Health Impact Assessment

Health Impacts of a Walkable Community

Date: 
03/11/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
Automobile-oriented developments have become more and more dominant in many parts of the world. Such communities often ignore needs of pedestrians, and may compromise residents’ physical and social health. There is now a substantial body of evidence that alternative, walkable developments (with mixed land uses, higher density, connected street networks, rich physical activity resources, and pedestrian-friendly designs) are associated with increased physical activities among residents. Limited studies also suggest that walkable communities may promote social health by encouraging outdoor activities, and thereby, facilitating social interactions and increasing neighborhood cohesion. However, most previous studies are cross-sectional in nature and intervention studies are scarce. It is unclear whether moving into walkable communities really increases people's physical and/or social activities, and more importantly, if yes, how such changes take place. This research addresses these knowledge gaps by conducting a pre-post study of residents moving into a walkable community.

Description
Mueller is a LEED-ND certified, mixed-use community in Austin, Texas, designed to house 10,000 residents and 10,000 employees. Developed based on principles of LEED-ND and New Urbanism, Mueller features activity-friendly characteristics such as high density, mixed land uses, well-connected street networks with sidewalks, and rich and diverse natural resources and open spaces. As of May 2013, Mueller has about 40% of its property developed, with about 3,500 employees and about 900 single family households.

This intervention evaluation study examines (1) if residents increased their physical activities and social interactions and cohesion after moving to Mueller, and (2) if yes, how environmental changes influenced such behavior changes. A conceptual framework was developed for the hypothesized mechanisms of such impacts: (1) the increase in community walkability promotes residents’ physical and social activities both directly and indirectly (by improving relevant personal attitudes and social support—the mediators), and (2) the resulting increases in physical activities and social interactions and cohesion mutually reinforce each other.

Focus groups and online surveys were conducted with Mueller residents in 2013 to inquire about their physical and social activities before and after the move, as well as personal, social, and physical environmental factors that may have an impact on these behaviors. Content analysis was used to analyze the focus group data. For survey data, t-tests were used to examine the pre-post move differences; structural equation models (SEM) were used to examine the complex mechanisms for behavior changes. Currently, this ongoing study has completed one focus group (n=13) and collected 154 valid survey responses. By December 2013, more focus groups will be conducted and more survey responses will be collected.

Lessons Learned
A preliminary analysis was conducted for current survey responses. Both adults and children had significant increases in their physical activities. For adults, time spent on walking increased by 40 minutes/week, while time spent on traveling in a car decreased by 96 minutes/week (p<0.001); days with 30+ minutes of physical activity increased by 0.8 per week (p<0.001). For children, days with 60+ minutes of physical activity increased by 0.8 per week (p<0.01); time spent playing outdoors in neighborhood increased by 11 and 13 minutes, on a typical school day and non-school day, respectively (p<0.05). Frequencies of using community resources (e.g., neighborhoods streets, parks, greenways/trails/paths, home/yard/porch spaces) for physical activities increased for both adults and children. Adults also reported significantly more social interactions (p<0.001) and stronger neighborhood cohesion (p<0.01) after the move. There was a significant correlation between changes in physical activities and increases of social interactions.

A preliminary analysis of the first focus group revealed that environmental features such as sidewalks, parks and open spaces, bike routes, diverse destinations, communal facilities (e.g., mailboxes), and front porches and back alleys played important roles in changing residents' behaviors. However, residents also reported concerns about traffic safety.

Conclusions and Implications
Preliminary results showed significant increases in both physical activities and social interactions and cohesion after residents moved to Mueller. For adult residents, time spent on walking in Mueller had a mean of 123 minutes. This is already very close to the public health guideline for the level of physical activities needed for adults to obtain significant health benefits—at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity per week, or a combination.

Next Steps
Before the conference date, follow-up analyses of the full SEM model (with more survey responses) and additional focus groups will further examine mechanisms for these behavior changes and roles of specific design elements. Findings from this research, especially the impacts of specific environmental features, will be checked against principles of LEED-ND and New Urbanism to see if they produced desired impacts on residents' health-related behaviors.

Support / Funding Source
This project is supported by grants from the American Institute of Architects and the Johns Hopkins University Global Center for Childhood Obesity.

Authors: 
Xuemei Zhu, PhD, Zhipeng Lu, PhD, Chia-Yuan Yu, PhD Candidate, Chanam Lee, PhD, & George Mann, BArch
Location by State: 

Park Prescriptions in Practice: The Community Driven Way

Date: 
03/10/2014
Description: 

Presentation at the 2014 Active Living Research Annual Conference.

