# ![](media/image1.wmf){width="2.3986111111111112in" height="2.2930555555555556in"} {#section .Chapter-#}

# 15 {#section-1 .Chapter-#}

# Injury and Violence Prevention

Lead Agency: Centers for Disease Control and Prevention

### Contents {#contents .Heading-Special}

[Goal Page 15-3](#goal)

[Overview Page 15-3](#overview)

[Issues and Trends Page 15-3](#issues-and-trends)

[Disparities Page 15-6](#disparities)

[Opportunities Page 15-7](#opportunities)

[Interim Progress Toward Year 2000 Objectives Page
15-8](#interim-progress-toward-year-2000-objectives)

[Healthy People 2010---Summary of Objectives Page
15-9](#healthy-people-2010summary-of-objectives)

[Healthy People 2010 Objectives Page
15-11](#healthy-people-2010-objectives)

[Injury Prevention Page 15-11](#injury-prevention-1)

[Unintentional Injury Prevention Page
15-23](#unintentional-injury-prevention-1)

[Violence and Abuse Prevention Page
15-43](#violence-and-abuse-prevention-2)

[Related Objectives From Other Focus Areas Page
15-55](#related-objectives-from-other-focus-areas)

[Terminology Page 15-55](#terminology)

[References Page 15-57](#references)

## Goal

Reduce injuries, disabilities, and deaths due to unintentional injuries
and violence.

## Overview

![](media/image2.wmf){width="4.680555555555555in" height="3.74375in"}The
risk of injury is so great that most persons sustain a significant
injury at some time during their lives.[^1] Nevertheless, this
widespread human damage too often is taken for granted, in the erroneous
belief that injuries happen by chance and are the result of
unpreventable "accidents." In fact, many injuries are not "accidents,"
or random, uncontrollable acts of fate; rather, most injuries are
predictable and preventable.[^2]

### Issues and Trends

#### Injury Prevention

In 1997, 146,400 persons in the United States died from injuries due to
a variety of causes such as motor vehicle crashes, firearms, poisonings,
suffocations, falls, fires, and drownings. About 400 persons die from
injuries each day, including 55 children and teenagers. One death out of
every 17 in the United States results from injury.[^3] Of these deaths,
63 percent are classified as unintentional and 34 percent as
intentional. Unintentional injury deaths include approximately 42,000
resulting from motor vehicle crashes per year. In 1997, of approximately
50,000 intentional injury deaths, almost 31,000 were classified as
suicide and nearly 20,000 as homicide.Error: Reference source not found
In 1997, injuries accounted for 20 percent more years of potential life
lost (YPLL) than cancer did (1,990 per 100,000 compared to 1,500 per
100,000).[^4]

For ages 1 through 44 years, deaths from injuries far surpass those from
cancer---the overall leading natural cause of death at these ages---by
about three to one. Injuries cause more than two out of five deaths (43
percent) of children aged 1 through 4 years and result in four times the
number of deaths due to birth defects, the second leading cause of death
for this age group. For ages 15 to 24 years, injury deaths exceed deaths
from all other causes combined from ages 5 through 44 years. For ages 15
to 24 years, injuries are the cause of nearly four out of five deaths.
After age 44 years, injuries account for fewer deaths than other health
problems, such as heart disease, cancer, and stroke. However, despite
the decrease in the proportion of deaths due to injury, the death rate
from injuries is actually higher among older persons than among younger
persons.

Injuries often are classified on the basis of events and behaviors that
preceded them as well as the intent of the persons involved. For
example, many injuries are preceded by alcohol consumption in amounts or
circumstances that increase risk of injury.[^5] Although the events
leading to an intentional injury and an unintentional injury differ, the
outcomes and extent of the injury are similar.

#### Unintentional Injury Prevention

More persons aged 1 to 34 years die as a result of unintentional
injuries than any other cause of death. Across all ages, 92,353 persons
died in 1997 as a result of unintentional injuries. Motor vehicle
crashes account for approximately half the deaths from unintentional
injuries; other unintentional injuries rank second, and falls rank
third, followed by poisonings, suffocations, and drownings.[^6]

Additional millions of persons are incapacitated by unintentional
injuries, with many suffering lifelong disabilities. These events occur
disproportionately among young and elderly persons. In 1995, 29 million
persons visited emergency departments as a result of unintentional
injuries.[^7]

Although the greatest impact of injury is in human suffering and loss of
life, the financial cost is staggering. Included in the costs associated
with injuries are the costs of direct medi­cal care and rehabilitation as
well as lost income and produc­tivity. By the late 1990s, injury costs
were estimated at more than \$441 billion annually, an increase of 42
percent over the 1980s.[^8] As with other health problems, it costs far
less to prevent injuries than to treat them. For example:

-   Every child safety seat saves \$85 in direct medical costs and an\
    additional \$1,275 in other costs.

-   Every bicycle helmet saves \$395 in direct medical costs and other
    costs.

-   Every smoke detector saves \$35 in direct medical costs and an\
    additional \$865 in other costs.

-   Every dollar spent on poison control centers saves \$6.50 in medical
    costs.[^9]

Several themes become evident when examining reports on injury
prevention and control, including acute care, treatment, and
rehabilitation. First, unintentional injury comprises a group of complex
problems involving many different sectors of society. No single force
working alone can accomplish everything needed to reduce the number of
injuries. Improved outcomes require the combined efforts of many fields,
including health, education, transportation, law, engineering, and
safety sciences. Second, many of the factors that cause unintentional
injuries are closely associated with violent and abusive behavior.
Injury prevention and control addresses both unintentional and
intentional injuries.

#### Violence and Abuse Prevention

Violence in the United States is pervasive and can change quality of
life. Reports of children killing children in schools are shocking and
cause parents to worry about the safety of their children at school.
Reports of gang violence make persons fearful for their safety. Although
suicide rates began decreasing in the mid-1990s, prior increases among
youth aged 10 to 19 years and adults aged 65 years and older have raised
concerns about the vulnerability of these population groups. Intimate
partner violence and sexual assault threaten people in all walks of
life.

Violence claims the lives of many of the Nation's young persons and
threatens the health and well-being of many persons of all ages in the
United States. On an average day in America, 53 persons die from
homicide, and a minimum of 18,000 persons survive interpersonal
assaults, 84 persons complete suicide, and as many as 3,000 persons
attempt suicide.[^10] (See Focus Area 18. Mental Health and Mental
Disorders.)

Youth continue to be involved as both perpetrators and victims of
violence. Elderly persons, females, and children continue to be targets
of both physical and sexual assaults, which are frequently perpetrated
by individuals they know. Examples of general issues that impede the
public health response to progress in this area include the lack of
comparable data sources, lack of standardized definitions and
definitional issues, lack of resources to establish adequately
consistent tracking systems, and lack of resources to fund promising
prevention programs.

Because national data systems will not be available in the first half of
the decade for tracking progress, one subject of interest, maltreatment
of elderly persons, is not addressed in this focus area's objectives.
The maltreatment of persons aged 60 years and older is a topic for
research and data collection for the coming decade.

### Disparities

While every person is at risk for injury, some groups appear to
experience certain types of injuries more frequently. American Indians
or Alaska Natives have disproportionately higher death rates from motor
vehicle crashes, residential fires, and drownings. In addition, their
death rates are about 1.75 times higher than the death rate for the
overall U.S. population. Higher death rates from unintentional injury
also occur among African Americans.Error: Reference source not found

Certain racial and ethnic groups experience more unintentional injuries
and deaths than whites. Unintentional injuries are the second leading
cause of death for American Indian males and the third leading cause of
death for American Indian females. More than 1,000 American Indians die
from injuries, and 10,000 more are hospitalized for injuries each year.
The age-adjusted injury death rate for American Indians is three times
higher than that of all other persons in the United States. Among
American Indians, 46 percent of the YPLL is a result of injury, which is
five times greater than the YPLL due to a next highest cause, heart
disease (8 percent). Among the factors that contribute to these
increased rates for American Indians are rural or isolated living,
minimal emergency medical services, and great distances to sophisticated
trauma care.[^11]

African American, Hispanic, and American Indian children are at higher
risk than white children for home fire deaths.[^12] Adults aged 65 years
and older are at increased risk of death from fire because they are more
vulnerable to smoke inhalation and burns and are less likely to recover.
Sense impairment (such as blindness or hearing loss) may prevent older
adults from noticing a fire, and mobility impairment may prevent them
from escaping its consequences. Older adults also are less likely to
have learned fire safety behavior and prevention information, because
they grew up at a time when little fire safety was taught in schools,
and most current educational programs target children.

In every age group, drowning rates are almost two to four times greater
for males than for females.[^13] In 1997, the overall drowning rate for
African Americans was 50 percent greater than that for whites; however,
the rate was not higher for all age groups. For example, among children
aged 1 through 4 years, the drowning rate for whites was slightly higher
than the rate for African Americans. For children aged 5 to 19 years,
African American children are twice as likely to drown as white
children.[^14]

Homicide victimization is especially high among African American and
Hispanic youth. In 1995, African American males and females aged 15 to
24 years had homicide rates (74.4 per 100,000) that were more than twice
the rate of their Hispanic counterparts (34.1 per 100,000) and nearly 14
times the rate of their white non-Hispanic counterparts (5.4 per
100,000).[^15]

Trends in suicide among blacks aged 10 to 19 years in the United States
during 1980--95 indicate that suicidal behavior among all youth has
increased; however, rates for black youth have shown a greater
increase.[^16]

Although black youth historically have lower suicide rates than have
whites, during 1980--95, the suicide rate for black youth aged 10 to 19
years increased from 2.1 to 4.5 per 100,000 population. As of 1995,
suicide was the third leading cause of death among blacks aged 15 to 19
years.[^17]

### Opportunities

To reduce the number and severity of injuries, prevention activities
must focus on the type of injury---drowning, fall, fire or burn,
firearm, or motor vehicle.[^18] For example, a nonfatal spinal cord
injury produces the same outcome whether it was caused by an
unintentional motor vehicle crash or an attempted suicide.

Understanding injuries allows for development and implementation of
effective prevention interventions. Some interventions can reduce
injuries from both unintentional and violence-related episodes. For
instance, efforts to promote proper storage of firearms in homes can
help reduce the risk of assaultive, intentional self-inflicted, and
unintentional shootings in the home.[^19] Higher taxes on alcoholic
beverages are associated with lower death rates from motor vehicle
crashes and lower rates for some categories of violent crime, including
rape.[^20]^**,**^ [^21]

Many injuries and injury-related deaths occur in some population groups
(such as younger children from birth to age 4 years) where the
intentionality of the injury is unknown and requires more detailed
investigation. As these cases are examined, interventions can be
developed to address ways injuries occur---for instance, unintentional
poisonings in children or hangings among teenagers---that are emerging
in society as growing public health concerns.

Poverty, discrimination, lack of education, and lack of employment
opportunities are important risk factors for violence and must be
addressed as part of any comprehensive solution to the epidemic of
violence. Strategies for reducing violence should begin early in life,
before violent beliefs and behavioral patterns can be adopted.

Many potentially effective culturally and linguistically competent
intervention strategies for violence prevention exist, such as parent
training, mentoring, home visitation, and education.[^22] Evaluation of
ongoing programs is a major component to help identify effective
approaches for violence prevention. The public health approach to
violence prevention is multidisciplinary, encouraging experts from
scientific disciplines, organizations, and communities to work together
to find solutions to violence in the Nation.

Many school-aged children suffer disabling and fatal injuries each year.
As educational programs for school children are developed and proven
effective in preventing injuries, these programs should be included in
quality health education curricula at the appropriate grade level.
Education should aim at reducing risks of injury directly and at
preparing children to be knowledgeable adults. (See Focus Area 7.
Educational and Community-Based Programs.)

## Interim Progress Toward Year 2000 Objectives

A total of 45 objectives addressed injury prevention in Healthy People
2000. Twenty-six objectives were specific for unintentional injuries,
and 19 objectives were specific for violence prevention. By the end of
the decade, targets had been met for 11 objectives. Unintentional injury
objectives showing achievement were unintentional injury
hospitalizations, residential fire deaths, nonfatal head injuries,
spinal cord injuries, nonfatal poisonings, and pedestrian deaths.
Violence prevention objectives that met their targets were homicide,
suicide, weapon carrying by adolescents, conflict resolution in schools,
and child death review systems.

Progress was made for 13 objectives. Much of the progress made in
unintentional injury objectives was with motor vehicle fatalities and
use of vehicle occupant restraints. Those unintentional injury
objectives showing progress were unintentional injury deaths, motor
vehicle deaths, motor vehicle crash deaths, motor vehicle occupant
protection systems, helmet use by motorcyclists and bicyclists, safety
belt use laws, alcohol-related motor vehicle deaths, and drownings.
Violence prevention objectives showing progress were firearm-related
deaths, partner abuse, rape and attempted rape, physical fighting among
adolescents aged 14 to 17 years, and the number of States with firearm
storage laws.

There were six objectives with no progress or movement away from the
Healthy People 2000 targets. In unintentional injury, the
hospitalization rate for hip fractures remains above baseline levels,
indicating no progress toward the year 2000 target. Data from five
violence prevention objectives also show movement away from the year
2000 target. Those objectives relate to child abuse and neglect, assault
injuries, suicide attempts among adolescents aged 14 to 17 years,
battered women turned away from shelters, and suicide prevention
protocols in jails.

