Risk and Protective Factors for Tribal Road Safety

Key points

  • People at increased risk include children and men.
  • Behaviors that increase risk include low seat belt use, low car seat and booster seat use, and impaired driving.
  • American Indian and Alaska Native communities have innate strengths and resilience rooted in tribal culture and traditional ways of life.

People at increased risk

Children

American Indian and Alaska NativeA children experience the highest unintentional injury death rates among all racial and ethnic groups in the United States. Motor vehicle traffic death rates among American Indian and Alaska Native children and youth ages 0–19 years were up to 8 times as high as those of other racial and ethnic groups.1

Men

In general, motor vehicle traffic death rates are higher among men than women. American Indian and Alaska Native people are at increased risk for injury, but American Indian and Alaska Native men are at especially high risk. Motor vehicle traffic death rates among American Indian and Alaska Native men ages 20 years and older are nearly twice that of women.1

Behaviors that can increase risk

  • American Indian and Alaska Native culture and traditions have been severely disrupted by colonialism, loss of land, and policies, such as assimilation, relocation, and tribal termination, resulting in historical trauma that contributes to risk factors for negative health outcomes.
  • Risk factors that contribute to higher motor vehicle crash death rates include poor safety infrastructure on roadways, as well as low restraint use (seat belt, car seat, and booster seat use) and high rates of impaired driving.

Low seat belt use

  • The overall rate of seat belt use in Indian Country was 78% in 2022 according to the Bureau of Indian Affairs Indian Highway Safety Program.2 Although belt use varies greatly across reservations,3 seat belt use in Indian Country (78%)2 on average is lower than that of the United States overall (92%).4
  • On reservations, almost 2 out of every 3 passenger vehicle occupants who died in crashes were not restrained at the time of the crash.5 In the United States overall, 1 out of every 2 occupants were not restrained.6B

Low car seat and booster seat use

  • American Indian and Alaska Native car seat and booster seat use rates are lower than that of other racial and ethnic groups.
  • Among children ages 8 years and younger who died in passenger vehicle crashes, almost half of American Indian and Alaska Native children were not restrained. In the United States overall, about a third were not restrained.B7 However, car seat and booster seat rates can vary greatly across tribal communities.89

Alcohol-impaired driving

  • American Indian and Alaska Native people have the highest alcohol-impaired driving death rates among all racial and ethnic groups.10 Alcohol-impaired driving death rates among American Indian and Alaska Native people are 2 to 11 times as high as among other racial and ethnic groups in the United States.10

Protective factors

American Indian and Alaska Native communities have innate strengths and resilience rooted in tribal culture and traditional ways of life. Communities may identify with strengths such as possessing wisdom passed down through generations, having pride in their community, sharing a sense of collective responsibility, being connected strongly to the past, and retaining or reclaiming traditional cultural practices.11 A community's strengths can be drawn upon for interventions, and they can also be protective factors against negative outcomes for individuals.111213 For example, having positive connections to family and community and having cultural beliefs valuing self-preservation are protective factors against alcohol or drug use.13

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Content Source:
National Center for Injury Prevention and Control
  1. On this webpage, statistics are reported for non-overlapping racial and ethnic groups. All people of Hispanic origin are grouped together, so, for example, statistics for American Indian and Alaska Native people and White people are for non-Hispanic persons.
  2. These percentages are based on passenger vehicle occupants for which restraint status was known.
  1. Centers for Disease Control and Prevention (CDC). WISQARS — Web-based Injury Statistics Query and Reporting System, 2018–2021 data. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2023.
  2. Bureau of Indian Affairs, Indian Highway Safety Program. FY 2022 Annual Report [PDF – 77 pages]. Albuquerque, NM: U.S. Department of the Interior, Bureau of Indian Affairs, Bureau of Indian Affairs, Office of Justice Services; 2023.
  3. Chaffe RHB, Solomon MG, Leaf WA. 2006 Seat Belt Use Estimate for Native American Tribal Reservations (Report No. DOT HS 810 967). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration; 2008.
  4. Boyle, L. Seat belt use in 2022 – Overall results (Traffic Safety Facts Research Note. Report No. DOT HS 813 407). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis; 2023.
  5. National Highway Traffic Safety Administration. Native American Traffic Safety Facts FARS 2016–2020. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis.
  6. National Center for Statistics and Analysis. Summary of motor vehicle crashes: 2020 data (Traffic Safety Facts. Report No. DOT HS 813 369). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis; 2022.
  7. National Highway Traffic Safety Administration (NHTSA). Fatality Analysis Reporting System (FARS), 2016–2020 data. Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis; November 2023.
  8. Billie H, Crump CE, Letourneau RJ, West BA. Child safety and booster seat use in five tribal communities, 2010–2014. J Safety Res. 2016; 59:113–117. Doi:10.1016/j.jsr.2016.09.002
  9. Lapidus JA, Smith NH, Lutz T, Ebel BE. Trends and correlates of child passenger restraint use in six Northwest Tribes: The Native children always ride safe (Native CARS) project. Am J Public Health. 2013;103(2);355–361. doi:10.2105/AJPH.2012.300834
  10. National Highway Traffic Safety Administration (NHTSA). Unpublished 2016–2020 data from the Fatality Analysis Reporting System (FARS). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics and Analysis; August 2023.
  11. Substance Abuse and Mental Health Services Administration (SAMHSA). Culture Card – A guide to Build Cultural Awareness: American Indian and Alaska Native [PDF – 4 pages]. Washington, DC: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, Indian Health Service, and Centers for Medicare & Medicaid Services; 2009.
  12. American Psychiatric Association. Mental Health Disparities: American Indians and Alaska Natives [PDF – 4 pages]. 2017.
  13. Indian Health Service. Protective Factors. Rockville, MD: U.S. Department of Health and Human Services, Indian Health Service.