Abstract: 

Background and Purpose
Park prescriptions is a movement to strengthen the connection between health care and parks and public lands to improve the physical and mental health among individuals and communities. Park prescriptions offers an alternative to treating or preventing health problems that focuses less on traditional medicine and more on connecting with parks and nature to increase levels of physical activity and reduce levels of stress. The movement has quickly grown from a conceptual phase into a period of rapid implementation with programs being developed across the country. The sustainability of the movement will require that we solve the operational hurdles present in parks and health collaborations, and that we hone and measure the best delivery models currently in practice. We hope you can join us and other leaders representing parks and health to refine on-the-ground tactics for program development, program delivery, measurement, and professional training around park prescriptions. While numerous park prescription programs exist at the local and state levels, little has been done to collect successful strategies and share them with other communities looking to implement similar models. Furthermore, programs that do exist each look different from one another, which raises a concern that agencies are “reinventing the wheel” as opposed to learning and building from successes.

Description
The Institute at the Golden Gate, the National Recreation and Park Association, and the Centers for Disease Control and Prevention are partnering to elevate park prescriptions and related programs from a new idea to a best practice in preventive health. The partners are convening local, state, and national experts to evaluate and refine aspects of current park prescription programs. Program standards created from shared knowledge will increase the quality of new and existing programs as well as support more accurate evaluation of program impacts.

Lessons Learned
Together we are defining park prescriptions, gaining a better understanding of the national landscape, and identifying standardized measurement and data collection methods needed to determine the effectiveness of park prescriptions.

Conclusions and Implications
By taking best practices from park prescription programs around the country we are aligning our objectives to more easily measure areas of success and improvement for the future. One area we have honed in on for improvement is better including leaders in the communities that we are working in. By including the community in creating the health intervention we can create a more sustainable and effective program that meets the unique needs of the population it serves. Sharing best practices and measurement tools will also help create opportunities for funding new and improved park prescription programs. Creating a strong national collaborative with agreed upon metrics and health intervention steps will also lead to policy.

Next Steps
A convening will take place in October 2013 to bring together leaders representing parks, public health, and health plan providers to refine on-the-ground tactics for program development, program delivery, measurement, and professional training. This convening will produce national standards based on qualitative and quantitative evidence from programs across the country, elevating the initiative from a new idea to a best practice in preventive health. This work will result in a nationally created toolkit with relevant training's and collateral so parks and health care providers across the country can more easily implement an effective and sustainable park prescriptions model.

Support / Funding Source
Kaiser Permanente; National Recreation and Park Association.

Authors: 
Kristin Wheeler, BA, Nooshin Razani, MD, MPH, & Zarnaaz Bashir, MPH
Location by State: 

Health Effects of Road Pricing in San Francisco, California

Date: 
09/01/2011
Description: 

Wier, M., Bhatia, R., McLaughlin, J., Morris, D., Comerford Scully, C., Harris, M., Bedoya, J., Cowles, S., Rivard, T. Health Effects of Road Pricing in San Francisco, California: Findings from a Health Impact Assessment. San Francisco, CA: San Francisco Department of Public Health, September 2011.

Abstract: 

This report documents the process and findings of a Health Impact Assessment (HIA) conducted by the San Francisco Department of Public Health on one future road pricing scenario being studied by the San Francisco County Transportation Authority (SFCTA). The scenario would charge $3 during AM/PM rush hours to travel into or out of the northeast quadrant of San Francisco which includes a concentration of San Francisco’s currently congested downtown streets. The scenario performed best (i.e., greatest benefits with fewest impacts) among dozens of scenarios studied, weighing SFCTA study criteria such as change in traffic and transit congestion, environmental benefits, and economic benefits. To date, no planning study for a specific road pricing proposal in the United States has included a comprehensive assessment of health impacts.

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Translating Research to Policy Through Health Impact Assessment in Clark County, Washington: A Commentary to Accompany the Active Living Research Supplement to Annals of Behavioral Medicine

Description: 

Haggerty, B., & Melnick, A. (2013). Translating Research to Policy Through Health Impact Assessment in Clark County, Washington: A Commentary to Accompany the Active Living Research Supplement to Annals of Behavioral Medicine. Annals of Behavioral Medicine, 45(Suppl 1), S6-S8.

Date: 
02/01/2013
Location by State: 

Page Avenue Health Impact Assessment: Building on Diverse Partnerships and Evidence to Promote a Healthy Community

Date: 
01/01/2012
Description: 

Hoehner, C.M., Rios, J., Garmendia, C., Baldwin, S., Kelly, C.M., Knights, D-M., et al. (2012). Page Avenue Health Impact Assessment: Building on Diverse Partnerships and Evidence to Promote a Healthy Community. Health & Place, 18(1), 85-95.