Note: Unless otherwise noted, data are from the Centers for Disease
Control and Prevention, National\
Center for Health Statistics, *Healthy People 2000 Review, 1998--99.*

## Healthy People 2010---Summary of Objectives

### Injury and Violence Prevention {#injury-and-violence-prevention-1 .Heading-Special-Sub}

**Goal:** Reduce injuries, disabilities, and deaths due to unintentional
injuries and violence.

+---------+------------------------------------------------------------+
| **N     | **Objective Short Title**                                  |
| umber** |                                                            |
+---------+------------------------------------------------------------+
| *       |                                                            |
| *Injury |                                                            |
| Preve   |                                                            |
| ntion** |                                                            |
+---------+------------------------------------------------------------+
| 15-1    | Nonfatal head injuries                                     |
+---------+------------------------------------------------------------+
| 15-2    | Nonfatal spinal cord injuries                              |
+---------+------------------------------------------------------------+
| 15-3    | Firearm-related deaths                                     |
+---------+------------------------------------------------------------+
| 15-4    | Proper firearm storage in homes                            |
+---------+------------------------------------------------------------+
| 15-5    | Nonfatal firearm-related injuries                          |
+---------+------------------------------------------------------------+
| 15-6    | Child fatality review                                      |
+---------+------------------------------------------------------------+
| 15-7    | Nonfatal poisonings                                        |
+---------+------------------------------------------------------------+
| 15-8    | Deaths from poisoning                                      |
+---------+------------------------------------------------------------+
| 15-9    | Deaths from suffocation                                    |
+---------+------------------------------------------------------------+
| 15-10   | Emergency department surveillance systems                  |
+---------+------------------------------------------------------------+
| 15-11   | Hospital discharge surveillance systems                    |
+---------+------------------------------------------------------------+
| 15-12   | Emergency department visits                                |
+---------+------------------------------------------------------------+
| *       |                                                            |
| *Uninte |                                                            |
| ntional |                                                            |
| Injury  |                                                            |
| Preve   |                                                            |
| ntion** |                                                            |
+---------+------------------------------------------------------------+
| 15-13   | Deaths from unintentional injuries                         |
+---------+------------------------------------------------------------+
| 15-14   | Nonfatal unintentional injuries                            |
+---------+------------------------------------------------------------+
| 15-15   | Deaths from motor vehicle crashes                          |
+---------+------------------------------------------------------------+
| 15-16   | Pedestrian deaths                                          |
+---------+------------------------------------------------------------+
| 15-17   | Nonfatal motor vehicle injuries                            |
+---------+------------------------------------------------------------+
| 15-18   | Nonfatal pedestrian injuries                               |
+---------+------------------------------------------------------------+
| 15-19   | Safety belts                                               |
+---------+------------------------------------------------------------+
| 15-20   | Child restraints                                           |
+---------+------------------------------------------------------------+
| 15-21   | Motorcycle helmet use                                      |
+---------+------------------------------------------------------------+
| 15-22   | Graduated driver licensing                                 |
+---------+------------------------------------------------------------+
| 15-23   | Bicycle helmet use                                         |
+---------+------------------------------------------------------------+
| 15-24   | Bicycle helmet laws                                        |
+---------+------------------------------------------------------------+
| 15-25   | Residential fire deaths                                    |
+---------+------------------------------------------------------------+
| 15-26   | Functioning smoke alarms in residences                     |
+---------+------------------------------------------------------------+
| 15-27   | Deaths from falls                                          |
+---------+------------------------------------------------------------+
| 15-28   | Hip fractures                                              |
+---------+------------------------------------------------------------+
| 15-29   | Drownings                                                  |
+---------+------------------------------------------------------------+
| 15-30   | Dog bite injuries                                          |
+---------+------------------------------------------------------------+
| 15-31   | Injury protection in school sports                         |
+---------+------------------------------------------------------------+
| #       |                                                            |
| ##### V |                                                            |
| iolence |                                                            |
|  and Ab |                                                            |
| use Pre |                                                            |
| vention |                                                            |
+---------+------------------------------------------------------------+
| 15-32   | Homicides                                                  |
+---------+------------------------------------------------------------+
| 15-33   | Maltreatment and maltreatment fatalities of children       |
+---------+------------------------------------------------------------+
| 15-34   | Physical assault by intimate partners                      |
+---------+------------------------------------------------------------+
| 15-35   | Rape or attempted rape                                     |
+---------+------------------------------------------------------------+
| 15-36   | Sexual assault other than rape                             |
+---------+------------------------------------------------------------+
| 15-37   | Physical assaults                                          |
+---------+------------------------------------------------------------+
| 15-38   | Physical fighting among adolescents                        |
+---------+------------------------------------------------------------+
| 15-39   | Weapon carrying by adolescents on school property          |
+---------+------------------------------------------------------------+

## Healthy People 2010 Objectives

### Injury Prevention

15-1. Reduce hospitalization for nonfatal head injuries.

**Target:** 45 hospitalizations per 100,000 population.

**Baseline:** 60.6 hospitalizations for nonfatal head injuries per
100,000 population occurred in 1998 (age adjusted to the year 2000
standard population).

**Target setting method:** Better than the best.

**Data source:** National Hospital Discharge Survey (NHDS), CDC, NCHS.

Note: The table below may continue to the following page.

+---------------------------------------------+------------------------+
| **Total Population, 1998**                  | **Hospitalizations     |
|                                             | for\                   |
|                                             | Nonfatal Head          |
|                                             | Injuries**             |
+=============================================+========================+
|                                             | Rate per 100,000       |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 60.6                   |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > American Indian or Alaska Native          | DSU                    |
+---------------------------------------------+------------------------+
| > Asian or Pacific Islander                 | DSU                    |
+---------------------------------------------+------------------------+
| > Asian                                     | DNC                    |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DNC                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | 58.4                   |
+---------------------------------------------+------------------------+
| > White                                     | 46.0                   |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | DSU                    |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | DSU                    |
+---------------------------------------------+------------------------+
| > Black or African American                 | DSU                    |
+---------------------------------------------+------------------------+
| > White                                     | DSU                    |
+---------------------------------------------+------------------------+
| **Gender**                                  |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 42.8                   |
+---------------------------------------------+------------------------+
| > Male                                      | 77.9                   |
+---------------------------------------------+------------------------+
| **Education level**                         |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | DNC                    |
+---------------------------------------------+------------------------+
| > High school graduate                      | DNC                    |
+---------------------------------------------+------------------------+
| > At least some college                     | DNC                    |
+---------------------------------------------+------------------------+
| ###### Select populations                   |                        |
+---------------------------------------------+------------------------+
| > Males aged 15 to 24 years (not age        | 117.6                  |
| > adjusted)                                 |                        |
+---------------------------------------------+------------------------+
| > Persons aged 75 years and older (not age\ | 174.9                  |
| > adjusted)                                 |                        |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

15-2. Reduce hospitalization for nonfatal spinal cord injuries.

**Target:** 2.4 hospitalizations per 100,000 population.

**Baseline:** 4.5 hospitalizations for nonfatal spinal cord injuries per
100,000\
population occurred in 1998 (age adjusted to the year 2000 standard
population).

**Target setting method:** 46 percent improvement. (Better than the best
will be used when data are available.)

**Data source:** National Hospital Discharge Survey (NHDS), CDC, NCHS.

Note: The table below may continue to the following page.

+---------------------------------------------+------------------------+
| **Total Population, 1998**                  | **Hospitalizations for |
|                                             | Nonfatal Spinal Cord   |
|                                             | Injuries**             |
+=============================================+========================+
|                                             | Rate per 100,000       |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 4.5                    |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > American Indian or Alaska Native          | DSU                    |
+---------------------------------------------+------------------------+
| > Asian or Pacific Islander                 | DSU                    |
+---------------------------------------------+------------------------+
| > Asian                                     | DNC                    |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DNC                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | DSU                    |
+---------------------------------------------+------------------------+
| > White                                     | 3.4                    |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | DSU                    |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | DSU                    |
+---------------------------------------------+------------------------+
| > Black or African American                 | DSU                    |
+---------------------------------------------+------------------------+
| > White                                     | DSU                    |
+---------------------------------------------+------------------------+
| ###### Gender                               |                        |
+---------------------------------------------+------------------------+
| > Female                                    | DSU                    |
+---------------------------------------------+------------------------+
| > Male                                      | 7.6                    |
+---------------------------------------------+------------------------+
| **Education level**                         |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | DNC                    |
+---------------------------------------------+------------------------+
| > High school graduate                      | DNC                    |
+---------------------------------------------+------------------------+
| > At least some college                     | DNC                    |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

The physical and emotional toll associated with head and spinal cord
injuries can be significant for the survivors and their families.
Persons with existing disabilities from head and spinal cord injuries
are at high risk for further secondary disabilities. Prevention efforts
should target motor vehicle crashes, falls, firearm injury, diving, and
water safety.

Among pedalcyclists killed, most died from head injuries. Similarly, the
common cause of death among motorcyclists is catastrophic head injury.
Death rates from head injuries have been shown to be twice as high among
cyclists in States lacking helmet laws or having laws that apply only to
young riders, compared with States where laws apply to all riders.

Falls account for 87 percent of all fractures among adults aged 65 years
and older and are the second leading cause of both spinal cord injury
and brain injury for this age group.[^23]^**,**^ [^24] Falls also cause
the majority of deaths and severe injuries from head trauma among
children under age 14 years. Falls account for 90 percent of the most
severe playground-related injuries treated in hospital emergency
departments (mostly head injuries and fractures) and one-third of
reported fatalities. Head injuries are involved in about 75 percent of
all reported fall-related deaths associated with playground equipment.

Many diving-related incidents also result in spinal cord injury.
Diving-related injury first becomes an issue during adolescence.
Injuries to males outnumber injuries to females. Diving injuries account
for one of eight spinal cord injuries, with half of those injuries
resulting in quadriplegia.[^25]

15-3. Reduce firearm-related deaths.

**Target:** 4.1 deaths per 100,000 population.

**Baseline:** 11.3 deaths per 100,000 population were related to firearm
injuries\
in 1998 (age adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

+---------------------------------------------+------------------------+
| **Total Population, 1998**                  | **Firearm-Related      |
|                                             | Deaths**               |
+=============================================+========================+
|                                             | Rate per 100,000       |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 11.3                   |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > American Indian or Alaska Native          | 11.3                   |
+---------------------------------------------+------------------------+
| > Asian or Pacific Islander                 | 4.2                    |
+---------------------------------------------+------------------------+
| > Asian                                     | DNC                    |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DNC                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | 20.3                   |
+---------------------------------------------+------------------------+
| > White                                     | 10.0                   |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | 9.7                    |
+---------------------------------------------+------------------------+
| > Cuban                                     | 11.0                   |
+---------------------------------------------+------------------------+
| > Mexican                                   | 9.8                    |
+---------------------------------------------+------------------------+
| > Puerto Rican                              | 8.4                    |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | 11.3                   |
+---------------------------------------------+------------------------+
| > Black or African American                 | 21.0                   |
+---------------------------------------------+------------------------+
| > White                                     | 9.6                    |
+---------------------------------------------+------------------------+
| **Gender**                                  |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 3.3                    |
+---------------------------------------------+------------------------+
| > Male                                      | 20.1                   |
+---------------------------------------------+------------------------+
| **Education level** (aged 25 to 64 years)   |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | 21.4                   |
+---------------------------------------------+------------------------+
| > High school graduate                      | 17.7                   |
+---------------------------------------------+------------------------+
| > At least some college                     | 7.0                    |
+---------------------------------------------+------------------------+
| **Select firearm-related deaths**           |                        |
+---------------------------------------------+------------------------+
| > Homicides                                 | 4.3                    |
+---------------------------------------------+------------------------+
| > Suicides                                  | 6.5                    |
+---------------------------------------------+------------------------+
| > Unintentional deaths                      | 0.5                    |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

15-4. Reduce the proportion of persons living in homes with\
firearms that are loaded and unlocked.

**Target:** 16 percent.

**Baseline:** 19 percent of the population lived in homes with loaded
and unlocked firearms in 1998 (age adjusted to the year 2000 standard
population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

+--------------------------------------------+-------------------------+
| **Total Population, 1998**                 | **Loaded, Unlocked\     |
|                                            | Firearms in Home**      |
+============================================+=========================+
|                                            | Percent                 |
+--------------------------------------------+-------------------------+
| > **TOTAL**                                | 19                      |
+--------------------------------------------+-------------------------+
| **Race and ethnicity**                     |                         |
+--------------------------------------------+-------------------------+
| > American Indian or Alaska Native         | 25                      |
+--------------------------------------------+-------------------------+
| > Asian or Pacific Islander                | DSU                     |
+--------------------------------------------+-------------------------+
| > Asian                                    | DSU                     |
+--------------------------------------------+-------------------------+
| > Native Hawaiian and other Pacific        | DSU                     |
| > Islander                                 |                         |
+--------------------------------------------+-------------------------+
| > Black or African American                | 28                      |
+--------------------------------------------+-------------------------+
| > White                                    | 18                      |
+--------------------------------------------+-------------------------+
|                                            |                         |
+--------------------------------------------+-------------------------+
| > Hispanic or Latino                       | 17                      |
+--------------------------------------------+-------------------------+
| > Not Hispanic or Latino                   | 19                      |
+--------------------------------------------+-------------------------+
| > Black or African American                | 28                      |
+--------------------------------------------+-------------------------+
| > White                                    | 18                      |
+--------------------------------------------+-------------------------+
| ###### Gender                              |                         |
+--------------------------------------------+-------------------------+
| > Female                                   | 16                      |
+--------------------------------------------+-------------------------+
| > Male                                     | 21                      |
+--------------------------------------------+-------------------------+
| **Education level** (aged 25 years and     |                         |
| older)                                     |                         |
+--------------------------------------------+-------------------------+
| > Less than high school                    | 22                      |
+--------------------------------------------+-------------------------+
| > High school graduate                     | 17                      |
+--------------------------------------------+-------------------------+
| > At least some college                    | 21                      |
+--------------------------------------------+-------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

15-5. Reduce nonfatal firearm-related injuries.

**Target:** 8.6 injuries per 100,000 population.

**Baseline:** 24.0 nonfatal firearm-related injuries per 100,000
population occurred\
in 1997.

**Target setting method:** Better than the best.

**Data source:** National Electronic Injury Surveillance System
(NEISS),\
Consumer Product Safety Commission (CPSC).

+---------------------------------------------+------------------------+
| **Total Population, 1997**                  | **Nonfatal             |
|                                             | Firearm-Related        |
|                                             | Injuries**             |
+=============================================+========================+
|                                             | Rate per 100,000       |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 24.0                   |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > American Indian or Alaska Native          | DSU                    |
+---------------------------------------------+------------------------+
| > Asian or Pacific Islander                 | DSU                    |
+---------------------------------------------+------------------------+
| > Asian                                     | DSU                    |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DSU                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | DNA                    |
+---------------------------------------------+------------------------+
| > White                                     | DNA                    |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | 39.0                   |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | DNA                    |
+---------------------------------------------+------------------------+
| > Black or African American                 | 92.0                   |
+---------------------------------------------+------------------------+
| > White                                     | 8.7                    |
+---------------------------------------------+------------------------+
| ###### Gender                               |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 5.3                    |
+---------------------------------------------+------------------------+
| > Male                                      | 43.5                   |
+---------------------------------------------+------------------------+
| **Education level**                         |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | DNC                    |
+---------------------------------------------+------------------------+
| > High school graduate                      | DNC                    |
+---------------------------------------------+------------------------+
| > At least some college                     | DNC                    |
+---------------------------------------------+------------------------+
| **Select populations**                      |                        |
+---------------------------------------------+------------------------+
| > Males aged 15 to 24 years                 | 143.8                  |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

The United States has the highest rates of lethal childhood violence
than every other industrialized country.[^26] The increase in the total
homicide rate from 1979 through 1993 resulted solely from increases in
firearm-related homicides.[^27] Fatalities, however, are only part of
the problem. For each of the 32,436 persons killed by a gunshot wound in
the United States in 1997, approximately 2 more were treated for
nonfatal wounds in hospital emergency departments.[^28]

15-6. (Developmental) Extend State-level child fatality review of deaths
due to external causes for children aged 14 years and under.

