Environmental Health Capacity Building: Health Impact Assessment at the Federal, State, and Local Level
- S. Heaton Kennedy, Centers for Disease Control and Prevention
- A. Dannenberg, Centers for Disease Control and Prevention
Background: Efforts to increase physical activity and reduce injury and chronic disease are advanced or hindered as we build, renew, and maintain our transportation systems, infrastructure, and public spaces. Community design decisions that do not assess potential health impacts are missed opportunities to provide a larger return on investment over time through prevention of disease and injury and improved health outcomes. Health impact assessment (HIA) is a framework of procedures and tools that such projects, policies, and programs can be evaluated based on their potential effects on the health of a population and the distribution of those effects within the population. Issue: HIA is employed internationally and domestically by public health professionals and nonpublic health professionals in collaboration with public health experts to inform the decision-making process as to the potential health effects of a proposed action. HIA in community design decision making is a critical area for development in US environmental health practice. Results: CDC National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) strategies are currently employed through the Healthy Community Design Initiative (HCDI) to increase the capacity of the environmental health workforce to be effective contributors in community design decision-making processes. These capacity-building efforts include supporting (1) HIA-methods training, (2) collaborations and technical assistance to employ HIA in transportation and land use proposals, (3) programmatic development that broadens the scope of health impact assessment in federal environmental policy, and (4) research and communications objectives to grow the evidence base and educate stakeholders and students of public health and planning on the health impacts of land use, transportation, and community design projects, policies, and plans. Lessons Learned: This presentation will discuss current efforts and challenges to improve health outcomes through the Healthy Community Design Initiative.
Overcoming Challenges Facing Rural Children's Environmental Health: A Novel Community and Family-Based Approach
- C. Waggett , Allegheny College
- L. Herendeen , University of North Carolina Chapel Hill
- K.Castillo , Allegheny College
- K. Huser , Allegheny College
Top childhood health concerns—obesity/overweight, asthma, and lead poisoning—have environmental etiologies and are in part or entirely preventable. However, prevention is sorely lacking, particularly in rural regions. Rural America is home to 14 million children. Rural families are more likely than urban families to live in poverty, and rural ethnic minorities are more than 3 times as likely as whites to live in poverty. There are enormous challenges to provide prevention services to rural families, such as transient patients, infrequent well-visits, and high demand for few pediatricians. Little time exists for prevention messages. We discuss a comprehensive community-based approach to rural childhood health, focusing on home environments and families' behavioral patterns. While targeting homes has been successful in urban settings, rural regions are widely dispersed. Focusing on the home must be combined with other community-based efforts to reach families effectively. In rural northwestern Pennsylvania, despite alarming figures of high childhood lead poisoning rates and a majority of homes failing lead dust tests, community partners chose not to focus exclusively any one initiative that might detract from the multitude of health concerns facing this region's children. In response, we developed Healthy Homes-Healthy Children (HHHC), a program partnering together schools, social service and health agencies, medical communities, and researchers to focus on collective strategies to reduce environmental childhood illnesses. Intervention efforts incorporate free in-home assessments; professional training for educators, health care, and social workers; community and educational outreach; and building community health capacity among undergraduates and youth. Moreover, it strengthens families as the primary foundation for children's health, instead of stressing the overburdened rural health care system. We highlight lessons learned for building health-based coalitions and prevention efforts in rural low-income children.
Changing Home Environmental Health Behaviors—The Power of Home Based Interventions
- M. Shea , Baltimore City Health Department
- S. Norman , Baltimore City Health Department
- L.Necochea , Baltimore City Health Department
Background/Objectives: Baltimore launched a “healthy homes” program in 2007 to develop, implement, and evaluate a model to expand an urban childhood lead poisoning prevention program to reduce asthma triggers, injury risks, carbon monoxide poisoning, and fire mortality. While some home environmental hazards are structural (i.e., housing quality), many are behavioral (i.e., cleaning, smoking, pest management, infant care). Staff received 89 hours of training in home environmental risk reduction knowledge and skills, including motivational interviewing, and used standardized assessment, inspection, education, and case management tools. Methods: Trained community health workers (CHWs) and inspectors assessed home environmental risks to provide tailored risk reduction education to reduce lead exposure, asthma triggers, fire and injury hazards, and infant death. Three months later staff reassessed risks and hazards using standardized forms. Results: A total of 60 matched pretest/posttest results show statistically significant behavioral changes important to home environmental risk reduction. A total of 65% of families reported indoor smoking at baseline compared to 45% 3 months later. Average number of indoor smokers decreased from 1 to 0.65; and evidence of smoking decreased from 50% to 37%. At baseline 58% of infants had a safe place to sleep compared to 89% 3 months later. Only 36% of homes were free of garbage and debris at baseline compared to 68% 3 months later. Conclusions/Implications: Home environmental health promotion often requires behavior change from interventionists and from caregivers—yet behavior change theory is rarely embedded in healthy homes models that build from enforcement approaches to risk reduction. Transitioning from childhood lead poisoning prevention programs with clearly defined hazards and health impacts to a comprehensive home environmental health program with more ambiguous priorities and solutions required a new approach informed by behavior change theory and practice.
Building Effective Partnerships to Promote Healthy Housing
- S. Fischbach, Rhode Island Legal Services
Background: The general public fails to recognize the relationship between common hazards found in residences and public health. No single actor can effectively communicate the public health consequences of cockroach infestation, mold, poorly maintained heating and ventilation systems, etc., to the general public. Collaboration among different stakeholders is a prerequisite for an effective healthy housing program. Issue: The Rhode Island Department of Health (RIDOH) developed a Healthy Housing Collaborative, composed of government agencies, community organizations, health providers, and others concerned about health and housing. The collaborative provides the space where different actors come together to share ideas and to develop a coordinated campaign that promotes healthy housing. Prior to the collaborative's formation, RIDOH brought several of the agency's programs under a single healthy housing banner. By doing so, RIDOH was able to recruit a wider range of stakeholders into the collaborative. Results: The collaborative has undertaken a wide range of activities, including the development of a Healthy Housing Data Book ; an Annual Healthy Housing Conference; trainings on healthy housing targeted to specific audiences such as nurses and judges; and educational materials for the general public. Members of the collaborative have framed healthy housing as an environmental justice issue, resulting in greater awareness of health-related problems in homes located in low-income and minority neighborhoods. Lessons Learned: State and local health departments are well positioned to take a leadership role in bringing together diverse actors to promote healthy housing. However, health departments, by themselves, cannot reach the many different sectors of society needed to bring about changes in housing conditions that improve health.
A Qualitative Report of the Baltimore City Transition From Lead Poisoning Prevention to Healthy Homes
- E. Maring , University of Maryland
- B. Singer , University of Maryland
- E.Shenassa , University of Maryland
The goal of this project was to create a guide for programs considering transition from lead poisoning prevention to healthy homes. The guide is a tool for state, local, and community agencies with resources to create and implement a successful program. Healthy homes programs are comprehensive, focusing on multiple residential housing hazards. This study focused on the Baltimore City Healthy Homes Division, which was selected by the Centers for Disease Control and Prevention to pilot the transition process. For this project, qualitative interviews with individual program staff and community focus groups with program participants were conducted. Grounded theory procedures were used for data analysis. Seventeen interviews were conducted with Baltimore City Healthy Homes Division staff. Three focus groups were held with 3–6 community participants in each group. Findings for the study are arranged around an organizational framework for which transition from lead poisoning prevention to healthy homes is the central phenomenon. Three general themes emerged: (1) programmatic changes; (2) policy changes; and (3) partnerships. Quotations from participating staff and community members provide supporting evidence for the results. Findings provide insight into the strengths and challenges of transition for one program. The study has implications for change on a national level as programs around the country transition to provide families with comprehensive healthy homes services.
Wisconsin Healthy Homes Program—An Overview
- B. Thompson , Wisconsin Division of Public Health
Background: The Wisconsin Bureau of Environmental and Occupational Health (BEOH) received a 3-year grant from the Centers for Disease Control and Prevention to conduct healthy homes outreach in 2007. BEOH partnered with 3 communities with which BEOH had existing relationships: Menominee Tribe of Wisconsin, Oneida Tribe of Indians of Wisconsin, and the Sixteenth Street Community Health Center in Milwaukee. The program is housed in community health centers/clinics serving low-income populations. There are 2 main components to this program: clinical intervention and home intervention. Through the home intervention component, outreach workers in each community conduct a home assessment and based upon their findings provide individualized education, interventions and community referrals to increase the health and safety in a client's home. Issues: People spend 90% of their time indoors. Defects in the home can be a source of multiple diseases, injuries, and possibly death. Oftentimes outreach workers go into homes, but only to address one issue. With public health budgets too tight to add additional home visitors, we saw the need for home visitors to expand their duties and to address multiple issues while in a home. Results: The 3 pilot communities combined to provide 300 interventions in 120 homes during the first year of this program. For the clinical intervention component, an online clinician library was developed as well as a poster that is placed in clinic exam rooms and waiting areas. For year 3, BEOH is considering offering mini-grants to additional communities to expand the program. Lessons Learned: Having outreach workers who already go into homes integrate a healthy homes program into their existing home visits is a successful way to initiate a healthy homes program.
A Suite of Healthy Homes Training for Health and Housing Professionals
- S. Aceti , National Center for Healthy Housing
Background: Funded by the US Centers for Disease Control and Prevention and the US Department of Housing and Urban Development, the National Center for Healthy Housing (NCHH) has been training health and housing professionals since 2005 through the Healthy Homes Training Center and Network (the Training Center). The Training Center has reached nearly 5,000 students through its flagship course, Essentials for Healthy Homes Practitioners, and a growing number of other courses. Issue: NCHH has expanded the selection of courses to provide a mix of training to more fully meet the needs of the health and housing professionals. These courses include the following: (1) Integrated Pest Management in Multi-Family Housing, designed to help property managers implement an integrated pest management program; (2) Healthy Homes for Community Health Workers, created to teach community health workers how to provide healthy homes information to members of their communities; (3) Code Inspection for Healthier Homes, which helps students identify health-related provisions of state and local housing codes and the International Property Maintenance Code, and describes strengths and weaknesses of various enforcement strategies; and (4) Launching a Healthy Homes Initiative, which brings together health and housing professionals from state and local agencies and other health and housing organizations to identify policies and practices to establish programs to make homes healthier.
An Evaluation of the Health Outcomes of Green and Healthy Housing Rehabilitation
- D. Jacobs , National Center for Healthy Housing
- J. Breysse , National Center for Healthy Housing
- C.Kawecki , National Center for Healthy Housing
- S. Aceti , National Center for Healthy Housing
- S. Dixon , National Center for Healthy Housing
- W. Weber , University of Minnesota
Background: The health outcomes associated with incorporating green and healthy housing principles into low-income housing rehabilitation have not been adequately characterized. Methods: The green, healthy housing rehabilitation studied here included improved ventilation with fresh air, low-VOC materials, integrated pest management, moisture management, geothermal energy, radon mitigation, and other features. Resident health was assessed with an adaptation of the Centers for Disease Control (CDC) National Health Interview Survey, ventilation measurements, and environmental testing. Results: In adults there were large improvements in general health, chronic bronchitis, hay fever, sinusitis, and asthma (p<0.05). Hypertension in adults also improved marginally (p = 0.083). Children's general health, respiratory allergies, ear infections, comfort, safety, and ease of house cleaning all improved but were not statistically significant due to small sample size. Building performance testing showed a tight building envelope and the need for improved duct sealing and exhaust ventilation. Radon mitigation was effective (<2 pCi/L), and VOCs were low. Conclusion: The results show that using green principles in low-income housing rehabilitation can produce significant health improvements for residents.
Challenges and Opportunities in Designing Health-Promoting Zoning Code: A Case Study of TransForm Baltimore
- A. Greiner , Johns Hopkins University
- D. German , Johns Hopkins University
- B.Feingold , Johns Hopkins University
- C. Fichtenberg , Baltimore City Health Department
- M. Shea , Baltimore City Health Department
Zoning codes, which regulate private land use and building form, have the potential to impact aspects of the built environment that have been shown to affect health behaviors such as physical activity, mental health, healthy eating, and violence, among others. Baltimore, Maryland, is currently revising its zoning code for the first time in nearly 40 years. Realizing the public health potential that this opportunity presents, the Baltimore City Health Department and a group of local public health students have been collaborating with the city Planning Department over the past year to (1) identify recommendations for how to modify the zoning code in ways that would maximize health, (2) gather the evidence to support those recommendations, and (3) advocate for such modifications to be included in the zoning recode. To date, the group has identified the following public health priorities for the zoning code rewrite: expanding areas that permit a mix of use to address mental health and cardiovascular diease limiting the concentration of harmful retail (fast food, liquor stores), promoting an urban form that facilitates social cohesion and increases the aesthetic quality of the environment, preventing crime through environmental design guidelines, increasing green space requirements, and including public health experts in the decision-making process. To accomplish the above goals, the group identified ways that public health priorities overlap with other city goals including sustainability and the city's latest comprehensive master plan and identified specific sections of the code where the above priorities could be introduced. As current zoning practice is often disconnected from its public health roots, it can be difficult to reintegrate health as an objective. However, substantial overlap exists among public health goals and other stakeholder interests (planners, architects, developers, sustainability). As such, great potential exists for health recommendations to be included in this and other zoning codes.
