Integrated Impact Assessment of Active Travel: Expanding the Scope of the Health Economic Assessment Tool for Walking and Cycling
Thomas Götschi, University of Zurich/University of OregonShow Abstract
Sonja Kahlmeier, Fernfachhochschule Schweiz
Alberto Castro Fernandez, University of Zurich
Christian Brand, University of Oxford
Paul Kelly, University of Edinburgh
Christoph Lieb, Ecoplan AG
David Rojas Rueda, Colorado State University
James Woodcock, University of Cambridge
Francesca Racioppi, WHO
The World Health Organization’s Health Economic Assessment Tool (HEAT) for walking and cycling is a user-friendly web-based model to assess health impacts of active travel. Health impacts are quantified in terms of premature deaths avoided (or caused) by walking or cycling in a population, and monetized in terms of Value of Statistical Life. HEAT was recently updated to include, in addition to the calculation of benefits from physical activity through active travel, assessments of the burden associated with air pollution exposure and crash risks while walking or cycling. Further, impacts of increased active travel (leading to reductions in vehicle travel) on carbon emissions can now be assessed. This article presents the main features of HEAT, the recent upgrades and underlying methods.
Compact Development and BMI: Environmental Determinism or Self-Selection?
Shima Hamidi, University of Texas, ArlingtonShow Abstract
Reid Ewing, University of Utah
The literature widely reports a statistical association between the built environment and obesity. What is less clear is the reason for the association. Is it environmental determinism that is the effect of the built environment on individual behavior, with compact places inducing more physical activity and hence lower weight? Or is it self-selection that is the tendency of healthy weight individuals to select to live in compact places where they can be more physically active, and possibly of overweight individuals to opt for sprawling places? Both theories have been promoted in the literature. This study seeks to address this issue using data from the National Longitudinal Survey of Youth. We study body mass indices of survey participants at two points in time and follow them longitudinally for a six-year time period as they move from place to place. We estimate models for the entire cohort and also for movers and stayers separately. We find evidence of self-selection. First, we find that compactness is not associated with BMI for those staying in the same place for the entire period. Second, we find no association between changes in sprawl and the changes in BMI for movers. Third, our longitudinal analysis show that individuals of healthy weight tend to move in the direction of greater neighborhood compactness, while overweight individuals tend to move in the direction of greater sprawl. These findings do not suggest that place characteristics are unimportant, as planners needs to meet the growing demand for walkable, compact and connected places, which are currently undersupplied. Still, place characteristics tend to have only a limited ability to impact the behaviors of individuals who choose not to be physically active.
The Geographic Disparities in Transportation-Related Physical Activity in the United States: An Analysis of 2017 NHTS Data
Hongwei Dong, California State University, FresnoShow Abstract
Research on the relationship between urbanicity and physical activity yielded mixed results despite many studies consistently showed that residents tended to undertake more transportation-related physical activity in a more urban environment. This study analyzed the 2017 NHTS data to examine the geographic disparities in physical activity, particularly transportation-related physical activity in the United States. Our analysis suggests that there is very slight geographic variation of the weekly rates of walk and bike trips that are strictly for exercise. There is, however, a lot more variation of the weekly rates of walk and bike trips that are for non-exercise purposes. The relationship between urbanicity and physical activity is non-linear. Residents tend to take more physically activity, particularly more walk trips, when they live in the areas from the two ends of the urbanization spectrum: inner cities and inner-suburbs of large metropolitan areas and the rural parts of non-metropolitan areas. Suburbanites, particularly mid-ring and outer-ring suburbanites walk the least. Walkers and cyclists in the different geographic locations report different infrastructure and safety barriers that keep them from walking and biking more. A lack of nearby paths or trails is the prominent infrastructure barrier to biking more for cyclists in the central locations of large metropolitan areas and cyclists in non-metropolitan areas. For suburban cyclists, a lack of nearby parks seem to be a more prominent barrier to biking more. Walkers in different geographic locations consistently report no sidewalks or sidewalks in poor conditions as the most prominent barriers to taking more walks.
