SAFE DRIVING

IN TRIBAL COMMUNITIES

What can Tribal governments 

and health professionals do?

THE FACTS

Motor vehicle crashes are 

a serious problem in Tribal 

communities:

Crashes are a leading cause 

of death for American Indian 

and Alaska Native people.1

The percentage of crash 

deaths involving alcoholimpaired drivers in 2020 

was higher among American 

Indian and Alaska Native 

people (41%) compared to 

the U.S. overall (30%).2

Seat belt use in Indian 

Country (78%)3

 is lower 

than that of the U.S. overall 

(92%).4

Tribal governments and local health professionals 

can make a difference. 

Below are proven strategies to increase the use of seat belts and child car 

seats, reduce alcohol-impaired driving, and improve teen driver safety. These 

strategies can reduce crash-related injuries and deaths in Tribal nations.

SEAT BELTS

HEALTH PROFESSIONALS CAN:

Counsel patients of all ages about the importance and 

effectiveness of buckling up.

Encourage caregivers to make sure children travel properly 

buckled in the back seat in an age- and size-appropriate car seat 

or booster seat, or with a seat belt (when seat belts fit properly).

TRIBAL GOVERNMENTS CAN:

Consider using proven strategies to reduce injuries and increase 

seat belt use, such as:

primary enforcement of seat belt laws (which allows police 

officers to stop and ticket someone for not buckling up) that 

cover front and back seats, and

high-visibility enforcement of seat belt laws.

Seat belts reduce the risk of getting hurt 

or killed in a car crash by about half. 
IMPAIRED DRIVING

HEALTH PROFESSIONALS CAN:

Conduct screening and brief interventions for risky behaviors, such as using alcohol and drugs 

and driving while impaired.5

Talk with patients about the dangers of alcohol-impaired driving. This includes reminding patients to:

never drink and drive,

get a safe ride home or call a ride if they drink,

stop friends from alcohol-impaired driving, and

offer alcohol-free beverages and designate a sober driver when hosting an event.

TRIBAL GOVERNMENTS CAN:

Fully enforce existing laws that can prevent alcohol-impaired driving. These include:

blood alcohol concentration (BAC) laws,

minimum legal drinking age laws, and

zero tolerance laws for drivers younger than 21 years old.6

Reduce alcohol-impaired driving by conducting publicized sobriety checkpoints. Checkpoints can reduce alcohol-related 

crash deaths by 9%.7

Require ignition interlock use for people convicted of alcohol-impaired driving, starting with their first offense.8 Additionally, 

incorporating alcohol use disorder assessment and treatment into ignition interlock programs shows promise in reducing 

post-interlock recidivism.9

Explore The Community Guide supported strategies that can reduce binge drinking.10

Provide Drug Recognition Expert (DRE) or Advanced Roadside Impaired Driving Enforcement (ARIDE) program training to 

law enforcement.11

TEEN DRIVER SAFETY

HEALTH PROFESSIONALS CAN:

Counsel patients about the importance and effectiveness of buckling up.

Encourage parents of new teen drivers to set and enforce the “rules of the road” and 

use tools like parent-teen driving agreements (available at 

www.cdc.gov/transportationsafety/teen_drivers).

Remind parents to always lead by example by practicing safe driving behaviors 

even before their children are old enough to drive.

TRIBAL GOVERNMENTS CAN:

Establish a graduated driver licensing (GDL) system, which helps new drivers gain 

experience under low risk conditions by granting driving privileges in 3 stages. 

Stage 1: Learner’s Permit

• Minimum age of 16 to obtain a learner’s permit 

• A requirement to have a learner’s permit for at least 12 months

• At least 70 supervised practice hours

Stage 2: Intermediate/Provisional License 

• No teen or young adult passengers

• Restrictions on nighttime driving (from 9 or 10 pm until 5 am, or sometimes longer)

Stage 3: Full Licensure

• Minimum age of 18 to obtain a full license
HEALTH PROFESSIONALS CAN:

Keep up-to-date on child passenger safety. Learn more at www.cdc.gov/transportationsafety/child_passenger_safety.