**Potential data source:** Inter-Agency Council on Child Abuse and
Neglect (ICAN) National Database, FBI Uniform Crime Report, U.S.
Department of\
Justice.

Death resulting from injury is one of the most profound public health
issues facing children in the United States today. In 1997, nearly
19,000 children aged 19 years and under were victims of injury---33
percent from violence and 67 percent from unintentional injury.[^29]

In examination of these trends in childhood injury-related cause of
death, information has typically come from one of several sources (vital
statistics, protective service records, and the FBI Uniform Crime
Report), each with specific limitations. In response to the increasing
trend of violence against children and the lack of a comprehensive data
source on violent childhood deaths, the Child Fatality Review Team
(CFRT) process was developed in 1978 in California.

The goal of the CFRTs is the prevention of childhood fatalities. Their
responsibility is to review so-called "suspicious" or "preventable"
childhood fatalities. Minimal or core standards for CFRTs must include
representatives from criminal justice, health, and social services.
After integrating information from multiple sources, review teams strive
to determine if the cause and manner of death were recorded accurately
and to suggest prevention initiatives for all relevant agencies. Simply
reviewing fatalities is not helpful unless recommendations for
prevention also are included and plans are made for periodic followup to
ensure that recommendations are being acted on.

Focusing on children aged 14 years and under will include most
"unexplained" childhood deaths and is considered a more reasonable goal
to achieve. However, States should continue to improve their CFRT
systems. Teams with adequate resources are encouraged to extend their
review to all causes of death for all children aged 18 years and under
as their ultimate goal. CFRTs also should include culturally appropriate
members.

15-7. Reduce nonfatal poisonings.

**Target:** 292 nonfatal poisonings per 100,000 population.

**Baseline:** 348.4 nonfatal poisonings per 100,000 population occurred
in 1997 (age adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Hospital Ambulatory Medical Care Survey
(NHAMCS), CDC, NCHS.

+---------------------------------------------+------------------------+
| **Total Population, 1997 (unless noted)**   | **Nonfatal             |
|                                             | Poisonings**           |
+=============================================+========================+
|                                             | Rate per 100,000       |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 348.4                  |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > American Indian or Alaska Native          | DSU                    |
+---------------------------------------------+------------------------+
| > Asian or Pacific Islander                 | DSU                    |
+---------------------------------------------+------------------------+
| > Asian                                     | DSU                    |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DSU                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | 464.5                  |
+---------------------------------------------+------------------------+
| > White                                     | 340.6                  |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | DSU                    |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | DSU                    |
+---------------------------------------------+------------------------+
| > Black or African American                 | DSU                    |
+---------------------------------------------+------------------------+
| > White                                     | DSU                    |
+---------------------------------------------+------------------------+
| **Gender**                                  |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 410.9                  |
+---------------------------------------------+------------------------+
| > Male                                      | 281.6                  |
+---------------------------------------------+------------------------+
| **Education level**                         |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | DNC                    |
+---------------------------------------------+------------------------+
| > High school graduate                      | DNC                    |
+---------------------------------------------+------------------------+
| > At least some college                     | DNC                    |
+---------------------------------------------+------------------------+
| ####### Se                                  |                        |
| lect types of poisonings (not age adjusted) |                        |
+---------------------------------------------+------------------------+
| > Assault or attempted homicides            | 6.0 (1996)             |
+---------------------------------------------+------------------------+
| > Intentional suicide attempts              | 63.0 (1996)            |
+---------------------------------------------+------------------------+
| > Unintentional poisonings                  | 268.0 (1996)           |
+---------------------------------------------+------------------------+
| ##                                          |                        |
| ##### Select populations (not age adjusted) |                        |
+---------------------------------------------+------------------------+
| > Children aged 4 years and under           | 460.0                  |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

15-8. Reduce deaths caused by poisonings.

**Target:** 1.5 deaths per 100,000 population.

**Baseline:** 6.8 deaths per 100,000 population were caused by
poisonings in 1998 (age adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

+------------------------------------------------+---------------------+
| **Total Population, 1998**                     | **Poisoning         |
|                                                | Deaths**            |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 6.8                 |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 8.1                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 1.6                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 7.9                 |
+------------------------------------------------+---------------------+
| > White                                        | 6.9                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 5.9                 |
+------------------------------------------------+---------------------+
| > Cuban                                        | 4.3                 |
+------------------------------------------------+---------------------+
| > Mexican                                      | 5.1                 |
+------------------------------------------------+---------------------+
| > Puerto Rican                                 | 12.0                |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 6.8                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 8.2                 |
+------------------------------------------------+---------------------+
| > White                                        | 6.9                 |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 4.1                 |
+------------------------------------------------+---------------------+
| > Male                                         | 9.6                 |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 18.5                |
+------------------------------------------------+---------------------+
| > High school graduate                         | 15.2                |
+------------------------------------------------+---------------------+
| > At least some college                        | 6.2                 |
+------------------------------------------------+---------------------+
| **Select poisoning deaths**                    |                     |
+------------------------------------------------+---------------------+
| > Unintentional deaths                         | 4.0                 |
+------------------------------------------------+---------------------+
| > Suicides                                     | 1.9                 |
+------------------------------------------------+---------------------+
| > Homicides                                    | 0\*                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

\*Value is greater than zero but less than 0.05.

Children are at significantly greater risk from poisoning death and
exposure than adults because children are more likely to ingest
potentially harmful chemicals. In 1995, 80 children aged 14 years and
under died from poisoning. Children aged 4 years and under accounted for
nearly half of these deaths. In 1996, more than 1.1 million
unintentional poisonings among children aged 5 years and under were
reported to U.S. poison control centers. Approximately 90 percent of all
poison exposures occur at a residence.[^30]

In 1996, 29 children aged 5 years and under died from exposure to
medicines and household products. Among children aged 5 years and under,
60 percent of poisoning exposures come from nonpharmaceutical products
such as cosmetics, cleaning substances, plants, foreign bodies, toys,
pesticides, and art supplies; 40 percent come from pharmaceuticals.
Immediately calling a poison control center can reduce the likelihood of
severe poisoning, decrease the cost of a poisoning incident, and prevent
the need for a hospital emergency department (ED) visit.

The total annual cost of poisoning-related injury and death exceeds
\$7.6 billion among children aged 14 years and under. Children aged 4
years and under account for \$5.1 billion, or two-thirds, of these
costs. Medical expenses associated with a poisoning exposure average
\$925 per case. The average cost of hospital treatment for a poisoning
exposure is \$8,700.[^31]

15-9. Reduce deaths caused by suffocation.

**Target:** 3.0 deaths per 100,000 population.

**Baseline:** 4.1 deaths per 100,000 population were caused by
suffocation in 1998 (age adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Total Population, 1998**                     | **Suffocation       |
|                                                | Deaths**            |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 4.1                 |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 7.6                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 3.5                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 4.2                 |
+------------------------------------------------+---------------------+
| > White                                        | 4.1                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 3.1                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 4.2                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 4.4                 |
+------------------------------------------------+---------------------+
| > White                                        | 4.1                 |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 2.4                 |
+------------------------------------------------+---------------------+
| > Male                                         | 6.0                 |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 6.5                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | 5.1                 |
+------------------------------------------------+---------------------+
| > At least some college                        | 2.2                 |
+------------------------------------------------+---------------------+
| **Select suffocation deaths**                  |                     |
+------------------------------------------------+---------------------+
| > Homicides                                    | 0.2                 |
+------------------------------------------------+---------------------+
| > Suicides                                     | 2.1                 |
+------------------------------------------------+---------------------+
| > Unintentional deaths                         | 1.7                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

In 1997, 10,650 persons died from suffocation. In the same year, 934
children aged 14 years and under died from suffocation. Of these
children, 64 percent were aged 4 years and under.[^32] Approximately
5,000 children aged 14 years and under are treated in hospital EDs for
aspirating and ingesting toys and toy parts each year. The majority of
childhood suffocations, strangulations, and chokings occur in the home.
The total annual cost of airway obstruction injury among children aged
14 years and under exceeds \$1.5 billion. Children aged 4 years and
under account for more than 60 percent of these costs. It is estimated
that as many as 900 infants whose deaths are attributed to sudden infant
death syndrome (SIDS) each year are found in potentially suffocating
environments, frequently on their stomachs, with their noses and mouths
covered by soft bedding.[^33]

15-10. Increase the number of States and the District of Columbia with
statewide emergency department surveillance\
systems that collect data on external causes of injury.

**Target:** All States and the District of Columbia.

**Baseline:** 12 States had statewide ED surveillance systems that
collected data on external causes of injury in 1998.

**Target setting method:** Total coverage.

**Data source:** External Cause of Injury Survey, American Public
Health\
Association (APHA).

15-11. Increase the number of States and the District of Columbia that
collect data on external causes of injury through\
hospital discharge data systems.

**Target:** All States and the District of Columbia.

**Baseline:** 23 States collected data on external causes of injury
through hospital discharge data systems in 1998.

**Target setting method:** Total coverage.

**Data source:** External Cause of Injury Survey, American Public
Health\
Association (APHA).

15-12. Reduce hospital emergency department visits caused by injuries.

**Target:** 126 hospital emergency department visits per 1,000
population.

**Baseline:** 131 hospital emergency department visits per 1,000
population were caused by injury in 1997 (age adjusted to the year 2000
standard population).

**Target setting method:** Better than the best.

**Data source:** National Hospital Ambulatory Medical Care Survey
(NHAMCS), CDC, NCHS.

Note: The table below may continue to the following page.

+----------------------------------------------+-----------------------+
| **Total Population, 1997**                   | **Injury-Related\     |
|                                              | Hospital Emergency\   |
|                                              | Department Visits**   |
+==============================================+=======================+
|                                              | Rate per 1,000        |
+----------------------------------------------+-----------------------+
| > **TOTAL**                                  | 131                   |
+----------------------------------------------+-----------------------+
| **Race and ethnicity**                       |                       |
+----------------------------------------------+-----------------------+
| > American Indian or Alaska Native           | DSU                   |
+----------------------------------------------+-----------------------+
| > Asian or Pacific Islander                  | DSU                   |
+----------------------------------------------+-----------------------+
| > Asian                                      | DSU                   |
+----------------------------------------------+-----------------------+
| > Native Hawaiian and other Pacific Islander | DSU                   |
+----------------------------------------------+-----------------------+
| > Black or African American                  | 182                   |
+----------------------------------------------+-----------------------+
| > White                                      | 127                   |
+----------------------------------------------+-----------------------+
|                                              |                       |
+----------------------------------------------+-----------------------+
| > Hispanic or Latino                         | DSU                   |
+----------------------------------------------+-----------------------+
| > Not Hispanic or Latino                     | DSU                   |
+----------------------------------------------+-----------------------+
| > Black or African American                  | DSU                   |
+----------------------------------------------+-----------------------+
| > White                                      | DSU                   |
+----------------------------------------------+-----------------------+
| **Gender**                                   |                       |
+----------------------------------------------+-----------------------+
| > Female                                     | 116                   |
+----------------------------------------------+-----------------------+
| > Male                                       | 146                   |
+----------------------------------------------+-----------------------+
| **Education level**                          |                       |
+----------------------------------------------+-----------------------+
| > Less than high school                      | DNC                   |
+----------------------------------------------+-----------------------+
| > High school graduate                       | DNC                   |
+----------------------------------------------+-----------------------+
| > At least some college                      | DNC                   |
+----------------------------------------------+-----------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

Emergency department (ED) patient records and hospital discharge systems
are an important source of public health surveillance and an integral
part of the vision of electronically linked health information systems
that can serve multiple purposes. Because of the volume and case mix of
patients they treat, EDs are well positioned to provide data on cause
and severity of injuries. Access to such data can help with the
development of population-based public health interventions.

### Unintentional Injury Prevention 

15-13. Reduce deaths caused by unintentional injuries.

**Target:** 17.5 deaths per 100,000 population.

**Baseline:** 35.0 deaths per 100,000 population were caused by
unintentional\
injuries in 1998 (age adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

Note: The table below may continue to the following page.

+----------------------------------------------+-----------------------+
| **Total Population, 1998**                   | **Unintentional       |
|                                              | Injury Deaths**       |
+==============================================+=======================+
|                                              | Rate per 100,000      |
+----------------------------------------------+-----------------------+
| > **TOTAL**                                  | 35.0                  |
+----------------------------------------------+-----------------------+
| **Race and ethnicity**                       |                       |
+----------------------------------------------+-----------------------+
| > American Indian or Alaska Native           | 59.9                  |
+----------------------------------------------+-----------------------+
| > Asian or Pacific Islander                  | 17.6                  |
+----------------------------------------------+-----------------------+
| > Asian                                      | DNC                   |
+----------------------------------------------+-----------------------+
| > Native Hawaiian and other Pacific Islander | DNC                   |
+----------------------------------------------+-----------------------+
| > Black or African American                  | 39.5                  |
+----------------------------------------------+-----------------------+
| > White                                      | 34.8                  |
+----------------------------------------------+-----------------------+
|                                              |                       |
+----------------------------------------------+-----------------------+
| > Hispanic or Latino                         | 30.2                  |
+----------------------------------------------+-----------------------+
| > Cuban                                      | 22.5                  |
+----------------------------------------------+-----------------------+
| > Mexican                                    | 32.1                  |
+----------------------------------------------+-----------------------+
| > Puerto Rican                               | 28.8                  |
+----------------------------------------------+-----------------------+
| > Not Hispanic or Latino                     | 35.1                  |
+----------------------------------------------+-----------------------+
| > Black or African American                  | 40.7                  |
+----------------------------------------------+-----------------------+
| > White                                      | 34.6                  |
+----------------------------------------------+-----------------------+
| ####### Gender                               |                       |
+----------------------------------------------+-----------------------+
| > Female                                     | 22.1                  |
+----------------------------------------------+-----------------------+
| > Male                                       | 49.4                  |
+----------------------------------------------+-----------------------+
| **Education level** (aged 25 to 64 years)    |                       |
+----------------------------------------------+-----------------------+
| > Less than high school                      | 54.5                  |
+----------------------------------------------+-----------------------+
| > High school graduate                       | 41.5                  |
+----------------------------------------------+-----------------------+
| > At least some college                      | 17.4                  |
+----------------------------------------------+-----------------------+
| **Select populations**                       |                       |
+----------------------------------------------+-----------------------+
| > American Indian or Alaska Native males     | 83.6                  |
+----------------------------------------------+-----------------------+
| > Black or African American males            | 60.8                  |
+----------------------------------------------+-----------------------+
| > Hispanic males                             | 46.2                  |
+----------------------------------------------+-----------------------+
| > White males                                | 48.7                  |
+----------------------------------------------+-----------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

15-14. (Developmental) Reduce nonfatal unintentional injuries.

