TRIBAL MOTOR VEHICLE INJURY PREVENTION (TMVIP)

BEST 

PRACTICES 

GUIDE

2016
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TRIBAL MOTOR VEHICLE INJURY PREVENTION (TMVIP)

BEST PRACTICES GUIDE

2016

Developed for: 

Centers for Disease Control and Prevention

Developed by: 

Robert J. Letourneau, MPH

Carolyn E. Crump, PhD

Department of Health Behavior

Gillings School of Global Public Health

The University of North Carolina at Chapel Hill
4 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Table of Contents

This Guide was developed to share lessons learned from several American Indian/Alaska Native 

(AI/AN) Tribes/Tribal Organizations that have tailored and carried out evidence-based strategies to 

reduce injury and death caused by motor vehicle crashes in AI/AN communities. It was designed 

to be an easy-to-use electronic document. Several hyperlinks — words underlined so you can click 

them to go to another location in the document — are provided to allow readers to move quickly to 

other sections within the guide or to external resources outside the document (for example, such as 

websites and PDF documents). 

Starting on this page, readers can move to sections they find most interesting or to the glossary to see 

definitions of words, phrases, or acronyms. In the glossary, hyperlinks are provided to return to the 

text where the word or phrase was used for the first time in the main text. In addition, a hyperlink to 

return to this Table of Contents page is provided in the footer at the bottom of each page.

List of Acronyms

A. Executive Summary 7

Overview of the Guide

B. Introduction 13

Why the Guide was developed, who developed it, and how to move through the Guide

C. Background 18

Summary of the burden of Motor Vehicle Crash (MVC) Injury and Death 

for American Indians and Alaska Natives (AI/AN)

D. What Works to Prevent Motor Vehicle Crash Injury and Death 21

Definitions and listing of recommended evidence-based strategies to increase 

seat belt use, increase child safety seat use, and reduce alcohol-impaired driving

E. Federal, Tribal/Tribal Organization, State Response 32

Summary of the federal agency, state, and Tribal response to the burden 

of MVC injury and fatality in Tribal communities

F. Components for Tribal Motor Vehicle Injury Prevention (TMVIP) 41

Summary of the components needed for TMVIP: 1) Commitment; 

2) Collaboration; 3) Data and Evaluation; 4) Tailored Evidence-Based Strategies; 

and 5) Technical Support
Table of Contents 5

G. COMMITMENT: Component #1 for TMVIP 44

Commitments Needed, Lessons Learned, Case Examples, 

Resources, and Action Calls

H. COLLABORATION: Component #2 for TMVIP 54

Collaborators Needed, Lessons Learned, Case Examples, 

Resources, and Action Calls

I. DATA and EVALUATION: Component #3 for TMVIP 67

Data and Evaluation Needed, Lessons Learned, Case Examples, 

Resources, and Action Calls

J. TAILORED EVIDENCE-BASED STRATEGIES: Component #4 for TMVIP 84

Summary of how strategies have been tailored in Tribal communities, 

Lessons Learned, Case Examples, Resources, and Action Calls

K. TECHNICAL SUPPORT: Component #5 for TMVIP 107

Summary of technical support available for components 1-4, 

Resources, and Action Calls

Glossary of Terms 122

References 127

Note: Names of Tribes were used in this document only if permission 

was provided or if there was a published article about the Tribe’s efforts.
6 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

List of Acronyms

BAC Blood Alcohol Concentration

BIA Bureau of Indian Affairs

CARS Children Always Ride Safe

CDC Centers for Disease Control and Prevention

CPS Child Passenger Safety

DOT Department of Transportation

DUI Driving Under the Influence

EMS Emergency Medical Services

FARS Fatal Accident Reporting System

FHWA Federal Highway Administration

IHS Indian Health Service

IHSP Indian Highway Safety Program

MVC Motor Vehicle Crash

MVIP Motor Vehicle Injury Prevention

NHTSA National Highway Traffic Safety Administration

RSA Roadway Safety Audit

SCR Safety Circuit Rider

SHSO State Highway Safety Office

SNAP Safe Native American Passengers

TEC Tribal Epidemiology Center

TIPCAP Tribal Injury Prevention Cooperative Agreements Program

TMVIP Tribal Motor Vehicle Injury Prevention

TMVIPP Tribal Motor Vehicle Injury Prevention Program

TTAP Tribal Technical Assistance Program

TTP Tribal Transportation Program

TTPSF Tribal Transportation Program Safety Funds
Executive Summary 7

A. Executive Summary

This Guide was developed to share lessons learned from several American Indian/Alaska Native (AI/

AN) Tribes/Tribal Organizations that have tailored and carried out evidence-based strategies to reduce 

injury and death caused by motor vehicle crashes in AI/AN communities. Lessons learned and 

examples in this document include Tribes funded by the Centers for Disease Control and Prevention, 

Indian Health Service, and the Bureau of Indian Affairs.

This Guide focuses on three evidence-based strategies to reduce motor vehicle injury and death: 

1. Increase Child Safety Seat Use, 

2. Increase Seat Belt Use, and

3. Decrease Alcohol-Impaired Driving. 

The main target audience for this Guide is motor vehicle injury prevention (MVIP) practitioners at 

Tribes/Tribal Organizations. Other key audiences include: 

● Tribal leadership (for example, executive and legislative members).

● Tribal public health and traffic safety professionals (for example, health directors, law 

enforcement, court staff, injury prevention practitioners, community health workers, emergency 

medical service staff).

● Non-Tribal public health and traffic safety professionals working with Tribes/Tribal 

Organizations (for example, state departments of health, transportation, and/or public safety).

Why is motor vehicle 

crash injury a critical 

health issue for 

American Indians 

& Alaska Natives?

● In the United States, adult motor vehicle-related death rates for AI/

AN are 1.5 times higher than those of whites and blacks.1

● Among infants less than one year of age, AI/AN have 8 times the rate 

of motor-vehicle traffic deaths than that of non-Hispanic whites.6 

● AI/AN have a high prevalence, or widespread occurrence, of 

alcohol-impaired driving and the highest alcohol-related motor 

vehicle death rate across racial/ethnic populations.11-12

● More than half (56%) of AI/AN passenger vehicle occupants who 

died in motor vehicle crashes were unrestrained, or not buckled, at 

the time of the fatal crash.1
8 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

What is included 

in this Guide?

This Guide includes the following sections:

● Background: A summary of the burden of MVC injury in 

Indian Country. 

● What Works to Prevent MVC Injury or Death: A summary of the 

strategies known to increase seat belt use, increase child safety seat 

use, and decrease impaired driving.

● Federal, Tribe/Tribal Organization, and State Response: 

Descriptions of programs that are aimed at reducing MVC injury in 

Indian Country.

Components for Tribal Motor Vehicle Injury Prevention: Descriptions 

of the five components needed for successful strategies in AI/AN 

communities, including lessons learned, case examples, calls to action, 

and resources for each component:

1. Commitment

2. Collaboration

3. Data and Evaluation

4. Tailored Evidence-Based Strategies

5. Technical Support
Executive Summary 9

What are the most 

effective strategies to 

address AI/AN motor 

vehicle crash injury?

There are eleven evidence-based strategies with strong evidence to 

support that increasing seat belt use, increasing child safety seat use, 

or decreasing impaired driving can reduce motor vehicle crash injury 

and death among AI/AN. In this Guide, the term child safety seat refers 

to car seats and booster seats, and the term impaired driving refers to 

alcohol-impaired or drunk driving. 

INCREASE SEAT BELT USE

1. Laws Mandating Use: Seat belt laws that require motor vehicle 

occupants to wear seat belts. 

2. Primary (vs. Secondary) Enforcement Laws: ‘Primary’ enforcement 

laws allow police to stop motorists because someone in the vehicle 

is unbelted. These are more effective than secondary enforcement 

laws, which allow police to ticket unbelted motorists only if they 

are stopped for other reasons (for example, breaking other traffic 

laws such as not stopping for a red light).

3. Enhanced Enforcement Programs: Enhanced enforcement 

conducted in addition to normal enforcement, including publicity, 

increases the public’s perceived risk of receiving a citation. The 

number of citations are increased along with the number of officers 

on patrol, or by issuing more citations during an officer’s normal 

patrol.

INCREASE CHILD SAFETY SEAT USE

1. Laws Mandating Use: Child safety seat laws that require children 

riding in motor vehicles to be restrained in car seats or booster seats 

that are appropriate for the child’s age, height, and weight and meet 

the safety standards of the federal government. 

2. Distribution and Education Programs: Programs that provide 

approved child safety seats to parents and caregivers combined with 

an educational component.
10 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

What are the most 

effective strategies to 

address AI/AN motor 

vehicle crash injury? 

(continued)

DECREASE ALCOHOL-IMPAIRED DRIVING

1. 0.08% Blood Alcohol Concentration (BAC) Laws: Laws that 

declare it is illegal for a driver’s BAC to reach 0.08% (0.08 g/dL) for 

drivers aged 21 years and older. 

2. Maintaining Current Minimum Legal Drinking Age (MLDA) Laws: 

Laws that specify an age below which the purchase or public 

consumption of alcoholic beverages is illegal (<21 years of age in 

the US).

3. Publicized Sobriety Checkpoint Programs: Programs with high 

visibility enforcement that includes publicity to attract public 

attention, run by law enforcement who stop drivers systematically 

to measure alcohol impairment. 

4. Multicomponent Interventions with Community Mobilization: 

Interventions to reduce alcohol-impaired driving that include 

several components (for example, sobriety checkpoints, training 

in responsible beverage service, education and awareness-raising 

efforts, and limiting access to alcohol).

5. Ignition Interlocks: Devices that are installed in motor vehicles 

(mandated by a court system or offered as an alternative to a 

suspended driver’s license) to prevent operation of the vehicle by 

a driver who has a BAC above a specified level (usually 0.02% – 

0.04%).

6. Mass Media Campaigns: Campaigns that use mass media 

channels, such as newspapers, radio, television, and/or billboards, 

to encourage people to avoid drinking and driving, or to prevent 

or stop others from drinking and driving. Mass media campaigns 

have strong evidence of effectiveness under certain conditions: 

employing theory, careful planning and execution; adequate 

audience exposure; and conducted in settings with other ongoing 

alcohol-impaired driving prevention efforts.
Executive Summary 11

What is needed 

to address motor 

vehicle crash injury 

in AI/AN 

communities?

Based on experiences and lessons learned from Tribes, federal, 

and state efforts to address motor vehicle crash (MVC) injury in AI/

AN communities, five components are needed for Tribal Motor Vehicle 

Injury Prevention (TMVIP): 1) Commitment; 2) Collaboration; 3) Data 

and Evaluation; 4) Tailored Evidence-Based Strategies; and 5) Technical 

Support.

1. COMMITMENT is needed for...

Funding: to support staff and project intervention activities. 

Staffing: to direct prevention efforts for motor vehicle injury 

and death.

Training: to enhance current knowledge and skills.

Supervisory and Administrative Support: to assist the administrative 

and financial functioning of a traffic safety program.

2. COLLABORATION is needed among the following stakeholders...

Tribal Leadership: to develop, enhance, and support enforcement of 

laws for seat belt/child safety seat use and impaired driving.

MVIP Practitioners: to coordinate Tribal efforts to plan or conduct 

activities, and evaluate progress (for example, determine if changes 

have occurred following program implementation).

Roads or Transportation Departments: to conduct highway safety 

improvements that focus on environmental conditions, and/or 

engineering (design) weaknesses that make a crash more likely or 

more severe.

Legal System: to manage citations and arrests handled in traffic and 

impaired driving courts, track the results of cases, identify repeat 

offenders, and collect fines.

Law Enforcement: to enforce traffic safety laws, complete and share 

data and information on crashes with tribal and non-tribal public 

health and other traffic safety professionals.

Emergency Medical Services: to safely transport those injured in 

MVCs and collect data about MVC crashes/events.

Media: to help share information and educate the public about how 

to prevent motor vehicle crashes, injury, and death.

Community Members, Groups and Institutions: to support, 

encourage, and be an example for the use of safe driving behaviors 

and actions that will lead to safe driving norms, customs, or standard 

behavior.
12 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

What is needed 

to address motor 

vehicle crash injury 

in AI/AN 

communities?

(continued)

3. DATA AND EVALUATION are needed to understand 

and evaluate...

Motor Vehicle Crashes (MVCs): how many; where; when; and why 

MVCs are happening.

MVC Injuries/Fatalities: how many; where; when; and why 

injuries and deaths are happening from MVCs. Can also include the 

outcomes of injuries and medical costs of injury.

Restraint Use: community behaviors and barriers to using seat belts 

and child safety seats (car seats and booster seats).

Laws and Policies: degree to which laws and policies exist or can 

be enhanced.

Enforcement and Prosecution: practices or barriers to enforcing 

and prosecuting or bringing legal actions against those who break 

the law. 

4. TAILORED EVIDENCE-BASED STRATEGIES are needed for ...

Child Safety Seat Use: to increase the number of people who 

properly use age- and size-appropriate car seats and booster seats 

for children.

Seat Belt Use: to increase the number of people who use seat belts.

Impaired Driving: to reduce the number of people who drive 

after drinking.

5. TECHNICAL SUPPORT is available to assist Tribes with...

Commitment: to prioritize injury as an important Tribal priority.

Collaboration: to build multi-disciplinary teams.

Data and Evaluation: to know what data might be needed to assess 

the problem and evaluate interventions.

Evidence-Based Strategies: to tailor recommended strategies for use 

in AI/AN communities.
Introduction 13

B. Introduction

Why is motor vehicle 

injury a critical public 

health issue for 

American Indians 

and Alaska Natives?

Motor vehicle crashes are a leading cause of death for American 

Indians/Alaska Natives (AI/AN) ages 1 to 44.1 Adult motor vehiclerelated death rates for AI/AN are 1.5 times higher than those of whites 

and blacks.1 

Why was this 

Guide developed?

This Guide was developed to share lessons learned from AI/AN Tribes/

Tribal Organizations conducting or implementing evidence-based 

strategies to reduce the burden associated with motor vehicle crashes in 

AI/AN communities. 

There are many evidence-based strategies and promising interventions

to reduce motor vehicle crash injury and death, including those that 

involve educational, environmental, engineering, and policy-related 

approaches. Three of these evidence-based strategies are increasing 

seat belt use, increasing child safety seat use and decreasing alcoholimpaired driving. These three strategies have been implemented by 

multiple Tribes/Tribal Organizations and are the primary emphasis of this 

Best Practices Guide. In this guide, the term child safety seat refers to 

car seats (including rear-facing and forward-facing car seats with a five 

point harness) and booster seats (belt positioning booster seats), and the 

term impaired driving refers to alcohol-impaired driving.

For whom is this 

Guide intended?

The primary target audience for this TMVIP Best Practices Guide is 

Motor Vehicle Injury Prevention (MVIP) Practitioners at Tribes/Tribal 

Organizations. Other target audiences include:

● Tribal leadership (for example, executive and legislative members). 

● Tribal public health and traffic safety professionals (for example, 

health directors, law enforcement, court staff, injury prevention 

practitioners, community health workers, and emergency medical 

services).

● Non-Tribal public health and traffic safety professionals working 

with Tribes and Tribal Organizations (for example, state health 

departments, transportation and/or public safety departments). 
14 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

What is included 

in this Guide?

This Guide includes the following information:

● Background: Description and definition of the burden of MVC injury 

and death in Indian Country. 

● What Works to Prevent MVC Injury and Death: Summary of the 

strategies known to be effective at increasing seat belt use, increasing 

child safety seat use, and decreasing impaired driving. 

● Federal, Tribe/Tribal Organization, and State Response: Description 

of programs that address MVC injury and death in Indian Country. 

● Components for Tribal Motor Vehicle Injury Prevention (TMVIP): 

A description of what is needed for successful TMVIP Programs.

● Lessons Learned, Case Examples, Calls to Action, and Resources: 

for five components to address MVC injury/death in 

AI/AN communities: 1) Commitment; 2) Collaboration; 

3) Data and Evaluation; 4) Tailored Evidence-Based Strategies; and 

5) Technical Support.

The Lessons Learned and Case Examples described in this Guide were 

developed based on the experiences of the authors and contributors 

to this Guide. They also support lessons learned from the 2004-

2009 and 2010-2014 cycles of the Centers for Disease Control and 

Prevention’s Tribal Motor Vehicle Injury Prevention Program2 and 

feedback provided by:

● Tribes and Tribal Organizations.

● Federal agencies (for example, Centers for Disease Control and 

Prevention, Indian Health Service, Bureau of Indian Affairs, 

National Highway Traffic Safety Administration).

● Program evaluation staff at the University of North Carolina at 

Chapel Hill that participated in a 2011 project funded by federal 

agency traffic safety partners to identify the ‘essential components’ of 

Tribal Motor Vehicle Injury Prevention3 and who provided on-going 

technical assistance during both CDC funding cycles.
Introduction 15

How can this Guide 

be used?

This Guide can be used by a variety of public health and traffic safety 

stakeholders. This includes those who are interested in learning 

more about how to plan, use, or evaluate Tribal motor vehicle injury 

prevention interventions. This Guide can also be used to: 

● Help Tribal leadership highlight motor vehicle crash injury as an 

important issue that might need more attention with staffing/funding.

● Help Tribal and non-Tribal public health and traffic safety 

professionals with collecting data or information, doing 

interventions that encourage changes in behavior, or 

completing evaluation activities.

How do you navigate 

or read through this 

Guide?

This Guide was developed to be an easy-to-use electronic document. 

Several hyperlinks – words highlighted in color and underlined so you 

can click on them to go to another location in the document – are 

provided to allow readers to move quickly to other sections that are

● within the Guide, using blue bold font, or 

● external resources outside the Guide, using brown underlined font 

(for example, websites, PDF documents, or other resources). 

Starting with the Introduction section, readers can move to sections 

they find most interesting or to the glossary to see definitions of words 

or phrases. In the glossary, hyperlinks are provided to return to the text 

where a word or phrase is used for the first time (in the main text). In 

addition, a hyperlink to return to the Table of Contents page is provided 

in the footer at the bottom of each page.
16 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Who developed 

this guide?

This guide was developed under contract #200-2014-M-58693 from 

the CDC, National Center for Injury Prevention and Control, Division 

of Unintentional Injury Prevention, to The University of North Carolina 

at Chapel Hill, Gillings School of Global Public Health, Department of 

Health Behavior:

● Robert J. Letourneau, MPH, Research Associate

● Carolyn E. Crump, PhD, Research Associate Professor

The team collaborated with staff from the Centers for Disease Control 

and Prevention’s National Center for Injury Prevention and Control, 

Division of Unintentional Injury Prevention:

● Holly Billie, MPH, Injury Prevention Specialist

● Leanna Fox, MPH, COTR, Public Health Advisor

● Ann Dellinger, Ph.D., MPH, Chief, Home, Recreation and 

Transportation Branch 

Additional input was provided by representatives from a federal agency 

partnership developed to coordinate traffic safety efforts in AI/AN 

communities, including (in alphabetical order):

● Nancy Bill, MPH, Indian Health Service Injury Prevention Program 

● Kenneth Copeland, National Highway Traffic Safety Administration

● Adam Larsen, Federal Highway Administration

● Lawrence Robertson, Bureau of Indian Affairs, Indian Highway 

Safety Program 

● Fawn Thompson, Federal Highway Administration

The following individuals (in alphabetical order) also contributed 

to the guide by reviewing and providing input to earlier drafts of 

the guide:

● Joe Amiotte, MSEH, REHS, Billings Area Indian Health Service

● Laurie Beck, MPH, Centers for Disease Control and Prevention, 

National Center for Injury Prevention and Control, Division of 

Unintentional Injury Prevention

● Lawrence Berger, MD, MPH, University of New Mexico School of 

Medicine

● Esther Corbett, Inter-Tribal Council of Arizona, Inc.

● William (Casey) Crump, RS, CP-FS, MPH, Bemidji Area Indian 

Health Service
Introduction 17

Who developed 

this guide?

(continued)

● Tabatha Harris, BA, Southern Plains Tribal Technical Assistance 

Program Center, Oklahoma State University

● Jason Hymer, REHS, MPH, Phoenix Area Indian Health Service

● Holly Kostrzewski, MPH, Northeast / Northwest Minnesota Toward 

Zero Deaths Regional Coordinator 

● Danielle Lippert, California Rural Indian Health Board

● Robert Morones, MPH, Phoenix Area Indian Health Service

● Jon Peabody, MPH, Phoenix Area Indian Health Service

● Jerry Lee, MPH, Albuquerque Area Indian Health Service

● Erin K. Sauber-Schatz, PhD, MPH, Centers for Disease Control 

and Prevention, National Center for Injury Prevention and Control, 

Division of Unintentional Injury Prevention 

● Gordon Tsatoke, Jr., MPH, California Area Indian Health Service

● Erica Weis, MPH, Inter-Tribal Council of Arizona, Inc.

● Don Williams, REHS, MPH, DAAS, Tucson Area Indian Health 

Service

● Siona Willie, RN, MA, BSN, Navajo Area Indian Health Service
18 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

C. Background

How serious is Motor 

Vehicle Crash (MVC) 

injury and death in 

AI/AN communities?

Motor Vehicle Crashes (MVCs) are a leading cause of unintentional 

injury death for AI/AN ages 1 to 44.1 

● Among AI/AN ages 19 years and younger, motor vehicle crashes are 

the leading cause of unintentional injury-related death.4 

● AI/AN as a group are at increased risk of injury, and AI/AN males 

are at especially high risk for many types of injuries. Compared with 

females the same age, AI/AN males ages 20 years and older are 

twice as likely to die from a motor vehicle crash.1

● Adult motor vehicle-related death rates for AI/AN are 1.5 times more 

than those of whites and blacks.1

MVC Deaths American Indians/Alaska Natives die in MVCs at higher rates than other 

Americans:

● From 2004–2010, five states had the highest motor vehicle-related 

death rates among American Indians/Alaska Natives, between 2.3 

and 3.6 times greater than the U.S. population rate of 19.7 deaths 

per 100,000, including: 

◆ Wyoming 3.6 times higher 

(72 deaths per 100,000 population)

◆ South Dakota 2.9 times higher 

(59 deaths per 100,000 population) 

◆ Montana 2.8 times higher 

(56 deaths per 100,000 population) 

◆ North Dakota 2.8 times higher 

(56 deaths per 100,000 population)

◆ Arizona 2.3 times higher 

(45 deaths per 100,000 population).5 

● Among infants less than one year of age, AI/AN have 8 times 

the rate of motor-vehicle traffic deaths than that of non-Hispanic 

whites.6 
Background 19

Limitations of MVC 

Death Data

● These and other statistics likely undercount deaths and injuries 

among AI/AN. Several research studies have shown that when 

people are put in the wrong racial category (which is called racial 

misclassification), fewer injuries and deaths are reported. Racial 

misclassification has been documented for AI/AN people in motor 

vehicle crashes.7-8 A 2014 study further describes issues with racial 

misclassification in the AI/AN population of Idaho, Oregon, and 

Washington.9 

● Another study found significant under-reporting of Tribal crash data 

to the federal database known as Fatality Analysis Reporting System 

(FARS). Results for AI/AN information might be unstable when 

compared with other populations in this database.10

● Both under-counting and under-reporting are important data 

limitations.

Impaired Driving AI/ANs have the highest alcohol-related MVC death rates of all racial 

groups:

● AI/AN have a high prevalence (or amount of) alcohol-impaired 

driving and the highest alcohol-related motor vehicle death rate 

among racial/ethnic populations.11-12

● Among AI/AN fatal crashes in 2012, an estimated 42 percent were 

alcohol-related.5 Nationally, during this same time period, 31 

percent of fatal crashes were alcohol-related for all races overall.13

● Fatally injured AI/AN females who were driving while intoxicated 

had BAC levels two times higher than females of other races.14 

● More AI/AN youth had been drinking when involved in deadly 

crashes when compared with other races.15

● Among those who drink, the rate of binge drinking and heavy 

drinking tends to be highest among Native Americans.16
20 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Low Seat Belt 

and Child Safety 

Seat Use

AI/AN seat belt and child safety seat use rates are lower than 

national rates:

● More than half (56%) of AI/AN passenger vehicle occupants who 

died in motor vehicle crashes were unrestrained at the time of the 

fatal crash, compared with 49% nationally.1,17

● Seat belt use varies across reservations, ranging from a low of 36.4 

percent to a high of 90.7 percent. According to NHTSA, American 

Indian seat belt use has increased from 69.6% in 2013 to 73.4% in 

2014.18-19 

● Reservations with primary enforcement laws have the highest seat 

belt use, followed by reservations with secondary enforcement laws. 

● Child safety seat use for AI/AN communities vary, and are generally 

much lower than those of other racial groups.20 In one 2002 study 

of three Northwest tribes, child safety seat use ranged from 12% to 

21% for children from birth to age four.21 In a 2005 study of AI/AN 

children at six Tribes in Idaho, Oregon, and Washington, child safety 

seat use ranged from 11% to 63% among children eligible to be in 

booster and infant seats, respectively.22

What progress is 

being made?

● Individual Tribes have published results showing increases in seat 

belt use, including: those funded by the CDC’s Tribal Motor Vehicle 

Injury Prevention Program from 2004-09 and 2010-14,23, 26, 27 Tribes 

funded by the IHS Tribal Injury Prevention Cooperative Agreements 

Program (for example, Ute Tribe24); and other Tribes. 

