor for drowning and other aquatic injuries. In: Watson RR, editor. Alcohol and accidents. Drug and alcohol abuse reviews. Vol 7. Totowa (NJ): Humana Press, Inc.; 1995.

¹¹Howland J, Hingson R. Alcohol as a risk factor for drownings: A review of the literature (1950–1985). Accident Analysis and Prevention 1988;20(1):19–25.

¹²Smith GS, Kraus JF. Alcohol and residential, recreational, and occupational injuries: A review of the epidemiologic evidence. Annual Rev of Public Health 1988;9:99–121.

¹³Quan L, Bennett E, Branche C. Interventions to prevent drowning. In Doll L, Bonzo S, Mercy J, Sleet D (Eds). Handbook of injury and violence prevention. New York: Springer, 2007

¹⁴ Gilchrist J, Sacks JJ, Branche CM. Self-reported swimming ability in U.S. adults, 1994. Public Health Reports 2000;115(2–3):110–1.

Teen Drivers: Fact Sheet

Motor vehicle crashes are the leading cause of death for U.S. teens, accounting for more than one in three deaths in this age group.¹ In 2005, twelve teens ages 16 to 19 died every day from motor vehicle injuries.

How big is the problem, and what are the costs?

Who is most at risk?

What are the major risk factors?

How can motor vehicle injuries be prevented?

How big is the problem, and what are the costs?

In the United States during 2005, 4,544 teens ages 16 to 19 died of injuries caused by motor vehicle crashes. In the same year, nearly 400,000 motor vehicle occupants in this age group sustained nonfatal injuries that required treatment in an emergency department.¹ Overall, in 2005, teenagers accounted for 10 percent of the U.S. population and 12 percent of motor vehicle crash deaths.²

Young people ages 15-24 represent only 14% of the U.S. population. However, they account for 30% ($19 billion) of the total costs of motor vehicle injuries among males and 28% ($7 billion) of the total costs of motor vehicle injuries among females.²

Who is most at risk?

The risk of motor vehicle crashes is higher among 16- to 19-year-olds than among any other age group. In fact, per mile driven, teen drivers ages 16 to 19 are four times more likely than older drivers to crash.³

Among teen drivers, those at especially high risk for motor vehicle crashes are:

• Males: In 2005, the motor vehicle death rate for male drivers and passengers ages 16 to 19 was more than one and a half times that of their female counterparts.¹
• Teens driving with teen passengers: The presence of teen passengers increases the crash risk of unsupervised teen drivers. This risk increases with the number of teen passengers.⁴
• Newly licensed teens: Crash risk is particularly high during the first year that teenagers are eligible to drive.³

What are the major risk factors?

• Teens are more likely than older drivers to underestimate dangerous situations or not be able to recognize hazardous situations.⁵
• Teens are more likely than older drivers to speed and allow shorter headways (the distance from the front of one vehicle to the front of the next). The presence of male teenage passengers increases the likelihood of this risky driving behavior.⁶
• Among male drivers between 15 and 20 years of age who were involved in fatal crashes in 2005, 38% were speeding at the time of the crash and 24% had been drinking.^7,8
• Compared with other age groups, teens have the lowest rate of seat belt use. In 2005, 10% of high school students reported they rarely or never wear seat belts when riding with someone else.⁹ In a national survey of seat belt use among high school students:

  Male high school students (12.5%) were more likely than female students (7.8%) to rarely or never wear seat belts.⁹

  African-American students (13.4%) and Hispanic students (10.6%) were more likely than white students (9.4%) to rarely or never wear seat belts.⁹

• At all levels of blood alcohol concentration (BAC), the risk of involvement in a motor vehicle crash is greater for teens than for older drivers.³
• In 2005, 23% of drivers ages 15 to 20 who died in motor vehicle crashes had a BAC of 0.08 g/dl or higher.⁸
• In a national survey conducted in 2005, nearly three out of ten teens reported that, within the previous month, they had ridden with a driver who had been drinking alcohol. One in ten reported having driven after drinking alcohol within the same one-month period.⁹
• In 2005, three out of four teen drivers killed in motor vehicle crashes after drinking and driving were not wearing a seat belt.⁹
• In 2005, half of teen deaths from motor vehicle crashes occurred between 3 p.m. and midnight and 54% occurred on Friday, Saturday, or Sunday.³

How can motor vehicle injuries be prevented?

