More than half of U.S. states (29) do not require bicycle helmets for all children, and 14 states do not have strong laws to prevent youth concussion during sports, according to a report card on injury prevention released May 22.

The report card is part of a new report on injury prevention – "The Facts Hurt: A State-By-State Injury Prevention Policy Report" – released by the Trust for America’s Health and the Robert Wood Johnson Foundation. The report was developed in partnership with leading injury-prevention experts from the Safe States Alliance and the Society for the Advancement of Violence and Injury Research.

Injuries are the third leading cause of death nationally and the leading cause of death for Americans between the ages of 1 and 44 years. Head injuries in youth sports is also a growing area of concern.

Injuries are the third leading cause of death nationally and are the leading cause of death for Americans between the ages of 1 and 44 years. Almost half of states (24) scored a 5 out of 10 or lower on the report card, which consists of 10 injury-prevention indicators. California and New York received the highest score of 9; Montana and Ohio scored the lowest with 2.

"Overall, we need to redouble our efforts to make safety research and policy a national priority. There’s compelling evidence that we should adopt, implement, and enforce any existing policies and programs to help spare millions of Americans from needless harm," said Andrea Gielen, Sc.D., director of the Johns Hopkins Center for Injury Research and Policy and past president of the Society for the Advancement of Violence and Injury Research.

"We know that bicycle crashes lead to around 700 deaths and more than 500,000 emergency room visits each year," said Dr. Gielen. "According to research, wearing an approved helmet in the proper way provides up to an 88% reduction in the risk of head and brain injury for bicyclists of all ages."

Brain injury as a result of sports participation also has garnered more attention in the United States in recent years. However, some states have yet to pass protective laws, according to Amber Williams, executive director of the Safe States Alliance.

"We focused on the growing understanding of steps that can be taken to reduce injuries in youth sports," she said. Prevention measures should include education, removal from play for suspected concussion, and required return-to-play evaluations.

The report includes data on the growing misuse of prescription drugs, particularly painkillers, Ms. Williams said. Sales of prescription painkillers tripled between 1999 and 2010, as did the number of fatal poisonings due to prescription pain medication. "Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month," she noted. The authors found that all but two states had drug-monitoring programs in place.

The key indicators used in the report card are as follows:

– Does the state have a strong youth sports concussion safety law? Fourteen states do not.

– Did the state enact a prescription drug-monitoring program? Two states and the District of Columbia have not.

– Does the state allow people in dating relationships to get protection orders? Only six states do not.

– Did the state receive an A grade according to the teen dating violence laws analysis conducted by the Break the Cycle organization? Forty-four states did not.

– Does the state have a primary seat belt law? Eighteen states do not.

– Does the state require mandatory ignition interlocks for all convicted drunk drivers, even first-time offenders? Thirty-four states and the District of Columbia do not.

– Does the state have a law requiring helmets for all motorcycle riders? Thirty-one states do not.

– Does the state require car seats or booster seats for children at least to age 8? Seventeen states do not.

– Does the state require bicycle helmets for all children? Twenty-nine states do not.

– Did more than 90% of injury discharges from hospitals in the state receive external cause-of-injury coding, which helps researchers and health officials track trends and evaluate prevention programs? Twenty-seven states and the District of Columbia did not.

The report identified other top causes of injury and emerging threats, including bullying, vehicular collisions that occur while the driver is texting, and falls.

According to the report, one person dies from an injury every 3 minutes, and injuries generate $406 billion annually in lifetime costs for medical care and lost productivity. Around 50 million Americans (18% of the population) are medically treated for injuries each year. Each year, more than 29 million people are treated in emergency departments for injuries, 2.8 million are hospitalized, and more than 180,000 die, according to the report. Roughly 9.2 million youth under the age of 20 years are treated in emergency departments for accidental injuries each year, and more than 12,000 of them die.

No conflicts of interest were reported for the authors.

States Don't Measure Up on Injury Prevention