Counsel parents and caregivers at each well-child checkup about:

the importance of using age- and size-appropriate car seats, booster seats, and seat belts on every trip,

the back seat being the safest place for all children under age 13, and

the correct time to move a child to the next seat type or seat belt.

CAR SEATS AND BOOSTER SEATS

TRIBAL GOVERNMENTS CAN:

Enforce child passenger safety laws that require all children until at least age 9 to travel properly buckled in an 

age- and size-appropriate car seat or booster seat.

Provide education and incentives for the use of car seats and booster seats.

Make sure your child is always buckled in a car seat, booster seat, 

or seat belt that is appropriate for their age and size. 

Birth until age 2–4

Buckle children in a rear-facing car 

seat with a harness until they reach 

the maximum weight or height limit 

of their car seat. Keep children 

rear-facing as long as possible. 

Never place a rear-facing car seat in 

the front seat. Front passenger air 

bags can injure or kill young children 

in a crash.

After outgrowing 

rear-facing car seat and 

until at least age 5

When children outgrow their 

rear-facing car seat, they should 

be buckled in a forward-facing car 

seat with a harness and a top 

tether in the back seat until they 

reach the maximum weight or 

height limit of their car seat.

After outgrowing 

forward-facing car seat and 

until seat belt ts properly

When children outgrow their 

forward-facing car seat, they 

should be buckled in a booster 

seat in the back seat until the 

seat belt ts properly without a 

booster seat. Proper seat belt t 

usually occurs when children are 

age 9–12.

When seat belt ts properly 

without a booster seat

Children no longer need to use a 

booster seat when the seat belt ts 

them properly. A seat belt ts 

properly when the lap belt is across 

the upper thighs (not the stomach) 

and the shoulder belt is across the 

center of the shoulder and chest (not 

across the neck or face, and not off 

the shoulder).

Keep children properly buckled in the back seat until age 13.

Child passenger safety recommendations: American Academy of Pediatrics 2018.

*Recommended age ranges for each seat type vary to account for differences in child growth and weight/height limits of car seats 

and booster seats. Use the car seat or booster seat manual to check for important information about installation, the seat weight 

and height limits, and proper seat use.

Birth

Age by Years*

1 2 3 4 5 6 7 8 9 10 11 12 13+

REAR-FACING CAR SEAT FORWARD-FACING CAR SEAT BOOSTER SEAT SEAT BELT

www.cdc.gov/transportationsafety/child_passenger_safety
WHAT’S WORKING IN TRIBAL COMMUNITIES

The Centers for Disease Control and Prevention’s Injury Center funded several tribes to tailor, implement, and evaluate 

evidence-based interventions to reduce motor vehicle-related injury and death. Read about their successes below.

DECREASING 

ALCOHOLIMPAIRED 

DRIVING

The San Carlos Apache 

Tribal Motor Vehicle Injury Prevention 

Program focused on reducing alcoholimpaired driving among Tribal members. 

Key parts of the program included media 

campaigns, sobriety checkpoints, short-term 

high-visibility enforcement, and local events.

THE RESULTS:

The San Carlos Tribal community experienced 

an increase in total driving under the 

influence (DUI) arrests and a decrease in the 

number of vehicle crashes. The community 

also passed a 0.08 BAC law.12

INCREASING CHILD 

CAR SEAT USE

The Yurok Tribe in 

California implemented 

the California Rural 

Indian Health Board’s 

Buckle Up Yurok Program. This program 

comprises community education clinics, a 

media campaign, and car seat checks and 

distribution events.

THE RESULTS:

In 2012, a new primary seat belt and child car 

seat law was implemented. It helped increase 

child car seat use and protection for all motor 

vehicle occupants. More than 250 car seats, 

with education on how to properly use them, 

were distributed over 4 years. Car seat use 

increased by 34% from 2011 to 2014.

INCREASING 

SEAT BELT USE

The Hopi Tribe 

improved collaboration 

with law enforcement to 

strengthen the existing 

seat belt law. A successful media campaign 

raised awareness among Tribal members 

about the importance of buckling up.