There are proven methods to helping teens become safer drivers. Research suggests that the most comprehensive graduated drivers licensing (GDL) programs are associated with reductions of 38% and 40% in fatal and injury crashes, respectively, among 16-year-old drivers.¹

Graduated driver licensing (GDL) systems are designed to delay full licensure while allowing teens to get their initial driving experience under low-risk conditions. For more information about GDL systems, see the Teens Behind the Wheel: Graduated Drivers Licensing fact sheet.

When parents know their state’s GDL laws, they can help enforce the laws and, in effect, help keep their teen drivers safe.

Resources

Graduated Drivers Licensing Toolkit (order a copy online here) In this Healthy States tool kit, users can find out more about GDL systems, why GDL laws are needed, and what state legislators can do to improve state GDL laws.

Graduated Drivers Licensing Fact Sheets (From the 2007 International Symposium on Novice Teen Driving: GDL and Beyond)
The National Safety Council, with sponsorship from the CDC, the National Highway Traffic Safety Administration (NHTSA), the GEICO Foundation, Nationwide Insurance, General Motors Corporation, and State Farm Insurance, held the second International Symposium on Novice Teen Driving in February 2007. These fact sheets summarize the current scientific findings on Graduated Driver Licensing that were presented at the Symposium in February. Information in the fact sheets is based on papers written by Symposium presenters and published in the April 2007 GDL Special Issue of the Journal of Safety Research.

The Guide to Community Preventive Services
This online guide offers recommendations about motor vehicle injury prevention issued by the Task Force on Community Preventive Services.

References

¹Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2008). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available from: URL: www.cdc.gov/ncipc/wisqars. [Cited 2008 Mar 14].

²Finkelstein EA, Corso PS, Miller TR, Associates. Incidence and Economic Burden of Injuries in the United States. New York: Oxford University Press; 2006.

³Insurance Institute for Highway Safety (IIHS). Fatality facts: teenagers 2005. Arlington (VA): The Institute; 2006 [cited 2006 Dec 1].

⁴Chen L, Baker SP, Braver ER, Li G. Carrying passengers as a risk factor for crashes fatal to 16- and 17-year old drivers. JAMA 2000;283(12):1578–82.

⁵Jonah BA, Dawson NE. Youth and risk: age differences in risky driving, risk perception, and risk utility. Alcohol, Drugs and Driving 1987;3:13–29.

⁶Simons-Morton B, Lerner N, Singer J. The observed effects of teenage passengers on the risky driving behavior of teenage drivers. Accident Analysis and Prevention

⁷National Highway Traffic Safety Administration (NHTSA), Dept. of Transportation (US). Traffic safety facts 2005: speeding. Washington (DC): NHTSA; 2006a [cited 2008 March 28]. Available from: URL: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSF2005/SpeedingTSF05.pdf.

⁸National Highway Traffic Safety Administration (NHTSA), Dept. of Transportation (US). Traffic safety facts 2005: young drivers. Washington (DC): NHTSA; 2006b [cited 2008 March 28]. Available from: URL: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSF2005/YoungDriversTSF05.pdf.

⁹Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 2005 [Online]. (2006b). National Center for Chronic Disease Prevention and Health Promotion (producer). Available from: URL: http://apps.nccd.cdc.gov/yrbss/CategoryQuestions.asp?cat=1&desc=Unintentional Injuries and Violence.* [Cited 2006 Nov 28].

* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links

Impaired Driving

Featured Observance National Drunk and Drugged Driving Prevention Month

• Impaired Driving navigation

• How big is the problem?
• Who is at risk?
• How can deaths and injuries be prevented?
• What are CDC’s research and program activities in this area?

Every day, 36 people in the United States die, and approximately 700 more are injured, in motor vehicle crashes that involve an alcohol-impaired driver.^{1, 2} The annual cost of alcohol-related crashes totals more than $51 billion.³ But there are effective measures that can help prevent injuries and deaths from alcohol-impaired driving.

How big is the problem?

