INTRODUCTION: Approximately 49,000 persons died by suicide in the United States in 2022, and provisional data indicate that a similar number died by suicide in 2023. A comprehensive approach that addresses upstream community risk and protective factors is an important component of suicide prevention. A better understanding of the role of these factors is needed, particularly among disproportionately affected populations. METHODS: Suicide deaths were identified in the 2022 National Vital Statistics System. County-level factors, identified from federal data sources, included health insurance coverage, household broadband Internet access, and household income. Rates and levels of factors categorized by tertiles were calculated and presented by race and ethnicity, sex, age, and urbanicity. RESULTS: In 2022, the overall suicide rate was 14.2 per 100,000 population; rates were highest among non-Hispanic American Indian or Alaska Native (AI/AN) persons (27.1), males (23.0), and rural residents (20.0). On average, suicide rates were lowest in counties in the top one third of percentage of persons or households with health insurance coverage (13.0), access to broadband Internet (13.3), and income >100% of the federal poverty level (13.5). These factors were more strongly associated with lower suicide rates in some disproportionately affected populations; among AI/AN persons, suicide rates in counties in the highest tertile of these factors were approximately one half the rates of counties in the lowest tertile. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Higher levels of health insurance coverage, household broadband Internet access, and household income in communities might play a role in reducing suicide rates. Upstream programs, practices, and policies detailed in CDC's Suicide Prevention Resource for Action can be implemented by decision-makers, government agencies, and communities as they work together to address community-specific needs and save lives.

Fatal and serious crashes on our roadways remain a persistent public health crisis. Vision Zero, based on the principles of a Safe Systems approach, is an initiative that has grown in popularity in the United States in the past decade. While the importance of cross-sector collaboration and the need for a supportive community culture in order to realize community change is well established, such tools and frameworks have not been applied as commonly for road safety initiatives as in other fields. We adapted and utilized the Community Readiness Assessment (CRA) tool, a well-established model within public health for assessing and informing community-based interventions in seven Vision Zero communities in one U.S. state. Three communities assessed were determined to be at an overall readiness level of four out of nine, or at a “preplanning” level and four of the communities scored a level of three, or at a “vague awareness” level. However, levels of readiness across the six dimensions measured varied, with community-related dimensions (e.g., community climate) scoring lower than readiness levels for stakeholder knowledge, leadership, and resources. Additionally, communities with more advanced stages of implementation had higher readiness scores, on average. Assessment results provided unique insights to inform next steps for local initiatives, particularly related to discrepancies between the readiness of the wider community and the readiness of leadership and available resources. Therefore, the CRA represents a potentially beneficial tool for communities pursuing Vision Zero initiatives. © 2023 The Authors

OBJECTIVE: The purpose of this study was to estimate the potential injuries and costs that could be averted by implementing evidence-based road safety policies and interventions not currently utilized in one U.S. state, North Carolina (NC). NC consistently has annual motor vehicle-related death rates above the national average. METHODS: We used the Centers for Disease Control and Prevention's Motor Vehicle Prioritizing Interventions and Cost Calculator for States (MV PICCS) tool as a foundation for examining the potential injuries and costs that could be averted from underutilized evidence-based policies, assuming a $1.5 million implementation budget and that income generated from policy-related fines and fees would help offset costs. We further examined costs by payer source. RESULTS: Model results indicated that seven interventions should be prioritized for implementation in NC: increased alcohol ignition interlock use, increased seat belt fines, in-person license renewal for ages 70 and older, license plate impoundment, seat belt enforcement campaigns, saturation patrols, and speed cameras. Increasing the seat belt fine had the potential to avert the greatest number of fatal (n = 70) and non-fatal (n = 6,597) injuries annually, along with being the most cost-effective of the recommended interventions. Collectively, the seven recommended evidence-based policies/interventions have the potential to avert 302 fatal injuries, 16,607 non-fatal injuries, and $839 million annually in NC with the greatest costs averted for insurers. CONCLUSIONS: This study demonstrates the utility of the MV PICCS tool as a foundation for exploring state-specific impacts that could be realized through increased evidence-based road safety policy and intervention implementation. For NC, we found that increasing the seat belt fine would avert the most injuries, and had the greatest financial benefits for the state, and the lowest implementation costs. Incorporating fines and fees into policy implementation can create important financial feedbacks that allow for implementation of additional evidence-based and cost-effective policies/interventions. Given the recent uptick in U.S. motor vehicle-related deaths, analyses informed by the MV PICCS tool can help researchers and policy makers initiate discussions about successful state-specific strategies for reducing the burden of crashes.