● Between 2002 and 2014, Tribes have also documented increases 

in child safety seat use (for example, Ho-Chunk Nation,23,26 Tohono 

O’odham Nation,26 several Tribes participating in the IHS Ride Safe 

Program,20 and several Northwest Tribes 21, 22).

● Several Tribes have documented decreases in motor vehicle crash 

injuries (for example, the Tohono O’odham Nation;26 San Carlos 

Apache Tribe;26 Ute Tribe;24 and Tribes funded by the CDC’s 2010-

2014 TMVIPP funding cycle: Rosebud Sioux Tribe, Hopi Tribe, 

and Yurok Tribe27). The Navajo Nation in 1992 and 2002 reported 

decreases in motor vehicle injury hospitalizations and pediatric 

discharge rates for motor vehicle injury.

25, 28 
What Works to Prevent MCV Injury/Facility? 21

D. What Works to Prevent MVC Injury/Death

What strategies are 

effective at reducing 

MVC injury and 

death in AI/AN 

communities?

This section defines effectiveness and how effectiveness is determined 

for traffic safety strategies. The section also lists the recommended 

strategies to increase seat belt use, increase child safety seat use, 

and reduce alcohol-impaired driving, as identified by The Guide to 

Community Preventive Services (The Community Guide).

Definitions What is effective?

General Definitions “Evidence-based” interventions (that is, policies or programs) are 

those that have been evaluated as effective using appropriate methods 

and measurement. Experts review multiple research studies selected 

using agreed upon standards and measures. They consider all results 

and outcomes from the selected studies to determine whether there is 

enough evidence that the intervention achieves the intended outcome 

(for example, changes in behavior, reductions in risk, reductions 

in death, disability or injury). In other words, does the evidence 

demonstrate that the intervention worked? Interventions can be classified 

or grouped by level of scientific evidence available:29

1. Evidence-Based: There is strong evidence the intervention works. 

There are sustainable, replicable programs that have demonstrated 

positive impact on prevention, costs and/or other stated outcomes.

2. Effective: There is some evidence the intervention is effective, but 

additional research is needed in multiple settings to determine their 

full impact or effectiveness.

3. Promising/Innovative/Emerging Practices: Cutting edge efforts 

that are untested or locally developed in which there is currently 

insufficient evidence to determine their impact (does not mean the 

strategy is ineffective, but rather additional study is needed).
22 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Traffic Safety 

Definitions

For traffic safety, one resource to identify evidence-based interventions 

for motor vehicle injury prevention is: The Guide to Community 

Preventive Services (The Community Guide): Motor Vehicle-Related 

Injury Prevention. 

The Community Guide describes a broad selection of strategies or 

programs that have been studied for effectiveness and success to decide 

how much and at what level the programs are recommended to increase 

child safety seat or seat belt use and to reduce alcohol-impaired driving 

(sometimes referred to as driving under the influence, or DUI). The 

Community Guide is maintained by the CDC and describes reasons why 

a strategy is recommended or not recommended:

● Recommended: The systematic review of available studies provides 

strong or sufficient evidence that the intervention is effective. The 

categories of “strong” and “sufficient” evidence reflect the Task 

Force’s degree of confidence that an intervention has beneficial 

effects. The categories do not directly relate to the expected 

magnitude of benefits. The categorization is based on several factors, 

such as study design, number of studies, and consistency of the effect 

across studies.

● Recommended Against: The systematic review of available studies 

provides strong or sufficient evidence that the intervention is harmful 

or not effective.

● Insufficient Evidence: The available studies do not provide sufficient 

evidence to determine if the intervention is, or is not, effective. 

This does NOT mean that the intervention does not work. It means 

that additional research is needed to determine whether or not the 

intervention is effective.

This TMVIP Best Practices Guide references and describes how three 

strategies outlined in The Community Guide —1) increase seat belt use; 

2) increase child safety seat use; and 3) reduce alcohol-impaired driving 

– have been used in AI/AN communities. 

The Community Guide, and other entities, have conducted research on 

evidence-based strategies for specific populations (for example, teens, 

motorcycle drivers, older adults). While these programs are not the 

focus of this Guide, strategies that focus on other types of drivers should 

also be considered, including: Motorcycle Helmet Use; Graduated 

Driver Licensing; and Older Adult Drivers.
What Works to Prevent MCV Injury/Facility? 23

Traffic Safety 

Definitions

(continued)

Countermeasures that Work is a resource developed by NHTSA to help 

State Highway Safety Offices (SHSO) select evidence-based strategies 

for traffic safety problems, including:

● Alcohol-Impaired and Drugged Driving

● Seat Belts and Child Restraints

● Aggressive Driving and Speeding

● Distracted and Drowsy Driving

● Motorcycle SafetyYoung Drivers

● Older Drivers

● Pedestrians

● Bicyclists

The Countermeasures resource describes major strategies and 

countermeasures that are relevant to SHSOs (that is, they can be 

conducted using funding from traditional highway safety grant 

programs). It summarizes strategy and countermeasure use, 

effectiveness, costs, and implementation time. It also provides 

references to research summaries and individual studies. The 

Countermeasures resource does not include strategies that SHSO cannot 

conduct using typical highway safety grant programs.

This TMVIP Best Practices Guide does not emphasize strategies 

designed to change how vehicles are made or how roads are built. 

However, Tribal motor vehicle injury prevention practitioners can find 

more information about environmental and engineering interventions at:

● National Highway Traffic Safety Administration 

Vehicle Safety Website.

● Federal Highway Administration’s Office of Safety website and the 

Highway Safety Improvement Program website (HSIP).
24 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Child Safety Seat Use What works to increase the use of child safety seats?

Recommended 

Strategies

The Guide to Community Preventive Services recommends four strategies 

with strong or sufficient evidence.30 The Guide’s Section J - Tailored 

Evidence-Based Strategies: Child Safety Seats provides information about 

how these strategies have been tailored in AI/AN communities.

Strong Evidence for increasing the use of child safety seats (car seats and 

booster seats):

1. Laws Mandating Use: Child safety seat laws require children riding 

in motor vehicles to be restrained in car seats or booster seats that 

are appropriate for the child’s age, height, and weight and meet 

the safety standards of the federal government. Requirements and 

enforcement guidelines and penalties vary by state or Tribe based 

on several factors (for example, child’s age, weight, height, or a 

combination of these). Laws mandating use of child safety seats 

in all 50 states allow drivers to be stopped for failing to properly 

buckle children in safety seats as required under each state’s law. 

Fines and enforcement requirements vary by state.

2. Distribution and Education Programs: Child safety seat distribution 

plus education programs provide approved child safety seats to 

parents and other caregivers many different ways (for example, 

free giveaway, low-cost purchase), combined with an educational 

component. These programs are created for parents or caregivers 

who need financial aid or for those who might not understand the 

importance of using a child safety seat.

Sufficient Evidence for increasing the use of child safety seats:

3. Community-Wide Information and Enhanced Enforcement 

Campaigns: These campaigns include using mass media (such 

as newspapers, radio, television and billboards), information 

and publicity, public displays of child safety seats, and other 

targeted strategies such as checkpoints, traffic safety focused 

law enforcement officials, or alternative penalties (for example, 

informational warnings instead of citations or tickets).

4. Incentive and Education Programs: These programs offer parents, 

caregivers or children rewards for using child safety seats the correct 

way. They also provide education, with variations in content, 

duration, intensity, and delivery methods.
Executive Summary 25

Insufficient 

Evidence

The Guide to Community Preventive Services has identified one strategy that 

does not have enough evidence to show effectiveness:

Education Programs When Used Alone: These types of programs provide 

information, alone, about the use of child safety seats and relevant skills 

to parents, children, or professional groups. Giving information alone is 

rarely enough for long-term change in behavior. However, it is a central and 

necessary piece of other interventions, such as community-wide information 

and enhanced enforcement campaigns, distribution and education 

programs, and incentive and education programs.

Seat Belt Use What works to increase seat belt use?

Recommended 

Strategies

The Guide to Community Preventive Services recommends three strategies 

with strong evidence.31 The Guide’s Section J - Tailored Evidence-Based 

Strategies: Seat Belts provides information about how these strategies have 

been tailored in AI/AN communities. 

Strong Evidence for increasing seat belt use and reducing fatal and non-fatal 

injuries among youth and adults:

1. Laws Mandating Use: Seat belt laws require motor vehicle occupants 

to wear seat belts. Currently 49 states (excluding NH), the District of 

Columbia, and some federally recognized Tribes with land jurisdictions 

(for example, those who live on a Reservation) have seat belt use laws 

for at least front seat occupants. Other requirements vary by state, 

such as: laws requiring rear seat or all vehicle occupant use; fines; 

age groups subject to laws; the type of enforcement law (primary vs. 

secondary); or exempt vehicles and drivers. An additional benefit of 

laws requiring adult seat belt use is that they also increase child safety 

seat use.

2. Primary (vs. Secondary) Enforcement Laws: ‘Primary’ laws allow 

police to stop motorists because someone in the vehicle is unbelted. 

These are more effective at reducing MVC injury and death than 

‘secondary’ seat belt laws. Secondary seat belt laws allow police to 

ticket unbelted motorists only if they are stopped for other reasons (for 

example, other moving violations).

3. Enhanced Enforcement Programs: Enhanced enforcement programs 

conducted in addition to normal seat belt enforcement increase the 

public’s risk of receiving a citation. They also include advertising or 

promotion. There are two categories: a) programs that increase tickets 

in combination with increasing the number of officers on patrol duty 

(called supplemental); and b) programs that encourage giving more 

tickets during an officer’s normal patrol duty (called targeted).
26 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

LESSON LEARNED

Dispelling Myths about Seat Belt Use

In some AI/AN communities, myths about seat belts may exist. For example, uncomfortable to wear, 

how difficult they are to use, danger in trapping people, how unnecessary they are at low speeds or in rear 

seats. The World Health Organization published a report about common seat belt myths, combined with 

facts that can be used to counter those myths when communicating with community members, groups, or 

decision-makers in a Tribal community. See page 44 of the WHO Seat-belts and child restraints: a road 

safety manual for decision-makers and practitioners.

Impaired Driving What works to reduce impaired driving?

Recommended 

Strategies 

The Guide to Community Preventive Services recommends six strategies 

with strong and two strategies with sufficient evidence.32 The Guide’s 

Section J - Tailored Evidence-Based Strategies: Impaired Driving

provides information about how these strategies have been tailored in 

AI/AN communities. 

Strong Evidence for reducing alcohol-related MVC deaths, alcoholrelated MVCs and associated injuries, alcohol-impaired driving, and 

alcohol-impaired driving re-arrest rates: 

● 0.08% Blood Alcohol Concentration (BAC) Laws: These laws state 

that it is not legal for a driver’s BAC to reach 0.08% (0.08 g/dL) for 

drivers aged 21 years and older. 0.08% BAC has been found to be 

effective in reducing alcohol-related MVC deaths. According to 

NHTSA, all states define driving with a blood alcohol concentration 

(BAC) at or above 0.08% as a crime, but certain laws and penalties 

differ from state to state. Some AI/AN Tribes have laws with less strict 

BAC limits (for example, 0.10%), while others have more strict laws 

(for example, 0.04%). In AI/AN communities, Tribal BAC laws apply 

only to those Tribes with oversight from Tribal Law Enforcement, 

courts, and detention centers. 

● Maintaining Current Minimum Legal Drinking Age (MLDA) Laws:

These laws make it illegal to buy or drink alcoholic beverages in 

public for any person under the age of 21. The laws have been 

effective at lowering alcohol-related MVCs and related injuries 

among 18 to 20-year-old drivers. All states currently have an MLDA 

of 21 years of age.
Executive Summary 27

Recommended 

Strategies 

(continued)

● Publicized Sobriety Checkpoint Programs: These programs 

include publicity with high visibility enforcement conducted by 

law enforcement officers who stop drivers systematically to check 

for alcohol impairment. These programs have been shown to be 

effective at reducing alcohol-impaired driving. Using media to 

publicize checkpoints increases the public’s belief that they will be 

arrested (that is, perceived risk of arrest). This increased perception 

of arrest risk helps reduce alcohol-impaired driving. In addition, 

alcohol-impaired drivers are identified (by using breath testing) and 

arrested at checkpoints. 

● Multicomponent Interventions with Community Mobilization: 

These interventions consist of several components acting 

synergistically and have been shown to be effective at reducing 

alcohol-impaired driving, combined with participation of active 

community workgroups or task forces to plan/implement these 

interventions (community mobilization). For example, sobriety 

checkpoints, training in responsible beverage services, education 

and awareness-raising efforts, and/or limiting access to alcohol may 

be combined in various ways to mobilize the community against 

drinking and driving. 

● Ignition Interlocks: These devices are installed in motor vehicles 

(mandated by a court system or offered as an alternative to a 

suspended driver’s license) to prevent operation of the vehicle 

by a driver who has a BAC above a specified level (usually 0.02% 

to 0.04%). Installed most often in vehicles of people who have 

been convicted of alcohol-impaired driving, interlocks have been 

shown to be effective at reducing re-arrest rates while the interlocks 

are installed
28 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Recommended 

Strategies 

(continued)

Strong Evidence for reducing alcohol-impaired driving and alcoholrelated crashes under certain conditions: 

● Mass Media Campaigns: These campaigns are designed to educate 

people to avoid drinking and driving, or to prevent others from 

drinking and driving. Campaigns used a variety of themes (for 

example, fear of arrest; fear of injury to self, others, or property; 

characterizing drinking drivers as irresponsible and dangerous). 

Things that make it effective include: careful planning and execution 

using theory; adequate audience exposure; and implementation in 

settings that have other ongoing alcohol-impaired driving prevention 

(for example, enforcement of laws).

Sufficient Evidence for reducing alcohol-related MVCs or riding with 

impaired drivers:

● Lower BAC Laws for Young or Inexperienced Drivers: These laws 

identify a lower illegal BAC (for example, 0.02% or lower) for young 

or inexperienced drivers under the age of 21 (the minimum legal 

drinking age in the U.S.) than for older or more experienced drivers 

and have been shown to be effective at reducing alcohol-related 

MVCs. 

● School-Based Instructional Programs: These programs are used 

to address the problems of alcohol-impaired driving and riding 

with alcohol-impaired drivers. Some programs have a broader 

focus that includes alcohol and other substance use (for example, 

illegal or prescription drugs). These programs have been shown 

to be effective in reducing riding with impaired drivers. However, 

there is insufficient evidence to determine the effectiveness of these 

programs on reducing alcohol-impaired driving or alcohol-related 

crashes among drivers themselves.

● Multicomponent Interventions: This approach which implements 

multiple programs and policies in various settings to reduce alcoholimpaired driving can include any or all of a number of components, 

such as sobriety checkpoints, training in responsible beverage 

service, education and awareness-raising efforts, and limiting access 

to alcohol. 
Executive Summary 29

Insufficient 

Evidence

The Community Guide identified four strategies that do not have 

sufficient evidence to show effectiveness at reducing alcohol-impaired 

driving or alcohol-related crashes, due to the limited number of studies 

conducted:

● School-Based Peer Organizing Interventions: These interventions 

seek to involve students in a number of different prevention activities 

focused on not driving impaired or not riding with an impaired 

driver.

● School-Based Social Norming Campaigns: These campaigns are 

typically ongoing, multiyear public information programs on college 

campuses designed to reduce alcohol use by providing objective 

normative information regarding student alcohol consumption to 

reduce misperceptions and change behavior. 

● Designated Driver Promotion Incentive Programs: These programs 

offer free incentives to encourage drinking establishment customers 

to act as designated drivers.

● Population-Based Designated Driver Promotion Campaigns: These 

campaigns use mass media and other ways to communicate with the 

public to promote and encourage using designated drivers, which 

means having or asking someone (designating) to drive who has not 

been drinking.
30 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

AT-A-GLANCE SUMMARY for What Works 

to Prevent MVC Injury/Death

RECOMMENDED STRATEGIES TO INCREASE CHILD SAFETY SEAT USE

Strategy Evidence

1. Laws Mandating Use: Child safety seat laws that require children riding in 

motor vehicles to be restrained in approved child restraints (for example, 

car seats and booster seats). Strong

2. Distribution and Education Programs: Programs that provide approved 

child safety seats to parents and caregivers combined with an educational 

component. Strong

3. Community-Wide Information and Enhanced Enforcement Campaigns:

Campaigns that include mass media, information and publicity, public child 

safety seat displays, and other targeted strategies such as checkpoints, 

dedicated law enforcement officials, or alternative penalties. Sufficient

4. Incentive and Education Programs: Programs that offer parents, caregivers, 

and/or children rewards for property using child safety seats, and 

education that varies in content, duration, intensity and delivery methods. Sufficient

RECOMMENDED STRATEGIES TO INCREASE SEAT BELT USE

Strategy Evidence

1. Laws Mandating Use: Seat belt laws that require motor vehicle occupants 

to wear seat belts. Strong

2. Primary (vs. Secondary) Enforcement Laws: ‘Primary’ enforcement laws 

allow police to stop motorists because someone in the vehicle is unbelted. 

They are more effective than secondary enforcement laws. Strong

3. Enhanced Enforcement Programs: Enhanced enforcement conducted in 

addition to normal enforcement; includes publicity; and increased citations 

in combination with increasing the number of officers on patrol or by 

issuing more citations during an officer’s normal patrol. Strong
Executive Summary 31

RECOMMENDED STRATEGIES TO REDUCE IMPAIRED DRIVING 

(AND ASSOCIATED CRASHES, INJURIES/DEATHS)

Strategy Evidence

1. 0.08% Blood Alcohol Concentration (BAC) Laws: Laws that declare it is 

illegal for a driver’s BAC to reach exceed 0.08% (0.08 g/dL) for drivers 

aged 21 years and older. Strong

2. Maintaining Current Minimum Legal Drinking Age (MLDA) Laws: 

Laws that specify an age below which the purchase or public consumption 

of alcoholic beverages is illegal (21 years of age). Strong

3. Publicized Sobriety Checkpoint Programs: Programs that involve high 

visibility enforcement conducted by law enforcement stopping drivers 

systematically to assess alcohol impairment. Strong

4. Multicomponent Interventions with Community Mobilization: 

Interventions that can include one or more components (for example, 

sobriety checkpoints, training in responsible beverage service, education 

and awareness-raising efforts, and limiting access to alcohol). Strong

5. Ignition Interlocks: Devices that are installed in motor vehicles (mandated 

by a court system or offered as an alternative to a suspended driver’s 

license) to prevent operation of the vehicle by a driver who has a BAC 

above a specified level (usually 0.02% to 0.04%). Strong

6. Mass Media Campaigns: Campaigns that are designed to educate 

individuals to avoid drinking and driving, or to prevent others from drinking 

and driving. Strong

7. Lower BAC Laws for Young or Inexperienced Drivers: Laws that identify a 

lower illegal BAC (for example, 0.02% or lower) for young or inexperienced 

drivers under the age of 21 (the minimum legal drinking age in the U.S.) 

than for older or more experienced drivers. Sufficient

8. School-Based Instructional Programs: Programs that address the problem 

of riding with alcohol impaired drivers. There is insufficient evidence 

to determine the effectiveness of these programs on reducing alcoholimpaired driving by the drivers themselves. Sufficient

a There is strong evidence under certain conditions, including: careful planning and execution, using theory; 

adequate audience exposure; and implementation in settings that have other ongoing alcohol-impaired driving 

prevention activities.
32 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

E. Federal, Tribal/Tribal Organization, State Response

What efforts have 

been made to address 

the burden?

Several federal agencies have established competitive grant and 

cooperative agreement programs for Tribes/Tribal Organizations 

to reduce MVC injury and death in AI/AN communities. Other 

organizations, some Tribal, have conducted TMVIP activities that can 

be valuable to many Tribes. This section provides a brief summary of 

federal agency programs that have provided funding for TMVIP, and 

other efforts to respond to the burden of MVC injury and death in 

Tribal communities.

Federal

Indian Health Service

(Department of Health 

& Human Services)

The Indian Health Service (IHS), an agency within the Department of 

Health and Human Services, is responsible for providing health services 

to members of federally-recognized American Indian and Alaska Native 

Tribes. The provision of the health services to members of federallyrecognized Tribes is due to the government-to-government relationship 

between the federal government and Indian Tribes. The IHS is the 

principal federal health care provider and health advocate for Indian 

people with a goal to raise their health status to the highest possible 

level. The IHS provides a comprehensive health service delivery for 

American Indians and Alaska Natives who are members of the 567 

federally recognized Tribes in the US.

IHS AREA OFFICE INJURY PREVENTION PROGRAMS

Many IHS Areas provide direct injury prevention services based on 

national and local priorities. IHS staff work with Tribal programs to 

conduct injury surveillance, develop and implement projects, and 

establish partnerships. IHS Area Injury Prevention Programs also host 

injury prevention training courses for capacity building of Tribal staff and 

community members, and those who work with them. Some purchase 

child safety seats and partner with Tribal highway safety programs and 

Safe Kids Coalitions for child safety seat clinics and fitting stations at IHS 

service units. Some Tribes partner with the county injury prevention 

programs that install child safety seats provided by state injury 

prevention programs and the governor’s offices of highway safety.

For contact information about each IHS Service Area’s Injury Prevention 

Program, visit this IHS Injury Prevention Program website and click on the 

IHS Area you are searching for, and then click the ‘view contacts’ tab. 
Federal, Tribal/Tribal Organization, State Response 33

Indian Health Service TRIBAL INJURY PREVENTION COOPERATIVE 

AGREEMENTS PROGRAM (TIPCAP)

To address the disparity or unequal difference in the injury problem, the 

Indian Health Service (IHS) provides funding for American Indian/Alaska 

Native Tribes/Tribal Organizations to develop infrastructure (for example, 

programs, systems, and/or policies) in injury prevention. The IHS Injury 

Prevention Program has funded more than $22 million in Cooperative 

Agreement grants to 96 Tribal/urban/non-profit American Indian/Alaska 

Tribes/Tribal Organizations since 1997. The lessons learned have helped 

to shape the program to encourage new ideas and best practices. The 

grants have also helped overcome challenges with continued benefit to 

reducing injuries in American Indian/Alaska Native communities (rural 

and urban), pueblos and villages. The 2010-2015 TIPCAP projects (n=40) 

addressed two IHS Injury Prevention Program priorities: 1) Motor Vehicle 

Crashes and 2) Fall Prevention. The IHS Injury Prevention Tribal grantees 

implemented effective strategies to target specific causes or hazards that 

can increase the chances or risk of someone being injured. 

There are 25 Tribal IP Coordinators certified as Child Passenger Safety 

(CPS) technicians and six National Highway Traffic Safety Administration 

(NHTSA) certified CPS Instructors. More than 100 CPS technicians were 

trained during the five year grant cycle. The 2010-2015 Cooperative 

Agreements awardees are grouped in three programs: 

● Part I grantees are new or with less experience with the IHS Injury 

Prevention Program. $65,000 for five years. 

● Part II grantees are Tribes/Tribal Organizations who develop, 

implement, and evaluate evidence-based or promising interventions 

(for example, specific interventions that have been tested and accepted 

widely to prevent injury and death). $10,000 for three years.

IHS RIDE SAFE PROGRAM

The Indian Health Service (IHS) developed Ride Safe to help tribal 

communities address motor vehicle injuries among American Indian and 

Alaskan Native children. The Ride Safe program seeks to reduce the rate 

of motor vehicle related injuries to children (aged 3 to 5 years) who are 

enrolled in participating Tribal Head Start programs. 

The program format and eight-part training manual is implemented 

locally by Tribes and is encouraged by IHS Area Injury Prevention 

Programs. To obtain a copy of the Ride Safe Curriculum, visit the 
34 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Indian Health Service

(continued)

IHS Injury Prevention Program website. The Ride Safe Program at one 

mid-western Tribe was evaluated and published in the Maternal & Child 

Health journal in 2008.20 

Office of Justice 

Services Bureau 

of Indian Affairs 

(Dept. of Interior)

INDIAN HIGHWAY SAFETY PROGRAM (IHSP)

The Highway Safety Act of 1966, USC Title 23, Section 402, provides 

U.S. Department of Transportation funding to assist federally recognized 

Indian Tribes in implementing traffic safety projects in the United States. 

The program has been administered by the BIA Indian Highway Safety 

Program (IHSP) since 1973. Oversight is provided by the National 

Highway Traffic Safety Administration, Region 6, located in Fort Worth, 

Texas.

Grant applications are mailed to Tribal Leaders of all federally 

recognized Indian Tribes in January of each year. The annual deadline 

to submit applications is May 1st. A Selection Committee reviews and 

scores all applications. Selected tribal projects are funded for a one year 

time period (October 1 - September 30).

The IHSP grants are developed based on data (that is, data-driven) and 

include plans to show if programs are making a difference (that is, 

performance-based). Applications must have sufficient traffic data to 

justify funding. About 40 Tribal Projects are funded each year. There is 

no minimum or maximum funding amount. Currently, annual funding 

amounts range from $30,000 to $425,000. Fundable program areas 

include: Police Traffic Services; Occupant Protection; Traffic Records; 

Impaired Driving Courts; and Safe Communities. For more information, 

visit The Office of Justice Services, Bureau of Indian Affairs.

Federal Highway 

Administration 

(Dept. Transportation)

FIXING AMERICA’S SURFACE TRANSPORTATION ACT

Fixing America’s Surface Transportation (FAST) Act funds surface 

transportation (that is, road and bridge) programs in the United States. 

