Personal Safety & Safety Behaviors
Background
Personal safety and safety behaviors relates to the structural conditions present and actions taken to prevent, reduce or eliminate the risk of injury and disease. Safety behaviors can include travel safety, fall prevention, vaccinations, and others.
Travel Safety
The District of Columbia has a long history of investing in innovative technologies, treatments, and policies to encourage and support walking. The District is a city of walkers—1 in 8 of the city’s residents walks to work, while the majority make one or more walking trips a day, whether out to lunch, to school and back, or home from the bus stop.
More than 880 miles of District streets have sidewalks on both sides, 150 miles have sidewalks on one side, and the city has more than 150 miles of recreational paths and trails [1].
In general, downtown is well covered by sidewalks, while neighborhoods to the northwest and southeast lack sidewalks on one or both sides of the street. Overall 24% of the District’s streets are missing sidewalks on one of both sides of the street [1].
In effort to improve transportation safety in the District, the DC Vision Zero plan details an all-hands-on-deck approach. The plan outlines the goal that by the year 2024, the District will eliminate fatalities and serious injuries to travelers of our transportation system through more effective use of data, education, enforcement, and engineering. At the heart of the Vision Zero plan is the acknowledgement that humans will always make mistakes, and so our transportation system must allow for errors in judgment. The consequences of such errors should not be fatal [2].
Regulated safety equipment includes helmets for bicycles and motorcycles and seat belts for other vehicles. Helmet use is mandatory for cyclists under the age of 16. Helmet use is strongly recommended for all others cyclists [3]. In 2017, an estimated 95.2% of District adults always or nearly always wore a seat belt when in a vehicle [4]. Among high school students in the District, 22% report that they rode in cars with a driver who had been drinking alcohol in the past month [5]. Despite these safety regulations, pedestrians are at an increased risk of death from motor vehicle crashes, which can be improved via street design, flow, and improvement/enforcement of traffic laws.
The addition of increased modes of transportation with little regulation could impact these data. For example, bike sharing has increased dramatically across the District, and, in 2017, companies began offering shared electric scooters throughout the streets of DC. In 2019, mopeds will be offered as an additional mode of transportation. Bike and scooter rentals do not include helmets, while the moped rental will include helmets and liners for riders. While access to these modes of transportation has improved across the District, work is still being done to create more connected streets and safe lanes/crossings for bikers and pedestrians.
Falls Prevention
Older adults are among the fastest growing population in the U.S., and the District of Columbia is striving to become an age-friendly city. Older adults are disproportionately affected by injuries, with falls causing severe disability for many, and health services for this and related issues should be tailored for these populations [1]. The Age-Friendly DC plan outlines the goal of establishing and implementing evidence-based fall prevention programs for District residents, particularly those with balance and mobility issues.
Over time, the rate of emergency department visits due to falls among older adults are down 15.5% from 2014 to 2017. In 2017, falls made up 13% of all accidental deaths. The burden on older adults is high, and the risk of death from falling increases as an individual ages.
Immunizations
Immunization has played a vital role in increasing life expectancy in the 20th century, largely due to improving child survival through reduction in infectious disease mortality and disability. Vaccines are among the most cost-effective clinical preventive services and childhood immunization programs provide a very high return on investment. For example, for each birth cohort vaccinated with the routine immunization schedule, society [1]:
• Saves 33,000 lives.
• Prevents 14 million cases of disease.
• Reduces direct health care costs by $9.9 billion.
• Saves $33.4 billion in indirect costs.
Current vaccination efforts in the U.S. targets 17 vaccine preventable diseases across the lifespan. Even with such advances in vaccines, the effectiveness depends on vaccinating a large majority of the population being protected (herd immunity). Without widespread immunization, the entire community is at risk for outbreaks that have not been seen in generations. People in the United States continue to get diseases that are vaccine preventable. Infectious diseases that are not yet eradicated remain a major cause of illness, disability, and death. The minor risks of vaccines are dwarfed by the substantial effects of infections such as measles, which cause death or permanent disability in up to 10% of those who contract it [2].