By 2030, it is estimated that one in five persons in the United States will be aged 65 or older.1 Although the vast majority of older adults prefer to age in place (grow old in their current homes), aging in place can present challenges, particularly when older adults begin to experience declines in mobility. Nearly 80% of older adults live in car-dependent suburban or rural communities, with most of these communities lacking alternative mobility options.2 Therefore, when older adults in these communities stop driving, they are left with few transportation options.3 To meet the transportation and mobility needs of aging populations, it will be necessary to have a clear understanding of when older adults expect to stop driving. The purpose of this study was to provide national prevalence estimates of the age at which older adults in the United States report they will stop driving. | Data were obtained from the Second Injury Control and Risk Survey, Phase 2, a cross-sectional, random-digit-dialed telephone survey that the Centers for Disease Control and Prevention conducted between March 2007 and May 2008. The study methodology has been detailed previously.4 This analysis was restricted to survey respondents aged 65 or older who reported being current drivers (N = 565). Information was collected on demographic characteristics, driving status, and views related to when they would stop driving. Nationally weighted estimates were calculated.

A previous analysis of National Vital Statistics System data for 2003-2007 that examined disparities in rates of motor vehicle-related death by race/ethnicity and sex found that death rates for American Indians/Alaska Natives were two to four times the rates of other races/ethnicities. To address the disparity in motor vehicle-related injuries and deaths among American Indians/Alaska Natives, CDC funded four American Indian tribes during 2004-2009 to tailor, implement, and evaluate evidence-based road safety interventions. During the implementation of these four motor vehicle-related injury prevention pilot programs, seat belt and child safety seat use increased and alcohol-impaired driving decreased. Four American Indian/Alaska Native tribal communities-the Tohono O'odham Nation, the Ho-Chunk Nation, the White Mountain Apache Tribe, and the San Carlos Apache Tribe-implemented evidence-based road safety interventions to reduce motor vehicle-related injuries and deaths. Each community selected interventions from the Guide to Community Preventive Services and implemented them during 2004-2009. Furthermore, each community took a multifaceted approach by incorporating several strategies, such as school and community education programs, media campaigns, and collaborations with law enforcement officers into their programs. Police data and direct observational surveys were the main data sources used to assess results of the programs. Results included increased use of seat belts and child safety seats, increased enforcement of alcohol-impaired driving laws, and decreased motor vehicle crashes involving injuries or deaths. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion as an example of a program that might be effective for reducing motor vehicle-related injury disparities in the United States. The Guide to Community Preventive Services recognizes these selected interventions as effective; this report examines the feasibility and transferability for implementing the interventions in American Indian/Alaska Native tribal communities. The findings in this report underscore the effectiveness of community interventions to reduce motor vehicle crashes among selected American Indian/Alaska Native communities.

In Botswana, increased development and motorization have brought increased road traffic-related death rates. Between 1981 and 2001, the road traffic-related death rate in Botswana more than tripled. The country has taken several steps over the last several years to address the growing burden of road traffic crashes and particularly to address the burden of alcohol-related crashes. This study examines the impact of the implementation of alcohol and road safety-related policies on crash rates, including overall crash rates, fatal crash rates, and single-vehicle nighttime fatal (SVNF) crash rates, in Botswana from 2004 to 2011. The overall crash rate declined significantly in June 2009 and June 2010, such that the overall crash rate from June 2010 to December 2011 was 22% lower than the overall crash rate from January 2004 to May 2009. Additionally, there were significant declines in average fatal crash and SVNF crash rates in early 2010. Botswana's recent crash rate reductions occurred during a time when aggressive policies and other activities (e.g., education, enforcement) were implemented to reduce alcohol consumption and improve road safety. While it is unclear which of the policies or activities contributed to these declines and to what extent, these reductions are likely the result of several, combined efforts.