Health and Housing Data
- M. Angeloni , Rhode Island Department of Health
- R. Vanderslice , Rhode Island Department of Health
- D.Quilliam , Rhode Island Department of Health
Background: The Rhode Island Department of Health has strong interest in learning more about the association between housing conditions and health effects, especially among children. The first step in the exploration process was an assessment of health- and housing-related resources that exist throughout the state. The assessment found that health and housing data are available; however, the lack of consistency across data sets limits the utility of existing data sets and highlights the need for a standardized data collection tool. Issue: During 2005, the Rhode Island Department of Health addressed this need by developing a comprehensive health and housing questionnaire that could potentially be used by various agencies and organizations throughout the state. In 2006, the home visiting agencies were the first to implement the questionnaire by incorporating it into routine home visits for high-risk newborn babies. Results: Thus far, data have been collected from more than 3,000 homes and have been compiled into a single database. These data are used to assess the feasibility of using the questionnaire to collect standardized information on the quality of housing and the presence of heath hazards in the home. In the third year of the data collection we learned that additional standardization of the questions and training of those collecting the data were critical to improve the quality of the data. As a result, the questionnaire was revised and streamlined. Lessons Learned: This presentation will include analyses based on the data from the Family Outreach Program and the Lead Centers and major challenges relative to the collection of healthy housing data.
American Healthy Homes Survey: The Relationship Between Pesticides Measured From Residential Floors, Pesticide Usage, and Housing Factors
- K. Bradham , US Environmental Protection Agency
- D. Stout , U.S. Environmental Protection Agency
- P.Egeghy , U.S. Environmental Protection Agency
- P. Ashley , U.S. Environmental Protection Agency
- E. Pinzer , U.S. Department of Housing and Urban Development
- W. Friedman , U.S. Department of Housing and Urban Development
The US Department of Housing and Urban Development in collaboration with the US Environmental Protection Agency conducted a survey measuring lead, allergens, and insecticides in a randomly selected nationally representative sample of residential homes. Multistage sampling with clustering was used to select the 1,131 homes, of which a subset of 500 randomly selected homes included the collection of hard surface floor wipes. Samples were collected between June 2005 and March 2006 using isopropanol wetted wipes and analyzed for a suite of 24 compounds that included insecticides in the organochlorine, organophosphate, pyrethroid, and phenylpyrazole classes, and the insecticide synergist piperonyl butoxide. The most commonly detected insecticides were permethrin (89%), chlorpyrifos (78%), chlordane (64%), piperonyl butoxide (52%), cypermethrin (46%), and fipronil (40%). Mean and geometric mean (GM) concentrations varied widely among compounds, but were highest for trans-permethrin (mean 2.22 ng/cm2 and GM 0.14 ng/cm2) and cypermethrin (mean 2.9 ng/cm2 and GM 0.03 ng/cm2). Results show that most floors in occupied homes in the United States have measurable levels of insecticides that may serve as sources of exposure to occupants. Preliminary findings will be presented relating the pesticide concentrations measured in homes and their relationships to the study's questionnaire results (housing factors and pesticide usage).
Bedbugs: Working Towards an Innovative Collaborative Solution for an Ancient Public Health Problem
- L. Rossi , U.S. Environmental Protection Agency
- S. Jennings , U.S. Environmental Protection Agency
Reports of bedbug infestations are surging in communities across the United States, affecting people from almost every ethnic and socioeconomic background. Although they are not known to vector disease, bedbugs cause a variety of negative physical, mental, and economic health consequences. Many communities are challenged by bedbugs. Local public health departments work with scarce resources, municipal codes struggle to identify responsible parties, while pesticide resistance and limited control options make control even more difficult. An integrated pest management (IPM) approach is the most effective means of control, but implementation on a communitywide scale requires active participation from residents to be successful. In April 2009 the Environmental Protection Agency (EPA) conducted a National Bedbug Summit, attended by 231 stakeholders in person and 138 via webinar. This meeting culminated with a list of recommended actions for EPA. Since this time, EPA has been actively working with the pesticide industry and academia to identify new pesticides to combat bedbugs. A new interagency task force has been organized to specifically target bedbug control on the federal level. In addition, EPA will also be updating its Web site in the near future to include a site specifically devoted to bedbugs and creating a permanent working group to advise the agency on public health issues (such as bedbugs) involving pesticides. Because resources are increasingly limited, it is crucial that all facets of government, industry, and academia work together efficiently. Effective bedbug control takes active participation and cannot be done in isolation, especially when multi-unit housing is involved. Actively collaborating and communicating among all stakeholders will be the key to minimizing cost and maximizing control at the community level.
Public Health Agency Response to Lead-Contaminated Drinking Water
- R. Scott , Alliance for Healthy Homes
A recent public health crisis of high lead levels in drinking water in the District of Columbia and frequent findings of high lead levels in tap water in schools in several US cities remind us of the importance of water as a significant, yet largely disregarded, lead exposure source. This presentation addressed lead in drinking water in the context of public health agency policies and practices for responding to and preventing childhood lead poisoning, as well as relevant guidance that the Centers for Disease Control and Prevention (CDC) provides or should provide to state and local lead poisoning prevention programs. It will look at why lead-contaminated drinking water is often overlooked as a potentially significant exposure source. CDC's current shift toward promoting a holistic approach to preventing disease and injuries from hazards in the home provides a new opportunity for public health agencies to develop clear and accurate educational messages about the health hazards of lead in water and ways to prevent exposure, to incorporate lead-in-water testing in their environmental risk assessments at the homes of children with elevated blood lead levels, and to more intensively monitor water lead levels in their jurisdictions. The presentation also discusses what some US cities and states have already done to address potable water used for drinking, cooking, and infant formula as a potential lead exposure source and practical federal, state, and local policies that could be taken to address this issue.
Lead Particulate Deposition From Housing Demolition
- D. Jacobs , National Center for Healthy Housing and University of Illinois at Chicago
- S. Cali , University of Illinois at Chicago
- A.Welch , University of Illinois at Chicago
- B. Catalin , University of Illinois at Chicago
- S. Dixon , National Center for Healthy Housing
- A. Evens , University of Illinois at Chicago
Background: Lead-contaminated dust can be released when housing containing lead-based paint is demolished. Methods: In Chicago, 101 scattered single family houses were demolished. In Baltimore, approximately 500 contiguous multifamily row houses were demolished using more extensive dust suppression methods, including barriers, continuous water spraying, containment, and deconstruction. Lead dustfall was measured by APHA (American Public Health Association) Method 502 and US Environmental Protection Agency (EPA) Methods SW3050B and SW6020. Air sampling for silica, particulate matter, asbestos, and airborne lead (Pb) and other metals was also conducted in 20 of the Chicago sites. Nested mixed models and maximum likelihood estimation models were developed. Results: Although far more houses were demolished within a smaller area over a shorter time period in Baltimore, lead dustfall and total dustfall were both much lower. The geometric mean lead dustfall during demolition in Chicago was 6.01 ìg Pb/ft2/hr (GSD = 4.47), but in Baltimore it was only 0.25 ìg Pb/ft2/hr (GSD = 3.57) (p<0.001). The percent of lead in dust in Chicago and Baltimore was 5.9% and 0.25%, respectively. After 8 hours of demolition, none of the Baltimore samples exceeded 800 ìg/ft2, but in Chicago 22% did so. Distance from demolition to the sampling site, relative humidity, wind direction, and main street versus side street were all significant predictors of lead dustfall. In Chicago, lead dustfall beyond 400 feet from the demolition site was not significantly different from background levels. Replicate samples showed lead dustfall measures had high repeatability (0.96). Levels of all other contaminants measured were low. Interviews with residents in Chicago suggested that improvements are needed in notification, public education, and dust cleanup procedures. Conclusion: Large amounts of lead-contaminated dust are generated from housing demolition, but can be controlled using simple dust suppression to protect the public health.
The Federal Lead and Copper Rule and Public Health
- Y. Lambrinidou , Parents for Nontoxic Alternatives
- P. Schwartz , Clean Water Action
The federal Lead and Copper Rule (LCR) was enacted in 1991 to reduce lead and copper concentrations in US drinking water through corrosion control and regular water monitoring. Since then, overall water lead levels have declined and public health authorities have largely assumed that the LCR is addressing lead-in-water hazards. While lead poisoning prevention programs tend to overlook lead at the tap as a potentially significant contributor to children's elevated blood lead levels (EBLLs), many members of the public continue to use lead-contaminated water for drinking, cooking, and mixing infant formula. Using Washington, DC, and Durham, North Carolina, as examples—2 cities where children recently experienced EBLLs from exposure to lead at the tap while the city water met LCR requirements—this presentation will discuss what a water utility's compliance with the LCR actually means and how such compliance does not always protect developing fetuses, infants, and young children from hazardous concentrations of lead in water. Focus areas will examine limits to the LCR's ability to protect public health as well as common practices some water utilities employ that miss lead-in-water problems. The presentation will also describe steps DC and North Carolina have taken to improve the LCR and better assess water lead levels generally and at the homes of children with EBLLs. The presentation will conclude with policy recommendations for strengthening the LCR's health protective potential, and suggestions for measures public health agencies and communities can take to help ensure the public is better protected from lead in drinking water.
Lead Safe Environments for Children: A Proactive Geographic-Wellness Approach
- H. Mielke , Tulane University
- E. Covington-Mielke , Delgado-Charity School of Nursing
Background: This study builds on our previous New Orleans projects. Twentieth-century US policies allowed millions of tons of lead (Pb) to accumulate in cities from paint and gasoline. Approximately 40% of New Orleans is Pb contaminated above the US 400 ppm soil Pb guidelines. Soil Pb is strongly associated with children's blood Pb. Children are the most vulnerable population and their play environments must be safe. Objectives: Child care centers are ideal places for Pb prevention. Prioritize child care centers by Pb risk using the New Orleans soil Pb map, and then target these centers for proactive Pb prevention. Create Pb-safe play environments with clean soil at these targeted child care centers, and incorporate an education component led by nurses. Methods: Surveying environmental Pb is the crux of the proactive geographic-wellness method. Overlay child care center sites on the soil Pb map of New Orleans and determine the probability of Pb-contaminated play areas. Results: A total of 44% of New Orleans child care centers have a predicted soil Pb >400 ppm. The predicted association between soil Pb and blood Pb at child care centers is strong (correlation coefficient = 0.73; p = 0.000). This study also predicts that 83 of 120 (69%) of the child care centers are located in communities where more than 5% of the children present with blood Pb = 10µg/dL. Conclusions: The current blood Pb surveillance and treatment approach perpetuates the reactive illness model. In contrast to relying on blood Pb to determine environmental Pb, the geographic-wellness approach is proactive because it relies on surveys of Pb dust in the environment in order to identify and curtail Pb dust. Therefore, the geographic-wellness approach focuses on primary prevention of childhood Pb exposure.
Environmental Health's Final Frontier: Creating Comprehensive State Programs for Indoor Environmental Quality
- K. Foscue , Connecticut Department of Public Health
- C. Mitchell , Maryland Department of Health and Mental Hygiene
Background: Indoor environmental quality (IEQ) is ranked by the US Environmental Protection Agency (EPA) and its Scientific Board as one of the top 5 environmental health risks facing the American people. Health problems caused by poor IEQ are costly: Estimates by the EPA suggest the net available costs associated with indoor air pollution amount to $150–$200 billion, including avoidable deaths, lost productivity, and avoidable respiratory diseases. Issue: State health departments are regularly called on to address IEQ problems in homes, schools, and workplaces; however, the vast majority of state environmental health programs are underresourced regarding IEQ. The principal goal of this session is to generate discussion and ideas about the need for state health departments to develop a more comprehensive approach to addressing IEQ problems utilizing a public health approach. Further, this comprehensive approach to IEQ needs adequate ongoing funding supported by federal funding. Objectives/Results: The objectives of this presentation will be to (1) describe the problem, including existing IEQ-related health data and regulatory/funding challenges; (2) present an overall IEQ program strategy; (3) describe and critique some existing program models; (4) lay out a suggested funding mechanism; and (5) generate discussion regarding how a comprehensive approach to addressing IEQ could be financed. Implications: Systematically addressing IEQ is integrated with the Centers for Disease Control and Prevention (CDC) Healthy Places goals (Healthy Schools, Healthy Homes, Healthy Workplaces). It is important to bring together state and federal public health professionals to formulate strategies to initiate adequately resourced, comprehensive state IEQ programs.
Achieving Lead Safe Housing Through the Resource Conservation and Recovery Act (RCRA)
- S. Harrykissoon , Centers for Disease Control and Prevention
Although there are numerous sources of lead poisoning, the major source is lead-based paint (LBP), dust, and soil in pre-1978 homes. The Resource Conservation and Recovery Act (RCRA) was enacted in 1976, and consists of the Solid Waste Disposal Act of 1965 and subsequent amendments thereto. Section 7003 of RCRA authorizes the Environmental Protection Agency (EPA) with the authority to protect the public from solid wastes that present an “imminent and substantial endangerment.” More important, Section 7002 of RCRA allows any citizen to bring a suit against any person for treating, storing, or disposing of hazardous wastes and for creating an imminent and substantial endangerment to human health and the environment. Lead paint qualifies as a hazardous waste under the RCRA statute; thereby a citizen may sue for the removal of lead-based paint from housing. Likewise “lead-based paint waste” (dust containing lead, and detached LBP chips or flakes) constitutes a “solid waste” under RCRA and any citizen may file suite for removal of the “waste.” Any citizen, including a state or local health agency with standing, can take action to get a lead-based paint hazard eliminated.