• In 2006, 13,470 people died in alcohol-impaired driving crashes, accounting for nearly one-third (32%) of all traffic-related deaths in the United States.¹
• In 2007, over 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics.⁴ That's less than one percent of the 159 million self-reported episodes of alcohol-impaired driving among U.S. adults each year.⁵
• Drugs other than alcohol (e.g., marijuana and cocaine) are involved in about 18% of motor vehicle driver deaths. These other drugs are generally used in combination with alcohol.⁶
• Half of the 306 child passengers ages 14 and younger who died in alcohol-related crashes in 2006 were riding with drivers who had a BAC level of .08 or higher.¹
• In 2006, 45 children age 14 years and younger who were killed as pedestrians or bicyclists were hit by alcohol-impaired drivers.¹

Who is at risk?

• Males: Male drivers involved in fatal motor vehicle crashes are almost twice as likely as female drivers to be intoxicated with a blood alcohol concentration (BAC) of 0.08% or greater.¹ It is illegal to drive with a BAC of 0.08% or higher in all 50 states, the District of Columbia and Puerto Rico.
• Young people:
  • At all levels of BAC, the risk of being involved in a crash is greater for young people than for older people.⁷ In 2006, 19% of drivers ages 16 to 20 who died in motor vehicle crashes had been drinking alcohol.¹
  • Young men ages 18 to 20 (under the legal drinking age) reported driving while alcohol-impaired more than any other age group. ^4,8
  • Of the 1,746 traffic fatalities among children ages 0 to 14 years in 2006, about one out of every six (17%) involved an alcohol-impaired driver.¹
• Motorcyclists:
  • Nearly half of the alcohol-impaired motorcyclists killed each year are 40 or older, and motorcyclists ages 40-44 have the highest percentage of fatalities with BACs of 0.08% or greater.⁹
  • Among drivers killed in fatal crashes, 30% have BACs of 0.08% or greater.⁹
• Drivers with prior driving while impaired (DWI) convictions: Among drivers involved in fatal crashes, those with BAC levels of 0.08% or higher were eight times more likely to have a prior conviction for DWI than were drivers who had not consumed alcohol.¹

How can deaths and injuries from impaired driving be prevented?

Effective measures include:

• Aggressively enforcing existing 0.08% BAC laws, minimum legal drinking age laws, and zero tolerance laws for drivers younger than 21 years old in all states.^4,8
• Promptly revoking the driver's licenses of people who drive while intoxicated.¹⁰
• Utilizing sobriety checkpoints.¹¹
• Implementing health promotion efforts that use an ecological framework to influence economic, organizational, policy, and school/community action.^12,13
• Using multi-faceted community-based approaches to alcohol control and DUI prevention.^10,14
• Requiring mandatory substance abuse assessment and treatment for driving-under-the-influence offenders.¹⁵

Other suggested measures include:

• Reducing the legal limit for blood alcohol concentration (BAC) to 0.05%.^16,17
• Raising state and federal alcohol excise taxes.¹⁷
• Implementing compulsory blood alcohol testing when traffic crashes result in injury.¹⁷

What are CDC’s research and program activities in this area?

Actions to decrease alcohol-related fatal crashes involving young drivers have been effective
Over the past 20 years, alcohol-related fatal crash rates have decreased by 60 percent for drivers ages 16 to 17 years and 55 percent for drivers ages 18 to 20 years, according to a study from the Centers for Disease Control and Prevention (CDC). However, this progress has stalled in the past few years. To further decrease alcohol-related fatal crashes among young drivers, communities need to implement and enforce strategies that are known to be effective, such as minimum legal drinking age laws and "zero tolerance" laws for drivers under 21 years of age.

Related article:

Elder RW, Shults RA. Involvement of young drivers in fatal alcohol-related motor vehicle crashes - United States, 1982-2001. MMWR 2002;51:1089-91.

Sobriety checkpoints reduce alcohol-related crashes
Fewer alcohol-related crashes occur when sobriety checkpoints are implemented, according to a CDC report published in the December 2002 issue of Traffic Injury Prevention. Sobriety checkpoints are traffic stops where law enforcement officers systematically select drivers to assess their level of alcohol impairment. The goal of these interventions is to deter alcohol-impaired driving by increasing drivers’ perceived risk of arrest. The conclusion that they are effective in reducing alcohol-related crashes is based on a systematic review of research about sobriety checkpoints. The review was conducted by a team of experts led by CDC scientists, under the oversight of the Task Force on Community Preventive Services—a 15-member, non-federal group of leaders in various health-related fields. (Visit www.thecommunityguide.org * for more information.) The review combined the results of 23 scientifically-sound studies from around the world. Results indicated that sobriety checkpoints consistently reduced alcohol-related crashes, typically by about 20 percent. The results were similar regardless of how the checkpoints were conducted, for short-term "blitzes," or when checkpoints were used continuously for several years. This suggests that the effectiveness of checkpoints does not diminish over time.