Estimation of PM Inhalation for Cyclists and Pedestrians in Short Urban Trips: A Comparison Based on a Lisbon Case Study
Anabela Ribeiro, Universidade de CoimbraShow Abstract
Marta Faria, Universidade de Lisboa Instituto Superior Tecnico
Diego Gimenez-Gaydou, Universidade de Coimbra
Ana Vasconcelos, Universidade de Lisboa Departamento de Engenharia Mecanica
Tiago Farias, Universidade de Lisboa Instituto Superior Tecnico
The main aim of this research work is to show that there are differences in the inhalation of pollutants considering diferente active modes of transportation in urban areas. It presents a new methodology that enables the estimation of particulate matter inhalation for pedestrians and cyclists without having to take in situ measurements. This methodology was calibrated based on laboratory and in situ measurements, which allowed the development of numerical models. It was applied to a case study in Lisbon, which compared the last mile of four routes to a University Campus using bicycles or walking. The results show that, although the distance travelled on foot is on average 18% shorter than the bicycle route, the total PM inhalation in the four analyzed paths is always worse for pedestrians, with values around 60% higher. This result is mainly because the trip requires a longer time. Even though average ventilation rates for cyclists are higher than for pedestrians, with values that can be 40% higher, the higher average speed for cyclists leads to trip duration around one third of those found for pedestrians. The balance between the ventilation rates and the time of exposure usually favor the cyclist. This methodology can help users to select the best active mode and to compare different routes. In addition, the local authority can use the route classification to choose where to build cycling and pedestrians infrastructure elements that best suit the expected needs.
Transportation Barriers to Health Care in the United States
Mary Wolfe, University of North Carolina, Chapel HillShow Abstract
Noreen McDonald, University of North Carolina, Chapel Hill
G. Holmes, University of North Carolina, Chapel Hill
Objectives To quantify the number of Americans who delay necessary medical care annually due to a lack of available transportation and examine the differential prevalence of this transportation barrier across sociodemographic characteristics and patient populations.Methods We used data from 1997 through 2017 from the National Health Interview Survey to examine this barrier over time and used multivariate analysis to examine correlates of this barrier for the year 2017.Results 5.8 million Americans delayed medical care in 2017 because they did not have transportation. Historically, about 2% of the population reports this barrier to care. Hispanic people, those living below the poverty threshold, and people with a functional limitation have greater odds of reporting a transportation barrier to care after controlling for other sociodemographic and health characteristics.Conclusions Transportation barriers to care disproportionately impact individuals who are poor and who have chronic conditions. Our study documents a significant problem in access to healthcare during a time of rapid change in transportation technology.
Transportation Health Economic Return on Investment. A New Health Metrics to Compare Projects and Practical Application on Road Maintenance Policies
Anne de Bortoli, EuroviaShow Abstract
Assessments of transportation policies effects on public health are most of the time limited to air pollution due to traffic. This approach can lead to biased decisions as potential substantial impacts are not taken into account. First, indirect emissions occurring during the life cycle besides the operation stage of vehicles – namely during manufacture, transportation, maintenance and End-of-Life of vehicles – but also due to the entire life cycle of the infrastructure. Secondly, other environmental impact categories affect human health, such as toxicity or climate change. We propose a new method to assess holistically the impact of transportation policies on human health, based on Life Cycle Assessment and Cost-Benefit Analysis. This method allows to calculate a new metrics, the Transportation Health Economic Return on Investment (THEROI), and to compare transportation policies based on their financially quantified impact on public health. This metrics is then used to compare road resurfacing maintenance policies on the case study of a highway section in France. This case study highlights pavement resurfacing investment as a potentially powerful lever for public health, and finally a systemic stake to maintain roads for a nation’s economy. In particular, results show an optimal THEROI around +50% of investment compared to current maintenance practices: the gains can reach more than 700€ for the health of local residents for each additional euro spent by the highway operator.