Neighborhood Level Risk Analysis of Childhood Lead Poisoning in the City of Atlanta
- A. Vaidyanathan , Centers for Disease Control and Prevention
- S. Kegler , Centers for Disease Control and Prevention
Objectives: Elevated blood lead levels (EBLLs) in young children have been associated with acute and long-term adverse health impacts. Childhood lead poisoning is a preventable condition, and the Centers for Disease Control and Prevention (CDC) recommends strategically testing children in high-risk areas. This study's objectives were to perform risk analysis by neighborhood for childhood lead poisoning based on established risk factors and to assess blood lead level (BLL) testing among children ages < 36 months living in city of Atlanta, Georgia. Methods: A composite risk index was used to assess testing of children at high risk for lead poisoning in the city of Atlanta. Factor analysis was used to compute a single risk index from multiple risk factors for childhood lead poisoning. Among the risk factors considered were older housing and children enrolled in the Women, Infants and Children (WIC) program (a surrogate measure for poverty). Risk analyses were carried out using the Rapid Inquiry Facility (RIF) tool at the neighborhood level for the city of Atlanta. The RIF is an automated tool that provides an extension to ESRI® ArcGIS functionality, and uses both database and geographic information system (GIS) techniques. Results: An estimated 18,113 children ages < 36 months were living in Atlanta in 2005, and 11.9% received BLL tests. There were 75,286 (89.6%) residential properties built before 1978, and 44% of children were enrolled in WIC. Increased testing levels were not observed for neighborhoods with higher proportions of older housing. Conclusion: BLL testing rates are low among children living in some Atlanta neighborhoods with risk factors for lead poisoning. Identifying and testing children in neighborhoods with high-risk housing is essential for childhood lead poisoning prevention.
Asthma and Serious Psychological Distress: Prevalence and Risk Factors Among U.S. Adults, 2001–2007
- E. Oraka , Centers for Disease Control and Prevention
- M. King , Centers for Disease Control and Prevention
- B.Callahan , Centers for Disease Control and Prevention
Background: For millions of adults, effective control of asthma requires a regimen of care that may be compromised by psychological factors such as anxiety and depression. This study estimated the prevalence and risk factors for serious psychological distress (SPD) and explored their relationship to health-related quality of life (HRQOL) among adults with asthma in the United States. Methods: We analyzed data from 186,738 adult respondents from the 2001–2007 US National Health Interview Survey. We calculated weighted average prevalence estimates of current asthma and SPD by demographic characteristics and health-related factors. We used logistic regression analysis to calculate odds ratios for factors that may have predicted asthma, SPD, and HRQOL. Results: From 2001 to 2007, the average annual prevalence of current asthma was 7.0%, and the average prevalence of SPD was 3.0%. Among adults with asthma, the prevalence of SPD was 7.5% (95% CI: 7.0–8.1%). A negative association between HRQOL and SPD was found for all adults, independent of asthma status. A similar pattern of risk factors predicted SPD and the co-occurrence of SPD and asthma, although adults with asthma who reported lower socioeconomic status, a history of smoking or alcohol use, and more comorbid chronic conditions had significantly higher odds of SPD. Conclusion: This research suggests the importance of mental health screening for persons with asthma and the need for clinical and community-based interventions to target modifiable lifestyle factors that contribute to psychological distress and make asthma worse.
Managing Exposures to Indoor Asthma Triggers: A Skill-Building Institute for Health Care Professionals
- M. Surricchio , American College of Preventive Medicine
Background: To ensure a better continuum of care, health care providers need access to the tools and education that will best equip them to help control their patients' asthma, manage triggers, and reduce exposures to indoor air pollutants, especially among children and patients from disproportionately impacted communities. Issue: Through a 3-year grant funded by the US Environmental Protection Agency (EPA) Indoor Environments Division, the American College of Preventive Medicine (ACPM) provides a training institute for health care providers and public health professionals that focuses on the importance of prevention and aims to enhance the ability of health professionals to incorporate high-quality asthma and environmental tobacco smoke (ETS) management into their daily practice. Results: ACPM has brought the training institute to 2 health care professional meetings in 2009. Both programs were well attended and garnered strong interest. All of the participants (100%) perceived the institutes to be of value. Following the institute, at least 62% indicated they would counsel patients or implement interventions on improving indoor air quality and managing asthma, and at least 80% indicated that the content they learned from the institute would impact their daily practice. Lessons Learned: By incorporating case studies, discussing the Guidelines for the Diagnosis and Management of Asthma, providing examples of environmental health history forms, and reviewing the Chronic Care Model, the institute will train participants in the best practices for interventions both in clinical settings and within community resource centers. This will encourage dialogue with at risk patients on harmful exposures and ultimately lead to reduced asthma attacks nationwide.
Comprehensive Use of Environmental Control Practices Among Children with Asthma
- A. Roy , Mount Sinai School of Medicine
- J. Wisnivesky , Mount Sinai School of Medicine
Background: Environmental triggers can play a significant role in asthma morbidity. Randomized controlled trials have shown that multifaceted environmental interventions reduce asthma symptoms and health care utilization. The national asthma guidelines recommend comprehensive use of environmental control practices (ECPs) for children with asthma. Little is known about why certain families use ECPs while others do not. Objective: To investigate the predictors of the comprehensive use of environmental control practices Methods: Data were gathered on 2003 children ages 0–17 years with asthma through the Centers for Disease Control and Prevention (CDC) National Asthma Survey. Information was collected on ECP use, including use of an air filter, use of a dehumidifier, smoking avoidance, pet avoidance, use of mattress/pillow covers, washing sheets in hot water, and not having carpets. Univariate and multivariate analyses were performed to examine predictors of comprehensive ECP use, which was defined as practicing at least 6 out of 8 of the listed ECPs. Results: Only 9.9% of homes of children with asthma had comprehensive ECP use. Comprehensive ECP use was positively associated with having received physician advice (OR: 3.0, p<0.005), higher number of routine care physician visits for asthma (OR: 5.8, p<0.005), and having others in the house with a diagnosis of asthma (OR: 1.4, p<0.05) in a multiple logistic regression model adjusted for age, race, gender, metropolitan statistical area, asthma severity, income, and insurance status. Conclusions: Only the minority of patients implemented a comprehensive approach to ECP use in the home. Receiving routine asthma care and education by pediatricians are 2 factors that appear to enhance ECP use, suggesting that universal access to health care and improved physician reimbursement for routine asthma care may ultimately improve asthma morbidity in children.
Healthy Home Environments for New Yorkers With Asthma (HHENYA): Integrating Community Services With Clinical Care
- A. Reddy , New York State Department of Health
- M. Gomez , New York State Department of Health
- S.McCauley , New York State Department of Health
- J. Anarella , New York State Department of Health
- F. Gesten , New York State Department of Health
- D. Luttinger , New York State Department of Health
Background: People with asthma often live in environments that exacerbate their symptoms and minimize their ability to control their asthma. Evidence suggests that a comprehensive approach to reducing triggers at home may be effective in reducing asthma morbidity, but these services may be difficult to offer within a clinical setting. Issues: The Healthy Home Environments for New Yorkers With Asthma (HHENYA) program connects a community-based program with Medicaid managed care plans to improve targeting of in-home services to people with poorly controlled asthma and to facilitate the integration of environmental management into routine asthma care. High-risk patients receive education, supplies, and referrals to address problems identified by an outreach worker during a home visit. A visit summary is sent to patients, their physician, and the referring health plan. The program is currently operating in select ZIP codes in Buffalo, New York, where asthma hospitalization rates exceed county and statewide averages. Results: Among 28 children and 27 adults who completed a 3–6 month revisit, there were significant (p<0.05) improvements in environmental conditions (dust accumulation, mold/mildew, plumbing leaks), self-reported asthma self-management (knowledge of personal asthma triggers and trigger avoidance strategies, feels asthma is controlled, uses peak flow meter, daily use of controller medication, decreased use of quick relief medication), and self-reported asthma morbidity (fewer days with worsening asthma and missed school/work/day care). Other triggers (e.g., smoking, pets) did not show significant improvements. Future analyses will include a larger sample, additional morbidity measures, a comparison group, cost data, qualitative data, and a longer follow-up period using health care utilization data. Lessons learned: Within a short follow-up period there were improvements in health and environmental outcomes. Additional analyses may answer remaining questions about the program's effectiveness, feasibility, and sustainability.
EPA's New Indoor AirPLUS: The Health Component of Green Building
- H. Slack , US Environmental Protection Agency
Background: US Environmental Protection Agency (EPA) studies have shown that levels of air pollution inside the home are often 2 to 5 times higher than outdoor levels. Poor air quality is associated with a host of health problems, including eye irritation, headaches, allergies, and respiratory problems such as asthma. In addition, indoor air quality may have a sizable financial impact on the home building industry. Issue: Indoor pollution derives from a variety of internal and external sources. The proper strategy to improve indoor air quality is to eliminate it at the source, and then to ventilate or filtrate. EPA developed the Indoor AirPLUS label to help builders implement this strategy, with the proper selection and installation of moisture control systems, HVAC equipment, combustion venting systems, and building materials. Results: Indoor AirPLUS label specifications were developed based on best available science and information about risks associated with indoor air quality problems, and balanced with practical issues of cost, builder production process compatibility, and enforceability. The initial specifications were piloted in several cities and revised based on input from the field. Homes that qualify for the Indoor AirPLUS label incorporate more than 30 additional home design and construction features to control moisture, chemical exposure, radon, pests, ventilation, and filtration. Indoor AirPLUS construction specifications are primarily prescriptive in nature, and go beyond the minimum indoor air quality (IAQ) requirements of most green building programs (http://www.epa.gov/indoorairplus/). Lessons Learned: ENERGY STAR–labeled homes that qualify for the Indoor AirPLUS label incorporate more than 30 additional home design and construction features to control moisture, chemical exposure, radon, pests, ventilation, and filtration.
AMI Morbidity and Comprehensive Smoke-Free laws: A Multi-State Investigation
- H. Juster , New York State Department of Health
- B. Loomis , RTI International
- T.Hinman , New York State Department of Health
- M. Farrelly , RTI International
Background/Objectives: Evidence is mounting that broad-based indoor smoking bans reduce the risk of cardiovascular disease, including acute myocardial infarction (AMI). We extend our original findings which showed that the implementation of a statewide smoke-free law in New York in 2003 was associated with reduced hospital admissions for AMI. We examine data from 3 additional states that vary in regards to the strength of their indoor smoke-free air laws. Methods: County-level, age-adjusted, monthly hospital admission rates for AMI from 1995–2006 in New York were analyzed as the dependent variable in a series of interrupted time series regression models. Independent variables were the main effect of a comprehensive smoking ban and the interaction of the ban with time. We controlled for the effects of preexisting smoking restrictions, seasonal trends, county differences, and secular trends. Similar analyses were conducted with data from Florida, which had laws similar to New York's. Data from Oregon and Pennsylvania served as control states. Results: Results from New York and Florida showed similar reductions in hospitalizations for heart attacks following implementation of their comprehensive statewide smoke-free laws. Similar effects were not seen in Oregon and Pennsylvania, where there were no strong smoke-free air laws. We will calculate the effect sizes, confidence intervals, and direct medical cost savings as a result of comprehensive smoke-free air laws. Conclusions/Implications: Comprehensive smoke-free air laws in New York and Florida were associated with reductions in hospital admissions for AMI, whereas similar reductions were not seen in Oregon and Pennsylvania. This confirms previous findings and provides stronger evidence for the association of improved health outcomes following comprehensive smoking bans.
Reduced Hospitalizations for Acute Myocardial Infarction Following Implementation of a Municipal Smoke-Free Law in Pueblo, Colorado
- C. Nevin-Woods , Pueblo City County Health Department
Background/Objectives: A comprehensive municipal smoke-free law making most workplaces and public places smoke free took effect in the city of Pueblo City, Colorado, on July 1, 2003. Local researchers undertook a study to assess whether the law impacted hospitalization rates for acute myocardial infarction (AMI). Methods: Pueblo researchers reviewed data on AMI hospitalizations from electronic Colorado Hospital Association administrative data. Trends in AMI hospitalization rates in Pueblo City were compared with trends in rates in 2 neighboring control areas that lacked smoke-free laws at the time of the study: areas of Pueblo County outside the Pueblo City limits and in El Paso County. The study period was January 2002–June 2006. Results: AMI hospitalization rates fell substantially in Pueblo City following implementation of the municipal smoke-free law: by 27% from the 18-month period before the law took effect to the 18-month period afterwards, and by 41% from the 18-month period before the law took effect to the second 18-month period following its effective date. No significant changes were observed in the 2 control sites. Conclusions/Implications: This is the first study to report that reductions in AMI hospitalizations are sustained over a 3-year period following implementation of a smoke-free law.