Motor vehicle crashes are a leading cause of death for children, teenagers, and young adults in the United States. In 2009, approximately 36,000 persons were killed in motor vehicle crashes, and racial/ethnic minorities were affected disproportionally. Approximately 4.3% of all American Indian/Alaska Native (AI/AN) deaths and 3.3% of all Hispanic deaths were attributed to crashes, whereas crashes were the cause of death for <1.7% of blacks, whites, and Asian/Pacific Islanders (A/PI).

INTRODUCTION: The U.S. population is shifting to become both older and more racially and ethnically diverse. Our current understanding of U.S. drivers' travel-related needs and concerns by race/ethnicity is limited. METHODS: Data from the 2010 HealthStyles survey, an annual, cross-sectional, national mail-panel survey of persons ages 18years or older living in the United States, were used to calculate weighted percentages of travel-related behaviors, opinions, and concerns by race/ethnicity. Logistic regression was used to explore associations between race/ethnicity and specific travel-related concerns, while adjusting for other demographic characteristics. RESULTS: Adequate transportation alternatives to driving were reported by a greater percentage of persons in certain minority groups compared to whites (Hispanic: 34.7%; white: 23.4%). Concern for the availability of alternatives to driving in the future was greater among minority groups (black: 57.7%; Hispanic: 47.3%; other: 50.9%) compared to whites (37.5%). Additionally, among persons with a household income of $25,000+, minorities were generally more likely than whites to report concern about having alternative transportation options to driving, whereas concern was consistently high among all racial/ethnic groups for those earning less than $25,000 annually. In each racial/ethnic group, more than 10% of persons reported not knowing how they would get around if they could no longer drive. CONCLUSIONS: Important variations by race/ethnicity in both travel behaviors and concerns for adequate alternatives to driving were found, revealing the need for further research to better understand reasons for these differences and to identify ways to meet the transportation needs of the changing U.S. population demographics. IMPACT ON INDUSTRY: Further research on adequate alternatives to driving and transportation needs is needed.

Motor vehicle crashes are the leading cause of death for persons in the United States aged 5--34 years (1). In 2007, approximately 44,000 persons were killed in motor vehicle crashes, and racial/ethnic minorities were affected disproportionally (1,2). Approximately 7% of all American Indian/Alaska Native (AI/AN) deaths and 5% of all Hispanic deaths are attributed to crashes, whereas crashes are the cause of death for<2% of blacks and whites (2). | | To assess the extent of disparities in motor vehicle--related crashes among persons of all ages, CDC analyzed data from the National Vital Statistics System (NVSS). This report summarizes the results of that analysis, which examined racial/ethnic death rates from motor vehicle crashes by sex. AI/ANs and males had the highest motor vehicle--related death rates. Overall motor vehicle--related mortality can be reduced through increased adoption of evidence-based strategies, including primary seat belt laws (legislation allowing police to stop a vehicle solely for a safety belt violation), legislation for ignition interlock devices (devices that disable a vehicle's ignition after detection of alcohol in the driver's breath), and multicomponent programs with community mobilization (programs that include numerous components such as sobriety checkpoints, education and awareness-raising efforts, and training in responsible beverage service, as well as, an active community coalition) (3). Tailoring these strategies to the unique cultures of different racial/ethnic groups also can help reduce disparities in motor vehicle--related mortality (4,5). |

