How States Rank in Injury Prevention

May 24, 2012

On a set of 10 steps states can take to prevent injuries , 24 states scored a five or lower. Two states, California and New York, received the highest score of nine out of a possible 10, while two states scored the lowest, Montana and Ohio, with two out of 10.

Overall, New Mexico has the highest rate of injury-related deaths in the United States, at a rate of 97.8 per 100,000 people, while New Jersey has the lowest rate at 36.1 per 100,000, according to the report. The national rate is 57.9 per 100,000 Americans who die in injury-related fatalities.

Injuries – including those caused by accidents and violence – are the third leading cause of death nationally, and they are the leading cause of death for Americans between the ages of one and 44.

The “Facts Hurt: A State-By-State Injury Prevention Policy Report,” released by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), concludes that millions of injuries could be prevented each year if more states adopted additional research-based injury prevention policies, and if programs were fully implemented and enforced.

Approximately 50 million Americans are medically treated for injuries each year, and more than 2.8 million are hospitalized. Nearly 12,000 children and teens die from injuries resulting from accidents each year and around 9.2 million are treated in emergency rooms. Every year, injuries generate $406 billion in lifetime costs for medical care and lost productivity.

For The Facts Hurt report, TFAH and RWJF worked with a committee of injury prevention experts from the Safe States Alliance and the Society for the Advancement of Violence and Injury Prevention (SAVIR) to develop a set of indicators of leading evidence-based strategies that have been shown to reduce injuries and save lives. Some key findings include:

  • 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 eight;
  • 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; and
  • 13 states do not have strong youth sport concussion safety laws.

“There are proven, evidence-based strategies that can spare millions of Americans from injuries each year,” said Jeff Levi, PhD, executive director of TFAH. “This report focuses on specific, scientifically supported steps we can take to make it easier for Americans to keep themselves and their families safer.”

The report found that many injury prevention activities have been scientifically shown to reduce harm and deaths, for instance:

  • Seat belts saved an estimated 69,000 lives from 2006 to 2010;
  • Motorcycle helmets saved an estimated 8,000 lives from 2005 to 2009;
  • Child safety seats saved around 1,800 lives from 2005 to 2009;
  • The number of children and teens killed in motor vehicle crashes dropped 41 percent from 2000 to 2009; and
  • School-based programs to prevent violence have cut violent behavior among high school students by 29 percent.

The report also identified a set of emerging new injury threats, including a dramatic, fast rise in prescription drug abuse, concussions in school sports, bullying, crashes from texting while driving and an expected increase in the number in falls as the Baby Boomer generation ages.

“Seat belts, helmets, drunk driving laws and a range of other strong prevention policies and initiatives are reducing injury rates around the country,” said Amber Williams, executive director of the Safe States Alliance. “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.”

“While tremendous progress has been made in preventing and treating injury, it remains a leading cause of death for people of all ages and the number one cause of death for children,” said Dr. Andrea Gielen, ScD, past president, SAVIR, and director, Johns Hopkins Center for Injury Research and Policy. “Texting while driving, the increasing numbers of falls in older adults, domestic violence and the astonishing rise in misuse of prescription drugs mean we need to redouble our efforts to make safety research and policy a national priority.”

The report also finds that funding for injury prevention for states from the U.S. Centers for Disease Control and Prevention (CDC) averages only $0.28 per American – and has dropped 24 percent from fiscal years 2006 to 2011 – and only 31 states have full-time injury and violence prevention directors, which limits injury prevention efforts.

The report was supported by a grant from the Robert Wood Johnson Foundation and is available on TFAH’s website at

Score Summary:

States received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from a number of sources, including: the Governors Highway Safety Association; the American Academy of Pediatrics; Break the Cycle; the Network for Public Health Law;; the Alliance of States with Prescription Drug Monitoring Programs; and the Agency for Healthcare Research and Quality.

  • 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, Nevada and New Hampshire
  • 3 out of 10: Idaho, Kentucky, North Dakota, South Carolina, South Dakota and Wyoming
  • 2 out of 10: Montana and Ohio


The 10 indicators include:

  1. Does the state have a primary seat belt law? (32 states and Washington, D.C. meet the indicator and 18 state do not)
  2. Does the state require mandatory ignition interlocks for all convicted drunk drivers, even first time offenders? (16 states meet the indicator and 34 states and Washington, D.C. do not)
  3. Does the state have a universal helmet law requiring helmets for all motorcycle riders? (19 states and Washington, D.C. meet the indicator and 31 states do not)
  4. Does the state require car seats or booster seats for children to at least the age of eight? (33 states and Washington, D.C. meet the indicator and 17 states do not)
  5. Does the state requirement bicycle helmets for all children? (21 states and Washington, D.C. meet the indicator and 29 states do not)
  6. Does the state allow for people in dating relationships to get protection orders? (44 states and Washington, D.C. meet the indicator and 6 states do not)
  7. Did the state receive an “A” grade in the teen dating violence laws analysis conducted by the Break the Cycle Organization? (6 states and Washington, D.C. meet the indicator and 44 states did not)
  8. Does the state have a strong youth sports concussion safety law? (37 states and Washington, D.C. meet the indicator and 13 states do not)
  9. Did the state enact a prescription drug monitoring program? (48 states meet the indicator and 2 states and Washington, D.C. do not)
  10. Did more than 90 percent of injury discharges from hospitals receive external cause-of-injury coding in the state, which help researchers and health officials track industry trends and evaluate prevention programs? (23 states meet the indicator and 27 states and Washington, D.C. do not)


Note: Rates include all injury deaths for all ages, for injuries caused by accidents and violence (intentional and unintentional) 1 = Highest rate of injury fatalities, 51 = lowest rate of injury fatalities. Rankings are based on combining three years of data (2007-2009) from the U.S. Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System to “stabilize” data for comparison purposes. The data are age-adjusted using the year 2000 to standardize the data. This methodology, recommended by the CDC, compensates for any potential anomalies or usual changes due to the specific sample in any given year in any given state. The numbers are based on how many deaths per 100,000 people.

1. New Mexico (97.8); 2. Montana (86.5); 3. Alaska (85.8); 4. Wyoming (84.7); 5. Mississippi (84.3); 6. Oklahoma (83); 7. West Virginia (82.2); 8. Louisiana (80.1); 9. Arkansas (76.9) 10. (tie) Alabama and Kentucky (76.5); 12. Tennessee (75.6); 13. South Carolina (71.7); 14. Nevada (71.3); 15. Arizona (70.7); 16. Missouri (70.2); 17. Colorado (67.8); 18. Florida (66.8); 19. North Carolina (66); 20. Idaho (65.3); 21. Utah (64.8); 22. Georgia (61.4); 23. Vermont (61.3); 24. Oregon (61.2); 25. North Dakota (61.1); 26. South Dakota (60.7); 27. (tie) Indiana and Kansas (60.4); 29. Washington, D.C. (60.2); 30. Pennsylvania (59.4); 31. (tie) Maine and Wisconsin (58.7); 33. Texas (58.5); 34. Washington (58.1); 35. Delaware (56.9); 36. Michigan (56.8); 37. Maryland (56.1); 38. Ohio (55.9); 39. Virginia (53.4); 40. Iowa (52.5); 41. Nebraska (51.3); 42. Minnesota (51.2); 43. Rhode Island (50.4); 44. New Hampshire (50); 45. Illinois (48.7); 46. Hawaii (48.3); 47. Connecticut (47.9); 48. California (47.6); 49. Massachusetts (41.1); 50. New York (37.1); New Jersey (36.1).

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