Related article:

Elder RW, Shults RA, Sleet DA, Nichols JL, Zaza S, Thompson RS. Effectiveness of sobriety checkpoints for reducing alcohol-involved crashes. Traffic Injury Prevention 2002;3:266-74.

Stronger state DUI prevention activities may reduce alcohol-impaired driving
Strong state activities designed to prevent driving under the influence (DUI), including legislation, enforcement, and education, may reduce the incidence of drinking and driving, according to a study from the Centers for Disease Control and Prevention (CDC). For the study, which was published in the June 2002 issue of Injury Prevention, CDC analyzed data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) national telephone survey, and the Mothers Against Drunk Driving (MADD) Rating the States 2000 survey, that graded states on their DUI countermeasures from 1996-1999. Results showed that residents of states with a MADD grade of "D" were 60 percent more likely to report alcohol-impaired driving than were residents from states with a MADD grade of "A." MADD based the grades on 11 categories of prevention measures, including DUI legislation; political leadership; statistics and records availability; resources devoted to enforcing DUI laws; administrative penalties and criminal sanctions; regulatory control and alcohol availability; youth DUI legislation; prevention and education; and victim compensation and support.

The study also found that 4 percent of the residents who consume alcohol reported they had driven after having too much to drink at least once during the previous month. Men were nearly three times as likely as women to report alcohol-impaired driving, and single people were about 50 percent more likely to report alcohol-impaired driving than married people or those living with a partner.

Related article:

Shults RA, Sleet DA, Elder RW, Ryan GW, Sehgal M. Association between state-level drinking and driving countermeasures and self-reported alcohol-impaired driving. Injury Prevention 2002;8:106-10.

Research identifies effective interventions against alcohol-impaired driving
CDC and the Task Force on Community Preventive Services—an independent, nonfederal panel of community health experts—published systematic reviews of the literature for eight community-based interventions to reduce alcohol-impaired driving. The reviews revealed strong evidence of effectiveness for 0.08% blood alcohol concentration (BAC) laws, minimum legal drinking age laws, sobriety checkpoints, and mass media campaigns (under certain conditions). They also found sufficient evidence of effectiveness for lower BAC laws specific to young or inexperienced drivers (zero tolerance laws), school-based education programs to reduce riding with a drinking driver, and intervention training programs for alcohol servers. They found insufficient evidence of effectiveness to recommend the use of designated driver programs.

The systematic review of the effectiveness of 0.08% BAC laws for drivers was helpful in establishing a 0.08% standard nationwide. The review revealed that state laws that lowered the illegal BAC for drivers from 0.10% to 0.08% reduced alcohol-related fatalities by a median of 7 percent, translating to 500 lives saved annually. With this evidence, the Task Force on Community Preventive Services strongly recommended that all states pass 0.08% BAC laws. In October 2000, the President signed the Fiscal Year 2001 transportation appropriations bill, requiring states to pass the 0.08% BAC law by October 2003 or risk losing federal highway construction funds. As of October 1, 2003, 45 states and the District of Columbia had enacted 0.08% BAC legislation.

In June 2001, Tommy G. Thompson, Secretary of the Department of Health and Human Services, awarded the Secretary’s Award for Distinguished Service to the CDC researchers who conducted systematic reviews for their contribution to the field. In September 2006, Mothers Against Drunk Driving (MADD) presented the Ralph W. Hingson Research in Practice National President’s Award to the CDC research team to recognize their important contributions to reducing alcohol impaired driving.

Related articles:

Elder RW, Nichols JL, Shults RA, et al. Effectiveness of school-based health promotion programs for reducing drinking and driving and alcohol-involved crashes: a systematic review. American Journal of Preventive Medicine 2005;28(5S):288-304.