New Evidence on the Role of Transportation and Land Use Systems on Public Health: Mortality in Heart Failure Patients
Mohammad Tayarani, Cornell UniversityShow Abstract
Subhi Al'Aref, Weill Cornell Graduate School of Medical Sciences
James Min, NewYork-Presbyterian Hospital/Weill Cornell Medical Center
Yiye Zhang, Weill Cornell Graduate School of Medical Sciences
H. Oliver Gao, Cornell University
In this study, we evaluate the role of the built environment in public health in a more accurate and holistic way than the existing studies. We also aim to provide urban policy implications to improve public health by recognizing the built environment factors that should be planned for in favor of public health. The study population is extracted from the electronic health record at Weill Cornell Medicine and New York-Presbyterian Hospital from 2012 to 2017 on 12,610 adult patients with at least one diagnosis of heart failure (ICD-9-CM: 428.*). Patients’ home addresses are geocoded and exposure to air pollution, transportation activity, land use, walkability, accessibility, and crime are examined controlling for smoking, income, education and other risk factors. The results show that land use, traffic, and air pollution significantly increase the risk of death in heart failure patients by 47.2%, 35%, and 14%, respectively. Access to public transit, green space, and active transportation do not significantly attenuate the odds of death in heart failure patients. Confiding factors such as household income play a vital role in finding the true association. The findings imply that not every urban planning strategies that are sought to be effective in reducing the amount of transportation activity are useful for public health. Urban infrastructure can enhance public health if they become consolidated at the early stages to account for the complex interactions between urban systems and public health.
Plan for Healthy Neighborhoods to Improve Mental Well-Being: A Pilot Study in Fresno, California
Hongwei Dong, California State University, FresnoShow Abstract
Ming Li, California State University, Fresno
Miguel Perez, California State University, Fresno
Chih-Hao Wang, California State University, Fresno
Using data collected from a self-administered survey, this study evaluates the variation of mental wellbeing between individuals and neighborhoods and its personal and neighborhood determinants in Fresno, California. It reveals the disparities of mental wellbeing, physical activity, and neighborhood environment between disadvantaged and non-disadvantaged neighborhoods in Fresno. Residents in disadvantaged neighborhoods report slightly lower levels of mental wellbeing and physical activity, significantly weaker neighborhood social capital, and much lower neighborhood environment quality. Our path analysis suggests that outdoor physical activity and perceived neighborhood social capital are the only two factors that influence mental wellbeing after controlling for personal socioeconomics and personality. Neither perceived nor objectively measured neighborhood environmental factors show significant and direct impacts on mental wellbeing. Neighborhood environment, however, shows indirect associations with mental wellbeing through their correlations with outdoor physical activity and perceived neighborhood social capital.
Overweight/Obesity Relationship with Travel Patterns, Socioeconomic Characteristics, and Built Environment Around an Individual
Gopal Patil, Indian Institute of Technology, BombayShow Abstract
Gajanand Sharma, Indian Institute of Technology Bombay
Overweight and obesity are important health issues in the modern era and have high correlation with one’s daily activity. Traveling activities by an individual for work, shopping, and social reasons has become a crucial part of one’s daily activity and may constitutes in getting affected by overweight or obesity. The objective of this study is to understand the complex relationship between overweight/obesity and travel pattern along with built environment for different socio-economic groups. The major parameters required for this study such as weight, height, travel pattern characteristics, and socio-economic characteristics were collected using a face to face home interview survey. The sample used for the analysis is of 4253 respondents. The built environment measure is derived from micro-level surrounding land use and zonal level data. Logistic regression model is developed to predict if a person is overweight/obese or not. The study reveals that travel pattern, socio-economic factors, and built environment parameters are important predictors of overweight/obesity. The study provides quantative support on the relationship between one’s commuting vehicle preferences and their chances of getting overweight/obese. The findings highlight the important of using active and public transport to enhance the physical activity in an individual’s daily routine, which will also lead to sustainable development. Increase in the use of walking and public transport as the mode of commuting along with the improvement in walkability measure of one’s surrounding (walkscore) can also turn out to be an effective public health intervention and overweight/obesity preventative strategies.