Abstract: 

The Page Avenue health impact assessment (HIA) was focused on a redevelopment in Missouri. This case study describes a comprehensive HIA led by an interdisciplinary academic team with community partners, as well as compliance with North American HIA Practice Standards. Some of the key lessons learned included: (1) interdisciplinary teams are valuable but they require flexibility and organization; (2) engaging community stakeholders and decision-makers prior to, during, and following the HIA is critical to a successful HIA; and (3) HIA teams should not be too closely affiliated with decision-makers. It is hoped that this case study will inform future HIAs.

Location by State: 

Rapid Health Impact Assessment: Clark County Bicycle and Pedestrian Master Plan

Description: 

Melnick, A., Hyde, J., Haggerty, B., & Lebowsky, L. (2010). Rapid Health Impact Assessment: Clark County Bicycle and Pedestrian Master Plan. Clark County, WA: Clark County Public Health.

Date: 
05/01/2010
Location by State: 

Translating Research to Policy: Health Impact Assessment in Clark County, WA

Description: 

Translating Research to Policy Award presentation at the 2012 Active Living Research Annual Conference.

Learn more about the 2012 Translating Research to Policy Award recipient.

Date: 
03/13/2012
Location by State: 

Hawaii's Opportunity for Active Living Advancement (HO'ALA): Addressing Childhood Obesity through Safe Routes to School

title-long: 
Hawaii's Opportunity for Active Living Advancement (HO'ALA): Addressing Childhood Obesity through Safe Routes to School
Date: 
07/01/2011
Description: 

Heinrich, K.M., Dierenfield, L., Alexander, D.A., Prose, M., & Peterson A.C. (2011). Hawaii's Opportunity for Active Living Advancement (HO'ALA): Addressing Childhood Obesity through Safe Routes to School. Hawaii Medical Journal, 70(7, Suppl 1), 21-26.

Funding Source: 
Funding by the Active Living Research program of the Robert Wood Johnson Foundation
Abstract: 

Increasing active transportation to and from school may reduce childhood obesity rates in Hawai‘i. A community partnership was formed to address this issue in Hawai‘i’s Opportunity for Active Living Advancement (HO‘ÄLA), a quasi-experimental study of active transportation in Hawai‘i County. The purpose of this study was to determine baseline rates for active transportation rates to and from school and to track changes related to macro-level (statewide) policy, locally-based Safe Routes to School (SRTS) programs and bicycle and pedestrian planning initiatives expected to improve the safety, comfort and ease of walking and bicycling to and from school. Measures included parent surveys, student travel tallies, traffic counts and safety observations. Assessments of the walking and biking environment around each school were made using the Pedestrian Environment Data Scan. Complete Streets and SRTS policy implementation was tracked through the activities of a state transportation-led Task Force and an advocacy-led coalition, respectively. Planning initiatives were tracked through citizen-based advisory committees. Thirteen volunteer schools participated as the intervention (n=8) or comparison (n=5) schools. The majority of students were Asian, Native Hawaiian, and Pacific Islander in schools located in under-resourced communities. Overall, few children walked or biked to school. The majority of children were driven to and from school by their parents. With the influence of HO‘ÄLA staff members, two intervention schools were obligated SRTS project funding from the state, schools were identified as key areas in the pedestrian master plan, and one intervention school was slated for a bike plan priority project. As the SRTS programs are implemented in the next phase of the project, post-test data will be collected to ascertain if changes in active transportation rates occur.

Resource URL: 
http://www.hawaiimedicaljournal.org/70.07.suppl1.htm
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Zoning for a Healthy Baltimore: A Health Impact Assessment of the TransForm Baltimore Comprehensive Zoning Code Rewrite

title-long: 
Zoning for a Healthy Baltimore: A Health Impact Assessment of the TransForm Baltimore Comprehensive Zoning Code Rewrite
Funding Source: 
Funded by the Active Living Research program of the Robert Wood Johnson Foundation
Date: 
08/01/2010
Description: 

Thornton, R.L.J., Fichtenberg, C.M., Greiner, A., Feingold, B., Ellen, J.M., Jennings, et al. (2010). Zoning for a Healthy Baltimore: A Health Impact Assessment of the TransForm Baltimore Comprehensive Zoning Code Rewrite. Baltimore, MD: Johns Hopkins University Center for Child and Community Health Research.

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Comprehensive Health Impact Assessment: Clark County Bicycle and Pedestrian Master Plan

title-long: 
Comprehensive Health Impact Assessment: Clark County Bicycle and Pedestrian Master Plan
Funding Source: 
Funded by the Active Living Research program of the Robert Wood Johnson Foundation
Date: 
12/01/2010
Description: 

Melnick, A., Hyde, J., Haggerty, B., & Lebowsky, L. (2010). Comprehensive Health Impact Assessment: Clark County Bicycle and Pedestrian Master Plan. Clark County, WA: Clark County Public Health.

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