Each year, 2% of the available Tribal Transportation Program (TTP) 

funds are set aside to address safety issues in American Indian/Alaska 

Native communities. Funds are available to federally recognized 

Indian tribes using a competitive application process to distribute nonspecific (discretionary) funding. Projects that describe plans to address 

and show the prevention and reduction of death or serious injuries, in 
Federal, Tribal/Tribal Organization, State Response 35

Federal Highway 

Administration 

(Dept. Transportation, 

continued)

transportation-related crashes, are funded yearly. The program supports 

the development of Strategic Transportation Safety Plans as a way for 

tribes to prioritize how transportation safety needs will be addressed in 

tribal communities. 

Under the Moving Ahead for Progress in the 21st Century Act 

(MAP-21) there have been two rounds of funding (FY13 and FY14) 

and an additional round in FY15 under review. In FY 2014, 94 of 

127 applications were funded. Four categories of funding have been 

established under TTP Safety Funds to distribute available funds: 1) 

Safety Planning (40%); 2) Engineering Improvements (30%); 

3) Enforcement/EMS (20%); and 5) Education (10%).

For more information on Tribal Transportation Program (TTP) Safety Fund, 

visit Tribal Transportation Program (TTP) Safety Fund. 

● Russell Garcia, TTP Safety Program Manager

Russell.Garcia@dot.gov, 202-366-9815

● Adam Larsen, TTP Safety Engineer

Adam.Larsen@dot.gov, 360-619-7751

TRIBAL TECHNICAL ASSISTANCE PROGRAM (TTAP)

The Federal Lands Highway Program (FLHP) works closely with TTAP 

centers. They help Tribal governments by offering training, technical 

assistance, and research opportunities. TTAP aims to: a) deliver 

technical assistance and training activities at the Tribal level; b) help 

implement administrative practices and new transportation technology 

at the Tribal level; c) provide training and assistance in transportation 

planning and economic development; and d) develop educational 

programs to encourage and motivate interest in transportation careers 

among Native American students. 

The TTAP program is financially supported by the Federal Highway 

Administration (FHWA) and the Bureau of Indian Affairs (BIA). Currently, 

there are seven TTAP centers including: 1) Alaska; 2) Mountain West 

(AZ); 3) Eastern (MI); 4) Northern Plains (ND); 5) Northwest (WA); 6) 

Southern Plains (OK); and 7) Western (CA).
36 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Centers for Disease 

Control and Prevention

National Center for Injury 

Prevention and Control 

(NCIPC)

Division of 

Unintentional 

Injury Prevention

(Dept. of Health 

and Human Services)

The mission of the CDC’s National Center for Injury Prevention 

and Control is to prevent violence and injuries, and reduce their 

consequences.

TRIBAL MOTOR VEHICLE INJURY PREVENTION 

PROGRAM (TMVIPP)

Reaching 12 Tribes/Tribal organizations over two funding cycles (2004-

2009, 2010-2014), TMVIPP provided funding and on-going technical 

assistance to support the tailoring of three evidence-based strategies, 

identified in The Community Guide, to reduce MVC injury: increase 

seat belt use; increase child safety seat use; and reduce alcohol-impaired 

driving. For more about TMVIPP and other roadway safety efforts, 

visit the CDC’s Motor Vehicle Safety webpage or listen to project 

coordinators share lessons from the 2010-2014 TMVIPP funding cycle. 

TRIBAL SAFETY CIRCUIT RIDER PROGRAM 

Through collaboration with the Federal Highway Administration 

(FHWA), CDC is funding a Tribal Safety Circuit Rider to provide 

technical assistance in three regional Tribal Technical Assistance Program 

(TTAP) locations which serve 207 tribes across 10 states. The 3-year pilot 

is modeled after the Safety Circuit Rider (SCR) Program developed by 

the U.S. Department of Transportation (DOT). The DOT program was 

designed to provide safety-related information, training, and support 

to agencies responsible for local roadway safety. The new Tribal SCR 

program expands technical assistance provide by the TTAPs beyond road 

improvements to include increasing seat belt use, increasing child safety 

seat use, and addressing alcohol-impaired driving; while emphasizing 

tailored evidence-based strategies for tribal traffic safety programs. 

For more, visit the TTAP website or these TTAP centers:

Northern Plains TTAP

Arden Boxer, Tribal Safety Circuit Rider aboxer@uttc.edu

Serves 24 tribes in Montana (Eastern), Nebraska (Northern), 

North Dakota, South Dakota, and Wyoming. 

Located at: United Tribes Technical College, Bismarck, ND
Federal, Tribal/Tribal Organization, State Response 37

Centers for Disease 

Control and Prevention

National Center for Injury 

Prevention and Control 

(NCIPC)

(Dept. of Health 

and Human Services)

Southern Plains TTAP

Tabatha Harris, Tribal Safety Circuit Rider 

tabatha.harris@okstate.edu

Serves 44 tribes in Kansas, Nebraska (Southern), 

Oklahoma, and Texas. 

Located at: Oklahoma State University, Stillwater, OK

Western TTAP

Carrie Brown, Tribal Safety Circuit Rider 

cbrown@NIJC.org

Serves 139 tribes in California and Nevada. 

Located at: National Indian Justice Center Santa Rosa, CA

Tribal Organizations

National Congress 

of American Indians 

(NCAI) Policy 

Research Center

NATIVE PUBLIC HEALTH LAW PARTNERSHIP PROJECT: 

RESERVATION ROAD SAFETY

The Native Public Health Law Partnership project was led by the 

National Congress of American Indians (NCAI), developed with the 

National Indian Health Board, and funded by the Robert Wood Johnson 

Foundation. The goals of the project were to: 1) provide information 

on public health laws in Indian Country; 2) recognize tribal authority to 

regulate public health; and 3) develop a database tool to enable tribes 

to share information with each other and the broader public health 

law community about tribal public health law, codes, and policy. Two 

publications came from the project (in the Summer of 2013 and Fall 

2014) summarizing reservation road safety:

● Reservation Road Safety: 

Reducing Unintentional Injury through Tribal Public Health Law

● Tribal Transportation Insights: 

Preventing Unintentional Injury and Death
38 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Tribal 

Epidemiology 

Centers

Tribal Epidemiology Centers (TEC) are organizations funded by the 

Indian Health Service, Division of Health & Human Services. They serve 

American Indian/Alaska Native Tribal and urban communities by:

● managing public health information systems (for example, 

data systems to track injuries or disease);

● investigating certain diseases;

● managing disease prevention and control programs ;

● responding to public health emergencies ;

● coordinating these activities with other public health authorities. 

The mission of Tribal ‘Epi’ Centers is to improve the health of American 

Indian/Alaska Native (AI/AN) by: 

● identifying and understanding health problems and disease risks;

● improving the ability of a Tribe to address public health needs 

(that is, strengthening public health capacity);

● developing solutions for disease prevention and control. 

Currently there are 12 TECs throughout the country. Several of these 

have conducted research on the issue of motor vehicle crash injury and 

death in AI/AN communities (for example, the Northwest Portland Area 

Indian Health Board and the Inter-Tribal Council of Arizona, Inc.). 

Find a list of current Tribal Epidemiology Centers. 

Tribal Organization and Tribe/State Partnerships

Some Tribal organizations and Tribe/state partnerships have focused efforts to address the burden of 

traffic safety in AI/AN communities. We highlight several below as examples.

Native CARS 

(Children Always 

Ride Safe)

Northwest Portland Area 

Indian Health Board

Native CARS seeks to improve child safety seat use for American Indian 

and Alaska Native (AI/AN) children in the Pacific Northwest and beyond. 

Northwest Portland Area Indian Health Board aimed to implement and 

test the effectiveness of community-led interventions to improve the 

use of child safety seats in six Northwest tribes. They are interested in 

disseminating what they have learned with other tribes by sharing the 

successful protocols, tools, and intervention materials used by Native 

CARS tribal partners. The Native CARS Atlas may be used by other 

Tribes as a blueprint to address child passenger safety concerns in tribal 

communities. 
Executive Summary 39

Wind River Reservation 

(Eastern Shoshone 

& Northern Arapaho 

Tribes) and Wyoming 

Department of 

Transportation

A partnership between the State of Wyoming and the Wind River 

Reservation (serving the Eastern Shoshone and Northern Arapaho Tribes) 

was developed between the Tribe’s Transportation Director, the Tribe’s 

Joint Business Council, the Wyoming Department of Transportation 

(WYDOT) District 5 Public Relations Specialist, and Hispanidad 

(Heinrich Marketing, Inc.). 

The partnership developed a community-based model to change 

behavior through messages about traffic safety that were directed toward 

families, friends, and co-workers. The effort included: 

1. Outreach (bringing information to the community) on behavioral 

transportation safety (or how our attitudes and how we act affects 

our safety when we are on the road) using culturally appropriate 

traffic safety messaging to address seat belt use, impaired driving, 

and pedestrian safety; 

2. Collaboration between the Tribe and WYDOT, NHTSA, and FHWA 

to make improvements to the highway infrastructure and to better 

coordinate between programs designed to change health behaviors 

and initiatives designed to improve roadway engineering; 

3. Development of a traffic safety plan for the Wind River Reservation, 

including a new traffic code with lower BAC limits for alcoholimpaired driving, lower speed limits, a mandatory seat belt law 

for the entire reservation, improved traffic signs, increased law 

enforcement, and more emphasis on education and prevention; and 

4. Two conferences on reservation safety, which brought together city, 

county, state, and federal reservation programs to work together to 

improve traffic safety both on and off the reservation.

The collaboration has helped to improve the reservation’s transportation 

infrastructure (for example, highways and bridges), and led to lowering 

the number of crashes and deaths that involved alcohol on the Wind 

River Reservation. 
40 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Other Tribe/State 

Partnerships

In 2012, the Inter-Tribal Council of Arizona (ITCA) Tribal Epidemiology 

Center (TEC) contacted the Nevada Department of Transportation 

(NDOT) to request two Road Safety Assessments (RSA); one each for 

the TeMoak Tribe of Western Shoshone and Duckwater Shoshone Tribe. 

The RSA reports became a transportation safety planning tool for both 

Tribes for preparing road designs to address low cost improvements 

for BIA roads within four TeMoak band areas and on the Duckwater 

Reservation. The tribes provided 5% local matching funds and NDOT 

provided the remaining 95% to fund the design and construction. 

Duckwater was awarded $119,000 Tribal Transportation Program Safety 

Funds to improve sight distance on a BIA road near the elementary 

school, which was a recommendation in the RSA report. 

The AZ Department of Health Services (ADHS) Office of Injury 

Prevention has worked with many Tribal injury prevention practitioners. 

This led to a large number of donations of child safety seats for 

installation in Tribal communities. When the ADHS sponsors child 

passenger safety technician courses that are nationally certified, they 

reach out specifically to Tribal and/or IHS staff working with Tribes.

The Kaibab Band of Paiute Indians has also completed two RSAs. 

Arizona Department of Transportation (ADOT) completed a project for 

improving intersections using Indian Highway Safety Program funds. 

See the ITCA Tribal Transportation Safety Summary for more details.

The Inter-Tribal Council of Arizona, Inc. has been promoting the 

methods used by RSA with multiple Tribes in Arizona through the 

Arizona Department of Transportation (ADOT). These Tribes include: 

● Tohono O’odham Nation

● Hopi Tribe

● Havasupai Tribe

● San Carlos Apache Tribe

● White Mountain Apache Tribe   

The Federal Highway Administration and ADOT have completed several 

RSAs with the Navajo Nation. Most of the RSAs have resulted in road 

improvement projects to remove road hazards. 

The California Rural Indian Health Board’s (CRIHB) Injury Prevention 

Department has developed a relationship with the state of California’s 

Department of Public Health (CA DPH). Through the CA DPH Office 

of Traffic Safety grant funding, CRIHB has been provided mini-grants 

for child safety seats, support for child safety seat events, and funding 

to host child passenger safety technician courses that are nationally 

certified. 
Executive Summary 41

F. Components for Tribal Motor Vehicle 

Injury Prevention

What is needed to 

address MVC injury 

and death in AI/AN 

communities?

Based on experiences and lessons learned from the federal, Tribal/

Tribal Organizations, and state entities seeking to address MVC injury in 

Tribal communities, this section summarizes the components needed for 

TMVIP: 1) Commitment; 2) Collaboration; 3) Data and Evaluation; 4) 

Tailored Evidence-Based Strategies; and 5) Technical Support. Sections 

G, H, I, J, and K describe how these components have been, or could 

be, carried out by Tribes/Tribal Organizations. 

1. COMMITMENT

Committment is needed to...

Funding Support staff and project intervention activities.

Staffing Direct efforts to prevent motor vehicle injury and death.

Training Enhance existing knowledge and skills.

Supervisory/

Admin. Support 

Assist the administrative and financial functioning of traffic 

safety activities.
42 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

2. COLLABORATION

Collaboration is needed among stakeholders to...

Tribal Leadership Develop, enhance, and support enforcement of laws for seat belt/

child safety seat use and impaired driving. 

MVIP Practitioners Coordinate efforts of the Tribe to plan or conduct activities, and 

evaluate progress (for example, determine if changes in safe driving 

have happened as planned).

Roads or 

Transportation 

Departments

Conduct highway safety improvements that focus on environmental 

conditions, and/or engineering (design) weaknesses that make a 

crash more likely or more severe.

Legal System Manage citations and arrests handled in traffic and impaired driving 

courts, track the results of cases, identify repeat offenders, and 

collect fines.

Law Enforcement Enforce traffic safety laws, complete and share crash data with tribal 

and non-tribal public health and other traffic safety professionals.

Emergency Medical 

Services

Safely transport those injured in MVCs and collect data about 

MVC events.

Media Promote and educate the public about prevention of MVCs and 

MVC injury/death.

Community Members, 

Groups, and 

Institutions

Support, encourage, and be a good example for the use of safe 

driving behaviors or actions that will lead to safe driving norms, 

customs, or standard behavior. 
Executive Summary 43

3. DATA AND EVALUATION

Data and Evaluation are needed to understand and evaluate...

Motor Vehicle Crashes 

(MVCs)

How many; where; when; and why MVCs are occurring.

MVC Injuries/Deaths How many; where; when; and why injuries and deaths are occurring 

from MVCs.

Restraint Use Community behaviors and barriers to using occupant restraints.

Enforcement and 

Prosecution

Practices or barriers to enforcing and prosecuting violations.

Laws and Policies Degree to which laws and policies exist or can be enhanced.

 

4. TAILORED EVIDENCE-BASED STRATEGIES

Tailored Evidence-Based Strategies are needed to...

Child Safety Seat Use Increase car seat and booster seat use.

Seat Belt Use Increase seat belt use.

Impaired Driving Reduce impaired driving.

5. TECHNICAL SUPPORT

Technical Support is available to assist Tribes to...

Commitment Make injury prevention a tribal priority.

Collaboration Build multi-disciplinary teams.

Data and Evaluation Know what data are needed to assess the problem 

and evaluate interventions. 

Evidence-Based Strategies Tailor recommended strategies for use in AI/AN communities.

 
44 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

G. Commitment: Component #1 for TMVIP

What 

COMMITMENT is 

needed to address 

MVC injury and 

death in AI/AN 

communities?

This section provides information about the first component needed for 

TMVIP – COMMITMENT – including: 

1. Commitments recommended for strong TMVIP efforts. 

2. General Lessons Learned and specific Case Examples about 

commitment from Tribal MVIP projects applying effective strategies.

3. Resources available to encourage commitment from stakeholders. 

4. Calls to Action for identifying or enhancing commitment from 

stakeholder groups to support tribal motor vehicle injury prevention 

(TMVIP). 

Funding

Staff and Projects Some Tribes and Tribal organizations have identified injury prevention 

as a leading health priority and recognize the need to prevent motor 

vehicle injuries and deaths in their communities. Funding for traffic 

safety projects can be obtained from outside sources, such as federal 

and state government programs described in Section E of this guide. 

Funds to support Tribal prevention efforts are more likely to be given 

when injuries in general, or motor vehicle injuries specifically, are 

prioritized as a leading health issue at a Tribe or Tribal Organization. 

Commitment to funding involves support for staff and project activities, 

regardless of funding source. 

CASE EXAMPLE

Two Tribes continued project efforts beyond the funding period. One in Wisconsin (Ho-Chunk) 

and the other in Arizona (San Carlos Apache) were funded during the 2004-2009 CDC Tribal 

Motor Vehicle Injury Prevention Program (TMVIPP) cycle. The Tribal MVIP Coordinator regularly 

updated Tribal leaders about progress the TMVIPP project was making to increase seat belt use, 

increase child safety seat use, and reduce alcohol-impaired driving. These updates included 

data summaries in presentations to Tribal Council or budget committee leaders to show changes, 

over several years, in restraint use, MVCs, and/or alcohol-impaired driving. Another factor that 

contributed to these projects being funded directly by the Tribe was effective communication 

from the TMVIP coordinators about ‘what it costs’ to run a Tribal MVIP program. The two Tribal 

project coordinators spoke clearly to the benefits of investing in motor vehicle injury prevention. 
Commitment: Component #1 for TMVIP 45

Staffing

Full-Time Lead Many successful TMVIP projects conducted in AI/AN communities have 

utilized the leadership of full-time staff. The title used to describe the 

project leader can vary, but he or she is often referred to as a coordinator, 

director, or specialist. For example, project leaders conducting traffic 

safety funded by CDC’s Tribal Motor Vehicle Injury Prevention Program 

were called ‘TMVIPP Coordinators.’ 

Regardless of title used, having at least one person, whose only job 

it is to plan, coordinate, and conduct traffic safety activities, shows 

commitment for MVIP in AI/AN communities. When hiring MVIP 

coordinators or injury prevention specialists, the interview process can 

be improved if it includes a description of realistic job expectations, and 

emphasizes the commitment and flexibility needed to perform well as a 

motor vehicle injury prevention coordinator.
46 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

LESSON LEARNED

A Tribal MVIP Coordinator or Injury Prevention Specialist is not a typical “desk job”. It 

requires commitment and flexibility to accomplish what needs to be done. This means that 

oftentimes the work of MVIP Coordinators is done: 

● in different locations (for example, at an office desk, in meetings, at conferences);

● at different times of the day (for example, during regular office hours, at early morning 

child safety seat installation events, at late night traffic safety enforcement events);

● in a range of different conditions (for example, outdoors, in wet/dry or hot/cold 

conditions).

● in different settings, for example:

◆ at schools giving presentations;

◆ at Tribal Council meetings presenting project summaries and data;

◆ at community events promoting traffic safety and program services;

◆ on roadsides or in vehicles collecting restraint use data;

◆ in vehicles installing child safety seats;

◆ on computers looking for data or resources for use in Tribal settings;

◆ in record storage rooms looking through documents to learn more about MVCs;

◆ at meetings with local, county, or state agencies. 

Understanding what is required of a coordinator will help in hiring “the right person for 

the job”.
Commitment: Component #1 for TMVIP 47

Training

To enhance the skills needed to plan, implement, and evaluate TMVIP projects, full-time coordinators, 

directors, or specialists might require additional training or certifications to enhance skills they have 

from other employment, educational, or life experiences. Several training opportunities that are 

particularly relevant to a TMVIP coordinator include: general injury prevention; child passenger 

safety; and other training programs.

General Injury 

Prevention

● IHS Introduction to Injury Prevention (Level I): This course 

introduces participants to the core components of the public health 

approach to preventing injuries among American Indians and Alaska 

Natives. Participants work in small teams to address injury issues 

in fictional Tribal communities. People who attend the training 

include tribal health board members, health directors, tribal council 

members, IHS environmental health personnel, and tribal injury 

prevention staff. The course is usually 3 or 3.5 days, with 2.0 

Continuing Education Units available. For more information, visit the 

IHS Environmental Health Support Center (EHSC). 

● IHS Intermediate Injury Prevention (Level II): This course reviews 

the basics of understanding injury data, workgroup building, program 

planning, evaluation, and marketing. The course will include 

several hands-on community and computer-based activities. Upon 

completing the course, those who attend are able to describe the 

complex causes of injury; describe the strategies for workgroup 

maintenance; demonstrate use of on-line or web-based data 

collection tools; describe basic methods to collect data; and outline 

process evaluation and impact evaluation methods. For more 

information, visit the IHS ESHC. 

● IHS Epidemiology and Program Development Fellowship Programs: 

These 12-month advanced learning experiences build on the 

IHS Injury Prevention Program short courses and the previous 

experiences of the participants. Both offer advanced training in 

community interventions, workgroup building, injury epidemiology, 

program evaluation, presentation skills, and field work. Fellows 

apply this training by working on individual projects involving 

data collection, program implementation, and evaluation. For 

more information, visit the IHS Injury Prevention Training Course 

webpage. 
48 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Child Passenger 

Safety Training

● Certified Child Passenger Safety Technician Course: The CPS

Certification Course is usually three to four days long and combines 

classroom instruction, indoor and outdoor hands-on activities, skills 

assessments with child safety seats and vehicles, and a community 

safety seat checkup event. Trainees who successfully complete the 

course are qualified to take the National CPS Technician exam. For 

more information, visit this website at Safe Kids. 

● Certified Child Passenger Safety Instructor Courses: Experienced 

CPS technicians who are ready to help others learn how to become 

technicians should consider working towards becoming a Certified 

Instructor. To earn this certification, CPS Technicians must complete 

the instructor candidacy process, successfully teach a Certification 

Course, and make sure their technician certification does not 

expire during the period when they are a candidate. The instructor 

candidacy process can take no longer than one year from the time 

you are approved as an instructor candidate. For more information, 

visit the instructor resources page at Safe Kids.

● Safe Native American Passengers (SNAP) Courses: Designed 

after the National Highway Traffic Safety Administration (NHTSA) 

National Standardized Child Passenger Safety Training, this 12-

hour course is specific to Native Americans and introduces 

attendees to the basic concepts of child passenger safety (CPS). 

The intended audience for this course is anyone who works in AI/

AN communities and is interested in CPS. Participants can include 

checkup event volunteers, Health Educators, Community Health 

Representatives, EMS personnel, Fire personnel, Law Enforcement, 

Tribal Environmental Health Specialists or Practitioners, and Child 

Care Providers. The SNAP course does not offer certification and 

does not replace, supplant or serve as a substitute for the nationally 

certified Child Passenger Safety (CPS) Technician training course. 

Rather, it serves as an introduction to CPS or preparatory training 

for the national CPS Technician certification course. Many SNAP 

course attendees have gone on to become certified CPS Technicians 

who now serve as important resources to their local communities. 

For more information about SNAP, visit the IHS Injury Prevention 

Program.
Commitment: Component #1 for TMVIP 49

Other Training ● Global Road Safety Surveillance Course: Road Traffic Injury 

Surveillance Course is designed primarily for professionals who 

develop or operate surveillance systems and conduct prevention 

activities in less-resourced areas. It describes the steps needed to 

establish and maintain a road traffic injury surveillance system; 

provides information on designing and monitoring prevention 

activities; and provides guidance for making informed decisions 

about road traffic injury prevention.

● Tribal Technical Assistance Program (TTAP) Training: TTAP centers 

assist tribal governments by providing training, technology transfer, 

and research opportunities. Currently, there are seven TTAP centers, 

which offer a variety of training courses, including but not limited 

to: Crash Data Reporting; Road Scholar Program, Roadway/Highway 

Safety Audits (Safe Journeys online course); Use of GIS/GPS; 

Fundamentals of Highway Safety; and Road/Pedestrian Safety.

● Traffic Safety Conferences: regular annual traffic safety conferences, 

at which Tribal programs are highlighted include:

◆ Lifesavers Conference: This annual conference on highway 

safety priorities is the largest gathering of highway safety 

professionals in the U.S. Each year, the conference provides 

a forum for the presentation and discussion of effective 

countermeasures and initiatives that address highway safety 

problems. Prior conference programs and presentations/

workshops are available online.

◆ Regional Tribal Transportation Safety Summits and National 

Tribal Transportation Safety Conference: Sponsored by the 

Federal Highway Administration, these events provide Tribal 

leaders and safety professionals an opportunity to focus 

on critical road safety issues. Summits can be a first step 

in engaging federal, state, local, and Tribal safety partners 

in a discussion of the nature and extent of the traffic safety 

problems on Tribal lands, as well as strategies to address them. 

At the Summits, participants: a) identify safety needs, resources, 

and solutions; b) get to know and build relationships with 

safety partners to continue to work collaboratively; c) share 

best practices and lessons learned; and d) commit to action 

items to build on their success. Prior Summit and Conference 

Reports are available.
50 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Other Training

(continued)

◆ Kids in Motion National Child Passenger Safety Conference: 

Held annually, this conference offers a continuing education 

forum with the single focus on keeping young passengers 

safe. Since 2005, the conference has drawn professionals from 

fields including health care, public health, law enforcement, 

fire and rescue, child restraint and vehicle manufacturers. The 

conference provides: 

● interactive educational opportunities to get the latest 

information on child passenger safety; 

● opportunities to provide feedback about current or 

proposed regulations and/or measures; and 

● networking opportunities to promote a sense of 

professional cooperation and community. 

● National Safety Council Defensive Driving Safety Training Program: 

Delivered in a range of affordable options and formats to meet 

the needs of organizations, employees, drivers, and vehicle 

types, this training provides: leading-edge curriculum for greater 

comprehension and content retention; cost effective training 

solutions for organizations of all sizes; immediate and post-incident 

training, when timing is crucial; new employee or refresher training; 

remote, onsite and customized training; and flexibility for ease of 

scheduling and student participation.