Vaccination rates in school children in the District have been declining over time, down to 79.1% in 2017. Campaigns like “No Shots No School” and updates in local legislation have attempted to halt this decline in coverage rates. Similarly, while higher than the national rate of 70%, 74% of toddlers (19-35 months old) in the District have received all the recommended vaccinations, falling short of herd immunity levels.
We know that it’s more than likely we can have an outbreak that spreads very quickly if our rates are below 95 percent. What we benefit from — called herd immunity — goes away when we’re below 95 percent. So we all need to band together and have our children vaccinated so that we can get those rates back up above 95%.
Influenza Vaccinations
Influenza vaccines are important for everyone in order to protect the very young, very old and persons who are immunocompromised. While flu vaccination rates for older adults are fairly high, only about 40% of the general population reported getting a flu vaccine in the past year.
HPV Vaccination
Human Papillomavirus, or HPV, is a common virus that can lead to six types of cancer later in life [4]. The HPV vaccine provides safe, effective, and long-lasting protection against certain types of cancer. Approximately 80% of people who are sexually active will get HPV at some time in their life without the HPV vaccination [5]. While most HPV infections will go away on their own, infections that don’t go away can cause certain types of cancer including: cervix, vaginal, and vulva cancer in women, penis cancer in men, and both anal and throat cancer in all adults.
According to the National Immunization Survey an estimated 80.6% of District adolescents 13-17 years old have received at least 2 doses of the HPV vaccine as of 2017 [3], which can prevent some forms of cervical cancer. In 2017, DC had the highest vaccine coverage rate among teenagers in the U.S. who had received at least one HPV vaccine at 91.7% coverage [3]. The CDC recommends all children get two doses of the HPV vaccine by the age 11 or 12 to ensure they are protected long before they are ever exposed to the virus [5].
Assets & Resources
Travel Safety
• Vision Zero community events
• DC safe routes to school program
• Street Smart Campaign
• Adult bicyclist education
• Pocket guide to DC bike laws
Falls Prevention
• Safe at Home
The Safe at Home program finances home accessibility adaptations to persons living with disabilities and residents over the age of 60 to allow for “Aging in Place.” The highest number of adaptations have occurred in Wards 4, 5, 7 and 8. Eligible residents receive up to $10,000 for adaptations to reduce the risk of falls and remove mobility barriers. The program now allows older adults to obtain private security camera systems to promote safety in and around their homes.
Immunization
• Vaccination Directory by Ward
• DC Pediatric Immunization Locations
• DC Primary Care Centers
• Immunization Requirement and Forms
• No Shots, No School FAQ
Promising Practices & Policies:
• IID-I Reduce client out-of-pocket costs for vaccinations, including flu vaccine (via Medicaid and/or private insurance companies).
• IVP-I Prioritize transportation infrastructure improvements related to bicycle and pedestrian safety using injury and crash data.
Funding Opportunities
Citations & Additional Data Resources
Travel Safety
1. Move DC. DC Department of Transportation 2014.
2. Vision Zero. DC Department of Transportation 2017.
3. Bicycle and Pedestrian Safety. DC Department of Transportation.
4. CDC. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data. 2015.
5. DC YRBS. 2017.
Additional Data:
• High Crash Intersection Evaluation for Vision Zero Data
Falls Prevention
1. Injury and Violence Prevention. DC Healthy People 2020.
Immunization
1. Immunization and Infectious Disease. Healthy People 2020.
2. Immunization and Infectious Disease. DC Healthy People 2020.
3. CDC. National Center for Immunization and Respiratory Diseases. 2018
4. CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention , National Center for Immunization and Respiratory Diseases, National Center for Chronic Disease Prevention and Health Promotion. Human Papillomavirus. 2019.
5. CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention , National Center for Immunization and Respiratory Diseases, National Center for Chronic Disease Prevention and Health Promotion. Human Papillomavirus and Reasons to Get Vaccinated. 2019.
Photo Credit: 14th and U in the Morning. Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)