**Potential data source:** National Hospital Ambulatory Medical Care
Survey, Emergency Department Component, CDC, NCHS.

15-15. Reduce deaths caused by motor vehicle crashes.

**[Target and baseline:]{.smallcaps}**

  ------------- ---------------------------- -------------- --------------
  Objective     Reduction in Deaths Caused   1998\          2010\
                by Motor Vehicle Crashes     Baseline       Target

  **15-15a.**   Deaths per 100,000           15.6\*         9.2
                population                                  

  **15-15b.**   Deaths per 100 million       1.6            0.8
                vehicle miles traveled                      
  ------------- ---------------------------- -------------- --------------

\*Age adjusted to the year 2000 standard population.

**Target setting method:** Better than the best for 15-15a; 50 percent
improvement for 15-15b. (Better than the best will be used when data are
available.)

**Data sources:** National Vital Statistics System (NVSS), CDC, NCHS;
Fatality Analysis Reporting System (FARS), DOT, NHTSA.

Note: The table below may continue to the following page.

+-------------------------------------------+------------+------------+
| **Total Population, 1998 (unless noted)** | **Motor    |            |
|                                           | Vehicle    |            |
|                                           | Crash      |            |
|                                           | Deaths**   |            |
+===========================================+============+============+
|                                           | **15-15a.\ | **15-15b.\ |
|                                           | Rate per   | Rate per   |
|                                           | 100,000**  | 100        |
|                                           |            | Million    |
|                                           |            | VMT**      |
+-------------------------------------------+------------+------------+
| > **TOTAL**                               | 15.6       | 1.6        |
+-------------------------------------------+------------+------------+
| **Race and ethnicity**                    |            |            |
+-------------------------------------------+------------+------------+
| > American Indian or Alaska Native        | 30.4       | DNC        |
+-------------------------------------------+------------+------------+
| > Asian or Pacific Islander               | 9.3        | DNC        |
+-------------------------------------------+------------+------------+
| > Asian                                   | DNC        | DNC        |
+-------------------------------------------+------------+------------+
| > Native Hawaiian and other Pacific       | DNC        | DNC        |
| > Islander                                |            |            |
+-------------------------------------------+------------+------------+
| > Black or African American               | 16.8       | DNC        |
+-------------------------------------------+------------+------------+
| > White                                   | 15.6       | DNC        |
+-------------------------------------------+------------+------------+
|                                           |            |            |
+-------------------------------------------+------------+------------+
| > Hispanic or Latino                      | 14.7       | DNC        |
+-------------------------------------------+------------+------------+
| > Cuban                                   | 10.9       | DNC        |
+-------------------------------------------+------------+------------+
| > Mexican                                 | 16.5       | DNC        |
+-------------------------------------------+------------+------------+
| > Puerto Rican                            | 10.8       | DNC        |
+-------------------------------------------+------------+------------+
| > Not Hispanic or Latino                  | 15.6       | DNC        |
+-------------------------------------------+------------+------------+
| > Black or African American               | 17.3       | DNC        |
+-------------------------------------------+------------+------------+
| > White                                   | 15.5       | DNC        |
+-------------------------------------------+------------+------------+
| ###### Gender                             |            |            |
+-------------------------------------------+------------+------------+
| > Female                                  | 10.1       | DNA        |
+-------------------------------------------+------------+------------+
| > Male                                    | 21.6       | DNA        |
+-------------------------------------------+------------+------------+
| **Education level** (aged 25 to 64 years) |            |            |
+-------------------------------------------+------------+------------+
| > Less than high school                   | 25.8       | DNC        |
+-------------------------------------------+------------+------------+
| > High school graduate                    | 20.2       | DNC        |
+-------------------------------------------+------------+------------+
| > At least some college                   | 8.9        | DNC        |
+-------------------------------------------+------------+------------+
| **Select populations**                    |            |            |
+-------------------------------------------+------------+------------+
| > Children aged 14 years and under (not   | 4.4        | DNA        |
| > age\                                    |            |            |
| > adjusted)                               |            |            |
+-------------------------------------------+------------+------------+
| > Persons aged 15 to 24 years (not age    | 26.4       | DNA        |
| > adjusted)                               |            |            |
+-------------------------------------------+------------+------------+
| > Persons aged 70 years and older (not    | 25.5       | DNA        |
| > age\                                    |            |            |
| > adjusted)                               |            |            |
+-------------------------------------------+------------+------------+
| > Motorcyclists                           | NA         | 21.0       |
|                                           |            | (1997)     |
+-------------------------------------------+------------+------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable. NA = not applicable.

Note: Data for 15-15a. are age adjusted to the year 2000 standard
population.

Note: The table above may have continued from the previous page.

15-16. Reduce pedestrian deaths on public roads.

**Target:** 1.0 pedestrian death per 100,000 population.

**Baseline:** 1.9 pedestrian deaths per 100,000 population occurred on
public roads in 1998.

**Target setting method:** 50 percent improvement. (Better than the best
will be used when data are available.)

**Data source:** Fatality Analysis Reporting System (FARS), DOT, NHTSA.

Note: The table below may continue to the following page.

+-----------------------------------------+----------------------------+
| **Total Population, 1998**              | **Pedestrian Deaths on     |
|                                         | Public Roads**             |
+=========================================+============================+
|                                         | Rate per 100,000           |
+-----------------------------------------+----------------------------+
| > **TOTAL**                             | 1.9                        |
+-----------------------------------------+----------------------------+
| **Race and ethnicity**                  |                            |
+-----------------------------------------+----------------------------+
| > American Indian or Alaska Native      | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian or Pacific Islander             | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian                                 | DNA                        |
+-----------------------------------------+----------------------------+
| > Native Hawaiian and other Pacific     | DNC                        |
| > Islander                              |                            |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNA                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNA                        |
+-----------------------------------------+----------------------------+
|                                         |                            |
+-----------------------------------------+----------------------------+
| > Hispanic or Latino                    | DNC                        |
+-----------------------------------------+----------------------------+
| > Not Hispanic or Latino                | DNC                        |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNC                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Gender**                              |                            |
+-----------------------------------------+----------------------------+
| > Female                                | 1.2                        |
+-----------------------------------------+----------------------------+
| > Male                                  | 2.7                        |
+-----------------------------------------+----------------------------+
| **Education level**                     |                            |
+-----------------------------------------+----------------------------+
| > Less than high school                 | DNC                        |
+-----------------------------------------+----------------------------+
| > High school graduate                  | DNC                        |
+-----------------------------------------+----------------------------+
| > At least some college                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Select populations**                  |                            |
+-----------------------------------------+----------------------------+
| > Persons aged 70 years and older       | 3.9                        |
+-----------------------------------------+----------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: The table above may have continued from the previous page.

15-17. Reduce nonfatal injuries caused by motor vehicle crashes.

**Target:** 933 nonfatal injuries per 100,000 population.

**Baseline:** 1,181 nonfatal injuries per 100,000 population were caused
by motor vehicle crashes in 1998.

**Target setting method:** 21 percent improvement. (Better than the best
will be used when data are available.)

**Data source:** General Estimates System (GES), DOT, NHTSA.

Note: The table below may continue to the following page.

+-----------------------------------------+----------------------------+
| **Total Population, 1998 (unless        | **Nonfatal Motor Vehicle   |
| noted)**                                | Crash Injuries**           |
+=========================================+============================+
|                                         | Rate per 100,000           |
+-----------------------------------------+----------------------------+
| > **TOTAL**                             | 1,181                      |
+-----------------------------------------+----------------------------+
| **Race and ethnicity**                  |                            |
+-----------------------------------------+----------------------------+
| > American Indian or Alaska Native      | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian or Pacific Islander             | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian                                 | DNC                        |
+-----------------------------------------+----------------------------+
| > Native Hawaiian and other Pacific     | DNC                        |
| > Islander                              |                            |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNC                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNC                        |
+-----------------------------------------+----------------------------+
|                                         |                            |
+-----------------------------------------+----------------------------+
| > Hispanic or Latino                    | DNC                        |
+-----------------------------------------+----------------------------+
| > Not Hispanic or Latino                | DNC                        |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNC                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Gender**                              |                            |
+-----------------------------------------+----------------------------+
| > Female                                | DNA                        |
+-----------------------------------------+----------------------------+
| > Male                                  | DNA                        |
+-----------------------------------------+----------------------------+
| **Education level**                     |                            |
+-----------------------------------------+----------------------------+
| > Less than high school                 | DNC                        |
+-----------------------------------------+----------------------------+
| > High school graduate                  | DNC                        |
+-----------------------------------------+----------------------------+
| > At least some college                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Select populations**                  |                            |
+-----------------------------------------+----------------------------+
| > Persons aged 16 to 20 years           | 3,116 (1997)               |
+-----------------------------------------+----------------------------+
| > Persons aged 21 to 24 years           | 2,496 (1997)               |
+-----------------------------------------+----------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: The table above may have continued from the previous page.

15-18. Reduce nonfatal pedestrian injuries on public roads.

**Target:** 19 nonfatal injuries per 100,000 population.

**Baseline:** 26 nonfatal pedestrian injuries per 100,000 population
occurred on public roads in 1998.

**Target setting method:** 28 percent improvement. (Better than the best
will be used when data are available.)

**Data source:** General Estimates System (GES), DOT, NHTSA.

Note: The table below may continue to the following page.

+-----------------------------------------+----------------------------+
| **Total Population, 1998**              | **Nonfatal Pedestrian      |
|                                         | Injuries on Public Roads** |
+=========================================+============================+
|                                         | Rate per 100,000           |
+-----------------------------------------+----------------------------+
| > **TOTAL**                             | 26                         |
+-----------------------------------------+----------------------------+
| **Race and ethnicity**                  |                            |
+-----------------------------------------+----------------------------+
| > American Indian or Alaska Native      | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian or Pacific Islander             | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian                                 | DNC                        |
+-----------------------------------------+----------------------------+
| > Native Hawaiian and other Pacific     | DNC                        |
| > Islander                              |                            |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNC                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNC                        |
+-----------------------------------------+----------------------------+
|                                         |                            |
+-----------------------------------------+----------------------------+
| > Hispanic or Latino                    | DNC                        |
+-----------------------------------------+----------------------------+
| > Not Hispanic or Latino                | DNC                        |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNC                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Gender**                              |                            |
+-----------------------------------------+----------------------------+
| > Female                                | DNA                        |
+-----------------------------------------+----------------------------+
| > Male                                  | DNA                        |
+-----------------------------------------+----------------------------+
| **Education level**                     |                            |
+-----------------------------------------+----------------------------+
| > Less than high school                 | DNC                        |
+-----------------------------------------+----------------------------+
| > High school graduate                  | DNC                        |
+-----------------------------------------+----------------------------+
| > At least some college                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Select populations**                  |                            |
+-----------------------------------------+----------------------------+
| > Persons aged 5 to 9 years             | 42                         |
+-----------------------------------------+----------------------------+
| > Persons aged 10 to 15 years           | 44                         |
+-----------------------------------------+----------------------------+
| > Persons aged 16 to 20 years           | 38                         |
+-----------------------------------------+----------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: The table above may have continued from the previous page.

15-19. Increase use of safety belts.

**Target:** 92 percent.

**Baseline:** 69 percent of the total population used safety belts in
1998.

**Target setting method:** 33 percent improvement. (Better than the best
will be used when data are available.)

**Data sources:** National Occupant Protection Use Survey (NOPUS), DOT,
NHTSA; Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

+-----------------------------------------+----------------------------+
| **Total Population, 1998 (unless        | **Safety Belt Use**        |
| noted)**                                |                            |
+=========================================+============================+
|                                         | Percent                    |
+-----------------------------------------+----------------------------+
| > **TOTAL**                             | 69                         |
+-----------------------------------------+----------------------------+
| **Race and ethnicity**                  |                            |
+-----------------------------------------+----------------------------+
| > American Indian or Alaska Native      | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian or Pacific Islander             | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian                                 | DNC                        |
+-----------------------------------------+----------------------------+
| > Native Hawaiian and other Pacific     | DNC                        |
| > Islander                              |                            |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNA                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNA                        |
+-----------------------------------------+----------------------------+
|                                         |                            |
+-----------------------------------------+----------------------------+
| > Hispanic or Latino                    | DNC                        |
+-----------------------------------------+----------------------------+
| > Not Hispanic or Latino                | DNC                        |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNC                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Gender**                              |                            |
+-----------------------------------------+----------------------------+
| > Female                                | DNA                        |
+-----------------------------------------+----------------------------+
| > Male                                  | DNA                        |
+-----------------------------------------+----------------------------+
| **Education level**                     |                            |
+-----------------------------------------+----------------------------+
| > Less than high school                 | DNC                        |
+-----------------------------------------+----------------------------+
| > High school graduate                  | DNC                        |
+-----------------------------------------+----------------------------+
| > At least some college                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Select populations**                  |                            |
+-----------------------------------------+----------------------------+
| > 9th through 12th grade students       | 84 (1999)                  |
+-----------------------------------------+----------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

15-20. Increase use of child restraints.

**Target:** 100 percent.

**Baseline:** 92 percent of motor vehicle occupants aged 4 years and
under used child restraints in 1998.

**Target setting method:** Total coverage.

**Data source:** National Occupant Protection Use Survey (NOPUS),
Controlled Intersection Study, DOT, NHTSA.

> **Data for population groups currently are not collected.**

15-21. Increase the proportion of motorcyclists using helmets.