● World Health Organization TEACH VIP E-learning: This is a 

comprehensive injury and violence prevention curriculum developed 

for self-paced, self-administered training online. Training modules 

include a variety of general and specific topics, including: Road 

Traffic Injuries; Community Surveys; Advocacy for Injury Prevention.

● Safe States Alliance Training Center: The Safe States Alliance has 

partnered with the Society for the Advancement of Violence and 

Injury Research (SAVIR) to create a joint initiative known as the 

National Training Initiative (NTI). Through NTI, both organizations 

have worked together to develop Core Competencies to address 

the training needs of professionals working in the field of injury and 

violence prevention. Safe States trainings and archived webinars 

organized by topic area are available at these websites: 
Executive Summary 51

◆ Web Events Co-Hosted by Safe States Alliance & Partners, including 

topics such as: Motor Vehicle Safety; Partnerships and Collaborations; 

Program Planning and Evaluation; Epidemiology; 

and Communication. 

◆ ASTHO, NACCHO, and Safe States Injury Prevention Webcast Series

◆ Safe States Self-Study Trainings. 

Supervisory and Administrative Support

Supervisory Support Tribal MVIP staff benefit from having the support and oversight of 

supervisors who can provide guidance and mentoring. Health Directors, 

Highway Safety Managers, and/or Community Health Representative 

(CHR) Directors are examples of staff who supervise Tribal MVIP 

coordinators, directors, or specialists. 

A commitment of support from supervisors for a Tribal MVIP program 

is especially useful when there is staff turnover in the MVIP coordinator 

position. The effectiveness of a Tribal MVIP project can be reduced 

unless supervisory support exists to orient and assist a new TMVIP 

coordinator. 
52 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

CASE EXAMPLE

One CDC-funded TMVIPP Project had five different TMVIPP Coordinators in the lead staffing 

role during the four year-project. This degree of staff turnover can be disruptive and while this 

problem is not exclusive to Tribal communities, the engagement of a supervisor can minimize 

disruptions. At this Tribe, the same person served as the supervisor for the multi-year project. 

The supervisor was engaged and took over some responsibilities when the position was vacant. 

The supervisor provided continuity in knowledge about the project and expectations for the 

coordinators. As a result, project progress continued despite the coordinator vacancies. 

LESSON LEARNED

Position a Tribal MVIP Coordinator within the police department, if possible.

It is helpful if the lead staff member directing a Tribe’s motor vehicle injury prevention program 

is located, physically and organizationally, within the police department. Examples from 

several Tribes have indicated that being located in the police department allowed for increased 

communication, collaboration, and access to data. In cases where a coordinator is housed 

within a different department (for example, health department, transportation department), 

additional and sometimes time-consuming relationship building has been required, often 

causing delays in collecting data about traffic safety activities conducted by the police 

department and/or the motor vehicle injury prevention program.

Administrative and 

Financial Support

Tribal MVIP staff benefit from assistance provided by administrative 

and financial staff at the Tribe. This can include assistance with 

budget planning, budget monitoring, and expense reporting. If 

funding is provided to the Tribe by an external source (for example, 

the Indian Health Service or Bureau of Indian Affairs), the knowledge 

and skills required for grants management and financial reporting 

(often using online tools) can reduce administrative difficulties. 

While Tribal MVIP coordinators might have some of the skills needed 

for this type of project management, a commitment to ensuring 

support from administrative and financial staff is important for tribal 

motor vehicle injury prevention efforts.
Executive Summary 53

LESSON LEARNED

Communicate about budget planning regularly to avoid overruns and surpluses!

The responsibility for managing contracts and grants might reside with a Tribe’s finance 

department, and not with the department that staffs the TMVIP program. Many TMVIP 

coordinators have found it beneficial to conduct regular meetings with the finance department 

staff member assigned to manage the TMVIP budget. This regular and on-going communication 

can help the TMVIP coordinator with project planning, and can avoid cost-overruns or year-end/

project-end budget surpluses. 

If project funds remain unspent at year-end, it might send the wrong message to a funder (for 

example, the funds were not needed). Budget surpluses are often a result of miscommunication 

and/or delayed accounting, monitoring, or reporting. Some TMVIP coordinators have developed 

their own internal budget spreadsheets to track funds, which can then be reconciled with 

financial department reporting during regular meetings. TMVIP coordinators should be proactive 

in placing equipment and supply orders during the first half of their funding period so that 

purchasing or invoicing delays do not result in budget surpluses. 

ACTION CALLS 

American Indian/Alaska Native Tribal Leaders are encouraged to identify reducing the burden 

of motor vehicle crash injury and death as a top community, public health, public safety, and 

financial priority. 

Working in partnership with Tribal and Non-Tribal Injury Prevention Practitioners and Public 

Health Professional Partners will ensure a future generation of safe and healthy AI/AN people by 

saving years of potential life lost, reducing costs from MVC injury, and thus, improving the quality 

of life in the community.
54 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

H. Collaboration: Component #2 for TMVIP

Who should AI/AN 

COLLABORATE with 

to address MVC? 

This section provides information about the second component 

needed for TMVIP – COLLABORATION – including: 

1. A list of potential collaborators to support TMVIP efforts. 

2. Case examples or Lessons Learned about collaboration from TMVIP 

projects.

3. Resources available to enhance collaboration among stakeholders. 

4. Calls to Action for identifying or enhancing collaboration among 

various stakeholder groups as they consider 

supporting TMVIP. 

LESSON LEARNED

The Value of Traffic Safety Workgroups! 

No one person or organization can do it all, or do all that is needed, to prevent MVC injuries. 

In most Tribal communities, injury prevention or traffic safety workgroups (sometimes referred 

to as committees, coalitions, or advisory councils) exist for the purpose of bringing multiple 

perspectives and partners to the table to discuss, plan, implement, and evaluate traffic safety 

program activities. This teamwork helps to coordinate existing resources in a community to 

avoid duplication and fill gaps in services.

Forming and maintaining TMVIP workgroups requires on-going engagement and outreach to 

potential partners. The collaborators described in this section of the Guide are often the core 

membership of TMVIP workgroups in AI/AN communities. Section J - Tailored Evidence-Based 

Strategies: Workgroups provides several tools that might be helpful to workgroup building and 

maintenance. 

Tribal Leadership

Executive and 

Legislative Leadership

To support the work of staff hired to coordinate TMVIP Programs, 

assistance is needed from Tribal leaders who serve in executive and 

legislative positions. 

Elected or appointed leaders of a Tribe (for example, Tribal Chair/

Vice-Chairpersons) serve as the primary executive authority in AI/AN 

communities. When seeking executive office, chairs/vice-chairs devote 

considerable energy to fulfilling the needs and priorities in a community, 

including its health and safety needs. 
Collaboration: Component #2 for TMVIP 55

Executive and 

Legislative Leadership

(continued)

Members of Tribal legislative authorities (for example, Tribal Councils) 

have the responsibility to develop and enforce laws, policies, and 

procedures that govern AI/AN communities. Because many evidencebased strategies for traffic safety describe passage, enhancement, and/ 

or enforcement of laws to protect Tribal and community members, 

support from Tribal legislative leaders can be important for TMVIP 

success. When faced with the need to develop new or strengthen 

existing laws related to traffic safety, TMVIP coordinators often can 

benefit from educating legislative committees (for example, health 

and safety, justice, transportation) about effective strategies before 

a new or enhanced law may be considered by the full legislative 

authority.

MVIP Practitioners 

Full-Time Practitioners Many successful TMVIP projects utilize Full-time Coordinators to 

lead, plan, implement, and evaluate traffic safety initiatives in Tribal 

communities. Some federal programs (for example, CDC TMVIPP, IHS 

TIPCAP) require that full-time staff be hired to support on-going traffic 

safety efforts. Coordinators and the program will benefit from training, 

supervision, and financial/administrative support.

Affiliated or Part-Time 

Practitioners

Many Tribal staff who work at other programs are, by the nature of 

their work, affiliated or part-time TMVIP practitioners. For example, 

Community Health Representatives (CHRs) are often staff members who 

obtain national child passenger safety (CPS) technician certification so 

that when families expand with the addition of newborn children, they 

can be discharged from hospitals with properly installed child safety 

seats and get help installing and using the right car seat and booster seat 

as the child grows. Examples of other affiliated or part-time traffic safety 

practitioners include, but are not limited to: Public Health Nurses who 

counsel expecting or new parents about child health and safety; Daycare 

Center/Head Start Center staff who regularly provide lessons about child 

safety; School Teachers who include lessons about safety; and Fire/Police 

Department personnel who often visit schools to provide education 

about safety.
56 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Roads and Transportation Departments

Engineers/Planners Tribal Transportation Departments typically employ engineers and 

planners who are responsible for identifying road and highway safety 

improvement projects. These projects can address environmental or 

engineering deficiencies that contribute to MVCs. Separate from or 

in partnership with TMVIP coordinators, the regular collection of data 

about MVCs can identify ‘trouble spots’ where there have been a high 

number of MVCs (for example, high-volume crash sites). Careful study 

of data about these crash sites can be used to identify environmental 

or engineering changes that can be made to reduce MVCs. In some 

states (for example, MN), advisory transportation councils have been 

established that foster networking and partnership between Tribal and 

state entities. 

CASE EXAMPLE

Roadway Widening/Channelization Project - San Carlos Apache Tribe, AZ

Data collection at the San Carlos Apache Tribe identified that injury from motor vehicle crashes 

(MVCs) involved severe injury and high treatment costs. Further data collection identified that 

most MVCs were occurring on a state-maintained road on the reservation (U.S. Highway 70). 

Based on two additional descriptive retrospective studies of MVCs occurring on this roadway, a 

roadway widening project was conducted to add left-turn, right-turn, and through lanes for traffic 

from both directions approaching a key intersection (this approach is called ‘channelization’). 

Funded by the Arizona Department of Transportation (ADOT), the project also removed visual 

obstructions and reduced the speed limit. The Tribe’s active involvement of a Councilman, 

who initiated and maintained dialogue with ADOT officials, and secured 300+ signatures on 

a petition requesting roadway improvements, helped to ensure this successful collaboration 

between the Tribe, IHS, and ADOT. See ADOT final report.

Road 

Maintenance 

Staff

Tribal Transportation Departments generally have staff responsible for 

routine road maintenance and upkeep. This can include repairing 

potholes, removing roadway debris, or replacing traffic signage and 

lighting. Collaboration among road maintenance staff, engineers/

planners, and Tribal MVIP coordinators might be helpful to increase 

traffic safety efforts.
Collaboration: Component #2 for TMVIP 57

Judicial System

Judges In AI/AN Communities, Judges who oversee traffic-related proceedings 

(often in civil court or ‘traffic court’) have discretion when adjudicating 

violations of Tribal traffic safety laws, including state laws which the 

Tribe has adopted. Because so many effective strategies for child 

safety seat use, seat belt use, and alcohol-impaired driving involve the 

enforcement of laws, judges’ knowledge of the Tribal motor vehicle 

injury prevention program is appropriate. 

In over-burdened and often under-staffed Tribal court systems, judges 

often have to prioritize decisions about adjudication of violations; 

weighing what penalties to issue based on the nature of the offense. 

Sometimes, a perceived ‘minor’ offense, such as not wearing a seat belt 

or not using a child safety seat, may be waived if there are other offenses 

deemed more serious by the judge. 

As a result, Tribal MVIP coordinators and partners could reach out to 

get to know and understand how and why judges make these decisions 

about traffic safety offenses. Understanding this decision-making 

process can help inform judges about strategies to reduce MVC injury/

death in a Tribal community. When a judge prioritizes traffic safety 

by adjudicating the laws to their fullest, Tribal community members 

might begin to change their behavior regarding restraint use or impaired 

driving. 

LESSON LEARNED

Identify and address enforcement system breakdowns!

To learn more about the degree to which traffic safety laws are being enforced, several Tribes 

have identified and researched the steps that should occur following the issuance of a traffic 

safety violation (for example, a citation for not using seat belts). In identifying all of the steps in 

the process, sometimes using a ‘flow-diagram’, traffic safety workgroups can see where possible 

breakdowns in the process could occur and/or might be occurring. TMVIP workgroups can then 

work with stakeholders to address identified barriers. This type of assessment can also identify 

communication breakdowns, procedural issues, or record-keeping challenges that might lessen 

the impact of traffic safety laws designed to reduce injuries and deaths.
58 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

District Attorneys 

and Prosecutors

Similar to judges, District Attorneys and Prosecutors have latitude 

when seeking to prosecute traffic law violators. Because of this, TMVIP 

coordinators and other partners should seek to learn the prosecution 

patterns of traffic safety laws at their Tribe (for example, to what degree 

are cases fully prosecuted, dismissed, and/or plea-bargained).

The National Highway Traffic Safety Administration has developed a 

Traffic Safety Resource Prosecutor’s Manual, useful for current or former 

prosecutors who provide training, education, and technical support to 

traffic crimes prosecutors and law enforcement agencies. Traffic crimes 

and safety issues include but are not limited to: alcohol and/or drug 

impaired driving, vehicular homicide (that is, when someone is charged 

with homicide due to their actions when driving a vehicle), occupant 

restraint and other highway safety issues.

Court System Staff Court system staff, including data clerks can help ensure that evidencebased strategies focused on enforcement are successful. In managing 

record keeping systems about traffic citations, prosecutions, and arrests 

that are processed in civil, traffic and/or driving under the influence 

(DUI) courts, court system staff play an important role in tracking 

prosecution rates, identifying/flagging repeat offenders, and collecting 

fines. As a result, TMVIP coordinators and partners should include these 

staff on workgroups and when identifying data needed to assess the 

Tribe’s traffic safety system. 

Note about 

Tribal Judicial Systems

If Tribes do not have their own Tribal police department and/or a court 

system to process traffic safety laws (for example, in Public Law 280 

states), federal criminal jurisdiction is limited while state jurisdiction 

is expanded, relationships between the Tribal and non-Tribal judicial 

systems might be limited, and there can be different sentencing and 

fine structures. 
Collaboration: Component #2 for TMVIP 59

LESSON LEARNED

Judicial system issues to consider when a Tribe is in a PL 280 state

It is important for TMVIP programs at Tribes in six PL 280 States (Alaska, California, Minnesota, 

Nebraska, Oregon, and Wisconsin) to understand differences between federal, state, and Tribal 

jurisdictions, identify if or how the differences might affect traffic safety efforts, and look for 

opportunities for collaboration. 

In addition, the Tribal Law & Order Act (TLOA) 2010 is a comprehensive federal law that 

attempts to improve public safety in Indian country throughout the United States. The TLOA 

consists of Title II of Public Law 111-211. Signed into law on July 29, 2010, it focuses on 

crime prevention, policing, information sharing, prosecution, courts, corrections, and other 

Indian country criminal justice issues. TLOA allows tribal governments to request that the US 

Department of Justice re-assume federal criminal jurisdiction over that tribe’s Indian country. 

If the DOJ grants the request, the federal government may once again prosecute Indian Country 

General Crimes Act and Major Crimes Act cases from that reservation, located in a mandatory 

PL-280 jurisdiction. 
60 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Law Enforcement

Police Chiefs As leaders of law enforcement activities, whether the police department 

is a Tribal entity or Bureau of Indian Affairs staffed/managed entity, 

Chiefs of Police are required collaborators for traffic safety in AI/AN 

communities. Often appointed by the Tribal Council, it is essential to 

remember that police chiefs, like most other Tribal government officials, 

must prioritize limited resources and staffing to protect and serve the 

public. As a result, traffic safety, or enforcement of traffic safety laws, 

might be only one of many other priorities. 

LESSON LEARNED

Collaboration with the Tribal Chief of Police is essential!

Securing and maintaining the support of the Tribal and/or BIA Chiefs of Police is vital for 

TMVIP program success. Often balancing a long list of community, Tribal leadership, and law 

enforcement priorities, TMVIP coordinators can position themselves as helpful allies working 

with a police department to address traffic safety. This can include: 

a. providing staff support to collect and/or summarize data about traffic safety 

enforcement activities; 

b. coordinating advertising and media activities for enforcement events; 

c. summarizing and sharing success stories and program evaluation results about traffic 

safety activities; and/or 

d. securing funding (internal and external) to support on-going traffic safety 

enforcement events. 

Highway Safety 

Officers

Dedicated full-time Highway Safety Officers are often supported 

with external funding to hire officers dedicated to traffic safety 

enforcement efforts. Using funding provided by the Indian Highway 

Safety Program, for example, highway safety officers help provide 

increased traffic safety enforcement to supplement the Tribal 

department’s enforcement efforts. This includes collaborations 

between BIA and Tribal/local police for DUI prevention efforts, 

including use of Breath Alcohol Testing (BAT) Mobiles during 

enhanced enforcement events. 
Collaboration: Component #2 for TMVIP 61

Patrol Officers Many effective strategies for traffic safety call for ‘enhanced’ 

or ‘special duty’ enforcement efforts. Regular, on-going law 

enforcement by Patrol Officers, backed by prosecution in court, is 

important for changing community norms and behaviors around safe 

driving. Tribes have received additional funds from federal or state 

sources to support overtime for these efforts.

Data/Records Staff Similar to court system staff, Police Department Data/Records Staff 

have a role in ensuring the success of enforcement strategies. In 

managing recording keeping systems for police dispatches and MVC 

crash reports, data/records staff enter and summarize data about MVC 

events. These reports are used by law enforcement personnel during 

court proceedings, and are often summarized on an annual basis for 

reporting to Tribal Council or the Council’s judiciary or law enforcement 

committee. TMVIP coordinators and partners will benefit if police data 

or records staff are involved with traffic safety workgroups.

Emergency Medical Services (EMS)

Transport 

Personnel 

and 

Data/Records Staff

Emergency Medical Services (EMS) Transport Personnel assist those 

injured in motor vehicle crashes often at the scene or in transport to a 

hospital. In doing so, they might track important details about crash 

events, such as location, time of day, and perhaps weather or roadway 

conditions. Similarly, EMS Data/Records Staff within an EMS department 

enter and summarize data about MVC events, including tracking where 

events occur, number and types of injuries or deaths, and whether 

those injured were buckled up. EMS records might contain important 

information about the behaviors of drivers and passengers in MVCs, 

which can enhance what might be included in a police department 

report/record and/or emergency department and hospital data. 
62 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Media

Free/Earned Media Free Media (also called ‘earned media’) is one category of media. Its 

use can allow a TMVIP program to receive no-cost publicity through 

promotional activity rather than paid advertising. Examples of Free 

Media include: 

1. Letters to the Editor 

2. Opinion-Editorial (Op-Ed) Pieces 

3. Press Releases and Public Service Announcements (PSAs) sent to 

television, radio, and newspapers contacts

4. Press Briefings/News Conferences 

5. Local Community Reporting, including but not limited to:

a. Announcements on the radio station

b. News coverage of events in the Tribal newspaper or newsletter 

(for example, articles, photos, or both) 

c. Local/cable/public access TV stories

d. Participation on radio talk-show style or call-in shows 

e. Tribal casino marquee messaging

f. Movie theater messaging 

g. Tribal website messaging 

h. Tribal employee emails/listserv postings

6. Social Media (for example, Facebook, Twitter, Instagram, Pinterest)

Paid Media Paid Media includes publicity and/or advertising that a TMVIP project 

pays for, including but not limited to: 

7. Brochures/Posters/Flyers (distributed throughout the community at 

large and/or at community events)

8. Billboards (developed for display on existing or new billboard space 

on or near major roadways)

9. Print/Radio/TV/Movie Theater Advertisements (Ads)
Collaboration: Component #2 for TMVIP 63

LESSON LEARNED

Media representatives can be TMVIP allies! 

In many Tribal communities, representatives from local media sources (for example, newspaper, 

radio, TV) are eager to learn about and report on issues, stories, or events that affect the 

community, particularly those that are having a positive impact. TMVIP projects in AI/AN 

communities have sought to include media representatives on TMVIP workgroups. While 

often too busy to attend every workgroup meeting, TMVIP coordinators have kept media 

representatives ‘in the loop’ by sending meeting summaries to all workgroup members (not only 

those who attend meetings).

Community Members, Groups, and Institutions

All members of a Tribal community have the potential to serve as collaborators for Tribal motor 

vehicle injury prevention. Acting as individuals, or as part of local groups or institutions, community 

members have the opportunity to model, support, and promote safe driving behaviors and practices, 

which over time can help to change community norms about safe driving. Several categories of 

community members are of particular importance for TMVIP programs:

Parents/Families Parents and other family members (for example, grandparents and 

caregivers) can be positive role models for safe driving behaviors. Much 

learning about safety occurs in the home or within the family unit. 

Studies have shown that safe (and unsafe) driving practices are learned 

through observation. If parents and other family members buckle-up 

and drive safely, children who learn from them will likely do the same 

as they get older.

Local Spokespeople Local spokespeople or ‘celebrities’ (for example, athletic leaders, 

sports team members, pow-wow pageant participants, Tribal dancers or 

drummers) can also be effective collaborators for TMVIP. Viewed as 

role models in a community, their public support for traffic safety (for 

example, in media messages), and personally modeling safe driving 

behaviors, are important to consider in Tribal communities.
64 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Teachers/Educators Teachers and educators (for example, at schools, Head Start or 

daycare centers) have the potential to support safe driving behaviors 

and incorporate safety messages into lessons, or by allowing TMVIP 

coordinators to provide safety messages during classroom activities. 

Many classroom subjects provide the opportunity for learning about 

traffic safety, including what works (health and safety class), how 

important data can be to define the problem and identify solutions 

(math class), and why MVCs are so dangerous (science class).

Community 

Safety Groups

Many communities have existing groups comprised of concerned citizens 

who meet to prioritize, plan, and implement safety activities. Examples 

include local Safe Kids Chapters, Mothers Against Drunk Driving 

(MADD) Chapters, and/or Students Against Destructive Decisions 

(SADD) Chapters. These resources can be helpful for Tribal motor 

vehicle injury prevention efforts for hosting events or providing printed 

materials for educational or media events.

Schools or School 

Districts, Head Start 

Centers, Women 

Infant Children (WIC) 

Programs

Community institutions such as schools and school districts, WIC 

programs, and Head Start Centers are important collaborators for child 

safety seat incentive and education programs, safe driving educational 

programs, and school-based instructional programs for impaired driving. 

Institutional support for conducting traffic safety education is important 

for Tribal Motor Vehicle Injury Prevention.

Tribal, County, and 

State Public Health 

Departments

Health departments at the Tribal, county, and state level are partners for 

TMVIP. Training, funding, and technical assistance is often available for 

Tribes to conduct child safety seat activities (for example, CPS Technician 

training, child safety seat installation events). In some states, Tribal/

State Liaison positions have been established to enhance leadership 

cooperation between Tribal and State leaders addressing motor vehicle 

injury prevention (for example, between Tribes and State Departments of 

Transportation, and/or Public Safety).
Collaboration: Component #2 for TMVIP 65

LESSON LEARNED

Be persistent and creative in recruiting collaborators!

In an environment where each Tribal program might have its own priorities, set by Tribal 

leadership, community input, or funding agency requirements, TMVIP coordinators can face 

challenges in trying to recruit members to a traffic safety workgroup, or to partner in a more 

general way to address traffic safety. 

Experience from many TMVIP projects has shown that persistence is needed, and can pay off! If 

at first you don’t succeed (in getting the involvement or collaboration for any of the stakeholders 

described in this section), keep trying. Don’t give up. 

Learn what motivates stakeholders (to be or to become involved with traffic safety) and identify 

how the TMVIP Program’s efforts can help them meet their program objectives. Look for and 

emphasize any overlap in priorities. When seeking involvement emphasize that by working 

together, progress can be made to address the burden of MVC injury and death.

Value and show appreciation for their time by: planning and conducting well-organized and 

productive workgroup meetings; stating clear requests for assistance; and by recognizing 

(privately and publicly) workgroup member contributions to your program’s efforts.
66 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

ACTION CALLS 

Tribal Leaders Can... 

1. Encourage the development and official recognition of traffic safety workgroups. 

2. Encourage stakeholder attendance at workgroup meetings. 

3. Provide support for workgroup meetings (for example, meeting space, food). 

4. Ask the workgroup to provide Tribal leadership information about the effectiveness of evidencebased strategies, program evaluation results, and challenges to program implementation. 

5. Encourage and foster a culture of communication, collaboration, and sharing of information 

among Tribal departments to support tribal motor vehicle injury prevention in AI/AN 

communities. 

Tribal IP Practitioners Can... develop and support traffic safety workgroups/committees by: 

1. Recruiting a variety of members. 

2. Planning and facilitating well-organized, productive workgroup meetings.

3. Recognizing the contributions of workgroup members. 

4. Distributing meeting agendas and summaries to all workgroup members (including those who 

are unable to attend meetings in person).

5. Providing year-end reports via email or sending mass emails to tribal employees about 

project successes.

Tribal Public Health Professionals & Partners Can... 

1. Regularly attend traffic safety workgroup meetings. 

2. Recruit others to the workgroup. 

3. Assist with planning, implementation, and evaluation of traffic safety programs and activities. 

State Entities Working with Tribes Can... 

1. Invite workgroup leaders and members to participate in state-wide traffic safety planning and 

activities.