Can Smoke-Free Laws Reduce Heart Attacks? Conclusions of the IOM Report
- S. Babb , Centers for Disease Control and Prevention
Background/Objectives: Exposure of nonsmoking adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease. Twelve published studies conducted in various communities, states, regions, and countries have reported that laws prohibiting smoking in indoor public places and workplaces were associated with rapid, substantial reductions in heart attack hospitalizations. The Centers for Disease Control and Prevention (CDC) funded the Institute of Medicine (IOM) to conduct an independent review on whether (1) secondhand smoke exposure causes heart attacks, (2) a relatively brief (e.g., under one hour) secondhand smoke exposure could trigger a heart attack, and (3) smoke-free policies reduce heart attacks. Methods: The IOM convened a committee of 11 researchers with a broad range of expertise and perspectives. The committee conducted an extensive review of the published literature on these 3 questions. The IOM issued a report on the review's findings in October 2009. Results: The IOM report on Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence concluded: (1) The evidence is consistent with a causal relationship between secondhand smoke exposure and acute coronary events, including acute myocardial infarctions. (2) It is biologically plausible that a relatively brief exposure to secondhand smoke could trigger an acute coronary event. (3) There is a causal relationship between smoke-free laws and decreases in acute coronary events. Conclusions/Implications: Smoke-free policies are one of the most cost effective and readily available approaches for preventing heart disease and heart attacks. Just over 40% of Americans currently live under comprehensive state or local smoke-free laws. Extending smoke-free protections to all Americans could substantially reduce the burden of heart attacks, heart disease and death, and related medical and economic costs.
Modeling the Effects of Outdoor Use of Gasoline Powered Generators on Indoor Carbon Monoxide Levels
- S. Emmerich , National Institute of Standards and Technology
- L. Wang , National Institute of Standards and Technology
Background: The US Centers for Disease Control and Prevention has reported that half of nonfatal carbon monoxide (CO) poisoning incidents during the hurricane season in 2005 involved generators operated outdoors but within 2.1 m (7 ft) of the home. The guidance provided on the safe operating distance of a generator is often neither specific nor consistent. Furthermore, some manufacturers recommend the use of extension cords "as short as possible,” which may result in placement of the generator too close to the home. Methods: Multiple scenarios of a portable generator operated outdoors were modeled using the CONTAM indoor air quality model with a computational fluid dynamics (CFD) model to predict CO concentrations near and within a home. The simulation cases included both human-controllable factors (e.g., generator location and window opening) and noncontrollable factors (e.g., weather). During a simulation, CFD predicted a distribution of CO outside the house that was provided as inputs for predictions of transient CO profiles in the house. Results: For the house modeled in this study, a generator positioned 4.6 m (15 ft) away from open windows may not be far enough away to limit CO entry into the house. A wind perpendicular to the open window caused more CO infiltration than wind at a different angle. Lower wind speed generally caused more CO entry when the difference between indoor and outdoor temperature is relatively small. When the buoyancy effect was significant, CO infiltration was determined by the combination of wind and buoyancy effects. To reduce CO entry, the generator should ideally be positioned outside the wind recirculation region. Implications: Significant CO entry into a house may occur when a portable generator is operated inside the wind recirculation zone near the house.
National Carbon Monoxide Poisoning Surveillance Framework
- S. Iqbal , Centers for Disease Control and Prevention
- F. Yip , Centers for Disease Control and Prevention
- J.Clower , Centers for Disease Control and Prevention and Contractor - TKC Integration Services
- P. Garbe , Centers for Disease Control and Prevention
Background: Unintentional carbon monoxide (CO) poisoning is highly preventable, yet it is one of the leading causes of poisoning in the United States. It is also a major health concern after natural disasters, often due to improper generator use. A comprehensive national surveillance framework is needed to guide public health prevention efforts. Issue: Several data sets are currently being used to assess overall burden of CO-related mortality and morbidity. Additional information on modifiable health behaviors such as the lack of CO detectors, improper generator use, poorly maintained home heating systems, or characterization of high-risk populations in post-disaster situations can provide opportunities for primary prevention. We continue to examine data sources and surveillance components as an ongoing effort to expand our national surveillance activities. Results: CO poisoning results in nearly 21,000 emergency department (ED) visits, 4,200 hospitalizations, and 450 deaths annually. We have identified the National Vital Statistics System and the national hospitalization and ED databases from the Agency for Healthcare Research and Quality as primary sources for data on CO-related mortality, hospitalizations, and ED visits. Data from poison control centers, hyperbaric oxygen treatment facilities, and syndromic surveillance can also be used to monitor CO-related morbidity and to characterize at-risk populations. Data from the American Housing Survey and the National Health Interview Survey will be utilized to assess CO detector use nationally. These data sources will capture a spectrum of CO-related health effects and behaviors for nationwide surveillance of CO poisoning. Conclusion: A comprehensive surveillance system enables systematic data collection for effective public health prevention. Continued collaboration among all stakeholders, including local, state, and national public health practitioners, is critical for the enhancement of the national CO poisoning surveillance framework.
Attitudes About Carbon Monoxide Safety in the United States: The 2005 and 2006 HealthStyles Survey
- M. King , Centers for Disease Control and Prevention
- S. Damon , Centers for Disease Control and Prevention
Background: Unintentional exposure to carbon monoxide (CO) causes approximately 450 deaths and 20,000 emergency room visits annually in the United States. Because CO is a colorless, odorless, toxic gas produced by the incomplete combustion of fossil fuels, the primary public health strategy to prevent poisoning is proper use and maintenance of fuel-burning devices, with a secondary strategy of CO detector use. Methods: CDC added questions to a national health marketing survey in 2005 and 2006 to identify attitudes toward fuel-burning appliances among the general public and help to profile the audiences for public health prevention messaging related to CO poisoning. The study population was selected from respondents to the 2005 and 2006 HealthStyles surveys. HealthStyles is the second of 2 mailed panel surveys administered by Porter/Novelli (Washington, DC) annually since 1995 to measure health knowledge, attitudes, and behaviors among adults in the United States. Results: This study is the first to assess public attitudes toward CO safety in the United States on a national level. Findings—such as 63% of respondents agreeing with the incorrect statement that “it is safe to run a generator in a garage as long as the door is open,” and 43% of respondents agreeing with the incorrect statement that it is safe to run a generator in the basement—indicate that many adults continue to hold beliefs and practice behaviors that may place them at increased risk for accidental CO poisoning. Implications: To the extent resources allow, messaging needs to individually target the specific attitudes and behaviors identified in the analysis.
Older Adult Pedestrian Injuries in the United States: What Are the Leading Causes and How Big Is the Problem?
- R. Naumann , Centers for Disease Control and Prevention
- A. Dellinger , Centers for Disease Control and Prevention
- T.Haileyesus , Centers for Disease Control and Prevention
- G. Ryan , Centers for Disease Control and Prevention
Background/Objectives: As the US population ages, more older adults will face transportation and mobility challenges. This study examines the characteristics and number of nonfatally injured older pedestrians. Methods: Data were obtained from the National Electronic Injury Surveillance System—All Injury Program (NEISS-AIP) for the years 2001 through 2006. Cases included persons ages 65 years and older who were nonfatally injured on a public roadway by falling, being hit by a motor vehicle, overexerting themselves, being struck by an object or animal, or being hit by some other form of transport. Results: Each year, an estimated 52,482 older adults were treated in emergency departments for nonfatal pedestrian injuries. Falling and being hit by a motor vehicle resulted in 92.5% of older adult pedestrian injuries. Older adult pedestrian injuries were often severe; about a third of injuries were to the head or neck, nearly a third resulted in a fracture, and 16% resulted in hospitalization or transfer to another facility. Nearly a quarter of, or more than 9,000, older pedestrian fall-related injuries involved a curb. Conclusions/Implications: The growth in the older adult population could add to the overall burden of these nonfatal pedestrian injuries, including negatively affecting the health and quality of life of older adults and further taxing the already strained US health care system. Making transportation and mobility improvements, including environmental modifications, is important to preventing these injuries. Modifications may include medians or refuge islands, extending the time older pedestrians have to cross the street, and curb modifications.
Physical Environmental Barriers to Community Mobility and Participation of Wheelchair Users
- J. Sanford , CATEA (Center for Assistive Technology and Environmental Access)/Georgia Tech
- F. Harris , CATEA/Georgia Tech
While a considerable body of literature has established a link between community environmental features and walkability of neighborhoods and physical activity of adults, few studies have examined the interaction between community environments and wheelchair users. More important, no studies have compared the impact of environmental barriers on community mobility and participation of younger and elder wheelchair users, even though elders constitute the majority (56%) of community-dwelling wheelchair users. This paper reports results from the 230 respondents (160 less than 60 years old and 70 greater than 60) to a Web-based survey hosted by Survey Gizmo. The purpose of the survey was to examine how specific characteristics of environmental features affect community mobility and participation of older adults compared to younger wheelchair users. Specifically, the survey examined level of difficulty (from no difficulty to so difficult that it prevents going into the community) for a range of physical environmental features, including many that are not considered in the Americans with Disability Act Accessibility guidelines as barriers as well as others, such as curb cuts and ramps that are required as facilitators. Data indicate that twice as many younger respondents (51% compared to 26%) use manual wheelchairs than do older respondents, whereas 70% of older respondents use power wheelchairs compared to only 47% of younger respondents. As expected, community features posed greater barriers to mobility and participation of older adults than to younger adults. Significantly higher percentages of older wheelchair users were prevented from going into the community across all the 50 features included. The presentation will discuss the specific community features that represent the largest barriers to mobility and participation of wheelchair users and present recommendations for environmental facilitators to overcome those barriers.
Leaving a Legacy: What Elders Can Do to Create Healthy Communities
- K. Sykes , US Environmental Protection Agency
There is finally some good news about climate change. According to a recent report by Lancet, mitigating green house gas emissions will generate health dividends. The return on our investment may be greater since our population is rapidly aging. By 2030, the 65+ population will represent about 20% of the total US population. The Intergovernmental Panel on Climate Change has described older adults as one of the high-risk populations with respect to the consequences of climate change. But this may actually be good news when we consider that the older adult population ranges from resilient to frail and this growing human resource could be tapped to tackle the greatest public health challenge of the 21st century—climate change path. Elders have the potential to play a key role by participating at local planning meetings. They have time, experience, and patience to shape our communities. Independence is at stake when driving is no longer an option. The shared interest in designing our communities with a variety of transportation options or housing developments situated near public transit creates another opportunity for investing in decisions that can make our communities more livable for older adults and environmentally sustainable. This article will explore creative responses involving elders as leaders in their communities. Preliminary results from 2 new US EPA Aging Initiative grants will be shared that are piloting a statewide training program for elders in Maine and demonstrating the benefits of sustainable or green streets in Oregon. In addition, the recognition program “Building Healthy Communities for Active Aging” will showcase achievement award winning communities that have implemented smart growth principles and encourage active lifestyles.
Identifying and Testing Mercury-Containing Polymer Floors: A Michigan Case Study
- C. Bush , Michigan Department of Community Health
In 2002, the Ohio Department of Health evaluated mercury exposures from mercury-catalyzed polyurethane floors in several schools. Since then, the health departments in Michigan, Minnesota, and Oregon have evaluated similar floors in their respective states. Evidence from these investigations indicates that these floors are off-gassing mercury vapors, sometimes at levels of concern. It is not known how many polymer floors exist nationally, whether they all contain mercury, and to what extent they are off-gassing mercury vapors. This presentation reviews Michigan's efforts to identify and test these sites, indoor mercury levels found, and how each situation was addressed. Not all schools that have been tested have mercury in the floors or indoor air levels of concern. Corrective actions have included increasing ventilation in the affected room, removing and replacing the floor, and covering the floor with a new surface. There likely are other institutions (e.g., fitness centers, prisons) that have mercury floors. Schools may resist or refuse self-identification since it could result in unexpected expenditures for testing, removal, and disposal. Facilities with these types of floors need incentives to self-identify. Grant money may be necessary to assist more cash-strapped school districts with testing, removal, and disposal costs. Polymer floor companies may resist identifying where they have installed these floors due to the potential for litigation. Incentives should be considered to encourage manufacturer and installer involvement.
Mercury-Containing Polymer Floors: Isolated Occurrences or National Issue?
- S. Jones , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
Background: From the 1960s to the 1980s, many schools throughout the country installed synthetic flooring in indoor gymnasiums that contained mercuryused as a catalyst in the polyurethane formulation. After many years of wear and tear, it has been found that these floors can off-gas mercury (Hg) vapors, potentially leading to levels of concern in indoor air. Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and our state health department partners have been working collaboratively to address health-related issues based on Hg emissions from these school gym floors. Issue: Based on concerns about ongoing exposures to children, public health investigations have been performed by several state health depts, including Michigan and Minnesota. Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry has been working with these and other health departments to determine the scope of the problem. Do those Hg-emitting floors represent the majority of the occurrences, or are they just the start of a national issue? This discussion will focus on addressing this issue, as well as present an overview that will lead into several related discussions, all submitted as part of an overall panel session. Results: Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and our state partners have been working to define the scope of the problem—how many schools and in how many states. We have been contacting flooring manufactures and performing outreach to states in an effort to identify potential schools. Once identified, health officials should work with school officials and contractors to develop a communication strategy focused on getting information to the parents and the community. Also, we need to work with the schools on disposal options. Overall, the continued discovery of additional schools dictates the need for an overall national strategy. Lessons Learned: Based on the number of floors that were installed in the 1960s–1980s, it is very possible that this issue may be widespread. It is imperative that Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and our state partners work cooperatively to fully understand the scope of the problem and work together to implement an overall strategy to address the issues.
