Background American Indians/Alaska Natives have the highest motor vehicle-related death rates of all racial and ethnic groups in the United States. The Centers for Disease Control and Prevention's Injury Center worked with four tribes to reduce the toll of motor vehicle injuries in their communities: the Tohono O'odham Nation (TO), the San Carlos Apache Tribe (SC), the White Mountain Apache Tribe (WM) and the Ho-Chunk Nation (HC).

Objectives To translate known effective strategies to reduce motor vehicle-related injuries among members of Tribal communities.

Methods Effective strategies were selected from The Guide to Community Preventive Services systematic reviews. Tribes tailored, implemented, and evaluated strategies to reduce alcohol-impaired driving, increase occupant restraint, and increase child safety seat use. Each Tribe included policy, media and awareness activities in their programs.

Results The Tribal programs have reduced alcohol-impaired driving, strengthened tribal laws, and increased occupant restraint use. As sovereign nations, the TO and the SC passed Primary enforcement seat belt laws and lowered the legal limit for alcohol to 0.08 BAC while driving. The TO has increased their seatbelt use by 73%. The SC has increased DUI arrests by 52%, and decreased crashes by 29%. The WM has increased driver seat belt use from 13% to 54%, and the HC has increased seat belt use 38% for drivers and 94% for passengers.

Conclusions These multi-component programs have produced a model for use in other Tribes. Lessons learnt from these programs will allow for improved implementation as strategies are disseminated to other American Indian communities.