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August 2012 Newsletter

TRB Health and Transportation Subcommittee Newsletter
This Issue: Puerto Rican Health Study, Sustainability Behaviors, and How to Get Involved

Greetings, friends of the TRB Health and Transportation Subcommittee (ADD50-01),

Our subcommittee has been growing – we now have more than 250 friends! As we prepare for the 2013 TRB Annual Meeting and other meetings, we invite you to join us in our many endeavors. New friends are welcome to join online. The Communications Working Group and the Research Needs Working Group welcome additional support. The Communications Working Group would also like to know how you’d like to receive information from the subcommittee, so please fill out our second information needs survey. Email the leads if you’d like to learn more or get involved:

  • Communications: Phyllis Orrick of SafeTREC at UC Berkeley (phylliso@berkeley.edu) and Carolyn (Carey) McAndrews, a Robert Wood Johnson Foundation Health & Society Scholar at the University of Wisconsin, Madison (cmcandrews@wisc.edu).
  • Research Needs: Andrew Dannenberg of the University of Washington and the Centers for Disease Control (acd7@cdc.gov) and Carey McAndrews (cmcandrews@wisc.edu).

On July 27, 2012, we had our Summer Subcommittee Meeting. The meeting started with a round robin of updates, and then two special presentations followed: Lilly Shoup from the DOT Office of the Secretary gave an overview of the DOT/CDC Healthy Communities Index initiative and Bill Lyons and other colleagues from the Volpe Center talked about a case study report highlighting MPOs' good practices regarding public health. The two subcommittee Working Groups provided updates as well. Visit the website to see presentation slides and links to documents and other references that were shared during the meeting.

With the passage of a new federal transportation bill, the TRB 2013 Annual Meeting is sure to be full of chatter about what the bill means for health-related issues in transportation. As of August 1st, several papers in response to our call for papers have been received; we thank everyone who submitted a paper and everyone who volunteered to serve as a paper reviewer. This is a great opportunity for our friends to get involved with the subcommittee. If you missed the chance to complete the form to become a paper reviewer, we invite you to complete the survey today.

Feature Articles

Research Summary: Urban traffic exposure in the Puerto Rican Health Study

By Ellin Reisner, Somerville Transportation Equity Partnership

People living close to major roads or in areas with greater traffic volume may be at a higher risk of getting sick because of chronic exposure to elevated levels of pollutants, as well as louder background noise. Researchers at Tufts and Northeastern University in Boston have conducted a study to determine if living close to traffic might cause an increased risk of cardiovascular disease (CVD), such as heart attacks and strokes. Dr. Christine Rioux and colleagues at Tufts and Northeastern Universities looked at participants in the Boston Puerto Rican Center for Population Health and Health Disparities study aged 45-75 in the greater Boston area. Dr. Rioux looked at the levels of C-reactive protein (CRP) in the blood of the 1,017 study participants, as well as their pulse pressure (the difference between the higher and lower numbers of blood pressure measurements) because both are signs of an increased risk of heart attack or stroke. Exposure to traffic was calculated in two different ways. Participants’ home addresses were used to find the distance to major roads on which more than 20,000 vehicles traveled per day and at the amount of traffic on the roads surrounding participants’ homes using Transportation Analysis Zones (TAZ) data from the Boston Region Metropolitan Planning Organization (MPO).

After considering many factors, significantly higher CRP levels were found in study participants living in areas with the highest traffic volume compared with people living in areas with the lowest traffic volume. When looking at only participants who were obese, those who live within 200 meters of a major road, as well as those living in areas with higher traffic volume, had higher CRP than those obese participants with lower levels of traffic exposure. People living within 200 meters of two or more major roads were found to have higher pulse pressure than those with no major roads close to their residence. The pulse pressure difference was even higher when looking at only obese participants and when looking at only those with diabetes.