Ditter S, Elder RW, Shults RA, et al. Effectiveness of designated driver programs for reducing drinking and driving and alcohol-involved crashes: a systematic review. American Journal of Preventive Medicine 2005;28(5S):280-7.

Elder RW, Shults RA, Sleet DA, et al. Effectiveness of mass media campaigns for reducing drinking and driving and alcohol-involved crashes. American Journal of Preventive Medicine 2004;27;57-65.

Elder RW, Shults RA, Sleet DA, et al. Effectiveness of sobriety checkpoints for reducing alcohol-involved crashes. Traffic Injury Prevention 2002;3:266-74.

Shults RA, Elder RW, Sleet DA, Nichols JL, Alao MA, Carande-Kulis VG, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving [published erratum appears in American Journal of Preventive Medicine 2002;23:72]. American Journal of Preventive Medicine 2001;21(4S):66-88.

References

¹Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts 2006: Alcohol-Impaired Driving. Washington (DC): NHTSA; 2008 [cited 2008 Oct 22]. Available at URL: http://www-nrd.nhtsa.dot.gov/Pubs/810801.PDF

²Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts 2005: Alcohol. Washington (DC): NHTSA; 2007 [cited 2008 Nov 5]. Available at URL: http://www-nrd.nhtsa.dot.gov/Pubs/810616.PDF

³Blincoe L, Seay A, Zaloshnja E, Miller T, Romano E, Luchter S, et al. The Economic Impact of Motor Vehicle Crashes, 2000. Washington (DC): Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA); 2002. Available at URL: http://www.nhtsa.dot.gov/staticfiles/DOT/NHTSA/Communication & Consumer Information/Articles/Associated Files/EconomicImpact2000.pdf

⁴Department of Justice (US), Federal Bureau of Investigation (FBI). Crime in the United States 2007: Uniform Crime Reports. Washington (DC): FBI; 2008 [cited 2008 Nov 5]. Available at URL: http://www.fbi.gov/ucr/cius2007/data/table_29.html

⁵Quinlan KP, Brewer RD, Siegel P, Sleet DA, Mokdad AH, Shults RA, Flowers N. Alcohol-impaired driving among U.S. adults, 1993-2002. American Journal of Preventive Medicine 2005;28(4(:346-350.

⁶Jones RK, Shinar D, Walsh JM. State of knowledge of drug-impaired driving. Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA); 2003. Report DOT HS 809 642.

⁷Zador PL, Krawchuk SA, Voas RB. Alcohol-related relative risk of driver fatalities and driver involvement in fatal crashes in relation to driver age and gender: an update using 1996 data. Journal of Studies on Alcohol 2000;61:387-95.

⁸Shults RA, Sleet DA, Elder RW, Ryan GW, Sehgal M. Association between state-level drinking and driving countermeasures and self-reported alcohol-impaired driving. Inj Prev 2002;8:106—10.

⁹Paulozzi LJ, Patel R. Changes in motorcycle crash mortality rates by blood alcohol concentration and age — United States, 1983 - 2003. MMWR 2004;53(47):1103-6.

¹⁰DeJong W. Hingson R. Strategies to reduce driving under the influence of alcohol. Annual Review of Public Health 1998;19:359-78.

¹¹Elder RW, Shults RA, Sleet DA, et al. Effectiveness of sobriety checkpoints for reducing alcohol-involved crashes. Traffic Injury Prevention 2002;3:266-74.

¹²Howat, P, Sleet, D, Elder, R, Maycock, B. Preventing Alcohol-related traffic injury: a health promotion approach. Traffic Injury Prevention, 2004;5:208-219.

¹³Hingson, R, Sleet, DA. Modifying alcohol use to reduce motor vehicle injury. In Gielen, Ac, Sleet, DA, DiClemente, R (Eds). Injury and Violence Prevention: Behavior change Theories, Methods, and Applications. San Francisco, CA: Jossey-Bass, 2006.

¹⁴Holder HD, Gruenewald PJ, Ponicki WR, Treno AJ, Grube JW, Saltz RF, et al. Effect of community-based interventions on high-risk drinking and alcohol-related injuries. Journal of the American Medical Association 2000;284:2341-7.