Avoiding Environmental Hazards In the School Siting Process
- S. Fischbach , Rhode Island Legal Services
Background: Local school districts in low-income communities across the nation are choosing to build schools on or near former industrial sites, garbage dumps, and other severely contaminated properties, despite local opposition to using such sites for schools. Issue: Environmental health advocates have responded to the siting of schools on contaminated sites in several ways, including community organizing, litigation, policy research, and legislative advocacy. Frequently, the school siting process lacked the opportunity for local residents and advocates to have meaningful input, resulting in protracted litigation. Public controversy over the selection of severely contaminated sites for schools caused Congress to direct the US Environmental Protection Agency (EPA) to develop voluntary school siting guidelines as part of the Energy Independence and Security Act of 2007. Results: In this session, 2 panelists will discuss case studies that typify the lack of formal community involvement in selecting new school sites and in investigating and cleaning up those sites for school use. A third panelist will describe school siting guidelines that were developed as part of an EPA-funded research project that surveyed existing laws and policies regarding the selection of school sites on or near sources of environmental pollution. Those recommendations are helping to inform voluntary school siting guidelines being developed by EPA. Lessons Learned: Short-term cost savings associated with selecting contaminated sites for schools have been offset by costs associated with long-term maintenance and monitoring of contaminated sites. Moreover, absent community involvement in the site selection and cleanup process, school districts will not develop site cleanup plans that adequately protect students and school workers.
Safe and Healthy School Environments
- I. Rubin , Emory University
- R. Geller , Emory University
- J.Nodvin , Emory University
- M. Marcus , Emory University
Background: In the United States, almost 50,000,000 students and 5,000,000 adults attend 100,000 schools daily. Children spend more time in schools than in any other environment except their home. Schools and school buildings house 1 in 5 Americans each day, often in close quarters and participating in a variety of activities other than direct academic learning—e.g., arts and crafts, woodwork, and outdoor sports and recreation. Issue: The US Government Accounting Office has reported that 1 in 3 schools had buildings in need of extensive repair or replacement; almost two-thirds had one major building feature that needed extensive repairs, overhaul, or replacement. The US Department of Education has reported unsatisfactory environmental conditions related to poor ventilation, acoustics or noise control, poor indoor air quality and poor heating and lighting. These adverse environmental factors affect health and wellness, and also affect school attendance and performance of both teachers and students. Results: In 2006 the Southeast Pediatric Environmental Health Specialty Unit (PEHSU) published a book on school environmental health. In 2008 and 2009, video training modules have been developed for distribution to schools and their personnel. A needs assessment of school administrators was conducted jointly with the Georgia Independent School Association to prioritize their concerns relating to environmental health and safety. Eight priority topics were identified and video content has been developed to address these, including indoor air quality, playground and sports facility safety, food and nutrition, emergency preparedness, accommodating individuals with special needs, and school plant evaluation. Each module lasts 7–15 minutes, introduces the topic, and guides viewers to participate in addressing the topic and to encourage colleagues to do the same.
Distribution of Schools in Close Proximity to High Volume Roads in Metropolitan Atlanta
- S. Foster , Centers for Disease Control and Prevention
- B. Lewis , Centers for Disease Control and Prevention
- V.Boothe , Centers for Disease Control and Prevention
- A. Dent , Centers for Disease Control and Prevention
Background: Health effects have been associated with exposure to air pollution generated from vehicles. Emission characterization studies indicate that traffic-related pollutants decline sharply from 0 to 150 meters from a major roadway. Given children may be at increased risk for health effects associated with acute and chronic exposures to pollutants, we describe the distribution of schools near high-volume roads. Methods: The study area consists of 12 counties comprising metropolitan Atlanta. Georgia Department of Environment and National Center for Education Statistics are the main data sources. Geographic information system (GIS) software linked and spatially evaluated road volume and demographic data. Results: Public schools comprise 57% of the schools located within 150 meters of high-volume roads in the study area. Of the public schools within metropolitan Atlanta, 98 (14%) are located within 150 meters of high-traffic volume roads. Of the students, 46% are African American, 31% are white, 6% are Asian American, and 13% are Hispanic. Seventy-four (30%) of the private schools are located within this distance. Of the private school students, 51% are white, 33% black, 2% Asian American, and 3% Hispanic. Approximately 90,000 public school students and 14,500 private school students in metropolitan Atlanta attend schools within 150 meters of a high-volume road. Conclusions: Preliminary results indicate that most of the public and private schools are not located within 150 meters of high-volume roads. Still, almost 105,000 school-age children attend schools close to a high-volume road in metropolitan Atlanta. As metro Atlanta's population continues to grow, there continues to be a need for new school construction. These results may be useful to city and community planners when considering new school locations.
To Play or Not to Play: Recess Air Quality Guidelines
- A. Martin , Utah Department of Health
- R. Giles , Utah Department of Health Asthma Program
- S.Packham , Utah Department of Environmental Quality
Background: High air pollution days are associated with increased emergency department visits, symptoms and medication use, and school absenteeism among those with asthma and other respiratory diseases. Calls from concerned parents and schools about poor air quality and children participating in outdoor school activities were made to the Utah Department of Environmental Quality and Utah Department of Health. Prior to 2004, these agencies did not have a coordinated message or recommendations to give them. Issue: A variety of stakeholders were brought together to develop school-based recess guidelines to give school administrators guidelines for what to do on days when PM2.5 (particulate matter) was considered unhealthy for sensitive or all students. Stakeholders included air quality experts, school personnel, health professionals, and health officials. In 2004, the Recess Guidance for Schools was developed. The guidance is not a policy but guidelines for schools to use to determine when to have indoor recess based on air quality. Results: Based on new science and experience, the guidance was updated in 2007. The updated guidance aligns with new recommendations from the Environmental Protection Agency Air Standard for PM2.5, allows for more flexibility in allowing healthy students to benefit from outdoor exercise, and provides a conservative level of protection when outdoor activities are not recommended for all students. The guidance is distributed every fall to all public, private, and charter schools in Utah. On the Utah Department of Health Web site the guidance was downloaded 1,566 times in 2 months. Focus group results held when updating the 2004 guidelines showed that the majority of school districts were familiar with the guidance. Schools continue to use the guidance. Lessons Learned: Air quality guidelines are desperately needed for schools to make appropriate decisions to keep students safe and healthy. Communication and involvement with key partners are vital to the success of school and community based air quality interventions.
Healthy Environments in Child Care and Preschools
- N. Obot Witherspoon , Children's Environmental Health Network
The District of Columbia (DC), Atlanta, Georgia, and Dallas/Ft. Worth, Texas have some of the nation's highest asthma rates in the country, and childhood lead poisoning remains a serious problem for all. The high levels of air pollutants and older housing/building stock greatly contribute to these dangerous health issues affecting DC, Georgia, and Texas residents, especially their children. In Atlanta, heavy pollution and transportation flow contribute to large amounts of smog, and high uranium soil connects to the high levels of radon exposure. Over 60% of children below age 6 spend a majority of their time in child care and preschool facilities. Failing to protect children outside of the K–12 public school environment represents a serious oversight. Most child care providers do not have the knowledge to address environmental health issues in their facilities. The goal of the Healthy Environments in Child Care and Preschools project is to prevent and reduce adverse childhood health effects from environmental hazards among licensed child care centers in Georgia, DC, and Texas by educating and increasing awareness among child care providers and directors. The DC program also includes collection of environmental assessment data of enrolled child care facilities. Project objectives include increasing health and safety in child care facilities, increasing the knowledge base among child care providers, and distributing best practices and tools to stakeholders in the child care community. Two essential evaluation tools have been developed and used for environmental assessments of the targeted child care facilities, training child care providers, directors, and facility managers to identify environmental hazard sources, and outlining steps to minimize human exposure within child care facilities. As in Georgia, DC, and Texas, child care providers connected to this project gain knowledge, awareness, and the tools needed to address environmental hazards and mobilize toward local child protective policies.
Why Did They Place a Daycare There? State Approaches to Safe Siting of Child Care Centers
- T. Somers , Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry
- S. Rusnak , Connecticut Department of Public Health
Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and our state partners have assessed the environmental health and safety of many child care centers placed on or near sites that were potentially harmful to the children. With more than 100,000 licensed child care centers in the United States, there are likely more sites to be discovered. Currently very few states have licensing requirements for child care centers to have environmental assessments. Like many environmental public health issues, states can use a variety of approaches to address this issue. The presentation will highlight different approaches intended to ensure that child care centers are safely located. The format is designed to provide techniques for others states to use to address child care center siting within their state. The presentation will discuss regulatory and nonregulatory approaches that states can use to help ensure the child care centers are located on safe sites.
CHANGE Tool: Assessing Local Level Policy, Systems, and Environmental Strategies to Create Healthy Communities
- S. Griffin-Blake , Centers for Disease Control and Prevention
- A. Ussery-Hall , Ginn Group
- S.Cory , Centers for Disease Control and Prevention
- A. Ivy , Northrop Grumman
Background: Communities across the country are struggling with how to assess and evaluate policy, systems, and environmental change strategies at the local level. The Healthy Communities Program within the Division of Adult and Community Health at the Centers for Disease Control and Prevention (CDC) realized this need for new ways of assessing and evaluating policy, systems, and environmental changes within local communities and developed the Community Health Assessment and Group Evaluation (CHANGE) tool. Methods: After synthesizing community assessment literature, reviewing numerous local and state assessment tools, and soliciting internal and external partner input, CDC's Healthy Communities Program developed and piloted the CHANGE tool, an assessment tool that provides communities with a snapshot of local policy, systems, and environmental change strategies currently in place or missing. Results: The CHANGE tool has been used in more than 100 communities. These communities find that the instrument is useful to (1) gain a picture of the current state of policy, systems, and environmental policies within sectors of a community; (2) develop a community action plan for improving the environment to facilitate and support healthy lifestyles; and (3) assist with prioritizing community needs and allocating available resources. Communities have used CHANGE to develop a community action plan for improving the social and built environment (e.g., preserving green space, improving neighborhood safety, developing walking trails, instituting community gardens) to facilitate and support healthy lifestyles as well as to assist with prioritizing community needs and allocating available resources. Implications: Creating a data-driven process, CHANGE employs a Likert-style scale that allows users to measure incremental policy, systems, and environmental changes across multiple community sectors (i.e., school, worksite, health care, community at large, community institution/organization) on an annual basis. This presentation will highlight the assessment tool, the strengths and challenges of implementing it, and ways these data have been used for creating healthy communities.
The Steps Program: Building Healthy Communities Through Policy and Environmental Changes
- A. Ussery-Hall , Centers for Disease Control and Prevention and Ginn Group (contractor)
- P. Nichols , Centers for Disease Control and Prevention
- B.Williams , Centers for Disease Control and Prevention
Background: To address chronic health concerns and unhealthy behaviors, the Centers for Disease Control and Prevention (CDC) Steps Program funded 40 communities to collaborate with local partners and implement social and environmental change strategies. The Steps Program supports changes in these arenas because they address population health, promote sustainability, and make healthy choices the easy choices. Issue: Interventions that promote policy and environmental changes are key to promoting health and reducing chronic conditions. The social and physical environment often dictates whether or not people have access to opportunities for physical activity, healthy food and beverages, and smoke-free facilities. Results: In 2008, Steps communities implemented 300 policy and environmental change strategies in community settings. These included development of new trails and walking paths, smoke-free parks, and promotion of existing paths and outdoor areas. The 250+ interventions addressing the school environment in Steps communities included school gardens, increased recess, and tobacco-free campuses. Communities implemented almost 150 policy and environmental change strategies for worksites, including stair promotion, increased access to nutritious foods in vending machines, smoke-free worksite policies, and onsite space for exercise. Steps communities implemented more than 100 policies and procedures in health care settings, including promotion of the Chronic Care Model and the use of electronic medical records for tracking and follow-up. Lessons Learned: Information about policy and environmental changes implemented in Steps communities will be shared. The theoretical background and evaluation framework of the Steps Program will also be shared, specifically as related to policy and environmental change. Background and recommendations for policy advocacy, development, and implementation will also be shared. This information can facilitate the development, adoption, and evaluation of policy and environmental change strategies by other communities.