**Target:** 79 percent.

**Baseline:** 67 percent of motorcycle operators and passengers used
helmets in 1998.

**Target setting method:** 18 percent improvement. (Better than the best
will be used when data are available.)

**Data sources:** National Occupant Protection Use Survey (NOPUS), DOT,
NHTSA; Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

+-----------------------------------------+----------------------------+
| **Motorcycle Operators and Passengers,  | **Helmet Use**             |
| 1998 (unless noted)**                   |                            |
+=========================================+============================+
|                                         | Percent                    |
+-----------------------------------------+----------------------------+
| > **TOTAL**                             | 67                         |
+-----------------------------------------+----------------------------+
| **Race and ethnicity**                  |                            |
+-----------------------------------------+----------------------------+
| > American Indian or Alaska Native      | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian or Pacific Islander             | DNC                        |
+-----------------------------------------+----------------------------+
| > Asian                                 | DNC                        |
+-----------------------------------------+----------------------------+
| > Native Hawaiian and other Pacific     | DNC                        |
| > Islander                              |                            |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNC                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNC                        |
+-----------------------------------------+----------------------------+
|                                         |                            |
+-----------------------------------------+----------------------------+
| > Hispanic or Latino                    | DNC                        |
+-----------------------------------------+----------------------------+
| > Not Hispanic or Latino                | DNC                        |
+-----------------------------------------+----------------------------+
| > Black or African American             | DNC                        |
+-----------------------------------------+----------------------------+
| > White                                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Gender**                              |                            |
+-----------------------------------------+----------------------------+
| > Female                                | DNC                        |
+-----------------------------------------+----------------------------+
| > Male                                  | DNC                        |
+-----------------------------------------+----------------------------+
| **Education level**                     |                            |
+-----------------------------------------+----------------------------+
| > Less than high school                 | DNC                        |
+-----------------------------------------+----------------------------+
| > High school graduate                  | DNC                        |
+-----------------------------------------+----------------------------+
| > At least some college                 | DNC                        |
+-----------------------------------------+----------------------------+
| **Select populations**                  |                            |
+-----------------------------------------+----------------------------+
| > 9th through 12th grade students       | 62 (1999)                  |
+-----------------------------------------+----------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

15-22. Increase the number of States and the District of Columbia that
have adopted a graduated driver licensing model law.

**Target:** All States and the District of Columbia.

**Baseline:** 23 States had a graduated driver licensing model law in
1999.

**Target setting method:** Total coverage.

**Data source:** U.S. Licensing Systems for Young Drivers, Insurance
Institute for Highway Safety.

Motor vehicle crashes remain a major public health problem. They are the
leading cause of death for persons in the United States aged 5 to 29
years. In 1998, 41,471 persons died in motor vehicle crashes.[^34]
Thirty-eight percent of these deaths occurred in alcohol-related
crashes.Error: Reference source not found The motor vehicle death rate
per 100,000 persons is especially high among persons aged 16 to 24 years
and persons aged 75 years and older. Safety belts, when worn correctly,
are the most effective way for occupants to reduce the risk of death and
serious injury in a motor vehicle crash on public roads (including those
on Indian Reservations). As of December 1998, the national safety belt
use rate was 69 percent.

In 1998, 69,000 pedestrians were injured, and 5,220 were killed in
traffic crashes in the United States. On average, a pedestrian is killed
in a motor vehicle crash every 101 minutes, and one is injured every 8
minutes.[^35]

In 1998, persons aged 70 years and older made up 9 percent of the
population but accounted for 14 percent of all traffic fatalities and 18
percent of all pedestrian fatalities. Compared with the fatality rate
for drivers aged 25 through 69 years, the rate for drivers in the oldest
group is nine times higher.[^36]

Older persons also are more susceptible than younger persons to medical
complications following motor vehicle crash injuries. Thus, they are
more likely to die from their injuries.Error: Reference source not found

Fewer persons aged 70 years and older are licensed to drive, compared to
younger persons, and they drive fewer miles per licensed driver. Persons
in this older age group, however, have higher rates of fatal crashes per
mile driven, per 100,000 persons, and per licensed driver than any other
group except young drivers (aged 16 to 24 years).

Pedestrians account for about 13 percent of motor vehicle deaths. The
problem of pedestrian deaths and injuries is worse among young children
and older adults. Children are more likely to be injured, while older
adults are more likely to die in pedestrian crashes.Error: Reference
source not found

As of December 1997, 49 States had safety belt laws. Eleven States had
primary enforcement laws, and the remaining 38 States had secondary
enforcement laws.[^37] In 1998, the average observed belt use rate by
States with secondary enforcement laws was 62 percent, compared to 79
percent in States with primary enforcement laws.Error: Reference source
not found

Among children aged 1 to 14 years, crash injuries are the leading cause
of death. In 1998, 2,549 children aged 14 years and under died in motor
vehicle crashes.Error: Reference source not found The use of
age-appropriate restraint systems can reduce this problem. Because all
States have child restraint laws, more children now ride restrained.
However, loopholes in the laws exempt many children from coverage under
either safety belt or child restraint use laws. Another problem is the
persistence of incorrect use of child restraints and safety belts.[^38]

Motorcycles are less stable and less visible than cars, and they have
high-performance capabilities. When motorcycles crash, their riders lack
the protection of an enclosed vehicle, so they are more likely to be
injured or killed. The number of deaths on motorcycles per mile traveled
is about 16 times the number of deaths in cars. Wearing a motorcycle
helmet reduces the chances of dying in a motorcycle crash by 29 percent
and reduces the chances of brain injury by 67 percent. An unhelmeted
rider is 40 percent more likely to suffer a fatal head injury, compared
with a helmeted rider. In 1998, 2,284 motorcyclists died in
crashes.[^39]

Teenagers accounted for 10 percent of the U.S. population in 1997 and 15
percent of the motor vehicle deaths. In 1998, 3,427 drivers aged 15 to
20 years were killed, and an additional 348,000 were injured in motor
vehicle crashes.[^40] Graduated licensing laws allow a young driver to
gain driving experience at incremental levels. Graduated licensing is a
system for phasing in on-road driving that allows beginners to obtain
their initial experience under lower risk conditions.

The National Committee on Uniform Traffic Laws and Ordinances (NCUTLO)
has developed a model law that calls for a minimum of 6 months in the
learner stage and a minimum of 6 months in the intermediate license
stage with night driving restrictions. Twenty-three States have all the
core provisions of the model graduated licensing model law developed by
NCUTLO. The NCUTLO model also requires applicants for intermediate and
full licenses to have no safety belt or zero tolerance violations and to
be conviction-free during the mandatory holding\
periods.

15-23. (Developmental) Increase use of helmets by bicyclists.

**Potential data sources:** Consumer Product Safety Commission;
Behavioral Risk Factor Surveillance System (BRFSS), CDC; World Health
Organization Study of Health Behavior in School Children.

15-24. Increase the number of States and the District of Columbia with
laws requiring bicycle helmets for bicycle riders.

**Target:** All States and the District of Columbia.

**Baseline:** 10 States had laws requiring bicycle helmets for bicycle
riders under age 15 years in 1999.

**Target setting method:** Total coverage.

**Data source:** National Safe Kids Campaign.

Head injuries are the most serious type of injury sustained by
pedalcyclists of all ages. In 1998, 761 bicyclists were killed in
crashes involving motor vehicles, and an additional 53,000 were injured
in traffic crashes. Almost one-third (30 percent) of the pedalcyclists
killed in traffic crashes in 1998 were between age 5 and 15 years. The
proportion of pedalcyclist fatalities among persons aged 25 to 64 years
was 1.7 times higher in 1997 than in 1987 (46 percent and 27 percent,
respectively).[^41] More bicyclists were killed on major roads than on
local roads (59 percent compared with 36 percent) in 1997.[^42]

Bicycle helmets reduce the risk of bicycle-related head injury by 85
percent.[^43] Although no States have bicycle laws that apply to all
riders, 15 States have laws that apply to young bicyclists under age 18
years.[^44] In addition, several localities have ordinances that require
some or all bicyclists to wear helmets. Helmets are important for riders
of all ages, especially because older bicyclists represent two-thirds of
bicycle deaths.Error: Reference source not found

15-25. Reduce residential fire deaths.

**Target:** 0.2 deaths per 100,000 population.

**Baseline:** 1.2 deaths per 100,000 population were caused by
residential fires in 1998 (age adjusted to the year 2000 standard
population).

**Target setting method:** Better than the best.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

Note: The table below may continue to the following page.

+---------------------------------------------+------------------------+
| **Total Population, 1998**                  | **Residential Fire     |
|                                             | Deaths**               |
+=============================================+========================+
|                                             | Rate per 100,000       |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 1.2                    |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > American Indian or Alaska Native          | 2.1                    |
+---------------------------------------------+------------------------+
| > Asian or Pacific Islander                 | 0.3                    |
+---------------------------------------------+------------------------+
| > Asian                                     | DNC                    |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DNC                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | 3.0                    |
+---------------------------------------------+------------------------+
| > White                                     | 1.0                    |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | 0.9                    |
+---------------------------------------------+------------------------+
| > Cuban                                     | DSU                    |
+---------------------------------------------+------------------------+
| > Mexican                                   | 0.9                    |
+---------------------------------------------+------------------------+
| > Puerto Rican                              | 1.2                    |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | 1.2                    |
+---------------------------------------------+------------------------+
| > Black or African American                 | 3.0                    |
+---------------------------------------------+------------------------+
| > White                                     | 1.0                    |
+---------------------------------------------+------------------------+
| **Gender**                                  |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 0.9                    |
+---------------------------------------------+------------------------+
| > Male                                      | 1.6                    |
+---------------------------------------------+------------------------+
| **Education level** (aged 25 to 64 years)   |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | 2.0                    |
+---------------------------------------------+------------------------+
| > High school graduate                      | 1.2                    |
+---------------------------------------------+------------------------+
| > At least some college                     | 0.4                    |
+---------------------------------------------+------------------------+
| **Select populations**                      |                        |
+---------------------------------------------+------------------------+
| > Persons aged 4 years and under (not age\  | 1.6                    |
| > adjusted)                                 |                        |
+---------------------------------------------+------------------------+
| > Persons aged 65 years and older (not age\ | 3.2                    |
| > adjusted)                                 |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | 3.0                    |
+---------------------------------------------+------------------------+
| > Females                                   | 2.2                    |
+---------------------------------------------+------------------------+
| > Males                                     | 4.0                    |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

15-26. Increase functioning residential smoke alarms.

**Target and baseline:**

+------------+----------------------------+-------------+-------------+
| Objective  | Increase in Functioning    | 1998\       | 2010\       |
|            | Residential Smoke Alarms   | Baseline    | Target      |
+------------+----------------------------+-------------+-------------+
|            |                            | #####       |             |
|            |                            | ### Percent |             |
+------------+----------------------------+-------------+-------------+
| *          | Total population living    | 88          | 100         |
| *15-26a.** | in\                        |             |             |
|            | residences with            |             |             |
|            | functioning smoke alarm on |             |             |
|            | every floor                |             |             |
+------------+----------------------------+-------------+-------------+
| *          | Residences with a          | 87          | 100         |
| *15-26b.** | functioning smoke alarm on |             |             |
|            | every floor                |             |             |
+------------+----------------------------+-------------+-------------+

\*Age adjusted to the year 2000 standard population.

**Target setting method:** Total coverage.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

Note: The table below may continue to the following page.

+-----------------------------------------+----------------------------+
| **Total Population, 1998**              | **15-26a.\                 |
|                                         | Live in Residences With    |
|                                         | Functioning Smoke Alarm on |
|                                         | Every Floor**              |
+=========================================+============================+
|                                         | Percent                    |
+-----------------------------------------+----------------------------+
| > **TOTAL**                             | 88                         |
+-----------------------------------------+----------------------------+
| **Race and ethnicity**                  |                            |
+-----------------------------------------+----------------------------+
| > American Indian or Alaska Native      | 84                         |
+-----------------------------------------+----------------------------+
| > Asian or Pacific Islander             | 90                         |
+-----------------------------------------+----------------------------+
| > Asian                                 | 91                         |
+-----------------------------------------+----------------------------+
| > Native Hawaiian and other Pacific\    | 88                         |
| > Islander                              |                            |
+-----------------------------------------+----------------------------+
| > Black or African American             | 86                         |
+-----------------------------------------+----------------------------+
| > White                                 | 88                         |
+-----------------------------------------+----------------------------+
|                                         |                            |
+-----------------------------------------+----------------------------+
| > Hispanic or Latino                    | 81                         |
+-----------------------------------------+----------------------------+
| > Not Hispanic or Latino                | 88                         |
+-----------------------------------------+----------------------------+
| > Black or African American             | 86                         |
+-----------------------------------------+----------------------------+
| > White                                 | 89                         |
+-----------------------------------------+----------------------------+
| **Gender**                              |                            |
+-----------------------------------------+----------------------------+
| > Female                                | 88                         |
+-----------------------------------------+----------------------------+
| > Male                                  | 87                         |
+-----------------------------------------+----------------------------+
| **Education level** (aged 25 years and  |                            |
| older)                                  |                            |
+-----------------------------------------+----------------------------+
| > Less than high school                 | 81                         |
+-----------------------------------------+----------------------------+
| > High school graduate                  | 88                         |
+-----------------------------------------+----------------------------+
| > At least some college                 | 90                         |
+-----------------------------------------+----------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

In 1997, 3,220 deaths occurred as a result of residential fires.
Residential property loss caused by these fires was roughly \$4.4
billion. In 1995, the cost of all fire-related deaths and injuries,
including deaths and injuries to firefighters, was estimated at \$15.8
billion.[^45]

Fires are the second leading cause of unintentional injury death among
children. Compared to the total population, children aged 4 years and
under have a fire death rate more than twice the national average. About
800 children aged 14 years and under die by fire each year, and 65
percent of these children are under age 5 years. Children are
disproportionately affected because they react less effectively to fire
than adults, and they also generally sustain more severe burns at lower
temperatures than adults. Two-thirds of fire-related deaths and injuries
among children under age 5 years occur in homes without functioning
smoke alarms.[^46]

Functioning smoke alarms on every level and in every sleeping area of a
home can provide residents with sufficient warning to escape from nearly
all types of fires. Therefore, functioning smoke alarms can be highly
effective in preventing fire-related deaths. If a fire occurs, homes
with smoke alarms are roughly half as likely to have a death occur as
homes without smoke alarms.Error: Reference source not found

15-27. Reduce deaths from falls.

**Target:** 3.0 deaths per 100,000 population.

**Baseline:** 4.7 deaths per 100,000 population were caused by falls in
1998 (age adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS.