2. Provide support and/or technical assistance for traffic safety workgroup development or activities.

3. Promote and/or attend Tribal traffic safety workgroup activities.
Data and Evaluation: Component #3 for TMVIP 67

I. Data and Evaluation: Component #3 for TMVIP

What DATA are 

needed to address 

MVC injury and 

death in AI/AN 

communities?

This section provides information about the third component needed for 

TMVIP – DATA and EVALUATION – including: 

1. Data recommended to plan and evaluate Tribal MVIP efforts. 

2. General Lessons Learned and specific Case Examples about data 

collection efforts at Tribal MVIP projects.

3. Resources available to identify, collect, and summarize data. 

4. Action Calls for collecting and sharing data among stakeholders. 

LESSON LEARNED

Data are needed to show progress or success, lessons learned, and the need 

for continued efforts!

As described in this section, collecting and summarizing data should be used to show the degree 

to which a TMVIP Program has:

● Done what the program said it would do (for example, reached the number of people or 

conducted the number of activities it planned), that is, process evaluation.

● Changed knowledge, attitudes, behaviors, or policies the program wanted to change (for 

example, occupant restraint use, enforcement of existing laws, new/enhanced policies), that 

is, impact evaluation.

● Reduced the number or types of motor vehicle crashes (events) and/or motor vehicle crash 

injuries and deaths (people) intended, that is, outcome evaluation. 

All of the types and sources of data described in this section are useful for program evaluation, 

which is needed when Tribes seek additional funding to continue traffic safety efforts. For more 

information about the types of program evaluation, including resources available for program 

evaluation, see Section J - Tailored Evidence-Based Strategies: Data and Evaluation.
68 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Motor Vehicle Crashes (MVC)

What is valuable to 

know about MVCs?

When collecting data about motor vehicle crashes (events, not people), 

it is valuable to collect and summarize information about each of the 

following items, listed in order of importance for TMVIP:

● Number: How many MVC events are occurring (each month or 

year)?

● Severity: Do the MVCs result in property-damage only or occupant 

minor injury, severe injury, or death?

● Type: Were the MVCs single-vehicle or multiple-vehicle events?

● Causes: What factors played a role in the crash (for example, driver 

impairment, speed, driver distraction, weather, road conditions, 

visibility)?

● Timing: When did the MVCs occur (for example, time of day, day of 

week, day of month, Holidays, season of year)?

● Locations: Where are MVCs occurring (for example, on what types 

of roads, in smaller/rural or larger/city center settings, in high or low 

volume traffic, in the same locations)?

● Groups at Risk: Are there any groups of people who have higher 

numbers of MVCs (for example, males/females or different age 

groups such as teens or elders)?

What are the data 

sources for MVCs?

In AI/AN communities, the primary sources of information about MVCs 

(events, not people) include:

● Police Departments: In most Tribal communities, investigating 

and documenting information about MVCs is the responsibility of 

law enforcement. There might be multiple jurisdictions with the 

responsibility to collect, store, and/or share data about MVC events, 

including Tribal police, Bureau of Indian Affairs (BIA) police, city/

town police, county police (for example, sheriffs), or state police (for 

example, highway patrol). 

● EMS: For many MVCs, particularly those involving injury/death, EMS 

might respond to the event and collect data about the MVC event.

● State Highway Safety Offices: In some Tribal communities, 

information about MVC events might be collected by state offices 

of highway safety, which obtain data from Tribal/state/county/local 

police department’s crash reports. Data sharing between Tribal and 

non-tribal law enforcement entities might be limited in some areas of 

the country. 
Data and Evaluation: Component #3 for TMVIP 69

What are the data 

sources for MVCs?

(continued)

TMVIP coordinators are encouraged to contact local Tribal Epidemiology 

Centers (TECs) for assistance with collecting, summarizing, and/or 

analyzing data.

CASE EXAMPLE

Road Safety Audits

Road Safety Audits (RSAs) have been used as a tool to proactively improve the future safety 

performance of a road project during the planning and design stages, and for identifying 

safety issues in existing transportation facilities. The Office of Safety at the Federal Highway 

Administration developed a report summarizing Tribal Road Safety Audit Case Studies, 

conducted throughout the United States in 2005 and 2006, involving tribal transportation 

agencies in North Dakota and in the Southwest. The National Indian Justice Center is promoting 

the RSA methodology with tribes in California and Nevada and has developed Safe Journeys: 

Tribal Road Safety Audits Online Course and other resources. In addition, the Inter Tribal 

Council of Arizona, Inc., has used the RSA methodology to focus on the Four E’s (education, 

enforcement, environmental modification, and engineering) for MVC injury prevention projects, 

especially when crash data are not readily accessible.

LESSON LEARNED

An important difference between Motor Vehicle Crashes (events) involving injury 

or death and MVC injuries or deaths (people).

Some MVC data sources (for example, law enforcement) include information about the event 

itself, not about the people in the event. When a figure or graph describes “Motor Vehicle 

Crashes with no injuries, with non-fatal injuries, or with fatalities” this is an indication that the 

data describe events. Data about events describe if a crash event did or did not result in injury 

or death. The information provided might not count how many people were injured or killed in 

the event(s). Remember that multiple injuries or deaths can occur from a single event. 

Other data sources about MVCs (death certificates, hospital data) include information about 

people in the event, not the event itself. When a figure or graph notes “MVC Injuries” or “MVC 

Injuries/Deaths” this is an indication that the data describe people. These data report the total 

number of people who were injured or killed. Remember that when relying on a single data 

source (for example, police MVC reports), determine if the reports summarize information about 

‘events’ or ‘people.’
70 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

LESSON LEARNED

No one data source has all you need to know about MVCs, nor are the data always 

shared among all sources!

It is important to remember that no one data source has all of the data needed to fully understand 

MVCs in a Tribal community, and multiple data sources might have conflicting information. 

Some data sources might have more complete information than others, and multiple data sources 

might collect the same or different data about crash events. When combining information from 

multiple sources, look closely at the information to remove duplicates and resolve conflicting 

information. Remember that data collected from multiple sources can help you summarize if 

a program: 

● did what a program wanted to do (process evaluation); 

● changed knowledge, attitudes, behaviors, or policies a program intended to change 

(impact evaluation); or 

● reduced MVC events or MVC injuries/deaths (outcome evaluation). 

MVC Injuries & Deaths

What is valuable 

to know about MVC 

Injuries/Deaths?

When collecting data about MVC Injuries or Deaths (people, not 

events), it is valuable to collect and summarize information about each 

of the following items, listed in order of importance for TMVIP:

● Number: How many people were injured (non-fatally or fatally) 

in MVCs (for example, each month or year)?

● Restraint Use: Were the vehicle occupants using restraints (for 

example, seat belts, car seats, booster seats) or were motorcyclists 

wearing helmets during the MVC?

● Alcohol-Involvement: Were drivers impaired due to alcohol?

● Severity: How severe were the injuries among people involved 

in MVCs: 

◆ no injury

◆ minor injury (for example, treated at scene)

◆ severe injury (required transport and/or hospitalization)

◆ death (for example, resulted in death at scene, during transport, 

or at a medical facility)?
Data and Evaluation: Component #3 for TMVIP 71

What is valuable 

to know about MVC 

Injuries/Fatalities?

(continued)

● Type: What types of injuries were sustained (for example, external 

injuries such as broken limbs, or internal injuries such as organ, 

spine or brain injuries)?

● Location: 

◆ Where in a vehicle were the people who were injured sitting 

(for example, front seat, back seat, truck bed)?

◆ Were the injured ejected from the vehicle? 

◆ Were the injured drivers, passengers, pedestrians, cyclists, 

motorcyclists, etc.?

TMVIP projects are encouraged to contact the nearest Tribal 

Epidemiology Centers (TECs) for assistance when collecting, 

summarizing, or analyzing data.

What are the data 

sources for MVC 

Injuries/Deaths?

In AI/AN communities, the primary sources of information about MVC 

Injuries and Deaths include:

● Police Departments/EMS: Police/EMS MVC reports often document: 

how many people were injured in a crash (information is often 

limited to the number of non-fatal injuries or the number of deaths); 

if restraints were used by occupants; and other details about those 

injured (for example, the sex, age, and seating location in the 

vehicle). 

● Hospitals/Clinics: Whether operated by the Indian Health Service, 

the Tribe, local municipality, or private entity, hospitals and clinics 

are often a primary source of information about the health outcomes 

of people injured or killed as a result of MVCs. Hospital data often 

include emergency department data, inpatient data for admitted 

patients, data about the types and severity of injuries, and less 

information about the scene or crash event details. In some IHS 

Areas, IHS and/or Tribal injury prevention staff prepare regular (for 

example, every two or three years) injury data summaries following 

Severe Injury Surveillance System procedures. Data sources for 

these summaries vary, as does how often they are produced, across 

IHS Area Injury Prevention Programs.

● Death Certificates: Vital statistic records (for example, death 

certificates) kept by a Tribe or a State often note causes of death, 

which can include MVC. 
72 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

What are the data 

sources for MVC 

Injuries/Deaths?

(continued)

● Employers: Large employers, such as a Tribal Government, might 

keep data records about employee MVCs, particularly those 

occurring among staff who are using Tribal/government vehicles.

● State Highway Safety Offices: In some Tribal communities, 

information about MVC injuries/deaths might be collected by 

state offices of highway safety, which obtain data from Tribal/state/

county/local police department MVC reports. Data sharing among 

Tribal and non-tribal law entities might be limited in many AI/AN 

communities.

● State Trauma Registries: Many states have developed trauma 

registries, which are databases that document acute care delivered 

to patients hospitalized with injuries. Three registries in states with 

large American Indian/Alaska Native populations include: 

◆ Alaska Trauma Registry

◆ Arizona Trauma Registry

◆ Washington Trauma Registry

● Other National Data Sources: Several national data sources can 

also be used to learn more about motor vehicle crashes occurring in 

Tribal Communities or in states where Tribes are located: 

◆ NHTSA Fatality Analysis Reporting System (FARS): FARS is an 

online database, accessible to the public, which is developed 

and kept by the National Highway Traffic Safety Administration 

(NHTSA). Only motor vehicle crashes on public roadways 

resulting in death of at least one person within 30 days of 

the crash are recorded in FARS. Results for AI/AN might be 

unstable when compared to other populations.10

◆ CDC Web-based Injury Statistics Query and Reporting System 

(WISQARSTM): This is an online, publically accessible database 

of fatal and non-fatal injuries, and violent deaths caused by a 

variety of reasons, including motor vehicle crashes. Users can 

query the database to generate tables, charts, maps, and reports 

based on intent of injury, cause of injury, injured body region, 

type of injury, geographic location where the injury occurred, 

and gender, race/ethnicity, and age of the injured person. Visit 

WISQARS tutorials for tips on how to use this database. 
Data and Evaluation: Component #3 for TMVIP 73

What are the data 

sources for MVC 

Injuries/Deaths?

(continued)

◆ State Emergency Department Databases (SEDD): as part of the 

family of databases and software tools developed for the Healthcare 

Cost and Utilization Project (HCUP). The SEDD capture emergency 

department (ED) visits that do not result in hospitalization. 

Information about patients initially seen in the ED and then 

admitted to the hospital (that is, inpatient data) is included in the 

State Inpatient Databases (SID). Tribes can request the publically 

available Hospital Discharge Data from state health departments to 

obtain a general picture of the number of visits. Currently, 32 states

collect at least ED and inpatient data from the majority of their 

hospitals. 

◆ CDC Behavioral Risk Factor Surveillance System (BRFSS): This is 

the world’s largest, ongoing telephone health survey system, tracking 

health conditions and risk behaviors in the United States yearly 

since 1984. Currently, data are collected monthly in all 50 states, 

the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and 

Guam and include self-reported information on seat belt use and 

alcohol-impaired driving.

◆ Youth Risk Behavior Surveillance System (YRBSS): This system 

monitors six types of health-risk behaviors that contribute to the 

leading causes of death and disability among youth and young 

adults, including behaviors that contribute to unintentional injuries 

and violence, such as seat belt use and impaired driving. 

◆ CDC Wide-ranging Online Data for Epidemiologic Research 

(WONDER): This is an easy-to-use, menu-driven system that makes 

the information resources of the CDC available to public health 

professionals and the public at large. It provides access to a wide 

array of public health information. With CDC WONDER, you 

can access statistical research data published by CDC, as well as 

reference materials, reports and guidelines on health-related topics 

and query numeric data sets on CDC’s computers, via “fill-in-the 

blank” web pages. Public-use data sets about mortality (deaths), 

census data and many other topics are available for query, and 

the requested data are readily summarized and analyzed, with 

dynamically calculated statistics, charts and maps.
74 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

What are the data 

sources for MVC 

Injuries/Deaths?

(continued)

◆ The Division of Transportation (DoT) within the Bureau of Indian 

Affairs (BIA): Oversees road maintenance and road construction 

programs for reservation roads in Indian country and keeps an 

inventory under the Tribal Transportation Program (TTP). The TTP 

also keeps an inventory website that provides a portal to report 

data about the uses of highway funds and assesses the most current 

data in a read-only format. Data are updated every month on the

Integrated Transportation Information Management System (ITIMS) 

website and is accessible to tribal transportation planners, tribal 

program managers, and the public. 

◆ Inventory of National Injury Data Systems: This is a list of 45 

different federal data systems operated by 16 different agencies 

and three private injury registry systems that provide nation-wide 

injury data. 

CASE EXAMPLE

Avoid duplicate counting of MVC events and injuries & deaths.

At a Southwest reservation Tribe (Hopi), two law enforcement groups (Tribal Police and BIA 

Police) often responded to the same MVC event. The group arriving first was most often the one 

that collected and completed a MVC report; however, this was not always the case, and both 

groups might have completed a report. Since the TMVIP coordinator received data from both 

the Tribal and BIA police, they were careful to avoid double counting crashes. One way to avoid 

double-counting is to match MVC events by date or location. 

CASE EXAMPLE

The benefits of sharing crash data with the state.

An IHS Injury Prevention Fellowship project (entitled ‘100 miles, 100 crosses’) identified 

discrepancies in motor vehicle crash data on Arizona Highway 86 from the town of Sells, 

AZ (headquarters of the Tohono O’odham Nation) to the Tribe’s border. More crashes were 

occurring on this road than were being reported to the state. The discrepancies were identified, 

and the Tribal police began regularly reporting MVC data (using a newly computerized data 

system) to the AZ Department of Transportation (DOT). In response to the more complete data, 

the Arizona DOT implemented roadway improvements (e.g., 12 foot lanes and 8 foot shoulders 

with rumble strips). Preliminary observation from EMS drivers in Sells, AZ indicate that MVCs 

have decreased along the improved roadway section, emphasizing the importance of sharing 

data between Tribes and states, so that roadway improvements can be identified and addressed. 
Data and Evaluation: Component #3 for TMVIP 75

Occupant Restraint Use

What is valuable 

to know about 

occupant 

restraint use?

To better understand the data collected about MVCs and MVC Injuries/

Deaths, it is vital to collect information about occupant restraint use (for 

example, seat belts, car seats, and booster seats) within a community. 

Information about seat belt use can be used to assess Overall Seat Belt 

Use behavior, as well as possible differences by: 

● Drivers/Passengers: Do drivers or passengers wear their seat belts 

more often? 

● Sex/Age: Does restraint use vary by sex or age groups?

● Vehicle Type: Does restraint use vary based on the type of vehicle 

driven (for example, passenger vehicles and pick-up trucks)?

Information about child safety seat use can be used to assess Overall 

Child Safety Seat Use behavior, as well as differences by: 

● Correct/Incorrect Use (Misuse): 

◆ Are children properly buckled in age- and size-appropriate 

child safety seats and seat belts?

◆ Are children riding properly buckled in age- and sizeappropriate child safety seats, booster seats, and seat belts in 

the back seat? Children 12 and under should ride properly 

restrained in a back seat for the best protection in a MVC. 

◆ Are child safety seats installed and used properly (according to 

Safe Kids standards)?

LESSON LEARNED

Present your seat belt use results in relation to state and national use rates.

When summarizing data about observed Tribal seat belt use (for drivers, passengers, or overall), 

show the Tribe’s results in comparison to state and national results, including use rates in MVCs 

with deaths. This can be helpful to show that while the Tribe’s seat belt use is perhaps increasing, 

it might still be lower than state or national use, and lower among those who died in crashes, 

indicating a continued need for TMVIP efforts. 
76 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

What are the data 

sources for occupant 

restraint use?

There are multiple ways to collect occupant restraint use data, each with 

some limitations or potential bias: 

● Observed Use: The best way to find out how many people in 

your community are buckling up is to observe them. The Indian 

Health Service and University of North Carolina developed 

an Observational Seat Belt Use Survey Protocol for Tribal 

communities. 

Valid seat belt use data requires observations completed at a variety 

of community locations (for example, rural or urban, high or low 

traffic volume) and times of day (morning, mid-day, late afternoon), 

particularly for seat belt use. 

For child safety seat use, choose locations where children are more 

likely to be observed being transported by passenger vehicles, such 

as day care centers, Head Start Centers, or other child-focused 

settings. Also, remember that ‘observed use’ is different from 

‘correct use’ of child safety seats. Conducting observations to check 

for ‘correct use’ is often conducted at Child Safety Seat Installation 

and Check Events. 

Section J - Tailored Evidence-Based Strategies: Observational 

Surveys of this guide lists several tools describing how to collect 

observational seat belt and child safety seat use data. 

● Self-Reported Use: Community surveys and/or interviews with 

community members can be used to find out what people think 

about restraint use. And, you can ask them about how often they 

buckle up. However, when you ask instead of observe, people may 

report that their seat belt use is higher than their actual use because 

seat belt use is the socially acceptable response. 

● Documented Use: The data sources listed for MVC events and MVC 

injuries and deaths (for example, police or EMS MVC reports) might 

document restraint use among vehicle occupants involved in MVCs, 

or use among occupants injured or killed in an MVC. Using these 

data to summarize the use of restraints among those involved or 

injured in MVCs can provide important insights about traffic safety 

in a Tribal community. 
Data and Evaluation: Component #3 for TMVIP 77

LESSON LEARNED

Go where the children are and link results to those you observe.

When choosing locations to observe child safety seat use, select locations where you can safely 

observe children entering or exiting vehicles. This includes locations where other traffic safety 

educational sessions or child safety seat installations are happening (such as Head Start or 

daycare facilities). Select observation times that correspond to when children are being pickedup or dropped off. 

Remember that your results will only be an estimate of use among the population being 

observed. For example, if all observations are done at Head Start centers, results obtained should 

be described as ‘use among Head Start center families’. 

If observations are conducted before and after interventions (for example, at the start and the end 

of the Head Start school year, with educational and installation activities occurring during the 

school year), some increase in child safety seat use is expected due to your program activities. 

However, in the Fall when new children are attending Head Start, coordinators should expect 

lower use rates. As community norms begin to shift, coordinators should see a gradual increase 

in use each year over time. For an example of this, you can read a summary of the Ho-Chunk 

Nation’s results described in a 2009 IHS Primary Care Provider Article. 

LESSON LEARNED

Observed restraint use at traffic safety enforcement events is overestimated!

At traffic safety enforcement events conducted in AI/AN communities, one of the data variables 

often collected at the event includes observed restraint use among vehicles passing through the 

event. While this might be a helpful measure of restraint use at events, it is not a valid reflection 

of ‘everyday use.’ When law enforcement officers are close by, community members tend to 

‘follow the rules’ more often than when they do not see law enforcement. To get a more reliable 

measure of restraint use in a community, conduct observational surveys that observe use in 

multiple locations (for example, by following the IHS-UNC Seat Belt Use Observational Restraint 

Use Survey Protocol).
78 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Enforcement/Prosecution 

What is valuable 

to know about 

enforcement and 

prosecution of traffic 

safety laws? 

Because many effective traffic safety strategies (to increase seat belt use, 

to increase child safety seat use, to reduce alcohol-impaired driving) 

involve the passage, enhancement, and/or enforcement of laws, it is 

valuable for a TMVIP project to collect and summarize data about 

traffic safety enforcement efforts (that is, issuing traffic safety warnings, 

citations, arrests), as well as the degree to which citations or arrests are 

prosecuted in Tribal/local courts. 

When collecting data about enforcement, it is valuable to collect and 

summarize information about each of the following items:

● Seat Belt Warnings: How many warnings are issued for seat belt use 

infractions (by month or year).

● Seat Belt Citations: How many citations are issued for seat belt use 

infractions (by month or year).

● Child Safety Seat Warnings: How many warnings are issued for 

child safety seat use/misuse infractions (by month or year).

● Child Safety Seat Citations: How many citations are issued for child 

safety seat use/misuse infractions (by month or year).

● Alcohol-Impaired Driving Arrests: How many arrests were made for 

driving under the influence?

● Alcohol-Impaired Driving Checkpoints: How many alcoholimpaired driving checkpoints were conducted (by month or year) 

and at these checkpoints, how many alcohol-impaired driving arrests 

were made?

● Alcohol-Impaired Driving Saturation Patrols: How many alcoholimpaired driving Saturation Patrols were conducted (by month or 

year) and during these patrols, how many alcohol-impaired driving 

arrests were made?

It is also important for a TMVIP program to assess the degree to which 

law enforcement face barriers to enforcing traffic safety laws. In Tribal 

communities, barriers can include law enforcement understaffing, 

competing priorities, differing beliefs about the effectiveness of 

enforcement, or family ties between law enforcement and community 

members. This sample survey lists questions that can be asked to 

assess possible local barriers to enforcement. Once those barriers are 

identified, TMVIP program efforts (for example, education, media, policy 

interventions) can address those barriers.
Data and Evaluation: Component #3 for TMVIP 79

What is valuable 

to know about 

enforcement and 

prosecution of traffic 

safety laws? 

(continued)

The University of North Carolina training, technical assistance, and 

evaluation team providing support to the 2004-2009 and 2010-2014 

CDC Tribal Motor Vehicle Injury Prevention Program developed data 

collection tools for Enhanced Occupant Restraint Use Enforcement 

Events and DUI Enforcement Events. 

LESSON LEARNED

Why is it helpful to have data about traffic safety warnings and citations?

The CDC’s TMVIP program encouraged Tribes to collect data about on-going enforcement, 

including warnings and citations issued for restraint use violators. However, tracking of warnings 

is uncommon because it is often an informal practice. 

In Tribal communities where regular restraint use is not the norm, initial efforts to increase seat 

belt and child safety seat use might be met with community opposition. Passage of new or 

improved traffic safety laws often include a ‘grace period’ during which enforcement is limited 

to issuing warnings only, as a way for law enforcement to educate the public about a new 

(or improved) law. When you have the opportunity to track warnings during a grace period, 

consider extending the data collection period past that point, that way you can document 

whether there are fewer warnings and more citations when the law goes into effect. Issuing 

citations rather than warnings provides a greater incentive for community restraint use.

What are 

the data sources 

for enforcement 

and prosecution?

In AI/AN communities, the primary sources of information about the 

Enforcement and Prosecution of seat belt use, child safety seat use, and 

alcohol-impaired driving laws include: 

● Police Department: Data/records managers often summarize data 

on a regular basis for reporting to funders and/or the Tribal Council. 

● Court System: While the primary stakeholder might vary by Tribe, 

clerk or administrative staff who work in the court system might 

be the source for data about the outcomes of traffic safety citations 

issued by law enforcement (for example, the degree to which the 

infractions were prosecuted and what judgment was made). 
80 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

LESSON LEARNED

Data sharing among traffic safety stakeholders is neither automatic nor customary.

It can be challenging to collect traffic safety data from other agencies (for example, law 

enforcement). While data about traffic safety (for example, MVCs, MVC injuries/deaths, 

enforcement) is regularly collected and summarized by law enforcement, obtaining those data 

(for example, summary reports, or basic data counts) can be challenging for those who work 

outside of that agency. Including law enforcement in TMVIP workgroups can facilitate data 

sharing among multiple stakeholders. Tribal leadership should encourage police chiefs to share 

summary traffic safety data with other agencies that have traffic safety or public health goals. 

Laws/Policies

What is valuable 

to know about traffic 

safety laws/policies?

When collecting data about laws and policies regarding seat belt use, child 

safety seat use, and alcohol-impaired driving, it is valuable to prepare 

answers to the following questions. In answering them, a TMVIP program 

coordinator will gain a firm understanding of the laws and their expected 

effectiveness, and be able to answer questions from decision-makers. 

● Seat Belt and Child Safety Seat Use: 

◆ Is there a law? Is it a Tribal law, or does it defer to state law?

◆ Is the law a primary or secondary enforcement law (see list of 

states with these laws at the Insurance Institute for Highway

Safety)?

◆ Who is covered by the seat belt law (front seat and rear seat 

occupants, or front-seat only)?

◆ What is covered by the child safety seat law (ages, location of 

seat, and/or types of seats)?

◆ What are the fines for non-restraint use and how do they compare 

to fines at the state level? Do the fines differ for non-use of a 

child safety seat versus improper use of a child safety seat?

◆ Does the law describe increased consequences for repeat 

offenders?

◆ Does the law include a ‘court diversion’ program and if so, who 

manages the court diversion program?

◆ Does the law stipulate how funds generated from citations or 

court fees are used (that is, do those funds support on-going 

traffic safety efforts)?
Data and Evaluation: Component #3 for TMVIP 81

What is valuable 

to know about traffic 

safety laws/policies?

(continued)

● Impaired Driving: 

◆ Is there a law? Is it a Tribal law, or does it defer to state law?

◆ How is the term ‘impaired’ defined (that is, alcohol-use, drugs, 

prescription medication)?