Steps and Strategic Alliance for Health: Supporting and Sustaining Healthy Communities
- P. Nichols , Centers for Disease Control and Prevention
Background: To continue the momentum achieved by Steps communities, the Centers for Disease Control and Prevention (CDC) Healthy Communities Program released a new funding opportunity, called Strategic Alliance for Health (SAH), for state and local health departments and tribes. The SAH encourages implementation of community-based programs that address cardiovascular disease, diabetes, obesity, and tobacco using sustainable policy, systems, and environmental strategies to increase opportunities for physical activity and access to healthy foods and beverages, and to decrease tobacco use and exposure to tobacco smoke. Issue: To address the need for public health programs that not only work across diseases and risk factors but also focus on sustainability, like the Steps Program, the SAH cooperative agreement funds state and local health departments and tribes to implement evidence-based community initiatives that focus on sustainable policy, systems, and environmental change strategies. Funded communities also engage community coalitions and numerous partners across all sectors of the community in order to increase reach and sustainability. Results: The program strategy for Strategic Alliance for Health was developed using the Steps Program model. This model resulted in Steps Program successes that demonstrate the effectiveness of multiple Steps interventions. Increases in physical activity, access to healthy foods and beverages, and the number of smoke-free public places resulted from the implementation of Steps interventions, as well as improvements in diabetes self-management and rates of tobacco cessation. Lessons Learned: The most common and successful interventions implemented by Steps communities will be described, as well as challenges associated with achieving policy, systems, and environmental change. SAH communities are fortunate in that they can take the lessons learned and best practices developed by Steps communities and utilize them in their own planning and implementation.
ACHIEVE: Cultivating and Sustaining Healthy Communities Through Strategic Partnerships
- B. Williams , Centers for Disease Control and Prevention
- A. Ussery-Hall , Centers for Disease Control and Prevention
- P.Nichols , Centers for Disease Control and Prevention
Background: The Centers for Disease Control and Prevention (CDC) Healthy Communities Program, utilizing successes and lessons learned from CDC-funded community-based programs, including Racial and Ethnic Approaches to Community Health Across the U.S. (REACH US), the Steps Program, and the YMCA Pioneering Healthier Communities®, designed Action Communities for Health, Innovation and Environmental Chang (ACHIEVE). ACHIEVE is based on an emerging CDC model that capitalizes on the experience and expertise of national organizations in strengthening community leadership and building capacity. The ACHIEVE model encompasses national partners working with community teams to build healthier communities by promoting policy, systems, and environmental change strategies to prevent chronic diseases. Issue: National organizations are adept at developing innovative, practical, and evidence-based strategies for building partnerships and implementing chronic disease prevention and health promotion policies through their local affiliates. National partners have received ACHIEVE funding to support the implementation of evidence-based policy, systems, and environmental change strategies in local communities. Results: ACHIEVE communities are successfully implementing strategies to promote physical activity, increase access to healthy foods, and support tobacco cessation. Examples include completing a food environment assessment to ascertain the impact of social determinants of health, banning smoking in city parks and playgrounds, and linking alleys to community gardens to enhance the built environment. National organizations and communities have increased their capacity to develop cross-collaborative partnerships and disseminate tools to implement policy, systems, and environmental changes. Lessons Learned: ACHIEVE communities are applying lessons learned and best practices from CDC-funded programs to build collaborative partnerships within and outside of public health and implement sustainable policy, systems, and environmental change strategies across worksites, schools, and the community.
Creating a Connected Landscape Structure in Florida: A Focus on Human Health Benefits
- C. Coutts , Florida State University
This study examines the Florida Communities Trust (FCT) public land acquisition program to determine the degree to which it has contributed to expanding and connecting open space. Creating connected open space systems is important for both natural resources protection and, although typically not explicit, supporting the social goal of health. The mixed-method approach employed in this study involved (1) an examination of 617 FCT proposals submitted from 2001 to 2006, (2) a state-level geographic information system (GIS) analysis of existing FCT-funded conservation lands, and (3) a survey of users of an FCT acquisition that contributed to a local-level green infrastructure system. The analysis revealed that the FCT has been relatively successful in extending and connecting open space with over half of communities proposing land acquisition that are adjacent to existing holdings. It also revealed that almost all users of one of these connected spaces were aware of this connectivity, and 67% attributed it to their increased use of the space. This is important not only because green infrastructure systems provide important ecological functions but also because many chronic public health ailments can be ameliorated by access to these public lands.
Assuring Environmental Health Hazards Are Considered in Land Use Community Design Decisions
- S. Holmes , Lincoln-Lancaster County Health Department
Background: Local planning commissioners are the primary decision makers on land use and community design. However, they typically lack knowledge of health risks posed by environmental health hazards, such as the use and transportation of toxic and hazardous materials. This results in uninformed decisions, which unnecessarily put the public at risk. Staff attempts to address risks through land use review processes were not entirely successful. Policy-level support was needed to assure that community design and land use decisions resulted in conditions in which people can be healthy. Issue: A joint committee composed of our local Planning Commission and Board of Health was formed to review the interwoven issues of public health and land use planning and community design, and to determine if current practice, policy, and law assured a safe and healthy community. The committee developed recommendations that are now being implemented. Results: Actions that have been taken include using health impact assessment concepts, all land use plans, changes of zone, and community design proposals are reviewed to identify environmental health hazards and make recommendations to reduce public health risk; standard separation distances between industrial and residential zoning were created; risk reduction technical assistance is being provided businesses with the most toxic chemicals; an algorithm was used to develop recommendations for separation/notification distances for pipelines carrying hazardous materials; and accurate geographic information system (GIS) maps of pipelines that carry hazardous materials and “buffer” zones were created. Lessons Learned: Educating planning commissioners on environmental health hazards and health risks resulted in land use and community design decisions that are more protective of the public This is a replicable model that could be employed at the local or state level.
Use of Health Impact Assessment in the United States: 56 case studies, 1999–2009
- A. Dannanberg , Centers for Disease Control and Prevention
- R. Bhatia , San Francisco Health Department
- B.Cole , University of California - Los Angeles
- S. Heaton , Centers for Disease Control and Prevention
- C. Rutt , Centers for Disease Control and Prevention
Objectives: To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions. Methods: Using multiple search strategies, 56 HIAs were identified that were completed in the United States during 1999–2009. Key characteristics of each HIA were abstracted from published and unpublished sources. Results: Topics examined in these HIAs ranged from policies about living wages and afterschool programs to projects about power plants and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Concerns about health disparities were especially important in HIAs on housing, urban redevelopment, home energy subsidies, and wage policy. The use of quantitative and nonquantitative methods varied among HIAs. Most HIAs presented recommendations for policy or project changes to improve health. Impacts of the HIAs were infrequently documented. Conclusions: These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes.
Neighborhood Food Store and Physical Activity Resource Utilization by East Harlem Children
- M. Galvez , Mount Sinai School of Medicine
- K. Donohue , University of Medicine and Dentistry of New Jersey
- H.Chea , Mount Sinai School of Medicine
- L. Hong , Mount Sinai School of Medicine
- J. Godbold , Mount Sinai School of Medicine
- B. Brenner , Mount Sinai School of Medicine
Background: Neighborhood factors are increasingly examined for their role in childhood obesity. Little is known about inner city children's use of neighborhood resources and subsequent relationship with body mass index (BMI). We hypothesized that in the inner city, minority community of East Harlem, New York, increased frequency of use of food stores and decreased use of physical activity resources is associated with BMI. Methods: Baseline data from a longitudinal study of East Harlem boys and girls 6–8 years old (n = 334) were utilized. Odds ratios adjusted for gender, race, family income, and population density were used to assess the relationship between use of resources and BMI (<85th and >85th percentile). Results: Reported use of physical activity resources is as follows: parks (96%), afterschool programs (61%), recreational facilities (50%), and summer camps (39%). Only 14% of children report purchasing from drink machines and 2% from snack machines. In contrast, 72% report purchasing from convenience stores, 64% from food stands, and 35% from fast food stores on the way to or from school. While reported use of summer camps was associated with lower BMI (OR: 0.52 (95% CI: 0.26–1.01) p = 0.05, we observed no significant associations between use of food resources and BMI. Conclusions/Implications: Recent legislation has limited access to vending machines in schools, diminishing use by children. However, outside the school, children frequent food stores regularly. Preliminary analyses found an association between use of summer camps and child's BMI. Further research is needed to assess the relationship between neighborhood resources and risk for obesity.
Objectively Measuring Route to Park Walkability in Atlanta, GA
- J. Dills , Centers for Disease Control and Prevention
- C. Rutt , Centers for Disease Control and Prevention
- K.Mumford , University of Minnesota
Background: Objectively measuring walkability from pedestrian perspectives refines methodologies that describe walkability at large spatial scales. We aim to describe walkability at the micro scale, hypothesizing that objective measures of route walkability will be higher for park users than nonusers. Methods: To address our question, we used a case-control design where cases were park users, and controls were randomly selected nonusers, all of whom lived within a mile of one of 9 parks in Atlanta, Georgia. For both cases and controls, we determined walking routes based on the shortest network distance from participants' homes to their parks. Trained observers used an assessment tool to score 12 elements along these routes. We calculated a composite walkability score from these 12 elements and compared mean sub-item scores and total scores for case and control routes using t-tests. Logistic regression models examined if park use could be predicted by exposure to walkable routes to parks, controlling for distance and education. Results: A total of 7 of 12 elements, plus the composite walkability score, showed significant differences between case and control routes. The strongest difference was for the composite score (p<0.001). The model adjusted for education and distance indicated each unit increase in the composite score was associated with a 20% greater likelihood of being a park user (OR: 1.20; 95% CI: 1.07,1.34). Conclusions: Environmental characteristics at the pedestrian scale influence individuals' use of their neighborhoods as venues for physical activity. Understanding which elements of the environment are influential at this scale can contribute to evidence-based design interventions to increase physical activity.
Health Effects of Estimated Exposure to Traffic-Related Pollutants in an Urban Area
- V. Boothe , Centers for Disease Control and Prevention
- D. Shendell , University of Medicine and Dentistry of New Jersey
- B.Lewis , Centers for Disease Control and Prevention
- P. Meyer , Centers for Disease Control and Prevention
- J. Hess , Emory University
Objective: The purpose of this study was to assess associations between proximity to traffic emissions within the city of Atlanta and respiratory and cardiovascular 911 emergency medical services (EMS) calls and subsequent emergency department (ED) visits. Methods: Case and control diagnostic groups were established for 8,668 EMS calls received between 2004 and 2008. Case diagnostic groups included asthma, cardiovascular outcomes, and stroke. Gastrointestinal groups were selected as controls. Cumulative traffic within a 100 m buffer of the call origination location was used as an indicator of traffic emission exposure. Using a case-control study design, associations between exposure to traffic emissions and case diagnostic groups were assessed, controlling for potential confounding factors, including age, gender, ethnicity, and socioeconomic status (SES). Subgroup analyses were performed to evaluate differences by age groups, gender, and SES. Results: Increased cumulative traffic was associated with increased odds of an EMS call and ED visit for cardiovascular outcomes compared to the controls after adjustment for confounding factors (OR: 1.07; 95% CI: 1.01–1.12 per vehicle mile). Strongest effects were among men and individuals ages 40 years and older. Increased cumulative traffic was also associated with an increased odds of stroke among individuals ages 18–39 years (OR: 1.18; 95% CI: 1.03–1.36 per vehicle mile). No statistically significant associations were found for EMS calls/ED visits for asthma. Conclusion: These results provide additional evidence that proximity to traffic is associated with adverse cardiovascular outcomes and stroke in certain age groups. Effective interventions are needed to protect the public and vulnerable populations from exposure to unhealthy levels of traffic emissions, including prohibiting construction of schools, day care facilities, nursing homes, and residences within 100 meters of busy roads.
Current Events and Trends in Ciclovía Programs Across America
- M. Leap , University of North Carolina–Chapel Hill
For 6 hours every Sunday, Bogotá, Colombia, closes 70 miles of roads to automobiles, and opens them to bicyclists, walkers, runners, and dancers. Approximately 2 million of the city's 8 million residents participate each week, reaping health, environmental, and social benefits. It is called Ciclovía, or “bicycle path” in Spanish. Ciclovía's popularity and success has, over the past 10 years, inspired cities across the globe to begin similar programs. Ciclovía programs seek to combat rising obesity rates and issues of equity caused by the increasing prevalence of auto-mobility. It offers free active living opportunities within urban settings, and, as there are no barriers to entry, it provides healthy options for residents of all incomes, especially those who cannot join gyms or travel for recreation. They provide physical, emotional, and mental health benefits as well as economic and community development benefits. Through surveys and anecdotal evidence, Ciclovía events have proven to be extremely popular among both participants and organizers. Ciclovía programs have a wide array of advocates, ranging from families looking for affordable entertainment in hard economic times, city officials looking to increase programming, those for the reduction of obesity and diabetes, avid cyclists, to many others. The program can be catered to the specific needs and abilities of each community sponsoring it. Though difficulties in finding funding and winning political buy-in are commonly cited as obstacles in the implementation process, they can be overcome, and actual implementation is the best proof that a Ciclovía program will work in a community. This study synthesizes the experiences behind Ciclovía events in the United States and contains background information and case studies of cities of varying sizes.