+-----------------------------------------------+----------------------+
| **Total Population, 1998**                    | **Deaths From        |
|                                               | Falls**              |
+===============================================+======================+
|                                               | Rate per 100,000     |
+-----------------------------------------------+----------------------+
| > **TOTAL**                                   | 4.7                  |
+-----------------------------------------------+----------------------+
| **Race and ethnicity**                        |                      |
+-----------------------------------------------+----------------------+
| > American Indian or Alaska Native            | 4.4                  |
+-----------------------------------------------+----------------------+
| > Asian or Pacific Islander                   | 3.4                  |
+-----------------------------------------------+----------------------+
| > Asian                                       | DNC                  |
+-----------------------------------------------+----------------------+
| > Native Hawaiian and other Pacific Islander  | DNC                  |
+-----------------------------------------------+----------------------+
| > Black or African American                   | 3.1                  |
+-----------------------------------------------+----------------------+
| > White                                       | 4.9                  |
+-----------------------------------------------+----------------------+
|                                               |                      |
+-----------------------------------------------+----------------------+
| > Hispanic or Latino                          | 3.7                  |
+-----------------------------------------------+----------------------+
| > Cuban                                       | 3.3                  |
+-----------------------------------------------+----------------------+
| > Mexican                                     | 3.6                  |
+-----------------------------------------------+----------------------+
| > Puerto Rican                                | 3.4                  |
+-----------------------------------------------+----------------------+
| > Not Hispanic or Latino                      | 4.7                  |
+-----------------------------------------------+----------------------+
| > Black or African American                   | 3.2                  |
+-----------------------------------------------+----------------------+
| > White                                       | 4.9                  |
+-----------------------------------------------+----------------------+
| **Gender**                                    |                      |
+-----------------------------------------------+----------------------+
| > Female                                      | 3.5                  |
+-----------------------------------------------+----------------------+
| > Male                                        | 6.4                  |
+-----------------------------------------------+----------------------+
| **Education level** (aged 25 to 64 years)     |                      |
+-----------------------------------------------+----------------------+
| > Less than high school                       | 2.9                  |
+-----------------------------------------------+----------------------+
| > High school graduate                        | 2.4                  |
+-----------------------------------------------+----------------------+
| > At least some college                       | 1.2                  |
+-----------------------------------------------+----------------------+
| **Select populations**                        |                      |
+-----------------------------------------------+----------------------+
| > Persons aged 65 to 84 years (not age        | 17.2                 |
| > adjusted)                                   |                      |
+-----------------------------------------------+----------------------+
| > Persons aged 85 years and older (not age\   | 107.9                |
| > adjusted)                                   |                      |
+-----------------------------------------------+----------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

15-28. Reduce hip fractures among older adults.

Target and baseline:

+---------+-----------------------------+--------------+--------------+
| Ob      | Reduction in Hip Fractures  | 1998         | 2010 Target  |
| jective |                             | Baseline     |              |
+---------+-----------------------------+--------------+--------------+
|         |                             | #            |              |
|         |                             | ####### Rate |              |
|         |                             |  per 100,000 |              |
+---------+-----------------------------+--------------+--------------+
| **15    | Females aged 65 years and   | 1,055.8      | 416          |
| -28a.** | older                       |              |              |
+---------+-----------------------------+--------------+--------------+
| **15    | Males aged 65 years and     | 592.7        | 474          |
| -28b.** | older                       |              |              |
+---------+-----------------------------+--------------+--------------+

**Target setting method:** Better than the best for 15-28a; 20 percent
improvement for 15-28b. (Better than the best will be used when data are
available.)

**Data source:** National Hospital Discharge Survey (NHDS), CDC, NCHS.

+------------------------------------------------+----------+----------+
| **Adults Aged 65 Years and Older, 1998**       | **Hip    |          |
|                                                | Fr       |          |
|                                                | acture** |          |
+================================================+==========+==========+
|                                                | **       | **       |
|                                                | 15-28a.\ | 15-28b.\ |
|                                                | F        | Males**  |
|                                                | emales** |          |
+------------------------------------------------+----------+----------+
|                                                | Rate per |          |
|                                                | 100,000  |          |
+------------------------------------------------+----------+----------+
| > **TOTAL**                                    | 1,055.8  | 592.7    |
+------------------------------------------------+----------+----------+
| **Race and ethnicity**                         |          |          |
+------------------------------------------------+----------+----------+
| > American Indian or Alaska Native             | DSU      | DSU      |
+------------------------------------------------+----------+----------+
| > Asian or Pacific Islander                    | DSU      | DSU      |
+------------------------------------------------+----------+----------+
| > Asian                                        | DNC      | DNC      |
+------------------------------------------------+----------+----------+
| > Native Hawaiian and other Pacific Islander   | DNC      | DNC      |
+------------------------------------------------+----------+----------+
| > Black or African American                    | 417.6    | DSU      |
+------------------------------------------------+----------+----------+
| > White                                        | 874.2    | 459.6    |
+------------------------------------------------+----------+----------+
|                                                |          |          |
+------------------------------------------------+----------+----------+
| > Hispanic or Latino                           | DSU      | DSU      |
+------------------------------------------------+----------+----------+
| > Not Hispanic or Latino                       | DSU      | DSU      |
+------------------------------------------------+----------+----------+
| > Black or African American                    | DSU      | DSU      |
+------------------------------------------------+----------+----------+
| > White                                        | DSU      | DSU      |
+------------------------------------------------+----------+----------+
| **Education level** (aged 25 to 64 years)      |          |          |
+------------------------------------------------+----------+----------+
| > Less than high school                        | DNC      | DNC      |
+------------------------------------------------+----------+----------+
| > High school graduate                         | DNC      | DNC      |
+------------------------------------------------+----------+----------+
| > At least some college                        | DNC      | DNC      |
+------------------------------------------------+----------+----------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

In 1995, falls became the leading cause of injury deaths among adults
aged 65 years and older. In 1997, 9,023 adults over age 65 years died as
a result of falls.[^47] Falls are the most common cause of injuries and
hospital admissions for trauma among elderly persons. Since most
fractures are the result of falls, understanding factors that contribute
to falling is essential to designing effective intervention strategies.
For all ages combined, alcohol use has been implicated in 35 to 63
percent of deaths from falls. For persons aged 65 years and older, 60
percent of fatal falls occur in the home, 30 percent occur in public
places, and 10 percent occur in health care institutions.[^48]

The most serious fall-related injury is hip fracture. Approximately
212,000 hip fractures occur each year in the United States among adults
aged 65 years and older; 75 to 80 percent of all hip fractures are
sustained by females.[^49] The impact of these injuries on the quality
of life is enormous. Half of all elderly adults hospitalized for hip
fracture cannot return home or live independently after the fracture.
The total direct cost of all fall injuries for adults aged 65 years and
older in 1994 was \$20.2 billion.[^50] Factors that contribute to falls
include difficulties in gait and balance, neurological and
musculoskeletal disabilities, psychoactive medications, dementia, and
visual impairment.[^51] Environmental hazards such as slippery surfaces,
uneven floors, poor lighting on stairs, loose rugs, unstable furniture,
grab bars in bathrooms, and objects on floors also may play a role.

15-29. Reduce drownings.

**Target:** 0.9 drownings per 100,000 population.

**Baseline:** 1.6 drownings per 100,000 population occurred in 1998 (age
adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Vital Statistics System (NVSS), CDC, NCHS,
CPSC.

Note: The table below may continue to the following page.

+---------------------------------------------+------------------------+
| **Total Population, 1998**                  | **Drownings**          |
+=============================================+========================+
|                                             | Rate per 100,000       |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 1.6                    |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > American Indian or Alaska Native          | 3.1                    |
+---------------------------------------------+------------------------+
| > Asian or Pacific Islander                 | 1.5                    |
+---------------------------------------------+------------------------+
| > Asian                                     | DNC                    |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DNC                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | 2.3                    |
+---------------------------------------------+------------------------+
| > White                                     | 1.5                    |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | 1.5                    |
+---------------------------------------------+------------------------+
| > Cuban                                     | DSU                    |
+---------------------------------------------+------------------------+
| > Mexican                                   | 1.5                    |
+---------------------------------------------+------------------------+
| > Puerto Rican                              | 1.0                    |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | 1.6                    |
+---------------------------------------------+------------------------+
| > Black or African American                 | 2.4                    |
+---------------------------------------------+------------------------+
| > White                                     | 1.5                    |
+---------------------------------------------+------------------------+
| **Gender**                                  |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 0.6                    |
+---------------------------------------------+------------------------+
| > Male                                      | 2.7                    |
+---------------------------------------------+------------------------+
| **Education level** (aged 25 to 64 years)   |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | 2.6                    |
+---------------------------------------------+------------------------+
| > High school graduate                      | 1.7                    |
+---------------------------------------------+------------------------+
| > At least some college                     | 0.9                    |
+---------------------------------------------+------------------------+
| **Geographic location**                     |                        |
+---------------------------------------------+------------------------+
| > Urban (metropolitan statistical area)     | 1.4                    |
+---------------------------------------------+------------------------+
| > Rural (nonmetropolitan statistical area)  | 2.1                    |
+---------------------------------------------+------------------------+
| **Select populations**                      |                        |
+---------------------------------------------+------------------------+
| > Males aged 15 to 34 years (not age        | 3.4                    |
| > adjusted)                                 |                        |
+---------------------------------------------+------------------------+
| > Black or African American males           | 4.2                    |
+---------------------------------------------+------------------------+
| Age groups                                  |                        |
+---------------------------------------------+------------------------+
| > Children aged 4 years and younger (not    | 2.9                    |
| > age\                                      |                        |
| > adjusted)                                 |                        |
+---------------------------------------------+------------------------+
| > Adolescents aged 10 to 14 years           | 1.0                    |
+---------------------------------------------+------------------------+
| > Adolescents aged 15 to 19 years           | 2.2                    |
+---------------------------------------------+------------------------+
| > Young adults aged 20 to 24 years          | 2.2                    |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

In 1997, drownings accounted for over 4,000 deaths in the United
States.[^52] In 1998, 8,061 crashes involving recreational boats
resulted in 4,612 injuries and 815 (574 drownings) deaths.[^53] Drowning
is the second leading cause of injury-related death for children and
adolescents aged 1 to 19 years, accounting for 1,502 deaths in
1995.[^54]

Most deaths involving diving occur among persons aged 15 to 39 years,
with the largest proportion (14.8 percent) occurring among persons aged
30 to 39 years. Many diving-related incidents result in spinal cord
injury. Alcohol use is involved in about 50 percent of deaths associated
with water recreation.Error: Reference source not found

Backyard swimming pools and spas represent the greatest risk to
preschoolers, particularly those 18 to 30 months of age. Of the 600
annual drowning deaths of children from birth to 5 years of age, more
than 300 occur in residential swimming pools. Annually, approximately
2,300 nonfatal injuries sustained in residential swimming pools occur in
this age group.Error: Reference source not found

15-30. Reduce hospital emergency department visits for nonfatal dog bite
injuries.

**Target:** 114 hospital emergency department visits per 100,000
population.

**Baseline:** 151.4 hospital emergency department visits per 100,000
population were for nonfatal dog bite injuries in 1997 (age adjusted to
the year 2000\
standard population).

**Target setting method:** Better than the best.

**Data source:** National Hospital Ambulatory Medical Care Survey
(NHAMCS), CDC, NCHS.

+------------------------------------------+---------------------------+
| **Total Population, 1997**               | **Hospital Emergency\     |
|                                          | Department Visits for\    |
|                                          | Nonfatal Dog Bite         |
|                                          | Injuries**                |
+==========================================+===========================+
|                                          | Rate per 100,000          |
+------------------------------------------+---------------------------+
| > **TOTAL**                              | 151.4                     |
+------------------------------------------+---------------------------+
| **Race and ethnicity**                   |                           |
+------------------------------------------+---------------------------+
| > American Indian or Alaska Native       | DSU                       |
+------------------------------------------+---------------------------+
| > Asian or Pacific Islander              | DSU                       |
+------------------------------------------+---------------------------+
| > Asian                                  | DNC                       |
+------------------------------------------+---------------------------+
| > Native Hawaiian and other Pacific      | DNC                       |
| > Islander                               |                           |
+------------------------------------------+---------------------------+
| > Black or African American              | 115.1                     |
+------------------------------------------+---------------------------+
| > White                                  | 164.2                     |
+------------------------------------------+---------------------------+
|                                          |                           |
+------------------------------------------+---------------------------+
| > Hispanic or Latino                     | DSU                       |
+------------------------------------------+---------------------------+
| > Not Hispanic or Latino                 | DSU                       |
+------------------------------------------+---------------------------+
| > Black or African American              | DSU                       |
+------------------------------------------+---------------------------+
| > White                                  | DSU                       |
+------------------------------------------+---------------------------+
| **Gender**                               |                           |
+------------------------------------------+---------------------------+
| > Female                                 | 150.8                     |
+------------------------------------------+---------------------------+
| > Male                                   | 152.0                     |
+------------------------------------------+---------------------------+
| **Education level**                      |                           |
+------------------------------------------+---------------------------+
| > Less than high school                  | DNC                       |
+------------------------------------------+---------------------------+
| > High school graduate                   | DNC                       |
+------------------------------------------+---------------------------+
| > At least some college                  | DNC                       |
+------------------------------------------+---------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Between 500,000 and 4 million persons in the United States are bitten by
dogs every year.[^55] Children are among the most vulnerable, and almost
half of all people are estimated to have been bitten by a dog during
childhood. Among children, more than half of bites have been to the
head, face, or neck. Because of the risk to large parts of the
population, especially children, effective prevention strategies are
needed to reduce the painful and costly burden of dog bites. More
knowledge is needed through a combination of enhanced and coordinated
dog bite reporting systems, expanded population-based surveys, and
implementation and evaluation of prevention trials. Particularly for the
more severe episodes, information needs to be obtained regarding
high-risk situations, high-risk dogs, and elements of successful
interventions.

15-31. (Developmental) Increase the proportion of public and\
private schools that require use of appropriate head, face, eye, and
mouth protection for students participating in school-sponsored physical
activities.

**Potential data source:** School Health Policies and Programs Study
(SHPPS), CDC, NCCDPHP.

Trauma to the head, face, eyes, and mouth occurs frequently during
school-sponsored physical activities. Schools with recreation and sports
programs can reduce traumas by requiring students to use appropriate
protective gear.

### Violence and Abuse Prevention

15-32. Reduce homicides.

**Target:** 3.0 homicides per 100,000 population.

**Baseline:** 6.5 homicides per 100,000 population occurred in 1998 (age
adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data sources:** National Vital Statistics System (NVSS), CDC, NCHS;
FBI Uniform Crime Reports, U.S. Department of Justice.

Note: The table below may continue to the following page.