◆ Does the law describe how ‘impairment’ must be measured, 

and if so, are those measurements different from state law?

◆ What are the consequences for first-time offenders? To what 

degree do those consequences differ from state laws?

◆ What are the consequences for repeat offenders? To what 

degree to those consequences differ from state laws?

◆ Does the law include a ‘child endangerment’ clause if children 

are in the vehicle at the time of arrest?

◆ Does the law include ‘court diversion’ or ‘alternate sentencing’ 

options, and if so, who manages those programs?

◆ Does the law stipulate how funds generated from fines or court 

fees are used (that is, do those funds support on-going traffic 

safety efforts)?

What are the data 

sources for traffic 

safety laws policies?

In some Tribal communities, it can be difficult for a TMVIP coordinator 

to know where to find and how to interpret the current codes or laws 

related to traffic safety. 

Identify stakeholders within the Tribe’s judicial system who will review 

relevant laws, interpret their meaning, and consider enhancements that 

the TMVIP coordinator might consider pursuing. 
82 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

CASE EXAMPLE

For one project funded by the CDC TMVIPP from 2010-2014, activities included efforts to 

educate on the benefits of 1) changing the existing Tribal seat belt use law to include higher 

fines; increasing penalties for repeat violations; and developing a first-time offender diversion/ 

education program; and 2) strengthening the existing Tribal Driving Under the Influence law to 

increase fines and penalties; increasing sentence length; and requiring education and treatment 

components. In providing education about the suggested revisions to Tribal laws, the TMVIPP 

coordinator had to study existing laws, conduct research to consider improvements to those laws, 

and in collaboration with a workgroup, provide education to decision-makers and community 

members about the potential consequences if changes were made to the existing laws. In 2014, 

the Tribal council passed revisions to the laws, including: making seat belt and child safety seat 

use a primary enforcement offense; increasing the fine for a seat belt violation (from $25 to $35, 

plus court fee); and increasing the fine for a child safety seat violation (from $25 to $250, plus 

court fee). 
Data and Evaluation: Component #3 for TMVIP 83

ACTION CALLS

Tribal Leaders Can... 

1. Promote a culture among Tribal programs and departments to share data that will benefit 

multiple programs.

2. Require programs conducting traffic safety to routinely share data about MVCs, MVC injuries/

deaths with all traffic safety partners at the Tribe. 

Tribal IP Practitioners Can... 

1. Start a project by identifying and making connections to staff or other projects that collect traffic 

safety data for the Tribe.

2. Consider what local data would be valuable to collect in order to evaluate progress, and 

determine if/how it has been collected in the past (and by whom).

3. Pilot-test different data collection methods to determine which are cost effective and/or provide 

helpful information for planning and program evaluation. 

4. Partner with IHS or Tribal EPI Center staff to periodically summarize outcome data (for example, 

motor vehicle injuries/deaths). 

5. Share data reports and program evaluation results with program partners and Tribal leadership. 

Tribal Public Health Professionals & Partners Can... 

1. Share information and data about health and safety with traffic safety partners requesting data, 

including Tribal IP practitioners.

2. Provide access to data or data reports from traffic safety partners.

State Entities Working with Tribes Can... 

1. Share data collected at the state level that can be used to put Tribal data in context 

(for example, state-wide restraint use, MVCs, enforcement data). 

2. Provide training to Tribal IP practitioners and partners about how to access state-level 

data sources.
84 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

J. Tailored Evidence-Based Strategies:

Component #4 for TMVIP

How are EvidenceBased Strategies for 

Traffic Safety tailored 

for use in AI/AN 

communities?

This section provides information about the fourth component needed 

for TMVIP – TAILORED EVIDENCE-BASED STRATEGIES – including: 

1. Descriptions of tailored evidence-based strategies for traffic safety 

in AI/AN communities. 

2. General Lessons Learned and specific Case Examples about tailored 

evidence-based strategies.

3. Resources available to identify, adapt, and tailor evidence-based 

strategies. 

4. Calls to Action for stakeholders to tailor evidence-based strategies. 

Tailored Child Safety Seat Strategies

(1) Laws Mandating 

Child Safety 

Seat Use

Child safety seat laws require children riding in motor vehicles to 

be restrained in approved child restraints (for example, car seats and 

booster seats). Requirements and enforcement guidelines and penalties 

vary by state or Tribe based on several factors (for example, child’s age, 

weight, height, or a combination of these).

The primary interventions used to tailor this recommended evidencebased strategy have been to Pass New or Strengthen Existing Child 

Safety Seat Use Laws. These interventions have included the following 

types of activities:

● Provide evidence about effective strategies to local workgroup and 

Tribal executive/legislative leaders to assess the impact of new Tribal 

laws mandating use of child safety seats. In many cases, the law 

used in the state could be adopted as is, or modified to fit the needs 

of the Tribe.

● Workgroup - Work with a local workgroup to educate Tribal 

government officials about the effectiveness of enhanced laws 

mandating use of child safety seats, such as:

◆ Tribal adoption of a primary enforcement law (if the current law 

is secondary enforcement), which allows local police to stop 

vehicles and issue citations solely based on the presence of 

unrestrained children.
Tailored Evidence-Based Strategies: Component #4 for TMVIP 85

(1) Laws Mandating 

Child Safety 

Seat Use

(continued)

◆ Defining enforcement, age/weight/height, and seat location in 

vehicle requirements to align with CDC recommendations for 

appropriate use by age/weight/height, or other Tribal or state 

laws, as summarized by: 

● The Governor’s Highway Safety Association: 

Summary of Child Passenger Safety Laws

● Insurance Institute of Highway Safety: 

Summary of Child Safety

● National Congress of American Indians Policy 

Research Center: Tribal Public Health Law Database

● Safe Kids Worldwide: Car Seat Tips

● CDC: Get t he Facts on Child Passenger Safety

● Increasing fines for citations issued and/or developing alternate 

sentencing options.

● Data and Evaluation - Collect on-going data about adherence/

enforcement of law, including:

◆ Child seat safety use observational surveys.

◆ Enforcement of existing laws (for example, citations/warnings 

issued).
86 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

CASE EXAMPLE

Several Tribes in California and Arizona as well as the California Highway Patrol, have used 

a modified version of the Safe Native American Passengers (SNAP) Course to educate law 

enforcement personnel about the importance of child safety seat use and enforcing child safety 

seat use laws. In these examples, the Tribes/California Highway Patrol have shortened the SNAP 

course to a two-hour version that focuses on age-appropriate seat selection combined with 

proper placement within the vehicle. This training allows law enforcement to quickly identify if 

the seat is right for the child, ensure that it is installed in the correct direction, and ensure it is not 

installed in front of an airbag. This gives officers the tools, and hopefully the confidence needed, 

to address CPS during traffic safety stops.

(2) Distribution and 

Education Programs 

Child safety seat distribution plus education programs provide approved 

child safety seats (car seats and booster seats) to parents in various ways 

(for example, giveaway, loan, or low-cost purchase), combined with 

an educational component. These programs are designed for parents/

caregivers requiring financial assistance and/or for those who might not 

understand the importance of using a child safety seat.

In AI/AN communities, the primary interventions conducted to tailor 

this recommended evidence-based strategy have been to Develop 

New or Enhance Existing Child Safety Seat Distribution and Education 

Programs. These interventions have included the following types of 

activities:

● Secure resources to purchase several types of child safety seats 

(infant, convertible, combination, and booster seats). Resources can 

be obtained by submitting grant applications to internal (for example, 

Tribal Council) or external funding sources (for example, state 

programs, Bureau of Indian Affairs Indian Highway Safety Program).

● Identify and collaborate with local Tribal or non-Tribal programs 

that have contact with expectant mothers/fathers or with young 

children to coordinate child safety seat distribution and education 

efforts. Examples of Tribal programs that coordinate child safety 

seat distribution include: Head Start Centers; Day Care Centers; 

Public Health Nurses; and Community Health Representatives. 

Coordination activities include: 
Tailored Evidence-Based Strategies: Component #4 for TMVIP 87

(2) Distribution and 

Education Programs 

(continued)

◆ Develop or adapt existing educational materials for parents/

caregivers. Examples from Tribal communities include: 

● NHTSA child passenger safety educational materials

● CRIHB Injury Prevention Toolkit 

● Alaska FOCUS on Safety Curriculum 

● CDC Roadway to Safer Tribal Communities Toolkit

◆ Identify clear procedures, roles and responsibilities for 

identifying and referring families that need child safety seats. 

◆ Identify clear procedures, roles and responsibilities for 

providing child safety seat education, training and installations; 

for example, determine whether to offer one-on-one or group 

installation sessions, and hours when installations can occur.

◆ Develop tracking files to document quantity and types of seats 

provided to or installed for parents/caregivers.

◆ Develop program materials to promote program services (for 

example, brochures, pamphlets, and websites).

◆ Develop liability waiver documents (that is, to ensure family 

responsibility for proper installation and use of child safety 

seats, and to release liability from a CPS technician). 

◆ Develop tracking systems to communicate with families when a 

child is likely to need a new or different child safety seat that is 

appropriate for the child’s age/height/weight. 

● Coordinate the certification and re-certification of program partner 

staff as Child Passenger Safety Technicians.

● Ensure a local/Tribal community member becomes a Certified 

Child Passenger Safety Instructor; local training experiences will be 

tailored to the Tribe. 

● Data and Evaluation - The University of North Carolina training, 

technical assistance, and evaluation team, providing support to 

the 2004-2009 and 2010-2014 CDC Tribal Motor Vehicle Injury 

Prevention Program, developed data collection tools for Child Safety 

Seat Events.
88 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

CASE EXAMPLE 

At the Hopi Reservation in northeastern Arizona, maintaining local certified Child Passenger 

Safety (CPS) Technicians was a challenge that resulted in difficulties for coordinating CPS 

activities for the Hopi Community. As part of an IHS Injury Prevention Fellowship training 

project, the TMVIP coordinator established a local CPS Management System. 

The system monitors and assists CPS technicians in: completing certification renewal 

requirements; researching CPS Instructor requirements; coordinating CEU/recertification 

trainings; and scheduling child safety seat check events. As a CPS Instructor, the TMVIP 

Coordinator also serves as a local resource for conducting CPS trainings and assisting CPS 

technicians in completing seat checks required for certification renewal. Regularly scheduled 

child safety seat clinics provide opportunities for CPS technicians to practice their skills and 

to provide convenient options for community members to receive services. The management 

system also tracks the number and types of child safety seat installations conducted by each of 

the CPS technicians, and uses forms provided to all technicians that can be used to study misuse 

issues over time.

Since the project began in 2014, 13 Hopi Tribal members received their CPS Technician 

certification and five existing CPS technicians renewed their certification. As a result, 20 local 

individuals have current CPS Technician certifications. This management plan has provided 

needed oversight of local CPS resources, and should prove beneficial in providing this important 

injury prevention service to reservation residents.

(3) Community-Wide 

Information and 

Enforcement 

Campaigns

Community-wide information and enforcement campaigns include 

mass media, information and publicity, public child safety seat 

displays, and other targeted strategies such as checkpoints, dedicated 

law enforcement officials, or alternative penalties (for example, 

informational warnings instead of citations).

In AI/AN communities, the primary interventions conducted to 

tailor this recommended evidence-based strategy have been Media 

Campaigns, Public Events, Training Child Passenger Safety-Dedicated 

Law Enforcement, Enforcement Events, and Alternative Enforcement 

Programs. 

Media Campaigns include the following types of activities:

● Develop a strategy for publicizing child safety seat checkpoints 

through media such as news stories and/or paid media.

● Develop media messages about child safety seat enforcement events 

that use or honor Tribal language, symbols, or culture (for example, 

referring to ‘cradle boards’ as the first ‘child safety seat’).
Tailored Evidence-Based Strategies: Component #4 for TMVIP 89

(3) Community-Wide 

Information and 

Enforcement 

Campaigns

(continued)

● Create ‘Did You Know’ media messages to increase awareness of 

existing or new traffic safety laws and enforcement efforts being 

conducted by police, including checkpoints. 

● Use CDC’s Roadway to Safer Tribal Communities Toolkit that 

includes fact sheets, posters, and a video specifically designed to 

keep tribal communities safe on the road.

● Host traffic safety call-in programs on Tribal radio stations to discuss 

child safety seat enforcement events.

● Develop traffic safety Public Safety Announcement (PSA) messages 

about child safety seat enforcement events narrated by local 

spokespersons (for example, admired Tribal leaders, well-known 

sports figures, pow-wow pageant contestants, or Tribal dancers/

drummers).

● Show existing videos about traffic safety in Indian Country, including 

CDC’s ‘Killer in Indian Country’ video.

● Use paid media outlets (for example, billboards, TV, radio, 

newspaper advertisements) to promote child safety seat enforcement 

events and services available with photos of Tribal members (in 

visual media). 

Use Digital Storytelling, a short form of digital media production that 

allows everyday people to share aspects of their lives. The media can 

include video, animation, stills, audio, or any of the other forms of nonphysical media. See examples here:

● Digital Story for Change

● Ways I Keep My Child Safe

● Data and Evaluation - The University of North Carolina training, 

technical assistance, and evaluation team providing support to 

the 2004-2009 and 2010-2014 CDC Tribal Motor Vehicle Injury 

Prevention Program developed data collection tools for Use of 

Media Events.
90 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

CASE EXAMPLE

‘DID YOU KNOW?’ Media campaigns

Several Tribal MVIP projects (Ute Tribe, Rosebud Sioux) have developed ‘Did You Know?’ media 

campaigns. For child passenger safety campaigns, particularly those that have involved changing 

laws or increasing enforcement, media messages (for example, on the radio, in newspapers) have 

repeated the phrase “Did You Know...’ to introduce traffic safety educational messages. Initial 

campaign messages have described: how effective child safety seats are and the Tribe’s observed 

child safety seat use rate; pending or recent changes to laws (for example, making non-use of a 

child safety seat a more costly or a primary enforcement offense); and/or notices of enhanced 

enforcement events for child passenger safety combined with resources where a family can get a 

seat installed by a certified child passenger safety technician.

(3) Community-Wide 

Information and 

Enforcement 

Campaigns

(continued)

Public Events have included conducting the following types 

of activities:

Conduct Child Safety Seat Installation & Check Events where the 

primary purpose is to provide seats to community members who 

voluntarily visit a stationary location (for example, a parking lot) and 

who: a) do not already have a child safety seat, b) want to ensure their 

existing seat is installed properly; or c) need a replacement child safety 

seat for children who have outgrown their seat, or for expired/recalled/

damaged seats. 

Develop and promote educational displays about child passenger safety 

at Tribal community events such as: health fairs; sporting events; or PowWow festivities.

Dedicated Child Passenger Safety Law Enforcement Official Training 

has included the following types of activities:

● Work with local police to ensure they understand the importance of 

enforcing child safety seat use to prevent injuries and deaths during 

a crash. This includes the following types of activities:

◆ Assess police officer attitudes/beliefs/practices regarding 

enforcement of child safety seat use laws (sample survey). 

◆ Coordinate the certification and re-certification of law 

enforcement officers as nationally certified Child Passenger 

Safety (CPS) Technicians. 

◆ Ensure the completion of a local/Tribal community member to 

become a Certified Child Passenger Safety Instructor, which 

can help to ensure that local CPS technicians maintain their 

certification.
Tailored Evidence-Based Strategies: Component #4 for TMVIP 91

(3) Community-Wide 

Information and 

Enforcement 

Campaigns

(continued)

◆ Plan and conduct abbreviated Safe Native American Passenger 

(SNAP) training events with law enforcement. 

◆ Work with chiefs of police or other law enforcement personnel 

to garner support and commitment for increased enforcement 

of existing child safety seat use laws (for example, as part of 

regular patrol/traffic safety enforcement efforts).

CASE EXAMPLE

During its five-year TMVIP project funded by the CDC (2004-2009), the Ho-Chunk Nation 

used a survey to assess knowledge, attitudes, and beliefs among law enforcement personnel 

for enforcing child safety seat use. In conducting this survey, the TMVIP coordinator learned 

and better understood some of the barriers that police face when stopping vehicles or issuing 

citations for non-use of child safety seats. 

Training activities to build law enforcement knowledge and skill were tailored to address the 

needs of local law enforcement (for example, why child safety seats are important, what size 

children belong in which seats, where a family can get a seat if they don’t have one). This 

tailored approach addresses actual or perceived barriers to enforcing traffic safety laws in Tribal 

communities. See a 2009 IHS Primary Care Provider Article for more about this project. 

LESSON LEARNED

Maintaining Child passenger safety technician certification is challenging

Many TMVIP coordinators recruit those who live and work in Tribal communities to become and 

remain certified as child passenger safety technicians. To keep certification, CPS technicians 

must complete certain requirements, including continuing education units. With busy work 

and home lives, it can sometimes be difficult for a CPS technician to find the time to fulfill all 

recertification requirements. TMVIP coordinators can help ensure that technicians are aware of 

recertification requirements, and they can help identify and eliminate barriers to recertification.

CASE EXAMPLE

After many years of being a certified CPS Technician, the TMVIP coordinator at the Caddo Nation 

of Oklahoma became a certified CPS Instructor. In doing so, her unique knowledge, skills, 

and experience conducting child safety seat installation and check events in Tribal communities 

helped support other Tribes located in Southwestern Oklahoma. This native CPS expert, one 

of the few AI/AN CPS Instructors in the country, is highly valued in Oklahoma by serving as an 

instructor at certification courses held at other Tribes, and by providing assistance at other Tribes’ 

installation and check events. 
92 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

(3) Community-Wide 

Information and 

Enforcement 

Campaigns

(continued)

Enforcement Events have included the following types of activities:

● Plan, advertise, and support child safety seat use saturation patrols

conducted by police officers. These can be conducted during: 

◆ Local seasonal events (for example, at the start or end of the 

school year). 

◆ National/state/local child passenger safety events, such as 

National Child Passenger Safety Week, held annually in 

September (information available from NHTSA’s Traffic Safety 

Marketing program).

● Conduct Child Safety Seat Enforcement and Installation Events 

where the primary purpose is to: 

◆ Check for proper installation and use of child safety seats that 

community members already have in vehicles.

◆ Provide new or replacement seats, if needed, for vehicles 

without seats or with expired, recalled or damaged seats. 

◆ Provide citations or warnings for those not using seats. 

● People are required to participate because the event is held where 

law enforcement can stop vehicles along a road and vehicles are 

stopped as they pass through the event.

Alternative Child Safety Seat Enforcement Programs include the 

following activities:

● Develop and implement ‘grace periods’ following the passage of 

new or enhanced traffic safety laws, whereby law enforcement do 

not issue citations for a certain period of time, and instead provide 

education and referral information for families needing seats or 

training about proper installation and use. These grace periods can 

be the focus of ‘Did You Know’ media messages.

● Develop court-diversion programs so that instead of having to pay 

a fine for a child safety seat citation, a driver is allowed to obtain a 

seat and training about proper installation, resulting in the fine being 

waived. 

● Collect observational restraint use data before and after campaigns. 
Tailored Evidence-Based Strategies: Component #4 for TMVIP 93

CASE EXAMPLE

At the Yurok Tribe in Northern California, the ‘Buckle-up Yurok Program’, funded from 2010-2015 

by the CDC through the California Rural Indian Health Board, developed a fine/fee diversion 

program for community members violating a new Tribal primary enforcement law (passed 

in 2012) for child safety seat and seat belt use. Maintained by the Tribal Court following the 

end of CDC funding, court staff offer a one-hour traffic safety class, developed by the TMVIP 

coordinator. For community members the fine for a violation is waived after completion and 

installation of a child safety seat. This alternative child safety seat enforcement program, and 

others like it, can be sustained with Tribal leadership commitment.

(4) Incentive and 

Education Programs

Incentive and Education programs offer parents, caregivers, or children 

rewards for properly using child safety seats. They also provide 

information that might help change both attitudes and behaviors to 

increase safe driving. The programs vary in content, duration, intensity, 

and delivery methods. 

In AI/AN communities, the interventions conducted to tailor this 

recommended evidence-based strategy have been to offer coupons or 

vouchers to attend local events if someone is ‘caught’ wearing a seat 

belt or having a properly installed child safety seat. These include the 

following types of activities:

◆ Secure resources for incentives, such as working with local 

businesses to donate redeemable tickets/coupons/vouchers for 

services or products.

◆ Work with local Tribal or non-Tribal law enforcement to 

conduct traffic stops for the incentive program.

◆ Develop a system to track incentives provided and media 

activities to publicize program results.

◆ Collect observational restraint use data before and after 

campaigns. 
94 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

CASE EXAMPLE

At a regional health corporation in rural Alaska, the TMVIP program developed a ‘Click-It for a 

Movie Ticket’ campaign to increase occupant restraint use. In collaboration with the local movie 

theater (a popular destination in this rural Alaskan outpost), and local law enforcement, the 

TMVIP coordinator was able promote important traffic safety messages, provide an opportunity 

for law enforcement to do more than issue tickets, and reward community members for safe 

driving behaviors. This type of tailoring to identify incentives that are locally valued can be 

applied in other Tribal communities.

Tailored Seat Belt Use Strategies

(1) Laws Mandating 

Seat Belt Use

(2) Primary 

Enforcement Laws

Seat Belt laws require motor vehicle occupants to wear seat belts. 

Currently 49 states (excluding NH), the District of Columbia, and many 

Tribes have seat belt use laws for at least front seat occupants. Other 

requirements vary by state and Tribe, such as: the type of enforcement 

law (primary vs. secondary); laws requiring rear seat use; amount of 

fines; age groups subject to laws; and/or exempt vehicles and drivers. 

‘Primary Enforcement’ seat belt laws allow police to stop and ticket 

motorists for being unbelted. Primary enforcement laws have been 

shown to be more effective at reducing MVC injury and death than 

‘Secondary Enforcement’ seat belt laws, which allow police to ticket 

unbelted occupants only if they are stopped for another reason (for 

example, other moving violations).

In AI/AN communities, the primary interventions conducted to tailor 

these two recommended evidence-based strategies have been to educate 

decision-makers about the effectiveness of New or Enhanced Tribal 

Seat Belt Use Laws. These interventions include the following types of 

activities:

● Workgroup - Work with a local workgroup to educate Tribal 

executive/legislative leaders about the effectiveness of new Tribal 

laws mandating use of seat belts by vehicle occupants (for example, 

front seat or all occupants). In many cases, the law used in the state 

could be researched, adopted as is, or modified to fit the needs of the 

Tribal community. For some Tribes, the Tribe’s law is more stringent 

than the state.
Tailored Evidence-Based Strategies: Component #4 for TMVIP 95

(2) Primary 

Enforcement Laws

(continued)

● Provide technical assistance to local workgroups to educate 

decisions-makers and Tribal government officials about the potential 

public health impact to be derived from strengthening existing laws

mandating seat belt use, such as:

◆ Tribal adoption of a primary enforcement law (if the current law 

is secondary enforcement only).

◆ Require all passengers to be restrained regardless of where 

they are sitting (i.e. primary coverage for front and back seat 

passengers). Research shows the importance of back-seat 

occupants wearing seat belts for injury prevention for all 

drivers/passengers in the vehicle. 

◆ Increase fines for citations issued.

◆ Develop alternate sentencing options (for example, court 

diversion programs).

● Enhancement of Tribal laws can include those that align with 

suggestions outlined in the following resources:

◆ National Highway Traffic Safety Administration,

Laws and Regulations.

◆ Governor’s Highway Safety Association: 

Summary of Seat Belt Use Laws.

◆ Insurance Institute of Highway Safety: Summary of Child Safety.

◆ National Congress of American Indians Policy Research 

Center: Tribal Public Health Law Database.

● Data and Evaluation - Collect on-going data about adherence and 

enforcement of laws, including:

◆ Seat Belt use observational surveys.

◆ Enforcement of existing laws (for example, citations and 

warnings issued, percent of motor vehicle crash deaths who 

were unrestrained).
96 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

LESSON LEARNED

When new laws are being written or improved, stay engaged to provide technical assistance 

on the components required for an effective law that will benefit public health and injury 

prevention. Some Tribes seeking to improve existing laws by making them primary enforcement 

laws have faced challenges during the development process. They have found it important to 

clarify during the drafting and review of the proposed law that it is intended to be a primary law, 

and when possible the coordinator should actively collaborate in the review process. 

At one western Tribe, the authors of the draft law collaborated closely with the Tribal attorneys 

during the review process to ensure that the intent of making the law a primary enforcement 

law was clearly stated in the law’s language. As a result, when the law was presented to the 

Tribal Council as a primary law, it was approved and subsequently enacted and interpreted and 

enforced by the police department as a primary enforcement law. 

By contrast, at another western Tribe, the authors of the draft law included language that 

indicated the intent for the law to be primary, however, somewhere during the review process, 

that language was removed. As a result, that intent was not clearly stated for the Tribal leadership 

who reviewed the draft law and voted to pass it. When the new law was enacted, there was 

uncertainty about the law being primary or secondary enforcement and due to the confusion, the 

police department has been reluctant to enforce seat belt use. This resulted in a lengthy process 

to amend the law to more clearly state it as a primary enforcement law. 

(3) Enhanced 

Enforcement 

Programs

Enhanced enforcement programs are those conducted in addition 

to normal enforcement. Such programs also include publicity that 

advertises the dates and locations when enhanced enforcement will 

occur. 

There are two categories: Supplemental, which include programs 

that increase citations in combination with increasing the number 

of officers on patrol; and Targeted, which include programs that 

promote issuing of more citations during an officer’s normal patrol.