Safe Routes to School: Local Programs Get Kids Active and Improve the Environment
- M. Pedroso , Safe Routes to School National Partnership
- R. Ping , Safe Routes to School National Partnership
In the past 40 years the rate of obesity has tripled among school-age children and youth, while at the same time opportunities for physical activity have decreased. Less than 15% of children walk or bicycle to school today, a drop from over 50% in 1969, and over 87% for those who lived within one mile of their neighborhood school. To counter these trends, Safe Routes to School programs have been launched in communities all over the United States, and in 2005 the federal government created a 5-year national funding program, administered by states. Safe Routes to School programs bring together parents, students, school staff, community members, and local health and transportation professionals, along with elected officials. The session outlines how several programs across the country have been able to make improvements to the built environment, motivate parents and students to walk or bicycle to school, and improve safety in school neighborhoods. Approaches include organizing school teams, making roadway and sidewalk improvements and calming traffic, creating walking school buses, and inspiring families to become more active and involved. In addition, program leaders have spearheaded efforts to change local policies that reduce barriers to active transportation. Changing behaviors, facilities, and policies can be challenging work, and the session will discuss lessons learned, and how Safe Routes to School programs are improving the environment and giving students the opportunity to be more physically active in their neighborhood. More information is available at www.saferoutespartnership.org.
Bike Share in Chattanooga: A Corporate Cooperative Model
- P. Pugliese , Active Living and Transportation Network
Background: Many communities in the United States and across Europe have targeted active transportation as a means to protect the environment and positively impact human health. The Outdoor Chattanooga Mobile Bicycle Fleet is one of these efforts. Its mission is to promote bicycling for transportation, recreation, and health, and specifically to reduce midday vehicle trips by employees and students in our urban area. Issue: Downtown employees typically will not consider bicycling as an effective and efficient means of midday transportation. By providing all necessary equipment onsite to local businesses and through guided experiential educational programming, these employees are provided a safe and comfortable environment to increase their physical activity choices through active transportation. Results: Participation rates and employee feedback on the program have demonstrated a high acceptance and satisfaction level with the experience. A follow-up program is under development to create a network of fixed, automated bicycle distribution sites throughout the urban core. As an added element, the University of Tennessee at Chattanooga Department of Psychology and Department of Health and Human Performance will systematically identify barriers, incentives, and appropriate messages to be used in the promotional campaign among employees and employers. After implementation, a formal evaluation will be developed by these university partners. Lessons Learned: This presentation will describe and compare traditional bike-share programs as they relate to Chattanooga's efforts and explore how create a sustainable alternative transportation model. Issues concerning program sustainability are more complex than initially thought.
A Case Study Examining the Applicability of Using Health Impact Assessment to Evaluate a Greyfield Redevelopment Project in Atlanta, GA
- C. Rutt , Centers for Disease Control and Prevention
- B. Cole , University of California, Los Angeles
- R.Shimkhada , University of California - Los Angeles
- N. Maricich , University of California - Los Angeles
- L. Roux , Centers for Disease Control and Prevention
- T. Yanagawa , Centers for Disease Control and Prevention
Background: The use of the health impact assessment (HIA) has been increasing in the United States in recent years, fueled by a growing recognition among public health, planning, and transportation professionals that land use and transportation planning decisions can have a substantial impact on the public's health. HIA is defined as “a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population, and the distribution of those effects within the population”. The purpose of this project was to examine the potential health outcomes related to redeveloping the area surrounding a highway with high rates of pedestrian injury using a health impact assessment (HIA). Methods: The study area included a population of 11,000 individuals (60.0% male, 49.8% Hispanic, 51.3% with less than a high school education, 61.1% foreign born, and 15.8% in poverty) living along 2.37 miles of Buford Highway, which is a major 7-lane arterial in Atlanta, Georgia. A variety of methods (expert opinion, literature review, and modeling) were used to estimate potential health impacts. Results: We estimated that individuals in the study area will walk approximately 124 additional minutes per week after the highway is redeveloped (range 64–217 min/week). A 91% (range: 89%–94%) reduction in pedestrian accidents is expected resulting in 6.1 (6.0–6.3) fewer injuries and 1.6 (1.5–1.7) fewer fatalities per year. A 60% (range: 39%–65%) reduction is expected for automobile accidents resulting in 73.8 (48.0–80.0) fewer injuries per year. Based on qualitative assessments, it is expected that there will be no changes in regional air pollution levels; a small decrease in noise pollution; an increase in gentrification, which will have mixed effects on safety and social capital; and a decline in automobile level of service. Conclusions: Numerous data gaps precluded quantitative analysis for many of the health-related outcomes, suggesting that more research is needed before more robust quantitative analysis can be performed. Nonetheless, important decisions will be made regarding projects and policies, and the purpose of HIA—even if the data are imperfect—is to use the best information available to allow health outcomes to be appropriately factored into complex decisions.
New Mexico Tracking and NASA Air Quality Data for User Communities
- C. Bales , University of New Mexico
- S. Morain , University of New Mexico
- O.Myers , University of New Mexico
- H. Krapfl , New Mexico Department of Health
- S. Penman , University of New Mexico
- T. Budge , University of New Mexico
Background: The University of New Mexico (UNM), University of Arizona (UA), and New Mexico Department of Health (NM DOH) are partners in National Aeronautics and Space Administration (NASA) projects to improve dust and ozone forecast models for the southwestern United States. These projects enhance air quality and respiratory disease data linkages, vulnerable community analyses, and public health decision support and surveillance systems. The New Mexico Environmental Public Health Tracking (NM EPHT) Network currently integrates dust forecast data and will include ozone forecasts when that model is developed. Issue: The NM EPHT program compiles and analyzes data for asthma and air quality from hospitalization records and ground-based monitoring stations. New Mexico air monitoring stations are sparsely located and provide incomplete measures for vulnerable populations and incomplete particulate matter and ozone data sets. Also, hospital discharge data may not adequately represent the small, scattered population or patient locations at time of asthma events. UNM, UA, and NM DOH use NASA project data to enhance public health analyses with comprehensive spatial coverage and improved air quality forecasts. Results: The NM EPHT Web application disseminates dust forecast and related NASA data to public, health, and environmental communities to help them plan outdoor activities based on poor air quality projections; ozone forecasts will be presented in a similar manner. EPHT epidemiologists use these data in linkage studies, population vulnerability studies, and to enhance ambient air data sets. These studies also identify the complexities of using remote sensing data for public health.
Impact of Exposure to Urban Air Toxics on Respiratory Illness and Asthma for the Pediatric Medicaid Population in Dearborn, Michigan
- H. Le , University of Michigan
- S. Batterman , University of Michigan
- K.Dombkowski , University of Michigan
- R. Wahl , Michigan Department of Community Health
- E. Wasilevich , Michigan Department of Community Health
- J. Wirth , Michigan State University
Introduction: Exposure to air pollutants, including urban air toxics (UATs), may contribute to the rising burden of pediatric asthma. This study examined the relationship between UAT exposure, expressed as source apportionment scores derived from receptor models (using positive matrix factorization), and emergency department (ED) visits for respiratory-related illness and asthma among the pediatric population making Medicaid claims in Dearborn, Michigan. Materials/Methods: A retrospective, ecological study design was used to evaluate asthma and respiratory-related claims for children. Daily measurements of 71 different carbonyl and volatile organic compounds (VOCs) were collected over a one-year period. These measurements were evaluated for quality assurance (QA) issues. Exposure estimates were derived from the UAT data directly and from source apportionment scores, which represented contributions from pollutant source categories. Poisson models were used to associate the daily counts of ED visits with the exposure estimates. Results: Of the 71 UATs, only 23 met QA criteria. Most of the UATs required a significant effort to identify and mitigate errors, outliers, and missing observations. Five source categories were determined through source apportionment scoring, including gasoline exhaust/evaporated gasoline, fuel combustion, combined industrial sources, photochemical pollutants, and industrial solvents. Exposure to source categories representing gasoline exhaust/evaporated gasoline was found to increase the risks of ED visits for respiratory-related illness among children. Discussion: Identifying health risks from UATs using source apportionment techniques can help to improve the effectiveness of air quality policies and management approaches. Steps to identify and mitigate errors, outliers, and missing observations should be performed prior to using these data.
Pollution Sources and Mortality Rates across Rural-Urban Areas in the United States
- M. Hendryx , West Virginia University
- E. Fdedorko , West Virginia University
- J.Halverson , West Virginia University
Background: Rural populations are potentially exposed to a variety of environmental risks from point or nonpoint pollution sources. A comprehensive assessment of rural environmental pollution sources and impacts on health has not yet been undertaken. Methods: We linked existing county-level databases to assess potential pollution sources and corresponding health outcomes, with particular attention to rural settings. Data were drawn from the Environmental Protection Agency, Department of Agriculture, National Land Cover Dataset, Energy Information Administration, Centers for Disease Control and Prevention, US Census, and other sources. We examined the statistical associations between pollution sources and all-cause, cardiovascular, respiratory, and cancer mortality rates. These associations were examined through Poisson regression modeling that accounted for age, sex, race, and other population characteristics. Results: On a per capita basis the exposure of rural populations to pollution sources was comparable to, or in some cases greater than, urban populations. Regression models specific to nonmetropolitan counties indicated that both air and water pollution sources were significantly associated with greater total and cancer mortality. Nonmetropolitan air pollution sources were associated with greater respiratory mortality rates. Coal mining areas also had higher mortality rates. Agricultural production was generally associated with lower mortality rates. Conclusions: The association between increased pollution exposure and mortality is not limited to metropolitan areas. Elevated adjusted mortality rates in nonmetropolitan areas in association with a variety of potential pollution sources carry important policy implications regarding the need for increased environmental monitoring and improved environmental standards. Further research is needed to better understand the types and distributions of pollution in rural areas, and the health consequences that result.
The Relationship Between Rural Status, Body Mass Index, and Self-Rated Health
- T. Bethea , Boston University
Background: Self-reported health (SRH) is a validated and efficacious measure of overall health and mortality. One hypothesized risk factor for SRH is urban or rural living. Methods: Data from the 2006 Behavioral Risk Factor Surveillance System were used to assess the relationship among rural status, body mass index (BMI), and SRH. The analysis utilized multinomial logistic and cumulative logistic regression models for complex survey data, controlling for covariates such as age, sex, race/ethnicity, marital status, smoking status, and socioeconomic status. Rural status was assigned based on residence outside a metropolitan statistical area (rural, urban); BMI was categorized as a 3-level variable (obese, overweight, neither); and SRH was categorized as a 5-level variable (excellent, very good, good, fair, poor). Results: Approximately one-third of respondents resided in rural areas. In crude analyses, being overweight was associated with increased risk of poorer SRH, ranging from an odds ratio of 1.46 (95% CI: 1.39, 1.53) for very good SRH to 1.64 (1.50, 1.79) for poor SRH (compared to excellent). The risks associated with being obese ranged from 2.20 (2.06, 2.34) for very good SRH to 5.71 (5.18, 6.28) for poor SRH. In crude and adjusted analyses, rural status was significantly associated with elevated BMI and poorer SRH. The results from cumulative logistic analyses were similar in magnitude and direction to those observed using multinomial logistic regression models. Conclusions: Residents of rural areas were more likely to be overweight or obese and more likely to self-report poorer health compared to residents of urban areas. Elevated BMI was also found to be associated with poorer self-rated health, such that controlling for BMI altered the relationship between rural status and self-rated health.
Health and Environmental Perceptions in a Fence-line and a Non Fence-line Community in Louisiana
- L. Langlois , Tulane University
- C. Shorter , Tulane University
- J.Shaffer , Tulane University
- L White , Tulane University
Background: Residents living in fenceline communities (FLCs) are believed to have greater concern about the impact environmental contaminants on their health than individuals in non-fenceline communities (NFLCs). FLC concerns receive attention following an incident that evokes outrage, but very little information is available to determine baseline environmental concerns. We conducted a survey in 2 communities in Louisiana, one an FLC and a comparable NFLC, to characterize community perceptions about health and environment issues. Additional questions on health status were included. The objective of the study is to characterize and compare environmental perceptions and health concerns relative to health status. Methods: A survey of 400 households was conducted using random digit dialing (RDD). Communities were matched on socioeconomic characteristics using 2000 US Census data. The survey included questions from core sections of the Behavioral Risk Factor Surveillance System (BRFSS) and Tulane's Health and Environment Perception survey. Odds ratios for each concern were reported in terms of major concerns for “fenceline residents” relative to “non-fenceline residents.” Results: There are few differences in health concerns between the FLC and NFLC. The communities differed with respect to environmental issues, specifically those issues perceived by the senses (e.g., visual, odor, noise). The self-reported health status was comparable when adjusted for age. Conclusions: This study shows that baseline concerns for general environmental issues and health effects are comparable in FLC and NFLC when there is not an incident that increases outrage. It also shows that environmental factors that can be seen, heard, or smelled are most likely to evoke concern.
