Injury Prevention Report Card: Nearly Half of U.S. States Score Low

Many states are failing to enforce proven strategies to prevent injury, such as requiring bike helmets for kids or enacting primary seat belt laws.

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Nearly 50 million Americans are treated for injuries each year, and more than 2.8 million are hospitalized. Injuries remain the third leading cause of death in the U.S., and yet many states are still lagging on injury prevention measures.

Take Montana, for example. According to The Facts Hurt: State-By-State Injury Prevention Policy Report, the state doesn’t enforce primary seat belt laws nor does it require bicycle helmets for all kids.

The new report, released Tuesday by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), scored all 50 U.S. states on injury prevention and rate of injury-related deaths.

Each state was scored based on a list of 10 key indicators of injury prevention measures that states can take. States received one point for achieving each indicator and zero for failing to achieve it. Indicators included questions like “Does the state require booster seats?” and “Did the state enact a prescription drug monitoring program?” Zero was the lowest possible score and 10 was the highest.

(MORE: Children Under Age 4 Are at Highest Risk For Drowning)

The researchers found that 24 states scored 5 points or lower. The highest scoring states were California and New York, each scoring 9 out of 10. Montana and Ohio scored the lowest, with 2 out of 10.

New Mexico had the highest rate of injury-related deaths with a rate of 97.8 per 100,000 people and New Jersey had the lowest rate at 36.1 per 100,000.

“Seat belts, helmets, drunk driving laws and a range of other strong prevention policies and initiatives are reducing injury rates around the country,” Amber Williams, executive director of the Safe States Alliance, said in a statement. “However, we could dramatically bring down rates of injuries from motor vehicles, assaults, falls, fires and a range of other risks even more if more states adopted, enforced and implemented proven policies. Lack of national capacity and funding are major barriers to states adopting these and other policies.”

Here are the scores for all 50 states:

9 out of 10: California and New York
8 out of 10: Maryland, North Carolina, Oregon, Rhode Island and Washington
7 out of 10: Connecticut, Washington, D.C., Hawaii, Illinois, Kansas, Louisiana, Massachusetts, New Jersey, New Mexico and Tennessee
6 out of 10: Alabama, Alaska, Arizona, Delaware, Florida, Georgia, Maine, Nebraska, Virginia and Wisconsin
5 out of 10: Arkansas, Colorado, Indiana, Iowa, Minnesota, Missouri, Oklahoma, Pennsylvania, Texas, Utah, Vermont and West Virginia
4 out of 10: Michigan, Mississippi and New Hampshire
3 out of 10: Idaho, Kentucky, Nevada, North Dakota, South Carolina, South Dakota and Wyoming
2 out of 10: Montana and Ohio

(MORE: Study: Brain Injuries in Childhood Have Lasting Effects on Learning)

“There isn’t one policy or program that is shown to be the most beneficial, but there are many out there and some states need stricter enforcement,” says Dr. Jeff Levi, the executive director of TFAH. “We hope this report will increase the attention paid at the federal level to make sure all states have injury-prevention programs. At the state level, we hope legislators will see the importance of adopting them.”

The report found that several evidence-based injury-prevention strategies are not enforced statewide. For instance:

  • 29 states do not require bicycle helmets for all children
  • 17 states do not require that children ride in a car seat or booster seat to at least the age of 8
  • 31 states do not require helmets for all motorcycle riders
  • 34 states and Washington, D.C., do not require mandatory ignition interlocks for convicted drunk drivers
  • 18 states do not have primary seat belt laws
  • 44 states scored a “B” or lower on a teen dating violence law review by the Break the Cycle organization
  • 14 states do not have strong youth sport concussion safety laws

“Thousands of injuries could be prevented and billions of dollars could be saved in medical costs each year with the wider implementation of research-based policies and an increased investment in programs, enforcement and public education,” the authors write in the report.

Among the injury-prevention measures that are proven to reduce harm and death, as highlighted by the study:

  • Seat belts: an estimated 69,000 lives saved from 2006 to 2010
  • Motorcycle helmets: an estimated 8,000 lives saved from 2005 to 2009
  • Child safety seats: about 1,800 lives saved from 2005 to 2009
  • School-based programs to prevent violence: violent behavior among high school students was cut by 29%

The report also identified emerging injury-related threats like prescription drug abuse, concussions from school sports, bullying, texting while driving and falls among adults age 65 and older. According to Levi, poisonings from prescription drugs have tripled in the last 11 years.

Yet, state funding for injury prevention from the U.S. Centers for Disease Control and Prevention (CDC) dropped 24% from 2006 to 2011. The authors write, “despite the pervasiveness of injuries, the high cost of injuries and the growing understanding that policies and programs can greatly reduce the number of injuries — the U.S. investment in science and public health practice of injury prevention is very limited.”

“I find this most disappointing,” says Levi. “Even though we have very large injury numbers that are costing us an extra $80 million in medical costs, funding has gone down.”

A full list of the indicators and scores, as well as the full The Facts Hurt report, are available on TFAH’s and RWJF’s websites.

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