In AI/AN communities, the primary interventions conducted to 

tailor this recommended evidence-based strategy have been Media 

Campaigns, Enforcement Events (Saturation Patrols or Checkpoints), 

and Alternative Enforcement Programs. 

Media Campaigns developed to support enhanced enforcement 

programs, include the following types of activities in AI/AN 

communities:
Tailored Evidence-Based Strategies: Component #4 for TMVIP 97

(3) Enhanced 

Enforcement 

Programs

(continued)

● Develop a strategy for publicizing seat belt checkpoints through 

media such as news stories and/or paid media.

● Develop media messages about seat belt enforcement events that use 

or honor Tribal language, symbols, or culture (for example, Public 

Service Announcements, billboards, posters, electronic marquees). 

The CDC’s Roadway to Safer Tribal Communities Toolkit provides 

example posters, fact sheets, and a video titled ‘A Killer in Indian 

Country.’ Available for free download.

● Create ‘Did You Know’ media messages to increase awareness of 

existing or new traffic safety laws and enforcement efforts being 

conducted by police, including checkpoints. 

● Host traffic safety call-in programs on Tribal radio stations to 

announce seat belt use enforcement events.

● Develop traffic safety PSA messages about seat belt enforcement 

events narrated by local spokespersons (for example, admired Tribal 

leaders, well-known sports figures, people ‘saved by the belt’, powwow pageant contestants, or Tribal dancers/drummers).

● Use paid media outlets (for example, billboards, TV/radio/newspaper 

advertisements) to promote seat belt enforcement events by using 

photos of local/Tribal members (in visual media).

Enforcement Events included the following types of activities:

● Plan, advertise, and conduct seat belt saturation patrols and/or 

checkpoints conducted by police officers. Often referred to as High 

Visibility Enforcement events, these can be conducted at any time 

but are often conducted during: 

◆ Local seasonal events (for example, at the start or end of the 

school year, sports events, new year holiday, prom, graduation, 

4th of July events) 

◆ National/state/local seat belt events, such as National Click-It 

or Ticket campaigns, held annually in summer (information 

available from NHTSA’s Traffic Safety Marketing program).
98 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

(3) Enhanced 

Enforcement 

Programs

(continued)

Alternative Seat Belt Enforcement Programs include the following 

activities:

● Develop and implement ‘grace periods’ following the passage of 

new or enhanced traffic safety laws, whereby law enforcement do 

not issue citations for a certain period of time, and instead provide 

education to occupants about seat belt use. 

● Develop fee/fine-diversion programs whereby in lieu of having to 

pay a fine for a seat belt violation, someone cited can be allowed to 

attend a brief training about seat belt use. 

LESSON LEARNED

Use local symbols and language in media campaigns.

Many CDC and IHS funded traffic safety programs have worked with

local artists and community members to inform culturally appropriate 

media campaigns. This is an important part of tailoring interventions to 

local communities. In one example, the Inter-Tribal Council of Arizona and two participating 

Tribal governments developed tribal seat belt media campaigns to speak directly to their 

audience – the AI/AN community. They designed vivid and colorful logos and artwork for the 

campaigns using culturally appropriate symbols of the community’s language and culture. 

The campaign logos were widely distributed and displayed using various media, including on 

commonplace items like cups and t-shirts.

CASE EXAMPLE

In 2012, the San Carlos Apache Tribe became the fifth Indian Tribe in Arizona to pass a primary 

occupant restraint law more stringent than the State’s secondary law. A three-month enforcement 

grace period following enactment of the law provided the San Carlos Police Department (SCPD) 

with a transition period to ready itself and the public for enforcement of the new law. Grace 

period activities included: notifying and educating the public regarding the new law and the 

importance of occupant protection, training SCPD staff, and issuing only warning citations 

for violations. After the grace period, full enforcement of the law began. Observed seat belt 

use increased initially during the grace period and additional increases occurred with full 

enforcement of the new law. The increased seat belt use is encouraging even as fewer citations 

were issued than expected. Full enforcement of the law, following a grace period, was critical to 

sustaining increased occupant restraint use. See a July 2007 IHS Primary Care Provider article 

for more about this project. 
Tailored Evidence-Based Strategies: Component #4 for TMVIP 99

Tailored Driving Under the Influence Strategies

(1) .08% Blood 

Alcohol Concentration 

(BAC) Laws 

Laws that declare that it is illegal for a driver’s blood alcohol 

concentration (BAC) to reach exceed 0.08% (0.08 g/dL) for drivers 

aged 21 years and older have been shown to be effective at reducing 

alcohol-related MVC deaths. All states, but not all AI/AN Tribes, define 

driving with a BAC at or above 0.08% as a crime, although specific laws 

and penalties vary from state to state and Tribe to Tribe. For example, 

some Tribes have less stringent BAC concentration limits (for example, 

0.10%), legally allowing drivers who drink to have more alcohol in their 

systems before it becomes a crime, while others have more stringent 

laws (for example, 0.04%). 

In AI/AN communities, the primary interventions conducted to tailor this 

recommended evidence-based strategy have been to educate decisionmakers and Tribal leaders about the effectiveness of New or Enhanced 

Tribal Impaired Driving Laws. These interventions include the following 

types of activities:

● Workgroup - Work with a local workgroup to educate Tribal 

government officials about the effectiveness of strengthening 

existing laws regarding impaired driving, such as:

● Tribal adoption of 0.08% BAC limits or below (if limits are above 

0.08% currently).

● Require administrative license suspension (ALS) on the first offense. 

● Require convicted drunk drivers (all, including repeat offenders) to 

install ignition interlock systems in vehicles. 

● Define open container provisions that prohibit the possession of 

any open alcohol beverage container, or the consumption of any 

alcoholic beverage, in the passenger area of any motor vehicle 

located on a public highway, or the right-of-way of a public 

highway.

● Provide specialized or alternate sentencing options for repeat 

offenders (for example, suspension of driving license privileges, 

impoundment or immobilization of vehicle, mandatory alcohol 

testing, mandatory imprisonment and/or community service). 

Enhancement of Tribal laws can include those that align with 

suggestions outlined in the following resources:

● Governor’s Highway Safety Association: Summary of Impaired 

Driving Laws
100 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

(1) .08% Blood 

Alcohol Concentration 

(BAC) Laws 

(continued)

◆ National Congress of American Indians Policy Research Center: 

Tribal Public Health Law Database.

● Data and Evaluation - Collect on-going data about adherence/

enforcement of the law, including:

◆ Enforcement of existing laws (for example, citations/warnings 

issued).

◆ Prosecution of existing laws (for example, outcomes related to 

impaired driving arrests, including convictions made, penalties 

issued, recidivism).

LESSON LEARNED

The lawmaking process within Tribal Communities is complex

As with any legislative process, it takes time to: research how traffic safety laws could be 

improved; draft and get approval on language to be used in a law; and submit and/or present the 

proposed laws to Tribal legislative and executive branch officials. In many Tribal communities, 

the entire process can take years. Many barriers can occur along the way, including: Tribal 

leadership changes; procedural hurdles; changes in political will (that is, elected officials’ 

willingness to make changes); and staffing changes among partners working together to pass 

a new or enhanced law. However, policy interventions can be one way to change norms to 

improve traffic safety in a Tribal community.

(2) Maintaining 

Current Minimum 

Legal Drinking 

Age Laws

Legal drinking age laws specify an age below which the purchase or 

public consumption of alcoholic beverages is illegal (21 years) and 

have been shown to be effective at reducing alcohol-related MVCs 

and associated injuries among 18 to 20-year-old drivers. Contributors 

to this Guide are unaware of any Tribal-specific efforts to address 

MVC injuries and deaths with laws specifying legal drinking age. 

Nevertheless, laws that establish a lower BAC level for young or 

inexperienced drivers than for older or more experienced drivers is 

an important strategy in tribal communities. 

(3) Publicized 

Sobriety 

Checkpoint 

Programs

Sobriety checkpoint programs involve high visibility enforcement 

conducted by law enforcement officers who stop drivers systematically 

to assess alcohol impairment. These programs have been shown to 

be effective at reducing alcohol-impaired driving. Using media to 

publicize sobriety checkpoints reduces alcohol-impaired driving by 

increasing the public’s perceived risk of arrest. Traffic Safety Marketing 

materials may help guide these types of activities.
Tailored Evidence-Based Strategies: Component #4 for TMVIP 101

CASE EXAMPLE

The San Carlos Apache Tribe conducted sobriety checkpoints and a comprehensive media 

campaign from 2004 to 2006. Described in a July 2007 IHS Primary Care Provider article, the 

media campaign used both paid and earned (unpaid) media, including: Tribal newspaper and 

radio station; local casino marquee; and public bulletin boards. Focus groups helped to inform 

culturally appropriate messages that were publicized more frequently during Tribal and national 

holidays. A total of 38 public service announcements and 21 community media events were 

conducted. Combined with 21 sobriety checkpoints, the project saw a 33% increase in DUI 

arrests, a 20% reduction in MVCs involving injuries or deaths, a 33% reduction in night-time 

crashes, and a 27% reduction in overall police-reported crashes.

(3) Publicized 

Sobriety 

Checkpoint 

Programs

(continued)

In AI/AN communities, the primary interventions conducted to tailor this 

recommended evidence-based strategy have been Media Campaigns,

Enforcement Events (Saturation Patrols or Checkpoints), and/or

Alternative Justice Programs. 

Media Campaigns conducted in conjunction with publicized sobriety 

checkpoints include the following types of activities in AI/AN 

communities:

● Develop a strategy for publicizing impaired driving checkpoints 

through media such as news stories and/or paid media.

● Develop media messages about enforcement events that use or 

honor Tribal/local language, symbols, or culture (for example, Public 

Service Announcements, billboards, posters, electronic marquees).

● Create ‘Did You Know’ media messages to increase awareness of 

existing or new impaired driving prevention laws and enforcement 

efforts conducted by police, including checkpoints. 

● Host traffic safety call-in programs on Tribal radio stations to discuss 

or announce enforcement events.

● Develop traffic safety PSA messages about enforcement events 

spoken by local spokespersons (for example, admired Tribal leaders, 

well-known sports figures, pow-wow pageant contestants, or Tribal 

dancers or drummers).

● Use paid media outlets (for example, billboards, TV, radio, 

newspaper advertisements) to announce impaired driving 

enforcement events with photos of Tribal members in visual 

messages. 
102 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

(3) Publicized 

Sobriety 

Checkpoint 

Programs

(continued)

Enforcement Events include the following types of activities:

● Develop and train Tribal law enforcement personnel in appropriate 

checkpoint practices following NHTSA Guidelines. 

● Plan, advertise, and conduct impaired driving saturation patrols and/

or checkpoints conducted by police officers. The latter are often 

referred to as Sobriety Checkpoints and can be conducted any time, 

but often during: 

◆ Local seasonal events (for example, at the start or end of the 

school year, sports events, new year holiday, prom, graduation, 

4th of July events) 

◆ National/State/Local Impaired Driving Campaigns, such as:

● Driver Sober or Get Pulled Over

● Buzzed Driving is Drunk Driving

● Don’t Shatter the Dream (BIA) 

● Mothers Against Drunk Driving (MADD) Campaigns

CASE EXAMPLE

At a Tribe in Arizona one of the first steps taken by a newly formed TMVIP project was to 

research, develop, and train law enforcement personnel in Tribal policies and procedures for 

conducting enforcement events (for example, seat belt and impaired driving checkpoints). 

By adopting and having the Tribe’s law enforcement leadership approve these policies, traffic 

safety enforcement became more standardized, transparent, and institutionalized – all of 

which were important when leadership and staffing changes occurred during the project.

Alternative Justice Programs include the following types of activities:

● Use of Impaired Driving (or DUI) Courts to manage impaired 

driving arrests and sentencing for convictions, particularly for 

repeat offenders. 

● Develop court-diversion programs whereby in addition to regular 

consequences (for example, fines, loss of license, jail time), those 

convicted must complete other requirements, such as:

◆ Attend Victims Impact Panels 

◆ Submission to Electronic Monitoring 

◆ Education Programs 

◆ Alcohol Treatment Programs 
Tailored Evidence-Based Strategies: Component #4 for TMVIP 103

CASE EXAMPLE

The Fort Peck Assiniboine & Sioux Tribes received IHS TIPCAP funding from 1997 to 2000. 

It has one of eight ‘DUI Courts’ in the state of Montana. Begun in 2008 as a way to address 

repeat impaired driving offenders, the first step was to develop policies and procedures for the 

DUI Court. The DUI Court guides clients through four phases. Client orientation is four weeks 

followed by an eight week early recovery period. Phase 3 lasts up to 24 weeks and focuses on 

maintenance and relapse. Phase 4 offers continuance of care for at least 16 weeks. A team works 

with each client to help them obtain their GED, to attend college or job training. The program 

also helps clients get their suspended driver’s license returned and make their way back into 

society while maintaining sobriety. For more, visit Fort Peck Journal.

(4) Multi-Component 

Interventions 

with Community 

Mobilization

A combination of interventions that include several components (for 

example, sobriety checkpoints, training in responsible beverage service, 

education and awareness-raising efforts, and limiting access to alcohol) 

have been shown to be effective at reducing alcohol-impaired driving. 

Successful interventions included those that used: 

1. multiple programs and/or policies in several different settings to 

effect the community environment to reduce alcohol-impaired 

driving, and 

2. community mobilization through the use of active community 

workgroups or task forces to plan and implement a variety 

of activities.

In AI/AN communities, the primary interventions conducted to tailor this 

recommended evidence-based strategy have been Tribal motor vehicle 

injury prevention programs that concurrently conduct the following 

impaired driving prevention activities: sobriety checkpoints, training in 

responsible beverage service, education and awareness-raising efforts, 

and limiting access to alcohol. 
104 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

CASE EXAMPLE

A Tribe in South Dakota funded by multiple federal agencies (that is, IHS, BIA, FHWA, CDC), 

tailored multi-component interventions with community mobilization by working in close 

partnership with the Alive Robert’s County organization, as well as MADD and other local 

groups. Together, they collaborated to organize and conduct: multi-jurisdictional sobriety 

checkpoints (for example, Tribal police, city police, county sheriffs); training in responsible 

beverage service among local establishments serving alcohol; education and awareness-raising 

efforts such as PSAs on the radio, billboards, and other media events; and actions to limit access 

to alcohol, including attempts to close an establishment known for serving minors and overserving patrons who drove after drinking.

(5) Ignition Interlocks Ignition interlocks are installed in motor vehicles to prevent operation 

of the vehicle by a driver who has a BAC above a specified level 

(usually 0.02% to 0.04%). Ignition interlocks can be mandated by a 

court system or offered as an alternative to a suspended driver’s license. 

The devices are installed most often in vehicles of people who have 

been convicted multiple times for alcohol-impaired driving, however 

CDC recommends using them for all convicted offenders. The devices 

have been shown to be effective at reducing re-arrest rates while the 

interlocks are installed. Contributors to this Guide are unaware of any 

Tribal-specific efforts to address MVC injuries and deaths with this 

strategy. Ignition interlocks, paired with alcohol treatment program, 

may boost prevention even further. 

(6) Mass Media 

Campaigns

Mass media campaigns are designed to educate individuals to avoid 

drinking and driving, or to prevent others from drinking and driving. 

Campaigns may use a variety of themes (for example, fear of arrest; 

fear of injury to self, others, or property; characterizing drinking drivers 

as irresponsible and dangerous). Conditions for effectiveness include: 

careful planning and execution, using theory; adequate audience 

exposure; and implementation in settings that have other ongoing 

alcohol-impaired driving prevention activities (for example, enhanced 

enforcement of laws through sobriety checkpoints and/or saturation 

patrols).
Tailored Evidence-Based Strategies: Component #4 for TMVIP 105

CASE EXAMPLE

A Tribe in Oklahoma with funding from the IHS and CDC, developed and tailored several mass 

media campaigns to educate individuals about the risks associated with drinking and driving. 

Working with youth at the local high school and law enforcement, the Alive at 25 curriculum 

was an important educational component. It contains a 41⁄2 hour driver’s awareness course 

designed by the National Safety Council for young drivers ages 15-24. The course includes a 

defensive driving classroom curriculum and decision-making and responsibility-taking interactive 

media, workbook exercises, role-playing, and class discussions. Coupled with on-going alcohol 

impaired driving prevention activities, the campaign included use of the Oklahoma Highway 

Patrol’s Breath Alcohol Testing (BAT) Mobile in Tribal communities, youth and law enforcement 

establishing alcohol compliance checks, and media components (radio PSAs and the display of 

billboards with photos of slogans that changed each year over a four-year period). 

(7) Lower BAC 

Laws for Young 

or Inexperienced 

Drivers

Laws that use a lower BAC limit (for example, 0.02%) for young or 

inexperienced drivers have been shown to be effective at reducing 

alcohol-related MVCs. In AI/AN communities, several Tribes have 

developed lower BAC laws by working with a local workgroup (that 

includes representation from youth groups or youth-serving agencies) to 

educate Tribal government officials about the effectiveness of enhancing 

existing impaired driving laws to include lower BAC limits and other 

sentencing options for youth. 

(8) School-Based 

Instructional 

Programs

School-based programs are used to address the problems of alcoholimpaired driving and riding with alcohol impaired drivers. They have 

been shown to be effective in reducing riding with impaired drivers 

among students. However, there is insufficient evidence to determine 

the effectiveness of these programs on drivers themselves. 
106 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

ACTION CALLS

Tribal Leaders Can... 

1. Provide financial support to a Tribal Motor Vehicle Injury Prevention Program.

2. Learn about, promote, and adopt evidence-based strategies.

3. Participate in workgroups that educate leaders about the importance of using evidence-based 

strategies.

4. Participate in media campaigns to promote safe driving behaviors.

Tribal IP Practitioners Can... 

1. Plan and implement comprehensive motor vehicle injury prevention programs.

2. Review the recommended strategies and develop specific plans to implement and evaluate them.

3. Identify ways that recommended strategies could be tailored for use in specific Tribal 

communities.

4. Partner with workgroups to educate Tribal leaders about the effectiveness of recommended 

evidence-based strategies.

Tribal Public Health Professionals & Partners Can... 

1. Assist with Tribal motor vehicle injury prevention programs.

2. Review and suggest methods to evaluate the impact and outcomes of programs.

3. Promote the evaluation of promising strategies.

State Entities Working with Tribes Can... 

1. Encourage Tribes to submit applications for funding.

2. Work with Tribes to implement evidence-based strategies.

3. Provide assistance for data collection and evaluation.
Technical Support: Component #5 for TMVIP 107

K. Technical Support: Component #5 for TMVIP

What technical 

support is available 

for traffic safety in 

AI/AN communities?

This section provides information about the fifth component needed for 

TMVIP – TECHNICAL SUPPORT – including: 

1. Summary of technical support available for components #1 to #4 

(that is, commitment, collaboration, data, tailored evidence-based 

strategies). 

2. Calls to Action for stakeholders to take advantage of available 

technical support to assist motor vehicle injury prevention in AI/AN 

communities. 

Commitment

Resources to 

Prioritize Motor 

Vehicle Prevention 

Centers for Disease Control and Prevention 

The mission of the National Center for Injury Prevention and Control is 

to prevent violence and injuries, and reduce their consequences.

● The CDC has developed a series of state-based fact sheets, including:

◆ Buckle-Up: Restraint Use State Fact Sheet

◆ Sobering Facts: Drunk Driving State Fact Sheet

◆ State-Based Costs from Crash Deaths

● Tribal Road Safety: This website includes information and resource 

links to prevent motor vehicle injury and death among American 

Indians and Alaska Natives.

● Roadway to Safer Tribal Communities Toolkit: The toolkit’s fact 

sheets, posters, and video include important steps for road safety, 

including increasing child safety seat use, increasing seat belt use 

and decreasing alcohol-impaired driving.

● Motorcycle Safety Guide: This resource describes the public 

health significance of motorcycle crashes, the best way to protect 

motorcycle riders, how states compare with each other in terms of 

motorcycle-related deaths and economic costs, and what you can do 

to increase motorcycle safety.

● Menu of Selected Tribal Laws Related to Motor Vehicle Safety:

This menu offers examples of selected tribal laws related to 1) 

primary seat belt laws, 2) child restraint laws, and 3) blood alcohol 

concentration laws and can be used by jurisdictions interested in 

developing or updating their own motor vehicle safety laws.
108 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Resources to 

Prioritize Motor 

Vehicle Prevention 

(continued)

Indian Health Service Injury Prevention Program

The mission of the IHS Injury Prevention Program is to raise the 

health status of American Indians and Alaska Natives to the highest 

possible level by decreasing severe injuries and death to the lowest 

possible level, and by increasing the ability of tribes to address their 

injury problems. The IHS has established a widely-recognized injury 

prevention program that works with tribes and other partners to reduce 

the disproportionate impact of injuries on Indian people. IHS staff 

facilitate capacity building of tribes and communities by increasing 

understanding about the injury problem, sharing effective strategies, and 

assisting communities in implementing prevention programs. 

Bureau of Indian Affairs Indian Highway Safety Program

The mission of the program is to reduce the number and severity of 

traffic crashes in Indian Country by supporting Education, Enforcement, 

and Engineering, as well as Safe Tribal Community Programs. The Indian 

Highway Safety Program seeks to assist Tribes by monitoring grants and 

sub-grants to keep American Indians/Alaska Native roads safe.

Federal Highway Administration

To address traffic safety issues among American Indians/Alaska Natives, 

the Federal Highway Administration supports these programs:

● Federal Highway Administration Tribal Transportation Program 

Safety Fund

● Tribal Technical Assistance Program (TTAP)

Native Public Health Law Partnership Project: Reservation Road Safety

The National Congress of American Indians has supported its 

Policy Research Center to study the issue of traffic safety in AI/AN 

communities, resulting in two publications:

● Reservation Road Safety: Reducing Unintentional Injury through 

Tribal Public Health Law

● Tribal Transportation Insights: Preventing Unintentional Injury 

and Death
Technical Support: Component #5 for TMVIP 109

Resources to 

Prioritize Motor 

Vehicle Prevention 

(continued)

Tribal Epidemiology Centers

Tribal Epidemiology Centers (TEC) are Indian Health Service, Division 

of Health & Human Services funded organizations that serve AI/AN 

Tribal and urban communities by managing public health information 

systems, investigating diseases of concern, managing disease prevention 

and control programs, responding to public health emergencies, and 

coordinating these activities with other public health authorities. 

Currently, there are 12 TECs around the country.

Native CARS (Children Always Ride Safe)

Native CARS seeks to improve rates of child safety seat use for AI/AN 

children in the Pacific Northwest and beyond. The project is currently 

developing and facilitating the use of a dissemination platform that will 

translate the successful protocols, tools, and intervention materials used 

by Native CARS tribal partners for use by other Tribes. It is intended 

that this dissemination platform, the Native CARS Atlas will serve as a 

blueprint for other Tribes to address child passenger safety concerns in 

tribal communities.

World Health Organization (WHO) Road Traffic Injuries Publications

● The WHO offers publications and resources for a variety of road 

safety topics including:

◆ World report on road traffic injury prevention (2004)

◆ Seat-belts and child restraints: a road safety manual for 

decision-makers and practitioners (2009)

◆ Drinking and driving: a road safety manual for decisionmakers and practitioners (2007)

◆ Data systems: a road safety manual for decision-makers and 

practitioners (2010)

◆ Pedestrian safety: a road safety manual for decision-makers 

and practitioners (2013)

◆ Mobile phone use: a growing problem of driver distraction 

(2011)
110 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

State Offices 

of Highway Safety

State offices of highway safety implement programs to address 

behavioral highway safety issues, including occupant protection, 

impaired driving, and speeding. Each state office of highway safety can 

serve as a resource for statewide campaigns, funding, and technical 

assistance.

TMVIP Coordinator 

Position Descriptions

A previous project conducted by federal agency partners identified skills 

and/or experiences that are important for staff hired to lead Tribal motor 

vehicle injury prevention efforts.3 A TMVIP coordinator should have 

knowledge of highway safety issues, an ability to collect data, and have 

good public relations skills. To the degree possible, assessment of these 

skills can be important to consider when recruiting and interviewing 

potential candidates for TMVIP Coordinator positions.
Technical Support: Component #5 for TMVIP 111

Training applicable 

for Motor Vehicle 

Injury Prevention

Indian Health Service Injury Prevention Training

● Introduction to Injury Prevention (Level I): This course introduces 

participants to the core components of the public health approach to 

preventing injuries among American Indians and Alaska Natives. For 

more information, visit the IHS Environmental Health Support Center 

(EHSC)

● Intermediate Injury Prevention (Level II): This course reviews the 

basics of data interpretation, workgroup building, program planning, 

evaluation, and marketing. For more information, visit the IHS EHSC

● Safe Native American Passengers: Designed after the National 

Highway Traffic Safety Administration (NHTSA) National 

Standardized Child Passenger Safety Training, this 12-hour course 

is Native American specific and introduces attendees to the basic 

concepts of child passenger safety (CPS). 

Child Passenger Safety Training from Safe Kids

● Certified Child Passenger Safety Technician Course (3-4 days) 

combining classroom instruction, indoor and outdoor hands-on 

activities, skills assessments with child safety seats and vehicles, and 

a community safety seat checkup event. 

