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ORIGINAL ARTICLE |
1 Divisions of Health Policy and Clinical Effectiveness and General and Community Pediatrics, Children’s Hospital Medical Center, Cincinnati, Ohio
2 Harborview Injury Prevention and Research Center, Department of Pediatrics, University of Washington, Seattle, Washington
3 Tuba City Indian Medical Center, Navajo Area Indian Health Service, Tuba City, Arizona
4 National Center for Injury Prevention and Control, Centers for Disease Control, Atlanta, Georgia
5 Navajo Area Indian Health Service, Office of Environmental Health and Injury Prevention Program, Window Rock, Arizona
Correspondence to:
Dr Kieran J Phelan, Assistant Professor, Pediatrics, Divisions of Clinical Effectiveness and General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, TCHRF 7548, 3333 Burnet Avenue, Cincinnati, OH 45229–3039, USA;
kj.phelan{at}chmcc.org
Background: Navajo motor vehicle mortality is the highest among the 12 Indian Health Service (IHS) administrative areas. In July 1988, the Navajo Nation enacted a primary enforcement safety belt use and a child restraint law.
Objective: Assess the impact of the laws on the rate and severity of pediatric (0–19 years) motor vehicle injury resulting in hospitalizations in the Navajo Nation.
Methods: Hospitalizations associated with motor vehicle related injury discharges were identified by International Classification of Diseases, 9th revision, CM E codes, 810–825 (.0,.1) from the Navajo IHS hospital discharge database. Age specific rates for the period before the law, 1983–88, were compared with those after enactment and enforcement, 1991–95. Severity of injury, measured by the abbreviated injury scale (AIS) score and new injury severity score (NISS), was determined with ICDMAP-90 software. Wilcoxon rank sum and 
2 tests were used for analysis.
Results: Discharge rates (SE) for motor vehicle injury (per 100 000) decreased significantly in all age groups: 0–4 years (62 (7) to 28 (4)), 5–11 years (55.3 (6) to 26 (4)), and 15–19 years (139 (14) to 68 (7)); p=0.0001. In children 0–4 years, the median AIS score decreased from 1.5 (1,3) (25th, 75th centile) to 1 (1,2), p=0.06, and the median NISS decreased from 3.5 (1,9) to 2 (1,5), p=0.07. The proportion of children with NISS scores >4 decreased significantly for the 0–4 year age group (p=0.03).
Conclusions: Concurrent with enactment of the Navajo Nation occupant and child restraint laws there was a reduction in the rate of motor vehicle related hospital discharges for children. Severity of injury declined in very young Navajo children. The effect of enactment and enforcement of this Native American child occupant restraint law may serve as an example of an effective injury control effort directed at Native American children.
Keywords: Navajo Nation; Native American; motor vehicle injury; hospital discharge; pediatric; occupant restraint law
Abbreviations: AIS, abbreviated injury scale; ICD9, International Classification of Diseases, 9th revision; IHS, Indian Health Service; NISS, new injury severity score
This article has been cited by other articles:
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  J. A. Lapidus, N. H. Smith, B. E. Ebel, and F. C. Romero Restraint Use Among Northwest American Indian Children Traveling in Motor Vehicles Am J Public Health, November 1, 2005; 95(11): 1982 - 1988. [Abstract] [Full Text] [PDF]
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 D Campos-Outcalt, C Bay, A Dellapena, and M K Cota Motor vehicle crash fatalities by race/ethnicity in Arizona, 1990-96 Inj. Prev., September 1, 2003; 9(3): 251 - 256. [Abstract] [Full Text] [PDF]
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L R Berger Injury prevention and indigenous peoples Inj. Prev., September 1, 2002; 8(3): 175 - 176. [Full Text] [PDF]
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