+---------------------------------------------+------------------------+
| **Total Population, 1998**                  | **Homicides**          |
+=============================================+========================+
|                                             | Rate per 100,000       |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 6.5                    |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > American Indian or Alaska Native          | 9.1                    |
+---------------------------------------------+------------------------+
| > Asian or Pacific Islander                 | 3.5                    |
+---------------------------------------------+------------------------+
| > Asian                                     | DNC                    |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DNC                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | 22.6                   |
+---------------------------------------------+------------------------+
| > White                                     | 4.0                    |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | 8.8                    |
+---------------------------------------------+------------------------+
| > Cuban                                     | 8.3                    |
+---------------------------------------------+------------------------+
| > Mexican                                   | 9.0                    |
+---------------------------------------------+------------------------+
| > Puerto Rican                              | 7.9                    |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | 6.2                    |
+---------------------------------------------+------------------------+
| > Black or African American                 | 23.4                   |
+---------------------------------------------+------------------------+
| > White                                     | 3.1                    |
+---------------------------------------------+------------------------+
| **Gender**                                  |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 3.1                    |
+---------------------------------------------+------------------------+
| > Male                                      | 10.0                   |
+---------------------------------------------+------------------------+
| **Education level** (aged 25 to 64 years)   |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | 17.1                   |
+---------------------------------------------+------------------------+
| > High school graduate                      | 9.9                    |
+---------------------------------------------+------------------------+
| > At least some college                     | 2.7                    |
+---------------------------------------------+------------------------+
| **Select populations** (not age adjusted)   |                        |
+---------------------------------------------+------------------------+
| > Children under 1 year                     | 8.1                    |
+---------------------------------------------+------------------------+
| > Children aged 1 to 4 years                | 2.6                    |
+---------------------------------------------+------------------------+
| > Children aged 10 to 14 years              | 1.5                    |
+---------------------------------------------+------------------------+
| > Adolescents aged 15 to 19 years           | 11.7                   |
+---------------------------------------------+------------------------+
| > Persons aged 15 to 34 years               | 13.0                   |
+---------------------------------------------+------------------------+
| > Intimate partners aged 14 to 45 years     | DNC                    |
| > (spouse, ex-spouse, boyfriend,            |                        |
| > girlfriend)                               |                        |
+---------------------------------------------+------------------------+
| > Black or African Americans aged 15 to 34  | 48.2                   |
| > years                                     |                        |
+---------------------------------------------+------------------------+
| > Females                                   | 13.3                   |
+---------------------------------------------+------------------------+
| > Males                                     | 84.9                   |
+---------------------------------------------+------------------------+
| > Hispanic males aged 15 to 34 years        | 33.5                   |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

Homicide was the cause of death for 19,491 persons in United States (7.2
per 100,000 population) in 1997.[^56] Homicide is the second leading
cause of death for young persons aged 15 to 24 years and the leading
cause of death for African Americans in this age group.[^57] Homicide
rates are dropping among all groups, but the decreases are not as
dramatic among youth, who already exhibit the highest rates. In 1997,
6,146 young persons aged 15 to 24 years were victims of homicide,
amounting to almost 17 youth homicide victims per day in the United
States.[^58] Of all homicide victims in 1997, 37 percent were under age
24 years.[^59] The homicide rate among males aged 15 to 24 years in the
United States is 10 times higher than in Canada, 15 times higher than in
Australia, and 28 times higher than in France or Germany.[^60]

15-33. Reduce maltreatment and maltreatment fatalities of\
children.

**15-33a.** Reduce maltreatment of children.

**Target:** 10.3 per 1,000 children under age 18 years.

**Baseline:** 12.9 child victims of maltreatment per 1,000 children
under age 18 years were reported in 1998.

**Target setting method:** 20 percent improvement. (Better than the best
will be used when data are available.)

**Data source:** National Child Abuse and Neglect Data System (NCANDS),
Administration on Children, Youth and Families, Administration for
Children and Families (ACF), Children's Bureau.

> **Data for population groups currently are not analyzed.**

**15-33b.** Reduce child maltreatment fatalities.

**Target:** 1.4 per 100,000 children under age 18 years.

**Baseline:** 1.6 child maltreatment fatalities per 100,000 children
under age 18 years occurred in 1998.

**Target setting method:** 12 percent improvement. (Better than the best
will be used when data are available.)

**Data source:** National Child Abuse and Neglect Data System (NCANDS),\
Administration on Children, Youth, and Families, Administration for
Children and Families (ACF), Children's Bureau.

> **Data for population groups currently are not analyzed.**

The 1997 Child Maltreatment report from the States to the National Child
Abuse and Neglect Data System found there were approximately 984,000
victims of maltreatment, a decrease from more than 1 million victims in
1996 in the 50 States, the District of Columbia, Puerto Rico, the Virgin
Islands, and Guam. The rate of child victims was 13.9 per 1,000 children
in the general population in 1997, which is slightly higher than the
rate of 13.4 victims per 1,000 children in 1990. There were an estimated
1,196 fatalities due to child maltreatment in the 50 States and the
District of Columbia. The findings regarding the types of maltreatment
were as follows: 55.9 percent neglect, 24.6 percent physical abuse, 12.5
percent sexual abuse, and 6.1 percent emotional abuse. It is also
important to note that 58.8 percent of the substantiated or indicated
reports of maltreatment were from professional sources: legal, medical,
social service, or education professionals. Based on data from 39
States, 75.4 percent of the perpetrators were the victim's parents, 10.2
percent were relatives, and 1.9 percent were individuals in other
caretaking relationships.[^61]

Information needs to be collected about new cases and causes of
maltreatment. National surveys of new cases are needed to describe the
magnitude of the problem. In addition, existing interventions and their
impact need to be evaluated. Some long-term studies on home-visitation
programs for young mothers have shown potential for preventing child
abuse and neglect.

15-34. Reduce the rate of physical assault by current or former intimate
partners.

**Target:** 3.3 physical assaults per 1,000 persons aged 12 years and
older.

**Baseline:** 4.4 physical assaults per 1,000 persons aged 12 years and
older by current or former intimate partners occurred in 1998.

**Target setting method:** Better than the best.

**Data source:** National Crime Victimization Survey (NCVS), U.S.
Department of Justice, Bureau of Justice Statistics.

Note: The table below may continue to the following page.

+------------------------------------------+---------------------------+
| **Persons Aged 12 Years and Older,       | **Physical Assault by\    |
| 1998**                                   | Current and/or Former\    |
|                                          | Intimate Partners**       |
+==========================================+===========================+
|                                          | Rate per 1,000            |
+------------------------------------------+---------------------------+
| > **TOTAL**                              | 4.4                       |
+------------------------------------------+---------------------------+
| **Race and ethnicity**                   |                           |
+------------------------------------------+---------------------------+
| > American Indian or Alaska Native       | DSU                       |
+------------------------------------------+---------------------------+
| > Asian or Pacific Islander              | DSU                       |
+------------------------------------------+---------------------------+
| > Asian                                  | DNC                       |
+------------------------------------------+---------------------------+
| > Native Hawaiian and other Pacific      | DSU                       |
| > Islander                               |                           |
+------------------------------------------+---------------------------+
| > Black or African American              | 5.1                       |
+------------------------------------------+---------------------------+
| > White                                  | 4.3                       |
+------------------------------------------+---------------------------+
|                                          |                           |
+------------------------------------------+---------------------------+
| > Hispanic or Latino                     | 3.4                       |
+------------------------------------------+---------------------------+
| > Not Hispanic or Latino                 | 4.4                       |
+------------------------------------------+---------------------------+
| > Black or African American              | DNA                       |
+------------------------------------------+---------------------------+
| > White                                  | DNA                       |
+------------------------------------------+---------------------------+
| **Gender**                               |                           |
+------------------------------------------+---------------------------+
| > Female                                 | 7.2                       |
+------------------------------------------+---------------------------+
| > Male                                   | 1.3                       |
+------------------------------------------+---------------------------+
| **Education level**                      |                           |
+------------------------------------------+---------------------------+
| > Less than high school                  | DNA                       |
+------------------------------------------+---------------------------+
| > High school graduate                   | DNA                       |
+------------------------------------------+---------------------------+
| > At least some college                  | DNA                       |
+------------------------------------------+---------------------------+
| ###### Sexual orientation                | DNC                       |
+------------------------------------------+---------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: The table above may have continued from the previous page.

15-35. Reduce the annual rate of rape or attempted rape.

**Target:** 0.7 rapes or attempted rapes per 1,000 persons.

**Baseline:** 0.8 rapes or attempted rapes per 1,000 persons aged 12
years and older occurred in 1998.

**Target setting method:** Better than the best.

**Data source:** National Crime Victimization Survey (NCVS), U.S.
Department of Justice, Bureau of Justice Statistics.

Note: The table below may continue to the following page.

+---------------------------------------------+------------------------+
| **Persons Aged 12 Years and Older, 1998**   | **Rape or Attempted    |
|                                             | Rape**                 |
+=============================================+========================+
|                                             | Rate per 1,000         |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 0.8                    |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > Other (Asian/Pacific Islander and         | DNA                    |
| > American\                                 |                        |
| > Indian/Alaska Native)                     |                        |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DNC                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | DSU                    |
+---------------------------------------------+------------------------+
| > White                                     | 0.8                    |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | DSU                    |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | 0.8                    |
+---------------------------------------------+------------------------+
| > Black or African American                 | DSU                    |
+---------------------------------------------+------------------------+
| > White                                     | DSU                    |
+---------------------------------------------+------------------------+
| ###### Gender                               |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 1.4                    |
+---------------------------------------------+------------------------+
| > Male                                      | DSU                    |
+---------------------------------------------+------------------------+
| **Education level**                         |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | DNA                    |
+---------------------------------------------+------------------------+
| > High school graduate                      | DNA                    |
+---------------------------------------------+------------------------+
| > At least some college                     | DNA                    |
+---------------------------------------------+------------------------+
| ###### Sexual orientation                   | DNC                    |
+---------------------------------------------+------------------------+
| ###### Select populations                   |                        |
+---------------------------------------------+------------------------+
| ######### Age groups                        |                        |
+---------------------------------------------+------------------------+
| > Adolescents aged 12 to 15 years           | DSU                    |
+---------------------------------------------+------------------------+
| > Adolescents aged 16 to 19 years           | DSU                    |
+---------------------------------------------+------------------------+
| > Young adults aged 20 to 24 years          | 3.4                    |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: The table above may have continued from the previous page.

15-36. Reduce sexual assault other than rape.

**Target:** 0.4 sexual assaults other than rape per 1,000 persons aged
12 years and older.

**Baseline:** 0.6 sexual assaults other than rape per 1,000 persons aged
12 years and older occurred in 1998.

**Target setting method:** Better than the best.

**Data source:** National Crime Victimization Survey (NCVS), DOJ, BJS.

Note: The table below may continue to the following page.

+---------------------------------------------+------------------------+
| **Persons Aged 12 Years and Older, 1998**   | **Sexual Assault Other |
|                                             | Than Rape**            |
+=============================================+========================+
|                                             | Rate per 1,000         |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 0.6                    |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > Other (Asian/Pacific Islander and\        | DSU                    |
| > American Indian/Alaska Native)            |                        |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DSU                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | DSU                    |
+---------------------------------------------+------------------------+
| > White                                     | 0.5                    |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | DSU                    |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | 0.7                    |
+---------------------------------------------+------------------------+
| > Black or African American                 | DNA                    |
+---------------------------------------------+------------------------+
| > White                                     | DNA                    |
+---------------------------------------------+------------------------+
| **Gender**                                  |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 1.1                    |
+---------------------------------------------+------------------------+
| > Male                                      | DSU                    |
+---------------------------------------------+------------------------+
| **Education level**                         |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | DNA                    |
+---------------------------------------------+------------------------+
| > High school graduate                      | DNA                    |
+---------------------------------------------+------------------------+
| > At least some college                     | DNA                    |
+---------------------------------------------+------------------------+
| ###### Sexual orientation                   | DNC                    |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: The table above may have continued from the previous page.

Both females and males experience family and intimate violence and
sexual assault. Perpetrators can be the same or opposite sex. Male
victimization of females is more common in intimate partner violence and
sexual assault.

In 1995, almost 5,000 females in the United States were murdered. In
those cases for which the Federal Bureau of Investigation had data on
the relationship between the offender and the victim, 85 percent were
killed by someone they knew. Nearly half of the females who knew the
perpetrators were murdered by a husband, ex-husband, or boyfriend.[^62]
In 1994, more than 500,000 females were seen in hospital EDs for
violence-related injuries, and 37 percent of those females were there
for injuries inflicted by spouses, ex-spouses, or nonmarital
partners.[^63] Although most assault victims survive, they suffer
physically and emotionally.

Violence against women is primarily partner violence. A national survey
conducted from November 1995 to May 1996 estimates that approximately
1.5 million females and 834,700 males are raped and/or physically
assaulted by an intimate partner annually in the United States.
Seventy-six percent of the females who were raped and/or physically
assaulted since age 18 years were assaulted by a current or former
husband, cohabiting partner, or date, compared with 18 percent of the
males. Females are significantly more likely than males to be injured
during an assault: 32 percent of the females and 16 percent of the males
who were raped since age 18 years were injured during their most recent
rape; 39 percent of the females and 25 percent of the males who were
physically assaulted since age 18 years were injured during their most
recent assault. About one in three females who were injured during a
rape or physical assault required medical care.[^64]

Estimates of abuse rates during pregnancy also are a concern. A 1996
literature review indicted that estimated proportions of women
experiencing IPV during pregnancy ranged between 0.9 percent and 20.1
percent. The majority were between 4 and 8 percent. The proportion of
pregnant women who had experienced IPV at any time in the past ranged
between 9.7 percent and 29.7 percent.[^65]

Males who are physically violent toward their partners are more likely
to be sexually violent toward them and are more likely to use violence
toward children.[^66] The perpetration of IPV is most common in adults
who, as children or adolescents, witnessed IPV or became the targets of
violence from their caregivers.Error: Reference source not found

Survey data from 1994 indicate that 407,190 females aged 12 years and
older were victims of rape, attempted rape, or sexual assault.[^67]
Other surveys indicate that the problem is underestimated.[^68] For
example, the National Women's Study, in conjunction with estimates based
on the U.S. Census, suggests that 12.1 million females in the United
States have been victims of forcible rape sometime in their lives.
According to this study, 0.7 percent or approximately 683,000 of adult
females experienced a forcible rape in the past year.[^69]

Teen dating violence is a concern that may stem from childhood abuse or
other experiences with violence. Battering in teen relationships is very
different from IPV that occurs between adults. The issue of teen dating
violence requires national attention and prevention efforts that need to
continue focusing on adolescent violence within the larger context of
family violence.

The nature of IPV and sexual violence makes such problems difficult to
study. Consequently, much remains unknown about the factors that
increase or decrease the likelihood that males will behave violently
toward females, the factors that endanger or protect females from
violence, and the physical and emotional consequences of such violence
for females and their children.

15-37. Reduce physical assaults.