INTRODUCTION: Many older drivers self-restrict or avoid driving under high-risk conditions. Little is known about the onset of driving self-restrictions or how widespread self-restrictions are among drivers of all ages. METHODS: The Second Injury Control and Risk Survey (ICARIS-2) was a nationwide cross-sectional, list-assisted random-digit-dial telephone survey from 2001 to 2003. National prevalence estimates and weighted percentages of those reporting driving self-restrictions were calculated. Multivariable logistic regression was used to explore associations between specific self-restrictions and age group, adjusting for other personal characteristics. RESULTS: More than half of all drivers reported at least one driving self-restriction. The most commonly reported restriction was avoidance of driving in bad weather (47.5%), followed by at night (27.9%) and on highways or high-speed roads (19%). A greater percentage of young adult women (18-24 years) reported self-restricting in bad weather compared to women in other age groups, and the percentage of drivers self-restricting at night, in bad weather, and on highways or high-speed roads increased steeply after age 64. We found that women, those in low income groups, and those who had driven low annual mileage were more likely to self-restrict. CONCLUSIONS: In addition to assessing self-restrictions among older drivers, a new finding from our study is that self-restrictions are also quite prevalent among younger age groups. Driving self-restrictions may be better understood as a spectrum across ages in which drivers' reasons for restriction change. IMPACT ON INDUSTRY: Future research on the ability of driving self-restrictions to reduce actual crash risk and prevent injuries is needed.

As the US population ages, more older adults will face transportation and mobility challenges. This study examines the characteristics and contributing circumstances of nonfatal older adult pedestrian injuries. Data were obtained from the National Electronic Injury Surveillance System-All Injury Programme (NEISS-AIP) for the years 2001 through 2006. Cases included persons aged 65 years and older who were nonfatally injured on a public roadway. The results indicated that on average, an estimated 52,482 older adults were treated in emergency departments each year for nonfatal pedestrian injuries. Falling and being hit by a motor vehicle were the leading mechanisms of injury, resulting in 77.5% and 15.0% of older adult pedestrian injuries, respectively. More than 9000 older pedestrian fall-related injuries each year involved a kerb. It is concluded that the growth in the older adult population could add to the overall burden of these nonfatal pedestrian injuries. Making transportation and mobility improvements, including environmental modifications, is important for preventing these injuries.

OBJECTIVES: To estimate the costs of motor vehicle-related fatal and nonfatal injuries in the United States in terms of medical care and lost productivity by road user type. METHODS: Incidence and cost data for 2005 were derived from several data sources. Unit costs were calculated for medical spending and productivity losses for fatal and nonfatal injuries, and unit costs were multiplied by incidence to yield total costs. Injury incidence and costs are presented by age, sex, and road user type. RESULTS: Motor vehicle-related fatal and nonfatal injury costs exceeded $99 billion. Costs associated with motor vehicle occupant fatal and nonfatal injuries accounted for 71 percent ($70 billion) of all motor vehicle-related costs, followed by costs associated with motorcyclists ($12 billion), pedestrians ($10 billion), and pedalcyclists ($5 billion). CONCLUSIONS: The substantial economic and societal costs associated with these injuries and deaths reinforce the need to implement evidence-based, cost-effective strategies. Evidence-based strategies that target increasing seat belt use, increasing child safety seat use, increasing motorcyclist and pedalcyclist helmet use, and decreasing alcohol-impaired driving are available.

INTRODUCTION: There are many factors that influence older adults' travel choices. This paper explores the associations between mode of travel choice for a short trip and older adults' personal characteristics. METHODS: This study included 406 drivers over the age of 64 who were enrolled in a large integrated health plan in the United States between 1991 and 2001. Bivariate analyses and generalized linear modeling were used to examine associations between choosing to walk or drive and respondents' self-reported general health, physical and functional abilities, and confidence in walking and driving. RESULTS: Having more confidence in their ability to walk versus drive increased an older adult's likelihood of walking to make a short trip by about 20% (PR=1.22; 95% CI: 1.06-1.40), and walking for exercise increased the likelihood by about 50% (PR=1.53; 95% CI=1.22-1.91). Reporting fair or poor health decreased the likelihood of walking, as did cutting down on the amount of driving due to a physical problem. DISCUSSION: Factors affecting a person's decision to walk for exercise may not be the same as those that influence their decision to walk as a mode of travel. It is important to understand the barriers to walking for exercise and walking for travel to develop strategies to help older adults meet both their exercise and mobility needs. IMPACT ON INDUSTRY: Increasing walking over driving among older adults may require programs that increase confidence in walking and encourage walking for exercise.