¹⁵Wells-Parker E, Bangert-Drowns R, McMillen R, Williams M. Final results from a meta-analysis of remedial interventions with drink/drive offenders. Addiction 1995;90:907-26.

¹⁶Howat P, Sleet D, Smith I. Alcohol and driving: is the .05% blood alcohol concentration limit justified? Drug and Alcohol Review 1991;10(1):151-66.

¹⁷National Committee on Injury Prevention and Control. Injury prevention: meeting the challenge. American Journal of Preventive Medicine 1989;5(3 Suppl):123-7.

* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

Child Passenger Safety: Fact Sheet

Child Passenger Safety: Fact Sheet

Featured Observance

National Child Passenger Safety Week

Motor vehicle injuries are the leading cause of death among children in the U.S.¹ But many of these deaths can be prevented. Placing children in age- and size-appropriate car seats and booster seats reduces serious and fatal injuries by more than half.²

How big is the problem?

What are the risk factors?

How can injuries to children in motor vehicles be prevented?

What are CDC’s research and program activities in this area?

Podcasts on Child Passenger Safety

How big is the problem?

• In the United States during 2005, 1,335 children ages 14 years and younger died as occupants in motor vehicle crashes, and approximately 184,000 were injured. That’s an average of 4 deaths and 504 injuries each day.²
• Among children under age 5, in 2006, an estimated 425 lives were saved by car and booster seat use.²

What are the risk factors?

• One out of four occupant deaths among children ages 0 to 14 years involved a drinking driver.³ More than two-thirds of these fatally injured children were riding with a drinking driver.⁴
• Restraint use among young children often depends upon the driver’s seat belt use. Almost 40% of children riding with unbelted drivers were themselves unrestrained.⁵
• Child restraint systems are often used incorrectly. One study found that 72% of nearly 3,500 observed car and booster seats were misused in a way that could be expected to increase a child’s risk of injury during a crash.⁶

How can injuries to children in motor vehicles be prevented?

• Child safety seats reduce the risk of death in passenger cars by 71% for infants, and by 54% for toddlers ages 1 to 4 years.²
• There is strong evidence that child safety seat laws, safety seat distribution and education programs, community-wide education and enforcement campaigns, and incentive-plus-education programs are effective in increasing child safety seat use.⁷
• The National Highway Traffic Safety Administration recommends booster seats for children until they are at least 8 years of age or 4'9" tall.⁸
• According to researchers at the Children's Hospital of Philadelphia, for children 4 to 7 years, booster seats reduce injury risk by 59% compared to seat belts alone.⁹
• All children ages 12 years and younger should ride in the back seat. Adults should avoid placing children in front of airbags. Putting children in the back seat eliminates the injury risk of deployed front passenger-side airbags and places children in the safest part of the vehicle in the event of a crash.
• Overall, for children less than 16 years, riding in the back seat is associated with a 40% reduction in the risk of serious injury.¹⁰ To learn more about effective interventions to increase child safety seat use, visit CDC's Motor Vehicle Occupant Safety page.

What are CDC’s research and program activities in this area?

Child passenger restraint use and emergency department-reported injuries: A special study using the National Electronic Injury Surveillance System-All Injury Program, 2004
CDC’s Injury Center conducted a special study of the NEISS-All Injury Program for 635 injured children aged 12 years or under treated at 15 hospital emergency departments (ED) in 2004. These children all sustained injuries in motor-vehicle crashes. Multiple injury diagnoses were collected and parents of children were interviewed about motor-vehicle crash circumstances. The study found that nine percent of the children were unrestrained and 36% were inappropriately restrained.¹¹

ICARIS 2 Child Counseling Study
CDC's Injury Center researchers conducted a cross-sectional, list-assisted random-digit-dial telephone survey of randomly selected children in English or Spanish-speaking households in all 50 states and the District of Columbia. The main outcome measures were respondents’ reports that they or their children received injury-prevention counseling from their child’s health care provider in the 12 months preceding the interview, children’s practices of safety behaviors, and the association of injury-prevention counseling and such behaviors. Findings suggest that, although the prevalence of pediatric injury-prevention counseling remains low, such counseling was associated with safer behaviors.¹²

ICARIS 2 Child Restraint Study (in progress)
CDC’s Injury Center funded the Second Injury Control and Risk Survey, a nationally representative cross-sectional telephone survey conducted in all 50 states. Respondents were asked about their children’s restraint practices (ages 0-12 years) during the past 30 days. While there have been several observational studies that record restraint use at one point in time, this study is investigating whether parents are always using correct restraints or whether children are sometimes inappropriately restrained during a one-month period.