**Target:** 13.6 physical assaults per 1,000 persons aged 12 years
older.

**Baseline:** 31.1 physical assaults per 1,000 persons aged 12 years and
older\
occurred in 1998.

**Target setting method:** Better than the best.

**Data source:** National Crime Victimization Survey (NCVS), U.S.
Department of Justice, Bureau of Justice Statistics.

+---------------------------------------------+------------------------+
| **Persons Aged 12 Years and Older, 1998**   | **Physical Assaults**  |
+=============================================+========================+
|                                             | Rate per 1,000         |
+---------------------------------------------+------------------------+
| > **TOTAL**                                 | 31.1                   |
+---------------------------------------------+------------------------+
| **Race and ethnicity**                      |                        |
+---------------------------------------------+------------------------+
| > American Indian or Alaska Native          | 99.4                   |
+---------------------------------------------+------------------------+
| > Asian or Pacific Islander                 | 13.7                   |
+---------------------------------------------+------------------------+
| > Asian                                     | DNC                    |
+---------------------------------------------+------------------------+
| > Native Hawaiian and other Pacific         | DNC                    |
| > Islander                                  |                        |
+---------------------------------------------+------------------------+
| > Black or African American                 | 33.8                   |
+---------------------------------------------+------------------------+
| > White                                     | 31.0                   |
+---------------------------------------------+------------------------+
|                                             |                        |
+---------------------------------------------+------------------------+
| > Hispanic or Latino                        | 25.9                   |
+---------------------------------------------+------------------------+
| > Not Hispanic or Latino                    | 31.4                   |
+---------------------------------------------+------------------------+
| > Black or African American                 | DNA                    |
+---------------------------------------------+------------------------+
| > White                                     | DNA                    |
+---------------------------------------------+------------------------+
| **Gender**                                  |                        |
+---------------------------------------------+------------------------+
| > Female                                    | 25.1                   |
+---------------------------------------------+------------------------+
| > Male                                      | DSU                    |
+---------------------------------------------+------------------------+
| ###### Education level                      |                        |
+---------------------------------------------+------------------------+
| > Less than high school                     | DNA                    |
+---------------------------------------------+------------------------+
| > High school graduate                      | DNA                    |
+---------------------------------------------+------------------------+
| > At least some college                     | DNA                    |
+---------------------------------------------+------------------------+
| **Select populations**                      |                        |
+---------------------------------------------+------------------------+
| > Adolescents aged 12 to 15 years           | 70.5                   |
+---------------------------------------------+------------------------+
| > Adolescents aged 16 to 19 years           | 76.8                   |
+---------------------------------------------+------------------------+
| > Young adults aged 20 to 24 years          | 56.0                   |
+---------------------------------------------+------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

15-38. Reduce physical fighting among adolescents.

**Target:** 32 percent.

**Baseline:** 36 percent of adolescents in grades 9 through 12 engaged
in physical fighting in the previous 12 months in 1999.

**Target setting method:** Better than the best.

**Data source:** Youth Risk Behavior Surveillance System (YRBSS), CDC,
NCCDPHP.

+-------------------------------------------------+--------------------+
| **Adolescents in Grades 9 Through 12, 1999**    | **Fighting in Past |
|                                                 | 12 Months**        |
+=================================================+====================+
|                                                 | Percent            |
+-------------------------------------------------+--------------------+
| > **TOTAL**                                     | 36                 |
+-------------------------------------------------+--------------------+
| **Race and ethnicity**                          |                    |
+-------------------------------------------------+--------------------+
| > American Indian or Alaska Native              | DSU                |
+-------------------------------------------------+--------------------+
| > Asian or Pacific Islander                     | DSU                |
+-------------------------------------------------+--------------------+
| > Asian                                         | DSU                |
+-------------------------------------------------+--------------------+
| > Native Hawaiian and other Pacific Islander    | DSU                |
+-------------------------------------------------+--------------------+
| > Black or African American                     | 41                 |
+-------------------------------------------------+--------------------+
| > White                                         | 34                 |
+-------------------------------------------------+--------------------+
|                                                 |                    |
+-------------------------------------------------+--------------------+
| > Hispanic or Latino                            | 40                 |
+-------------------------------------------------+--------------------+
| > Not Hispanic or Latino                        | 35                 |
+-------------------------------------------------+--------------------+
| > Black or African American                     | 41                 |
+-------------------------------------------------+--------------------+
| > White                                         | 33                 |
+-------------------------------------------------+--------------------+
| **Gender**                                      |                    |
+-------------------------------------------------+--------------------+
| > Female                                        | 27                 |
+-------------------------------------------------+--------------------+
| > Male                                          | 44                 |
+-------------------------------------------------+--------------------+
| ###### Parents' education level                 |                    |
+-------------------------------------------------+--------------------+
| > Less than high school                         | DNC                |
+-------------------------------------------------+--------------------+
| > High school graduate                          | DNC                |
+-------------------------------------------------+--------------------+
| > At least some college                         | DNC                |
+-------------------------------------------------+--------------------+
| **Select populations**                          |                    |
+-------------------------------------------------+--------------------+
| > 9th grade                                     | 41                 |
+-------------------------------------------------+--------------------+
| > 10th grade                                    | 38                 |
+-------------------------------------------------+--------------------+
| > 11th grade                                    | 31                 |
+-------------------------------------------------+--------------------+
| > 12th grade                                    | 30                 |
+-------------------------------------------------+--------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

15-39. Reduce weapon carrying by adolescents on school\
property.

**Target:** 4.9 percent.

**Baseline:** 6.9 percent of students in grades 9 through 12 carried
weapons on school property during the past 30 days in 1999.

**Target setting method:** Better than the best.

**Data source:** Youth Risk Behavior Surveillance System (YRBSS), CDC,
NCCDPHP.

+--------------------------------------------+-------------------------+
| **Students in Grades 9 Through 12, 1999**  | **Weapon Carrying on    |
|                                            | School Property in Past |
|                                            | 30 Days**               |
+============================================+=========================+
|                                            | Percent                 |
+--------------------------------------------+-------------------------+
| > **TOTAL**                                | 6.9                     |
+--------------------------------------------+-------------------------+
| **Race and ethnicity**                     |                         |
+--------------------------------------------+-------------------------+
| > American Indian or Alaska Native         | DSU                     |
+--------------------------------------------+-------------------------+
| > Asian or Pacific Islander                | DSU                     |
+--------------------------------------------+-------------------------+
| > Asian                                    | DSU                     |
+--------------------------------------------+-------------------------+
| > Native Hawaiian and other Pacific        | DSU                     |
| > Islander                                 |                         |
+--------------------------------------------+-------------------------+
| > Black or African American                | 6.1                     |
+--------------------------------------------+-------------------------+
| > White                                    | 7.0                     |
+--------------------------------------------+-------------------------+
|                                            |                         |
+--------------------------------------------+-------------------------+
| > Hispanic or Latino                       | 7.9                     |
+--------------------------------------------+-------------------------+
| > Not Hispanic or Latino                   | 6.8                     |
+--------------------------------------------+-------------------------+
| > Black or African American                | 5.0                     |
+--------------------------------------------+-------------------------+
| > White                                    | 6.4                     |
+--------------------------------------------+-------------------------+
| **Gender**                                 |                         |
+--------------------------------------------+-------------------------+
| > Female                                   | 2.8                     |
+--------------------------------------------+-------------------------+
| > Male                                     | 11.0                    |
+--------------------------------------------+-------------------------+
| **Parents' education level**               |                         |
+--------------------------------------------+-------------------------+
| > Less than high school                    | DNC                     |
+--------------------------------------------+-------------------------+
| > High school graduate                     | DNC                     |
+--------------------------------------------+-------------------------+
| > Some college                             | DNC                     |
+--------------------------------------------+-------------------------+
| **Select populations**                     |                         |
+--------------------------------------------+-------------------------+
| > 9th grade                                | 7.2                     |
+--------------------------------------------+-------------------------+
| > 10th grade                               | 6.6                     |
+--------------------------------------------+-------------------------+
| > 11th grade                               | 7.0                     |
+--------------------------------------------+-------------------------+
| > 12th grade                               | 6.2                     |
+--------------------------------------------+-------------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

In 1998, physical assault victimization among adolescents took place
twice as often as in the general population of persons aged 12 years and
older. Assaults were significantly higher among males. While the total
assaults for blacks and whites and Hispanics and non-Hispanics were
similar, aggravated assault was higher for blacks than whites (11.9
versus 7.0 per 1,000), and simple assault was higher for non-Hispanics
than Hispanics (23.9 versus 19.5 per 1,000). Assaults were higher for
those with lower household incomes; rates of assault victimization
decreased from 54.2 per 1,000 persons in households with annual incomes
of less than \$7,500 to less than 30 per 1,000 persons in households
with annual incomes greater than \$35,000.[^70]

In 1999, 36 percent of students in grades 9 through 12 had been in a
physical fight one or more times during the 12 months preceding the
survey.[^71] Overall, male students were significantly more likely than
female students to have been in a physical fight. This gender difference
was identified for white and Hispanic students and for each grade.
Overall, Hispanic students (40 percent) were significantly more likely
than white students (33 percent) to have been in a physical fight.
Female and male students in grade 9 were significantly more likely than
female and male students in grade 11 to have been in a physical fight.
Black female students were more likely than white female students to
report this behavior, and male students in grade 9 were much more likely
than male students in grade 12 to report this behavior. Nationwide, 4.0
percent of students had been treated by a doctor or nurse for injuries
sustained in a physical fight one or more times during the 12 months
preceding the survey.Error: Reference source not found

Nationwide, 6.9 percent of students carried a weapon (for example, a
gun, knife, or club) on school property one or more times during the 30
days preceding the survey. Overall, male students were significantly
more likely than female students to have carried a weapon on school
property. This significant gender difference was identified for white
and Hispanic students and each grade. Overall, Hispanic students were
significantly more likely than black students to have carried a weapon
on school property. Black female students were significantly more likely
than white female students to have carried a weapon on school property,
and Hispanics and white male students were significantly more likely
than black male students to report this behavior.**^71^**

Violence prevention programs for youth need to focus on strategies that
reduce involvement in physical fighting and discourage weapon carrying
on school property. Strategies to reduce weapon carrying on school
property, physical fighting, and resulting injuries among youth should
begin early in life and must be tailored to youth of widely varying
social, economic, cultural, and ethnic backgrounds.[^72] As with other
areas of violence and abuse, carefully controlled studies to evaluate
the effectiveness of various strategies and interventions are needed.
Physicians and other health professionals are in a position to provide
effective primary prevention messages to youth and their families. Also,
ED workers treating adolescents with fight-related injuries can practice
secondary interventions, as they do with victims of child abuse, sexual
assault, or attempted suicide.

## Related Objectives From Other Focus Areas

1\. Access to Quality Health Services

1-3. Counseling about health behaviors

1-11. Rapid prehospital emergency care

1-12. Single toll-free number for poison control centers

7\. Educational and Community-Based Programs

7-3. Health-risk behavior information for college and university
students

8\. Environmental Health

8-13. Pesticide exposures

8-24. Exposure to pesticides

8-25. Exposure to heavy metals and other toxic chemicals

18\. Mental Health and Mental Disorders

18-1. Suicide

18-2. Adolescent suicide attempts

20\. Occupational Safety and Health

20-1. Work-related injury deaths

20-2. Work-related injuries

20-5. Work-related homicides

20-6. Work-related assaults

26\. Subtance Abuse

26-1. Motor vehicle crash deaths and injuries

26-5. Alcohol-related hospital emergency department visits

26-6. Adolescents riding with a driver who has been drinking

26-7. Alcohol- and drug-related violence

26-24. Administrative license revocation laws

26-25. Blood alcohol concentration (BAC) levels for motor vehicle
drivers

## Terminology

(A listing of abbreviations and acronyms used in this publication
appears in Appendix H.)

**Age-adjusted injury rate:** An injury rate calculated to reflect a
standard age distribution.

**Attempted rape:** Includes males and females, heterosexual and
homosexual rape, and verbal threats of rape.

**Graduated licensing laws:** Require young drivers to progress through
phases of restricted driving before they are allowed to get their
unrestricted licenses. Such restrictions include a mandatory supervised
driving period, night driving curfews, limits on teen passengers riding
with a beginning driver, and a lower blood alcohol concentration (BAC)
level for teens than for adults.

**Homicide:** Fatal injury intentionally caused to one human being by
another.

**Impaired driving:** Driving while under the influence of alcohol or
drugs.

**Injury:** Unintentional or intentional damage to the body resulting
from acute exposure to thermal, mechanical, electrical, or chemical
energy or from the absence of such essentials as heat or oxygen.

**Intimate partner(s):** Refers to spouses, ex-spouses, boyfriends,
girlfriends, and former boyfriends and girlfriends (includes same-sex
partners). Intimate partners may or may not be cohabitating and need not
be engaging in sexual activities.

**Intimate partner violence:** Actual or threatened physical or sexual
violence or psychological and emotional abuse by an intimate partner.

**Motorcyclist:** Includes both operator and rider (passenger).

**NCUTLO:** National Committee on Uniform Traffic Laws and Ordinances.

**Pedalcyclists:** Riders of bicycles and tricycles.

**Premature death:** Dying before life expectancy is reached.

**Primary enforcement:** A stipulation of a safety belt use law that
allows law enforcement officials to stop a driver solely on the basis of
a safety belt law violation.

**Rape:** Forced sexual intercourse, including both psychological
coercion and physical force. Forced sexual intercourse means vaginal,
anal, or oral penetration by the offender(s) and includes incidents of
penetration by a foreign object. Also included are attempted rapes, male
and female victims, and heterosexual and homosexual rape.

**Risk factor:** A characteristic that has been demonstrated
statistically to be associated with a particular injury.

**Secondary enforcement:** A stipulation of a safety belt use law that
allows law enforcement officials to address a safety belt use law
violation only after a driver has been stopped for some other purpose.

**Sexual assault:** A wide range of victimizations separate from rape
and attempted rape. Included are attacks or attempted attacks of
unwanted sexual contact between the victim and the offender that may or
may not involve force; includes grabbing or fondling. Verbal threats
also are included.

**Suffocation:** Includes inhalation and ingestion of food or other
objects; accidental mechanical suffocation; suicide and self-inflicted
injury by hanging, strangulation, and suffocation; assault by hanging
and strangulation; and hanging, strangulation, or suffocation
undetermined whether accidental or purposely inflicted.

**Target population:** The group of persons (usually those at high risk)
whom program interventions are designed to reach.

**Trauma registry:** A collection of data on patients who receive
hospital care for certain types of injuries, such as blunt or
penetrating trauma or burns. Such collections are designed primarily to
ensure quality care in individual institutions and trauma systems but
also provide useful data for the surveillance of injury and death.

**Unintentional injury:** A type of injury that occurs without
purposeful intent.

**Vehicle miles traveled (VMT):** The miles of travel by all types of
motor vehicles as determined by the States on the basis of actual
traffic counts and established estimating procedures.

**Violence:** The intentional use of physical force or power, threatened
or actual, against another person or against oneself or against a group
of people, that results in or has a high likelihood of resulting in
injury, death, psychological harm, maldevelopment, or deprivation.

**Vulnerable populations:** Refers to children, elderly persons, and
persons with disabilities.

**Years of potential life lost (YPLL):** A statistical measure used to
determine premature death. YPLL is calculated by subtracting an
individual's age at death from a predetermined life expectancy. The
Centers for Disease Control and Prevention generally uses 75 years of
age for this purpose (for example, a person who died at aged 35 years
would have a YPLL of 40).

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