● Certified Child Passenger Safety Instructor Course: designed 

for CPS technicians who are ready to help others learn how to 

become technicians. Requirements include successfully teaching a 

Certification Course, and ensuring their technician certification does 

not expire during the candidacy period. The instructor candidacy 

process can take no longer than one year from the time a technician 

is approved as an instructor candidate. For more information, visit 

the instructor resources page at Safe Kids.

Other Training

● Designing and Implementing Injury Surveillance Systems in Indian 

Country Course: This course was developed collaboratively by the 

CDC and IHS for tribal and non-tribal injury prevention practitioners. 

● Tribal Technical Assistance Program (TTAP): seven TTAP centers 

offer a variety of training courses, including but not limited to: Crash 

Data Reporting; Road Scholar Program, Roadway/Highway Safety 

Audits; Use of GIS/GPS; Fundamentals of Highway Safety; and Road/

Pedestrian Safety.
112 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Training applicable 

for Motor Vehicle 

Injury Prevention

(continued)

● Traffic Safety Conferences: regular annual traffic safety conferences, 

at which Tribal programs are highlighted include:

◆ Lifesavers Conference: Prior conference programs and 

presentations/workshops are available online.

◆ Regional Tribal Transportation Safety Summits and National 

Tribal Transportation Safety Conference: Prior Summit and 

Conference Reports are available online.

● World Health Organization TEACH VIP E-learning: This is 

comprehensive injury and violence prevention curriculum 

developed for self-paced, self-administered training online. Training 

modules include a variety of general and specific topics, including: 

Road Traffic Injuries; Community Surveys; and Advocacy for Injury 

Prevention.

● Safe States Alliance Training Center: The Safe States Alliance has 

partnered with the Society for the Advancement of Violence and 

Injury Research (SAVIR) to create a joint initiative known as the 

National Training Initiative (NTI). Through NTI, both organizations 

have worked together to develop Core Competencies to address 

the training needs of professionals working in the field of injury and 

violence prevention. Safe States trainings and archived webinars 

organized by topic area are available at these websites: 

◆ Web Events Co-Hosted by Safe States Alliance & Partners, 

including on topics such as: Motor Vehicle Safety; Partnerships 

and Collaborations; Program Planning and Evaluation; 

Epidemiology; and Communication. 

◆ ASTHO, NACCHO, and Safe States Injury Prevention 

Webcast Series

◆ Safe States Self-Study Trainings. 
Technical Support: Component #5 for TMVIP 113

Collaboration

Resources to Develop 

Traffic Safety 

Collaboration and 

Workgroups

● Developing Coalitions: An Eight-step Guide: Coalitions are an 

effective means to implement evidence-based programs for nearly all 

injury topic areas.

● The Tension of Turf: Making it Work for a Coalition: The nature 

of coalition work as well as other alliances between organizations 

contains inherent challenges, including the issue of turf.

● Community How to Guide on Coalition Building: Developed to 

help communities sustain underage drinking prevention coalitions, 

this resource provides examples of how to overcome obstacles and 

support community prevention components including enforcement 

and education.

Judicial Support The National Highway Traffic Safety Administration has developed a 

Traffic Safety Resource Prosecutor’s Manual, useful for current or former 

prosecutors who provide training, education and technical support to 

traffic crimes prosecutors and law enforcement agencies throughout 

their state. Traffic crimes and safety issues include but are not limited 

to: alcohol and/or drug impaired driving, vehicular homicide, occupant 

restraint and other highway safety issues.

Media The CDC developed a Roadway to Safer Tribal Communities Toolkit in 

coordination with IHS which includes posters, fact sheets, and a video 

titled A Killer in Indian Country. The toolkit components are focused 

on child passenger safety, seat belt use, and alcohol-impaired driving 

prevention with fact sheets for tribal community members and health 

professionals working in AI/AN communities. All items are available 

for download at CDC’s Tribal Road Safety Page and at the IHS Injury 

Prevention Program web page. 

To inform media messages, an additional resource is a tutorial featuring 

AI/AN examples for CDC’s Web-based Injury Statistics Query and 

Reporting System (WISQARS). WISQARS offers AI/AN death data for 

unintentional injuries, including motor vehicle-related injuries. 

http://www.cdc.gov/injury/wisqars/fatal_help/mapping.html
114 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Data and Evaluation

Program Evaluation Centers for Disease Control and Prevention 

● Centers for Disease Control and Prevention Program Performance 

& Evaluation Office: This office has developed a Framework for 

Program Evaluation in Public Health, which provides a set of steps 

and standards for practical evaluation by programs and partners. 

The focus is public health programs, however, the approach can be 

generalized to any evaluation effort. A practical, non-prescriptive 

tool, the evaluation framework summarizes and organizes the steps

and standards for effective program evaluation. The framework was 

originally published in a 1999 Morbidity and Mortality Weekly 

Report (MMWR) article.

● Introduction to Program Evaluation for Public Health Programs: A 

Self-Study Guide: This document is a “how to” guide for planning 

and implementing evaluation activities. The manual, based on CDC’s 

Framework for Program Evaluation in Public Health, is intended to 

assist managers and staff of public, private, and community public 

health programs to plan, design, implement and use comprehensive 

evaluations in a practical way.

● Demonstrating Your Program’s Worth: A Primer on Evaluation 

for Programs to Prevent Unintentional Injury: This free resource 

is designed for program managers, coordinators, and planners to 

conduct evaluation, and provides examples of why evaluation is 

worth resources and effort needed to conduct it. 

Technical support to plan and conduct program evaluation is also 

available from experts who have experience working in Tribal 

communities. These can include: Tribal Epidemiology Centers, 

individual or institutional/university-affiliated evaluation consultants, 

and schools of public health. 

Data sources 

for Motor Vehicle 

Crash Injuries and 

Deaths and Risks 

NHTSA Fatality Analysis Reporting System (FARS)

FARS is an online database, accessible to the public, which is developed 

and maintained by the National Highway Traffic Safety Administration 

(NHTSA). 
Technical Support: Component #5 for TMVIP 115

Data sources 

for Motor Vehicle 

Crash Injuries and 

Deaths and Risks 

(continued)

CDC Web-based Injury Statistics Query and Reporting System

(WISQARSTM)

WISQARSTM is an online, publically accessible database of fatal and 

non-fatal injuries and violent deaths due to a variety of causes, including 

motor vehicle crashes. Visit http://www.cdc.gov/injury/wisqars/fatal_

help/tutorial.html for a tutorial on how to use WISQARS.

CDC Behavioral Risk Factor Surveillance System (BRFSS) 

BRFSS is the world’s largest, ongoing telephone health survey system, 

tracking health conditions and risk behaviors in the United States yearly 

since 1984. 

CDC Youth Risk Behavior Survey (YRBS) 

The Youth Risk Behavior Surveillance System (YRBSS) monitors six 

types of health-risk behaviors that contribute to the leading causes of 

death and disability among youth and adults, including behaviors that 

contribute to unintentional injuries and violence. YRBSS includes a 

national school-based survey conducted by CDC and state, territorial, 

tribal, and local education and health agencies and tribal governments. 

CDC Wide-ranging Online Data for Epidemiologic Research

(WONDER) 

This is an easy-to-use, menu-driven system that makes the information 

resources of the CDC available to public health professionals and the 

public at large. It provides access to a wide array of public health 

information. With CDC WONDER, you can access statistical research 

data published by CDC, as well as reference materials, reports and 

guidelines on health-related topics and query numeric data sets on 

CDC’s computers, via “fill-in-the blank” web pages. Public-use data sets 

about mortality (deaths), census data and many other topics are available 

for query, and the requested data are readily summarized and analyzed, 

with dynamically calculated statistics, charts and maps.
116 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Data sources 

for Motor Vehicle 

Crash Injuries and 

Deaths and Risks 

(continued)

Roadway Data Sources 

The Division of Transportation (DoT) within the Bureau of Indian Affairs 

(BIA) oversees the road maintenance and road construction programs for 

Indian reservation roads in Indian country and maintains an inventory 

under the Tribal Transportation Program (TTP). The TTP maintains a 

comprehensive database of all transportation facilities eligible for TTP 

funding by tribe, reservation, BIA agency and region, Congressional 

district, State, and county. Other specific information collected and 

maintained under the TTP includes classification, route number, bridge 

number, current and future traffic volumes, maintenance responsibility, 

and ownership. The TTP also maintains an inventory website that 

provides a portal to report data and access the most current data in a 

read-only format. Data are updated every month on the Integrated 

Transportation Information Management System (ITIMS) website and 

are accessible to tribal transportation planners, tribal program managers, 

and the public.

Trauma Registries State Trauma Registries: databases that document acute care delivered 

to patients hospitalized with injuries. Three registries in states with large 

American Indian/Alaska native populations include: 

● Alaska Trauma Registry

● Arizona Trauma Registry

● Washington Trauma Registry

Data Collection 

Templates for Traffic 

Safety Intervention 

Activities

In support of the 2010-2014 CDC TMVIPP, technical assistance 

providers from the University of North Carolina developed templates to 

track consistent information about four types of traffic safety intervention 

activities promoted by the CDC TMVIPP. Each template includes an 

introduction, instructions on how to complete the template, a sample 

completed template, and a blank template:

1. Enhanced Occupant Restraint Use Enforcement Events

2. Enhanced Driving Under the Influence (DUI) Enforcement Events

3. Child Safety Seat Events

4. Use of Media Events
Technical Support: Component #5 for TMVIP 117

Observational 

Seat Belt 

Use Surveys

In 2003, under contract to IHS, faculty and staff from the University 

of North Carolina pilot-tested an observational seat belt use survey 

protocol among several Tribal communities participating in TIPCAP. 

The purpose of the pilot was to examine whether the locations selected 

for the observations had an effect on the results (that is, the estimate 

of seat belt use in the community) so that valid procedures to estimate 

seat belt use in AI/AN communities could be recommended. Based on 

findings from this initial project, UNC developed the UNC-IHS Seat Belt 

Observational Survey Protocol in 2005 and revised it in 2010 and 2011. 

The protocol includes four phases to follow: 1) Observation Location 

Identification and Traffic Volume Assessment; 2) Selecting Observation 

Locations to Survey; 3) Conducting Observational Seat Belt Surveys; and 

4) Summarize Annual Seat Belt Use Data. The document also includes 

an appendix for estimating seat belt use in small communities. 

NHTSA’s National Center for Statistics and Analysis conducts an annual 

National Occupant Protection Use Survey (NOPUS). Data collected 

from states include data from Indian Country. The 2014 NOPUS Report

indicates that the overall seat belt use rate in the United States is 

87 percent.

Observational 

Child Safety 

Seat Use Surveys

The Child Safety Seat Observation Survey Guide was originally 

developed by staff from the Indian Health Service and faculty and 

staff at the University of North Carolina (UNC) for the Indian Health 

Service’s child passenger safety program called Ride Safe. Ride Safe 

is a Tribal Head Start Center-based child passenger safety program 

that combines education and the distribution of child passenger safety 

seats to the families of Head Start aged children. This version of the 

Child Safety Seat Observation Survey Guide was revised by the UNC 

team as a technical assistance tool for Tribes and Tribal organizations 

that conducted child passenger safety initiatives for the CDC’s 2010-

2014 Tribal Motor Vehicle Injury Prevention Program (TMVIPP). The 

protocol provides guidelines to help Tribal Injury Prevention Program 

coordinators in AI/AN communities make decisions about estimating 

child safety seat use rates for a specific group within the community. 

The Guide outlines steps to conduct observational child safety seat use 

surveys. The surveys described in this guide help to document the use 

of child safety seats, they are not used to determine if the restraints are 

being used correctly. Child Safety Seat ‘check’ events are used to assess 

proper use and, if necessary, make corrections to those misusing child 

safety seats. 
118 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Observational 

Child Safety 

Seat Use Surveys

(continued)

The Native CARS Project has several articles describing the methods 

and results used to collect data about child occupant restraint use in the 

Pacific Northwest.

NHTSA conducts a national survey about the use of booster seats. 

Methods include collecting observational and interview data about 

children ages newborn to 12 years old in passenger vehicles at selected 

gas stations, day care centers, recreation centers, and fast-food-chains. 

For more information about these data collection methods for booster 

seat use, see the 2013 National Survey of the Use of Booster Seats.

Knowledge, 

Attitudes, 

Behavior Surveys 

for Law Enforcement, 

Community Members, 

and Youth

Technical assistance providers from the University of North Carolina 

developed several surveys to assess knowledge, attitudes, and practices 

regarding child safety seat use and enforcement, occupant restraint 

use and traffic safety laws, and youth alcohol use. The surveys were 

developed to help coordinators plan project activities. The questions 

used in each of the three sample surveys should be modified, as needed, 

to best suit your project’s needs. 

1. Sample Child Safety Seat Law Enforcement Survey

2. Sample Occupant Restraint Use Community Survey

3. Youth Alcohol Use Survey Sample

Working with States 

to Conduct and Share 

Crash Reporting

Guide for Effective Tribal Crash Reporting

This publication provides guidance for state agencies and tribal leaders 

to improve their crash reporting. It was developed based on best 

practices, success stories, lessons learned, published literature, and 

data from tribes and states. The Guide provides valuable knowledge to 

both tribal law enforcement and state transportation agencies to better 

understand the extent and causes of crashes on tribal lands to develop 

more effective safety programs and countermeasures.
Technical Support: Component #5 for TMVIP 119

Tailoring Technical Assistance Strategies

Laws Mandating 

Child Safety 

Seat Use

In working with a local workgroup to educate Tribal government 

officials about the effectiveness of enhancing existing laws mandating 

child safety seat use, consider the following resources to: define 

enforcement type, age/weight/height, and seat location in vehicle 

requirements to align with CDC safety recommendations or other Tribe 

or state laws, as summarized by:

● The Governor’s Highway Safety Association: 

Summary of Child Passenger Safety Laws

● Insurance Institute of Highway Safety: Summary of Child Safety

● National Congress of American Indians Policy Research Center: 

Tribal Public Health Law Database

● Safe Kids Worldwide: Car Seat Tips

● Centers for Disease Control and Prevention: 

Get the Facts on Child Passenger Safety

● 2011 American Academy of Pediatrics Updated Child Passenger 

Safety Recommendations (Policy Statement and Technical Report)

Child Safety Seat 

Distribution and 

Education Programs

To coordinate child safety seat distribution plus education efforts, 

consider the following resources to: 

● Develop or adapt existing educational materials: 

◆ NHTSA child passenger safety educational materials

◆ CRIHB Injury Prevention Toolkit 

◆ Alaska FOCUS on Safety Curriculum 

◆ CDC Roadway to Safer Tribal Communities Toolkit

● 2014 Vital Signs on Child Passenger Safety

● Develop liability waiver documents to ensure family responsibility 

for proper installation and use of child safety seats, and to release 

liability from a CPS technician. 

● Search the Safe Kids Worldwide website, including a national 

database for certified Child Passenger Safety Technicians, and to 

learn about child passenger safety training and other activities. 

● To track and target types of child safety seat misuse over time, use 

the Safe Kids child safety event data collection instruments.
120 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Laws Mandating 

Seat Belt Use 

Collaborate with a local workgroup to educate Tribal government 

officials about the effectiveness of enhancing existing laws mandating 

use of seat belts, consider laws that align with suggestions outlined in 

the following resources:

● National Highway Traffic Safety Administration 

Laws and Regulations

● Governor’s Highway Safety Association: 

Summary of Seat Belt Use Laws

● Insurance Institute for Highway Safety: 

Summary of Restraint Laws

● National Congress of American Indians Policy Research Center: 

Tribal Public Health Law Database

● Research about the importance of laws requiring 

back seat restraint use

Enhanced 

Enforcement 

Programs

To plan, advertise, and conduct seat belt use saturation patrols or 

checkpoints conducted by police officers, often referred to as High 

Visibility Enforcement events, consider scheduling them with National/

state/local seat belt events, such as National Click-It or Ticket campaigns, 

held annually in summer (information available from NHTSA’s Traffic 

Safety Marketing program). NHTSA’s Impaired Driving Prevention 

Toolkit can be a useful guide for these types of activities.

08% Blood Alcohol 

Concentration (BAC) 

Laws 

When collaborating with a local workgroup to educate Tribal 

government officials about the effectiveness of enhancing existing laws

regarding impaired driving, consider the following resources to align 

laws with suggestions outlined in the following resources:

● Governor’s Highway Safety Association: 

Summary of Impaired Driving Laws

● Insurance Institute for Highway Safety: 

Summary of DUI/DWI Laws

● National Congress of American Indians Policy Research Center: 

Tribal Public Health Law Database
Technical Support: Component #5 for TMVIP 121

ACTION CALLS

American Indian/Alaska Native Tribal Leaders are encouraged to share the technical support 

resources listed in these sections with staff working to address traffic safety issues at the Tribe. 

Partnerships between Tribal and Non-Tribal IP Practitioners and Public Health Professional Partners, 

including State Entities, can use and apply lessons learned from technical support resources to help 

ensure a future generation of safe and healthy AI/AN people.
122 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Glossary of Terms

Booster Seat A seat that boosts a child up, letting the child sit up higher in the 

vehicle, which improves adult seat belt fit. Generally, children 

need to use a booster seat until the adult seat belts fits properly. 

Seat belts fit properly when the lap belt lays across the upper 

thighs (not the stomach) and the shoulder belt lays across the 

chest (not the neck). For most children, seat belts will fit properly 

without a booster seat between the ages of 8 to 12 years. 

See more at Safe Kids Worldwide.

Return to first use of Booster Seat.

Capacity Building Development of knowledge, skills, commitment, structures, 

systems and leadership to enable effective health promotion and 

injury prevention. Return to first use of Capacity Building.

Death Rates The ratio of deaths to the population of a particular area during 

a particular period of time, usually calculated as the number of 

deaths per one thousand people per year in a small population, 

and per 100,000 people per year for the country as a whole.

Return to first use of Death Rates.

Epidemiology The study of the disease distribution and determinants of health 

states or events in specific populations, and the application of 

this study to the control of health problems. 

Return to first use of Epidemiology.

Evidence-based 

Strategies

Activities, efforts, or programs for which there is strong or 

sufficient evidence the strategy works. These are programs that 

can be sustained (sustainable) and replicated (duplicated) and 

they have demonstrated positive impact on prevention, costs, 

and/or other stated outcomes.

Return to first use of Evidence-Based Strategies.
Glossary of Terms 123

Impact Evaluation The process used to determine if a program changed what 

it intended to change. For motor vehicle injury prevention 

programs, this often includes changes in: knowledge; attitudes; 

behaviors; or policies the program wanted to change (for 

example, occupant restraint use, enforcement of existing laws, 

new or strengthened policies).

Return to the first use of Impact Evaluation.

Impaired Driving Often called “drunk driving.” This refers to operating a motor 

vehicle while a person’s blood alcohol content is above the legal 

limit set by law, which is judged to be the level at which a person 

cannot drive safely. In the context of this guide, impairment is 

used to indicate a blood alcohol content at or above 0.08g/dL. 

More recently, includes impairment due to the use or misuse of 

prescription or illegal drugs. 

Return to the first use of Impaired Driving.

Interventions When used to describe injury prevention or public health, 

these include activities or programs conducted on behalf of 

communities and the individuals and families living in them. For 

example, a seat belt use intervention is a set of activities designed 

to increase restraint use in a community to help reduce motor 

vehicle crash injury or death. 

Return to the first use of Interventions.

Four E’s of 

Injury Prevention

Education (for example, provision of individual or group 

information, written or in-person) 

Enforcement (for example, law enforcement issuing citations) 

Engineering (vehicle modifications such as air-bags, stability 

control systems) 

Environmental modifcation (for example, changes to roadways 

including lighting and cross-walks). 

Return to the first use of the Four E’s of Injury Prevention.
124 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Mass Media This refers to media channels, such as newspapers, magazines, 

radio, television, or billboards that are used to convey 

information to large numbers of people, often at the same time. 

For example, a radio announcement about the importance of 

using seat belts has the potential to reach any radio listener 

within many hundreds of miles. 

Return to first use of Mass Media.

PL 280 State This law transfers legal authority (jurisdiction) from the federal 

government to state governments which significantly alters 

the division of legal authority among tribal, federal, and state 

governments. Congress gave six states (California, Minnesota, 

Nebraska, Oregon, Wisconsin, and Alaska upon statehood) 

extensive criminal and civil jurisdiction over tribal lands within 

the affected states (the so-called “mandatory states”). Public 

Law 280 also permitted other states to acquire jurisdiction 

at their option. For more information, visit American Indian 

Development Associates, LLC. 

Return to first use of PL 280 State.

Primary 

Enforcement 

Laws

A primary enforcement seat belt law means a police officer can 

pull a vehicle over and issue a ticket just because a driver or 

passenger covered by the law is not wearing a seat belt. 

Return to first use of Primary Enforcement Laws.

Process 

Evaluation

Assessment as to whether a program completed the activities 

as intended (e.g., type, quantity, quality). For motor vehicle 

injury prevention programs, this often includes whether the 

program: conducted the number of media activities it planned; 

distributed the number of child safety seats it planned; conducted 

the number of community-wide educational events it intended. 

Return to first use of Process Evaluation.

Promising 

Interventions

Cutting edge efforts that are untested in which there is currently 

insufficient evidence to determine their impact (does not mean 

the strategy is ineffective, but rather additional study is needed). 

Sometimes called “emerging” or “innovative” interventions. 

Return to first use of Promising Interventions.
Glossary of Terms 125

Public Health Organized efforts of society to prevent disease, promote health, 

and prolong life among the population as a whole. Activities 

focus on entire populations, not on individual patients or 

diseases. 

Return to first use of Public Health.

Racial 

Misclassification

When the race of one person or group of people is incorrectly 

determined to belong to another person or groups of people. For 

example, when someone who is American Indian is classified as 

Hispanic (for example, in a health record, on a death certificate). 

Return to first use of Racial Misclassification.

Risk The probability of an unwanted event occurring (for example, 

a motor vehicle crash). Often used in the phrase ‘risk factor,’ 

which is a factor that makes an unwanted event more likely. 

For example, not wearing a seat belt is a risk factor for being 

injured in a motor vehicle crash because you are more likely to 

be injured if you are not using the seat belt. 

Return to first use of Risk.

Secondary 

Enforcement 

Laws

A secondary enforcement law only allows a police officer to 

issue a ticket for someone not wearing a seat belt if the driver has 

been pulled over for some other offense. 

Return to first use of Secondary Enforcement Laws.

Stakeholder A person, or group of persons, with an interest or concern 

in a particular issue (for example, concerned citizens, nongovernment organizations, religious organizations, researchers, 

professional associations, government agencies or leaders). 

Return to first use of Stakeholder.
126 Tribal Motor Vehicle Injury Prevention (TMVIP) Best Practices Guide

Surveillance Systematic ongoing collection, organization, and analysis of data 

and the timely dissemination of information to those who need to 

know so that action can be taken. 

Return to first use of Surveillance.

Tailored When describing an injury prevention or public health program 

(or an evidence-based strategy), this refers to making the program 

custom-made for a specific group or audience. For example, 

a Tribal program may include radio, newspaper, or television 

announcements in both the Tribe’s local language and English to 

tailor messages to their target audiences. 

Return to first use of Tailored.

Systematic 

Review

A summary of the literature or a critical assessment and 

evaluation of all research studies that address a particular issue, 

conducted in a systematic way. Systematic reviews are used to 

answer these types of questions: 1) Which program and policy 

interventions have been shown to be effective?; 2) Are there 

effective interventions that are right for my community?; and 3) 

What might effective interventions cost and what is the likely 

return on investment? 

Return to first use of Systematic Review.

Unintentional 

Injury

The unintentional physical damage (for example, fracture, 

concussion, burn) or trauma to the human body from acute 

exposure to energy (thermal, mechanical, kinetic, electrical, 

or chemical) in amounts that exceed its threshold of tolerance, 

or from the absence or over-exposure to vital elements such as 

oxygen or health (for example, drowning, hypothermia). What 

some think of as “accidental” injury. 

Return to first view of Unintentional Injury.

Unintentional 

Injury Death

Death from injuries that were caused by unplanned events that 

were not intended, desired, or meant to happen. What some 

think of as “accidental” injury deaths. 

Return to first view of Unintentional Injury Death.
References 127

References

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2. Letourneau, RJ; Crump, CE; Billie, H. (2011). Applying funding agency lessons learned to 

enhance motor vehicle injury prevention in American Indian/Alaska Native communities. IHS 

Primary Care Provider. 36(7):142-146.

3. Engelberg, M & Remba, D. (2011). Essential components in Tribal MVIP programs Final Report. 

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4. Wallace, LJD; Patel, R; & Dellinger, A. (2003). Injury mortality among American Indian and 

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index.html

6. Murphy, T; Pokhrel, P: Worthington, A; Billie, H: Sewell, M; & Bill, N. (2014). Unintentional 

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American Journal of Public Health. 104(S3):S470-S480. 

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8. Puukka, E; Stehr-¬Green, P; & Becker, TM. Measuring the health status gap for American 

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95(5):838¬43. 

9. Dankovchik, J; Hoopes, MJ; Joshi, S; Bigback, K; Weiser, T; & Warren¬-Mears, V. (2014). 

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11. Voasm RB; Tippets, AS; & Fisher, DA. (2000). Ethnicity and alcohol related fatalities: 1990 to 

1994. Landover, MD: Pacific Institute for Research and Evaluation; Report no. DOT HS 809 068.

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United States, 2001-2005. MMWR. 57(34):938-941.

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Executive Summary 131

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