Data obtained from death certificates and medical records showed that neighbor islands had higher annual injury hospitalization and death rates than Oahu. Increased injury death rates on neighbor islands primarily resulted from vehicular and drowning accidents. When compared with State rates, neighbor island residents had more injuries from unintentional causes, while Oahu residents had more intentional injuries. Homicide rates were several times as high in central cities as in rural settings. Resident risk of injury on neighbor islands varied by district, and South Kona residents had the highest injury rate in the State. Injury prevention recommendations are offered that focus on community-based programs and the need for a wide range of complementary solutions. 17 references and 12 tables