This study contributes to an increasing body of evidence that people living closer to major roads or in high-traffic areas may experience greater risks of numerous health problems. In addition, people with diabetes or obesity, who are already at a higher risk of CVD and heart attacks, may be at an even greater risk of these conditions when they are also exposed to high levels of traffic and pollution. To learn more about this research, please refer to the following source in Environmental Health Perspectives: http://dx.doi.org/10.1289/ehp.0901182.

map of study subjects with diabetes in urban traffic exposure stduy
Dr. Rioux and her fellow researchers also noticed an interesting trend in people with Type 2 diabetes while investigating whether individuals in the Boston Puerto Rican Health Study were at an increased risk of heart attack and stroke if they lived closer to major roads. When they looked at just people in their study who had diabetes, they noticed the trend they expected was reversed. People with diabetes living closer to major roads had a lower risk of heart attack and stroke than those living further away from major roads. The darker areas have more traffic, while the lighter zones are less well-traveled. The black dots represent participants in the study.

This interesting finding prompted a focus on the population of 379 study participants with Type 2 diabetes. Researchers looked at the different medications people were taking to control their diabetes to determine if diabetes medication affects the relationship between exposure to traffic and risk of heart attack and stroke.

The risk of heart attack and stroke was determined by measuring levels of C-reactive protein found in study participants’ blood samples. C-reactive protein (CRP) is found in everyone’s blood. When people are sick, CRP levels rise as part of the immune system’s response to infection. High CRP is also a warning that someone is at risk of having a heart attack or stroke. CRP is also higher in people with Type 2 diabetes. To learn more about this research, refer to the following source in Environmental Pollution: http://www.sciencedirect.com/science/article/pii/S0269749110005919.


Sustainable Environments, Sustainable Behaviors

By Ipek Nese Sener, PhD, Texas Transportation Institute

Walking and bicycling are the two primary modes of transportation that provide numerous environmental, health and economic benefits. After years of research, it is a well-established fact that these active transportation modes not only provide transportation solutions in terms of congestion management, air quality and energy dependency, but also offer substantial health benefits, thereby enhancing the livability and mobility of our lives. For instance, according to a recent Bicycling and Walking in the United State: 2012 Benchmarking Reportsupported by the Centers for Disease Control and Prevention (CDC), there are significant and positive correlations between higher levels of walking/bicycling and lower levels of certain diseases such as obesity, hypertension and diabetes. Undeniably, walking and bicycling lie at the crux of sustainable transportation and public health.

On the other hand, despite the known benefits of walking/bicycling, not many of us use these active modes as means of transportation. The CDC report indicates that only 12% of all trips are made by walking and biking; critically, more than 60% of trips one mile or shorter are made by car in the U.S. Many agencies have initiated programs to encourage people to be more active and use active modes of transportation, but the impact of these efforts has been minimal. What really prevents us from walking or biking (more)? As sedentary travel behavior becomes increasingly prevalent in the U.S., and in recognition of the significant relationship between health and transportation, many transportation researchers have been examining the barriers to non-motorized travel. Among others, neighborhood environmental characteristics are being acknowledged as one of the primary constraints. It is obvious that the lack of walkable/bikable communities adversely influences our decision to walk/bike; development of mixed land-use neighborhoods, increased accessibility, and greater connectivity considerably increase walk/bike trips.

an image of self-powered people
As researchers however, we should also keep in mind that we are concerned with complex human behavioral mechanisms. In other words, we are dealing with humans, who  are inherently affected by various emotional, physiological, and social factors, habits, inertias, attitudes, and perceptions. Consequently, we need to acknowledge that individuals oftentimes function with many self-imposed attitudinal or behavioral constraints that prevent them from walking for even very short distances and  others may never even consider walking/biking as an option regardless of the environment. Perhaps then it is worth entertaining the idea that sometimes it is individuals themselves with their self-imposed/perceived constraints discouraging non-motorized behavior, other times the environment, and sometimes both. Therefore, giving equal emphasis to both observed and unobserved components of the problem may help to further understand what prevents people from walking/biking (more); and the true solution might be hidden under an umbrella of solutions.