THE RESULTS:

Driver seat belt use increased by 33% and 

passenger seat belt use increased 

by 50% between 2011 and 2014.

LEARN MORE AT

www.cdc.gov/transportationsafety/native

or call 1-800-CDC-INFO

The Centers for Disease Control and Prevention’s National 

Center for Injury Prevention and Control and the Indian Health 

Service’s Injury Prevention Program work in partnership with 

American Indian and Alaska Native communities to implement 

proven programs.

LOCAL INFORMATION

References

1. Web-based Injury Statistics Query and Reporting System. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available at 

https://www.cdc.gov/injury/wisqars/. Accessed August 30, 2023.

2. National Highway Traffic Safety Administration. Fatality and Injury Reporting System Tool (FIRST). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety 

Administration, National Center for Statistics and Analysis. Available at https://cdan.dot.gov/query. Accessed August 30, 2023.

3. Bureau of Indian Affairs, Indian Highway Safety Program. FY 2022 Annual Report. Albuquerque, NM: U.S. Department of the Interior, Bureau of Indian Affairs, Office of Justice Services. 

2023. Available at https://www.nhtsa.gov/sites/nhtsa.gov/files/2023-05/BIA_FY2022HSPAR-v2%20tag.pdf. Accessed August 30, 2023.

4. Boyle, L. Seat belt use in 2022 – Overall results (Traffic Safety Facts Research Note. Report No. DOT HS 813 407). Washington, DC: U.S. Department of Transportation, National Highway 

Traffic Safety Administration, National Center for Statistics and Analysis; 2023. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/813407. Accessed August 30, 2023.

5. Higgins-Biddle, J., Dilonardo, J. Alcohol and highway safety: Screening and brief intervention for alcohol problems as a community approach to improving traffic safety (Report No. 

DOT HS 811 836). Washington, DC: National Highway Traffic Safety Administration; 2013. Available at https://www.nhtsa.gov/sites/nhtsa.gov/files/documents/811836.pdf. Accessed 

August 30, 2023.

6. Guide to Community Preventive Services. CSPTF Findings for Motor Vehicle Injury. 2021. Available at https://www.thecommunityguide.org/pages/task-force-findings-motor-vehicleinjury.html. Accessed August 31, 2023.

7. Bergen G, Pitan A, Qu S, Shults RA, Chattopadhyay SK, Elder RW, Sleet DA, Coleman HL, Compton RP, Nichols JL, Clymer JM, Calvert WB, Community Preventive Services Task Force. 

Publicized sobriety checkpoint programs: A Community Guide systematic review. Am J Prev Med 2014;46 (5):529-39.

8. Guide to Community Preventive Services. Motor Vehicle Injury – Alcohol-Impaired Driving: Ignition Interlocks. 2021. Available at https://www.thecommunityguide.org/findings/motorvehicle-injury-alcohol-impaired-driving-ignition-interlocks.html. Accessed August 31, 2023.

9. Voas RB, Tippetts AS, Bergen G, Grosz M, and Marques P. Mandating treatment based on interlock performance: Evidence for effectiveness. Alcohol Clin Exp Res. 2016;40(9):1953–60.

10. Guide to Community Preventive Services. Excessive alcohol consumption. Available at https://www.thecommunityguide.org/topics/excessive-alcohol-consumption.html. Accessed 

August 31, 2023.

11. Venkatraman V, Richard CM, Magee K, Johnson K. Countermeasures That Work: A Highway Safety Countermeasures Guide for State Highway Safety Offices, 10th Edition, 2020 (Report 

No. DOT HS 813 097). Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration; 2021.

Available at https://www.nhtsa.gov/sites/nhtsa.gov/files/2021-09/15100_Countermeasures10th_080621_v5_tag.pdf. Accessed August 21, 2023.

12. West BA, Naumann RB. Tribal motor vehicle injury prevention programs for reducing disparities in motor vehicle-related injuries. MMWR Suppl. 2014 Apr 18;63(1):28-33.

November 2023