On the Equitable Restoration of the Healthcare Infrastructure in Post-Katrina New Orleans
- S. Verderber , Clemson University
It has been 4 years since Hurricane Katrina flooded 80% of New Orleans and caused nearly 1,800 deaths along the US Gulf Coast. The region's health care infrastructure was devastated in the hurricane's aftermath and the rebuilding of this system has been severely hampered by ineffective leadership at all levels of government. Perhaps the most notable case of dysfunction in this regard is the controversy over the replacement of the art deco Charity Hospital (1938) in downtown New Orleans. The advantages and disadvantages of constructing a total replacement hospital are analyzed from the standpoint of the healthy community movement, new urbanism, the sustainability of conserving and reusing historic architectural resources, and the ramifications of the proposed replacement facility on the targeted parcel, a 74-acre site in a neighborhood on the edge of the central business district that contains more than 140 historic structures. The process of how nearly 40 local grassroots organizations banded together to oppose the replacement facility is documented, as a case study in how a community can unite in support of preserving a walkable, bikeable, human-scaled neighborhood that holds much promise in a reinvigorated New Orleans. The close interrelationship between the built environment and community health promotion and wellness is the core focus. The implications of this controversy are carefully examined in the context of related case studies internationally.
How do African Americans in a Poor Urban Neighborhood Frame the Link Between the Built Environment and Health?
- Y. Redwood , Centers for Disease Control and Prevention
- A. Schulz , University of Michigan
- B.Israel , University of Michigan
- Yoshihama M. , University of Michigan
- C. Wang , University of Michigan
- M. Kreuter , Georgia State University
Background/Objectives: Growing evidence suggests that the built environment in many high-poverty urban areas contributes to negative health outcomes. Poor minorities are more likely to experience both built environment hazards and negative health outcomes, yet few studies make the explicit link between environmental inequality and health inequity. Even fewer investigate this relationship from the perspectives of poor minorities. The objective of this study was to develop a conceptual model describing the relationship between the built environment and health from the perspectives of poor urban African Americans. Methods: We recruited 20 residents of Atlanta's Neighborhood Planning Unit-V , one of 24 geographic areas in Atlanta, to participate in Photovoice, a methodology that involves iterations of photo taking followed by group discussions using a semistructured, open-ended interview guide. We analyzed tape-recorded and transcribed discussions using grounded theory methodologies. Results: The conceptual model developed through this process suggests that neighborhood and housing disinvestment by local institutions and speculative development by investors combine to create poor neighborhood and housing conditions (e.g., vacant properties, water and sewage leaks, and rat and roach infestation) and contributes to poor health outcomes such as injuries, violence, and chronic illness. Speculative development also contributes to community displacement, with negative impacts on the mental health of displaced residents. Conclusions/Implications: Participants linked aspects of the built environment, community displacement, and speculative development to excess poor health, and substantial research evidence exists to support these associations. Study implications include the need for (1) environmental justice frameworks to address environmental inequalities, (2) studies on the impact of displacement on health outcomes, (3) infrastructure investments in low-income neighborhoods, and (4) further integration of public health and urban planning using tools such as health impact assessments.
The County Health Rankings—Mobilizing Action Toward Community Health (MATCH)
- V. Boothe , Centers for Disease Control and Prevention
In January 2009, the Robert Wood Johnson Foundation announced 3-year funding for the University of Wisconsin Population Health Institute (UWPHI) to pilot the expansion of the Wisconsin county health rankings to all 50 states. The Mobilizing Action Toward Community Health (MATCH) county rankings are based on a model of population health improvement in which health outcomes are influenced by a set of health determinants, which in turn can be addressed by policies and programs (Kindig and Stoddart 2003). Accordingly, annual rankings are based on an index of health outcomes (morbidity and mortality) and a related index of health determinants, including health care access and quality, health behavior, socioeconomic factors, and environmental conditions. This effort supports a comprehensive, prevention-focused approach to health. Providing annual rankings and consistent use of population-based health measures will allow counties to assess their progress over time as well as compare their health to other counties. From a national and state perspective, MATCH can be used to draw insights from the healthiest counties and identify counties most in need of resources and attention. To enhance the utility of this effort, Centers for Disease Control and Prevention (CDC) is developing a measures database that will allow users to examine their indicators by age, gender, race/ethnicity, or other population group. Each indicator would also be linked to related data and interventions evaluated in the CDC Community Guide or other reputable source. A user-friendly tool will assist communities in identifying the evidence-based interventions and associated tools most appropriate for their unique populations and circumstances. There are many communities around the country with limited capacity to utilize local data to drive effective action that could greatly benefit from this database and tool.
Impacts of Large-scale Built-Environment on the Obesity Epidemic
- X. Zhang , Centers for Disease Control and Prevention
- J. Holt , Centers for Disease Control and Prevention
- J.Yang , Georgia Institute of Technology
- S. French , Georgia Institute of Technology
Background: Research has shown that the local neighborhood environment is strongly associated with excessive food intake and physical inactivity, and the urbanization process in last 3 decades may be an important driver of the current obesity epidemic. Metropolitan spatial structure has a strong influence on urban transportation and commuting between home and workplace at the population level. However, little research has been done to evaluate its effects on obesity and relevant risk behaviors. Objective: The objective of this collaborative project between Centers for Disease Control and Prevention (CDC) and the Georgia Institute of Technology is to explore associations between the urban social and built environment and obesity at both neighborhood and metropolitan levels. Methods: This project uses the National Health Interview Survey (NHIS) to examine the influence of both neighborhood-level and metropolitan-level social and built environments on obesity outcomes. A geographic information system (GIS) is being used to link the geocoded NHIS (1986–2006) with census data and to generate built environment measures. A multilevel modeling framework is being developed to better understand the relative importance of the social and spatial contexts on obesity epidemic at different geographic aggregation levels. Implications: This project is drawing upon urban planning, transportation, and GIS expertise from the Georgia Institute of Technology and epidemiology, statistics, and GIS expertise from CDC. Results: The results from this project may be used to formulate sustainable and effective public health interventions for obesity prevention at the population level. Preliminary results from multilevel analysis of Behavioral Risk Factor Surveillance System (BRFSS) data show that the county-level job–employed residents ratio (JER) and self-containment index are significantly associated with obesity outcomes (obesity and overweight) and increase the risk of obesity and overweight at population level.
Assessing Pedestrian Safety Hazards Around Georgia State University Using GIS
- D. Dai , Georgia State University
- E. Taquechel , Georgia State University
Pedestrian safety in the urban environment has been the subject of increasing attention. In 2004, there were a total of 265,906 motor vehicle accidents in urban areas within Georgia. Nearly all the 25,000 pedestrians on the campus of Georgia State University (GSU), an urban university, must cross high-speed and high-volume streets daily. Protecting Pedestrians on the Move, a project funded by the National Highway Traffic Safety Administration and the American Public Health Association, seeks to find and implement solutions that improve pedestrian safety and reduce pedestrian injuries in downtown Atlanta. As a part of this project, this study has 2 objectives: (1) to identify locations in GSU downtown campus area with identifiable and modifiable hazards, and (2) to provide policy makers with information that will encourage the adoption of safety features and procedures. This study will collect data on pedestrian facilities in the GSU campus area using a built environment audit tool. Observational studies of pedestrian interactions with the facilities are scheduled. Motor vehicle crash data for pedestrians have been obtained from the Georgia Department of Transportation. The geographic information system (GIS) will be used to visualize and analyze pedestrian facilities and risks associated with crashes and pedestrian injuries. Findings will help city, university, and community-based organizations perform planning and advocacy to improve pedestrian safety in the downtown Atlanta and Georgia State campus environment.
Measuring Residential Segregation for Public Health Research: Race, Place, and Very Preterm Birth
- M. Kramer , Emory University
- C. Hogue , Emory University
Background: Residential segregation has been called a “fundamental cause” of racial disparities in health because of the manner in which it sorts individuals into residential environments on the basis of race or class, thus differentially allotting protective or deleterious place-based exposures. The black–white racial disparity in very preterm birth (birth <32 weeks gestation) is large, longstanding, and a primary driver of the disparity in infant mortality and morbidity. Methods: A 2-step process was conducted to explore the segregation–preterm birth association. First, valid characterization of the degree of residential segregation in US metropolitan areas requires appreciation for the role of spatial patterns and neighborhood scale more flexible than the arbitrary boundaries of census tracts. Novel spatial segregation measures recently introduced in the social science literature were thus validated for public health research. Second, hierarchical Bayesian models were fit to estimate the association between metropolitan-level segregation patterns and individual preterm birth risk under a variety of model specifications. Results: The spatial segregation measures were found to be more robust than census tract–derived measures. Spatial isolation segregation is modestly but significantly associated with increased risk for very preterm birth in black but not white women in the United States, while spatial clustering segregation is health protective. Conclusions: Viewing this epidemiologic question through a geospatial lens facilitated improved measures of segregation and conceptualization of possible mechanisms linking residential segregation to racial disparities in very preterm birth.
Creating Healthy Places: Effective Strategies for Local Health Departments
- H. Kuiper , University of California–Berkeley
- R. Jackson , University of California - Los Angeles
- W.Satariano , University of California - Berkeley
Background/Objectives: Rising chronic disease and declining environmental conditions call for innovative public health actions, especially those that improve the built environment. This study identified key opportunities, critical strategies, and core organizational elements that can enable local health agencies to play an influential role in land use decisions and shape the built environment. Methods: Using survey and comparative case study methodologies, the study evaluated 326 responses from local public health and environmental health leaders and staff, and their partners and adversaries from planning, political, and private sectors. Regression and pattern-matching analyses were employed. Results: For all findings, explanatory details and priorities will be provided. Engaging in a range of land use and transportation procedures increases local health's impact on the built environment (OR: 1.68, p<0.004). Diverse collaboration is also key: Collaboration across public agencies, public administration, and the private sector increases health's impact (OR: 4.38, p<0.03). Even with modest staffing, local health can have an impact (OR: 2.59, p<0.001). However, investment in staff skills is critical (OR: 3.56, p<0.03), as is strong leadership; weak leadership was twice as prevalent in failed initiatives as in successful ones. Appropriate use of authority, influence, diplomacy, and timing was 4 times more prevalent, and adding value to built environment processes was 8 times more common among successful initiatives than failures. Details of how to add value, wield power, and get a seat at the table, and barriers most salient to failure are presented. Conclusions: The study demonstrated local health leadership and action can influence land use decisions. Investment in skills development and policy support for local health increases its effectiveness.
As the Crow Flies: Comparing Radial and Network Analysis of Park Service Areas
- D. Merriam , Centers for Disease Control and Prevention
- T. Giarrusso , Georgia Institute of Technology
Issue: Travel distance impacts walkability. The methods used to calculate site accessibility affect our understanding of service and planning decisions. Service estimates can be established using either radial analysis that includes all land within a specified distance regardless of barriers or network analysis that follows actual travel routes. Radial analysis overstates access, but how much? Results: The study mapped catchment areas for 154 park sites. In all cases the radial analysis resulted in larger service estimates. The citywide catchment acreage for the quarter-mile travel distance resulted in a radial analysis service area estimate 147% larger than the area estimated using network analysis (29,138 acres vs. 11,778 acres). The half-mile travel analysis resulted in an 80% difference (56,385 acres vs. 31,380 acres). Lessons Learned: Entrance location and route availability have significant impacts on pedestrian site access. The least accessible parks had one entrance and limited street connectivity. The number and location of park entrances and the characteristics of the surrounding street network directly impact the size of the park catchment area. Appropriate entrances and street patterns with small blocks and a dense pattern of intersections increased the ratio of network to radial catchment areas. Network analysis provides a more accurate estimate of pedestrian access than radial analysis and adds valuable insights at both the system and site scales. At the system level, the more precise maps provide a clearer representation of gaps in park distribution. At the site level, the graphics created for each park illustrate where strategic acquisitions, street development, or additional entrances could expand pedestrian access. The graphic representations can also illustrate the impact of additional entrances and how they expand access from adjacent neighborhoods.
Developing a Prevention Through Design National Initiative
- P. Schulte , Centers for Disease Control and Prevention
- D. Heidel , Centers for Disease Control and Prevention
- A.Okun , Centers for Disease Control and Prevention
- C. Geraci , Centers for Disease Control and Prevention
Background: Millions of workers are killed, injured, or sickened at work each year. Too often, interventions are to control workplace risks and hazards rather than to design them out. Issue: The objective of the Prevention through Design (PtD) National Initiative is to prevent or reduce work-related injuries, illnesses, fatalities, and exposures by including prevention consideration in all designs that affect individuals in the occupational environment. This will be accomplished through the application of hazard elimination and risk minimization methods in the design of work facilities, processes, equipment, tools, and work methods. Results: A plan for the 7-year initiative was developed by an extensive process that included partnerships, consultation, and workshops with a diverse group of stakeholders from industry, labor, academia, government agencies, and nongovernment organizations (NGOs). The plan (http://wwwdev.niosh.cdc.gov/niosh/programs/ptdesign/default.html) contains 5 strategic and 52 intermediate goals in the categories of research, education, practice, policy, and small business. The plan involves processes to (1) create awareness of PtD in all industrial sectors, in organizations and agencies, and at schools and universities by sharing PtD benefits, success stories, best practices, and financial returns; (2) obtain commitments from businesses, organizations, and workers to incorporate PtD into work processes and health and safety management systems; and (3) monitor the impact of PtD on eliminating hazards and minimizing risks to ensure that appropriate program and process adjustments occur as needed. Lessons Learned: A growing number of business leaders are recognizing PtD as a cost-effective means to enhance occupational safety and health. Success of the initiative will come through a coordinated, phased approach to PtD activities that takes into consideration the unique challenges faced by businesses within all industrial sectors.