New Resources of Note

Sustainable Transportation Analysis & Rating System (STARS)

Looking for a tool to improve the safety, health, and equity outcomes of transportation and land use plans and projects? Upstream Public Health, the North American Sustainable Transportation Council and the Portland (OR) Bureau of Transportation recently published the STARS Safety, Health and Equity Credits to help agencies better integrate these concerns. The Safety, Health, and Equity Credits are part of a suite of transportation planning tools offered through STARS, the Sustainable Transportation Analysis & Rating System. STARS is an evaluation framework and rating system for developing, analyzing, and rating outcome-based transportation plans and projects. The STARS Safety, Health, and Equity Credits integrate health at the start of the plan or project by rewarding agencies that establish safety, health and equity-related goals and measurable performance objectives, such as increasing walk, bike and transit mode splits, in the project corridor or plan area.  STARS also addresses access and mobility, climate and energy, and economic benefit.

Report from Transportation Alternatives: Crime and Walkability: Mid-August Release

Much research supports that residents living in lower income neighborhoods are more likely to walk than use other modes of transportation, particularly in their own neighborhoods. While those neighborhoods are generally more accommodating to walking than others, those neighborhoods are also more likely to have higher crime rates and other incivilities. Transportation Alternatives’ new report, Safe Streets are Healthy Streets: The Role of Crime and Traffic in Neighborhood Health, to be released in mid-August, diagnoses how crime and incivilities may impede physical activity. Transportation Alternatives compared measures of safety and physical activity in two New York City Police Department (NYPD) precincts in Brooklyn: Brownsville, which has a high crime rate and Cobble Hill, where the crime rate is low.

The investigation of both quantitative and qualitative measures of crime, perceptions of neighborhood safety and physical activity in these neighborhoods make this endeavor unique. Of note, this is the first community-based project about crime and physical activity to utilize the Photovoice methodology to inform local change. 

In both Brownsville and Cobble Hill, traffic safety concerns and community recreation space deficits were found to be community concerns. Yet notably, children from the Brownsville neighborhood who participated in the project engaged in significantly less neighborhood-based physical activity than their Cobble Hill counterparts. This disparity is influenced by police harassment of youth, as well as increased perceptions of crime.

To increase neighborhood physical activity, and overcome the disparity between physical activity levels in high and low crime areas, Transportation Alternatives makes the following recommendations:

  1. Design street infrastructure to improve pedestrian safety and reduce driver speeding
  2. Build more centrally-located public recreation centers to improve access to physical activity
  3. Educate youth about their rights, and
  4. Host NYPD-led youth programs to reduce harassment and improve relations between youth and police officers.

Tool on Health Impact Assessments: Final Report Coming Soon

bus riders
Urban Design 4 Health, in partnership with Placeways, recently completed the development of evidence-based Health Impact Assessment (HIA) software tools for San Diego County, California, and Toronto, Ontario. Using results from analyses based on local data, a range of health-related indicators were added to the CommunityViz GIS-based scenario planning software. The resulting tool allows public health officials and planners to quantify and compare the health impacts of transportation and land use decisions efficiently and consistently, alongside an array of already-available planning indicators.

To use the tool, users enter detailed parcel level land use, transportation system, and accessibility characteristics of potential development or redevelopment scenarios. The HIA tools predict the impacts of these scenarios on a wide range of health indicators. The indicators include utilitarian physical activity (minutes of walking and biking), minutes of sedentary transportation, minutes of leisure physical activity, body mass index, overweight/obesity, diabetes, cardiovascular disease, high blood pressure, asthma and risk of pedestrian/cyclist collisions with automobiles. 

Users can also modify land use characteristics (land uses, housing types and densities), transportation system characteristics (street connectivity, sidewalk and bike lane coverage, transit service type and stop/route locations) and locations of schools, parks and food outlets. The tools account for demographic and socioeconomic characteristics, such as age, gender, income, education, race/ethnicity, household size and vehicle ownership. The tools have been successfully applied to evaluate health impacts in both regions already. Final reports and documentation are complete and forthcoming soon. For further information on these tools, please contact Sarah Kavage at skavage@ud4h.com or Lawrence Frank at ldfrank@ud4h.com.