Identifying risk factors and examining outcomes for older children involved in motor vehicle crashes
CDC’s Injury Center is supporting the Children’s Hospital of Philadelphia to examine risk factors and outcomes for children younger than 16 years of age who were involved in motor vehicle crashes. Researchers are interviewing parents to learn about their typical use of child restraints and the particular restraint in use at the time of the crash. Interview questions also assess the parent’s understanding of child restraint laws in their state and explore how the motor vehicle crash has affected the child's daily life. This information will be considered with data about the types of injuries sustained in the crash, the child’s position in the car, and demographic characteristics of the child and driver. This research is part of an ongoing surveillance system that is a collaborative effort between researchers at the Children’s Hospital of Philadelphia and State Farm Insurance. The study will shed light on the impact of motor vehicle crashes on children’s daily lives. Results will be used to improve prevention strategies.

References

¹CDC. Web-based Injury Statistics Query and Reporting System [online]. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available from URL: www.cdc.gov/ncipc/wisqars. [2008 May 5].

²Department of Transportation (US), National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts 2006: Children. Washington (DC): NHTSA; 2008. [cited 2008 May 5]. Available from URL: Available from URL: http://www.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSF2005/810618.pdf.

³Department of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts 2006: Alcohol-Impaired Driving. Washington (DC): NHTSA; 2008 [cited 2008 May 5]. Available from URL: http://www.nhtsa.dot.gov/portal/site/nhtsa/
menuitem.6a6eaf83cf719ad24ec86e10dba046a0/.

⁴Shults RA. Child passenger deaths involving drinking drivers—United States, 1997−2002 [published erratum appears in MMWR 2004;53(5):109]. MMWR 2004;53(4):77–9.

⁵Cody BE, Mickalide AD, Paul HP, Colella JM. Child passengers at risk in America: a national study of restraint use. Washington (DC): National SAFE KIDS Campaign; 2002. Available from URL: http://www.usa.safekids.org/content_documents/ACFD6C.pdf

⁶Department of Transportation (US), National Highway Traffic Safety Administration (NHTSA), Traffic Safety Facts Research Note 2005: Misuse of Child Restraints: Results of a Workshop to Review Field Data Results. Washington (DC): NHTSA; 2006. Available from URL: http://www.nhtsa.dot.gov/people/injury/research/TSF_ MisuseChildRetraints/images/809851.pdf. [cited 2008 March 19]

⁷Zaza, S, Sleet DA, Thompson RS, Sosin DM, Bolen JC, Task Force on Community Preventive Services. Reviews of evidence regarding interventions to increase the use of child safety seats. American Journal of Preventive Medicine 2001 : 21 (4S), 31-47.

⁸Department of Transportation (US), National Highway Traffic Safety Administration (NHTSA). BoosterSeat.gov. Washington (DC): NHTSA; 2006. Available from URL: http://www.nhtsa.dot.gov/portal/site/nhtsa/menuitem.
9f8c7d6359e0e9bbbf30811060008a0c/. [cited 2008 May 16]

⁹Durbin DR, Elliott MR, Winston FK. Belt-positioning booster seats and reduction in risk of injury among children in vehicle crashes. JAMA 2003;289(14):2835–40.

¹⁰Durbin DR, Chen I, Smith R, Elliott MR, Winston FK. Effects of seating position and appropriate restraint use on the risk of injury to children in motor vehicle crashes. Pediatrics 2005;115:305-9.

¹¹Lee K, Shults RA, Greenspan AI, Haileyesus T, Dellinger A. Child passenger restraint use and emergency department-reported injuries: a special study using the National Electronic Injury Surveillance System- All Injury Program, 2004. Journal of Safety Research 2008. 39; 25-31.

¹²Chen J, Kresnow M, Simon TR, Dellinger A. Injury Prevention Counseling and Behavior Among US Children: Results from the Second Injury Control and Risk Survey. Pediatrics 2007. 119(4): e958-65.

* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.