Easter Seals on Access to Transportation Choices

Easter Seals is working with national stakeholders to seek answers to whether access to transportation choices affects individuals’ health and wellness. Recent efforts include leading a research initiative funded by Federal Transit Administration (FTA) cooperative agreements, and partnering with AARP to host an exchange with other national organizations on health and transportation. In May 2012, Easter Seals and AARP convened stakeholders across public health, transportation and human services to discuss possible synergies between health and wellness and access to transportation. Attendees agreed there is an opportunity to improve health and wellness by breaking down service silos; panelists shared the value of coordinated planning, mobility management and coalition building.

The Easter Seals Transportation Group will soon release Dr. Tom Prohaska’s final report with a literature review on the intersection between health and wellness and transportation. The study uses data provided by Logisticare, and scientific support from the American Medical Association. Dr. Prohaska’s Healthy Aging Network Team, a program funded by the Centers for Disease Control and Prevention, found empirical support for a number of links between health and access to non-emergency medical transportation. These findings include the importance of dialysis transportation, the role of age and ambulation in accessing transportation resources and the costs of medical transportation. The final reports will soon be posted on http://www.projectaction.org


highway lanes
Get Involved: Selected Upcoming Events

NCHRP proposal deadline is right around the corner: September 15, 2012

 The next deadline for a National Cooperative Highway Research Program (NCHRP) proposal is coming up on September 15, 2012.  Submitting research needs statements is a good way to get involved in TRB, and this is a real opportunity to advance knowledge of transportation and health.  If you or your organization has research needs that you would like to propose through the Health and Transportation Subcommittee, we can organize a working group to draft them. If you are working with other TRB committees and think that our groups’ research needs overlap, then we can coordinate across the groups.  If you want to contribute to writing or reviewing proposals, there are a few proposals underway including: cost-benefit analyses of active transportation investments as they relate to health, and the link between food security and transportation. Read more about the NCHRP, and see this TRB publication about how to write an effective research needs statement. For more information, contact Carolyn McAndrews (cmcandrews@wisc.edu) or Andy Dannenberg (acd7@cdc.gov).

Learn more about active transportation at Pro Walk/Pro Bike 

Pro Walk/Pro Bike: Pro Place will take place in Long Beach, Calif. this year on Sept. 10-13, 2012. This is a conference focusing on walking, bicycling, and creating great communities through place-making. The Pro Walk/Pro Bike summit brings together advocates and practitioners across different disciplines.  

Free webinar series on active transportation and health

 The Pedestrian Bicycle Information Center and the American Public Health Association have collaborated to offer a three-part webinar series on active transportation and health. The first webinar in the series was held in late July 2012, and was titled Using Health Impact Assessments to connect bicycle and pedestrian safety and health. Presenters hailed from the Health Impact Project, St. Louis County, Minnesota, Public Health and Human Services, the Arrowhead Regional Development Commission Regional Planning Division, and the Clark County, Washington Public Health Department. Webinars are planned for September 19 and November 13 2012, and will look at the health benefits of pedestrian and bicycle initiatives funded by Communities Putting Prevention to Work grants and ways public health professionals are supporting trail programs. Check the website for more details as the dates near.

Calendar of Events

 2012

August

6-9 - National Conference of State Legislatures (NCSL) - Legislative Summit: Chicago
12-15 - Institute of Transportation Engineers (ITE) Annual Meeting: Atlanta
14-16 - State Public Transportation Partnership Conference: Chicago (co-sponsored by AASHTO, APTA and CTAA)

September

10-13 - ProWalk/ProBike: Long Beach, Calif.
12-14 - Transportation Planning for Small and Medium-Sized Communities: Big Sky, Mont.
30-10/3 - American Public Transportation Association (APTA) Annual Meeting: Seattle

October
3 - Walk to School Day: International
14-17 - Rail~Volution: Los Angeles
27-30 - American Public Health Association (APHA) Annual Meeting: San Francisco

2013

January
13-17 - Transportation Research Board (TRB) Annual Meeting: Washington

 February
7-9 - New Partners for Smart Growth Conference: Kansas City, Mo.