Role of Transportation and Urban Design to the Health Impacts: A Case Study of Dallas-Fort Worth, Texas
Shirin Rad, University of Texas, ArlingtonShow Abstract
MEHRDAD ARABI, University of Texas, Arlington
Kyung Hyun, University of Texas, Arlington
Stephen Mattingly, University of Texas, Arlington
Transportation sources account for a large proportion of the pollutants found in most urban areas. Also, transportation activity and intensity appear likely to contribute to the risk of respiratory disease occurrence. Thus, this research investigates the impacts of transportation, urban design and socioeconomic characteristics on the occurrence risk of air pollution-related respiratory diseases in one of the biggest MSAs (Metropolitan Statistical Area) in the US, Dallas-Fort Worth (DFW) at the Block Group (BG) level, by considering respiratory hazard quotient (RHQ) as the dependent variables. Baesd on the literature, 30 indicators have been found effective in relation to respiratory diseases and named as EIR (Effective Indicators of Respiratory diseases). A three-step modeling including Principal Component Analysis (PCA), Ordinary Least Square (OLS) and Geographically Weighted Regression (GWR) applied to reach the final model. The results of this study demonstrated a strong variability in the study area which explains the spatial difference of the impact of selected indicators including socioeconomic characteristics, transit access to jobs, automobile access and etc on the risk of traffic-related respiratory diseases. For instance, transportation and urban planning decisions related to public health and specifically respiratory diseases in the center of Dallas MSA which may be characterized by lower income level and jobs, are more vital than suburban areas. Researchers and practitioners can analyse the key factors which can affect the health impacts of air pollution specifically respiratory diseases based on the spatial variation of each of the main predictors.
Quantifying the Health Impacts of Transportation Investments to Support Routine Transportation Decision Making: A Case Study in Raleigh, North Carolina
Theodore Mansfield, RSG IncShow Abstract
Vincent Bernardin, RSG Inc
Mushtaqur Rahman, Baseline Mobility Group, Inc.
While tools continue to emerge to better estimate transportation heath impacts, integration of these tools with models used by transportation practitioners, such as travel demand models, remains nascent. In this work, we link disaggregate travel demand model outputs to a health impact model to estimate the health impacts of five future transportation-land use scenarios for Raleigh, NC. We find that an equitable transit-oriented development scenario is most beneficial to public health, reducing annual premature mortality by 0.70 deaths per 100,000 persons. On the other hand, we estimate that a future scenario focusing on expanding freeway capacity increases premature mortality by 0.10 deaths per 100,000 annually. Additionally, we find that congestion charging in the region would yield slight positive health impacts (annual reduction of 0.16 deaths per 100,000) due to mode shifts to non-motorized and public transit modes. By integrating our model with disaggregate travel demand model outputs, we are also able to explore how health impacts vary across five sub-populations (low-income households, zero-vehicle households, medium-income households with fewer cars than workers, medium-income households at least as many cars as workers, and high-income households). Low-income households see even greater benefits in the equitable transit-oriented development scenario (annual reduction of 1.0 deaths per 100,000 persons) but are also most negatively impacted in the freeway expansion scenario (increase of 0.72 deaths 100,000 annually). The approach developed in this paper offers a novel way to harmonize transportation and public health models to support the integration of health consideration into routine transportation decision-making.
What Affects Motocyclists' Attitudes Toward Air Pollution in a Polluted City?: A Case Study in Tehran
Arsham Bakhtiari, No OrganizationShow Abstract
Meeghat Habibian, Amirkabir University of Technology
Tehran, the capital city of Iran, is amongst many cities around the world which suffers from air pollution and the rapid growth of gasoline-powered motorcycles usage has considerably contributed to this increased air pollution in this city. To cope with this problem, changing the motorcyclists' travel behavior, by increasing their awareness, could be an effective strategy. Although recent studies have aimed at motorcyclists’ behavior, few studies have taken motorcyclists’ attitudes, especially their attitudes toward air pollution into account profoundly. Attitudes are thought to play a significant role on determining motorcyclists’ behavior, hence, it is expected that motorcyclists’ attitude toward air pollution affects their daily travel patterns. The aim of the present paper is to account for effective factors on motorcyclists’ attitude toward air pollution. To do so, a survey of 503 motorcyclists whose workplaces were located in the central business district of Tehran through a face-to-face interview was conducted. In order to identify the effects of trip-related, socio-economic and motorcycles' characteristics of motorcyclists on three attitudinal statements including “Tehran's air pollution is serious”, “Air pollution is detrimental to human health”, and “Gasoline-powered motorcycle is one the main sources of air pollution”, two binary logit models and a generalized ordered logit model have been developed. The results revealed the effects of socio-economic status, age, education, residence location and riding experience on the stated statements.
Assessing the Impact of Transportation on Health: A Review of Performance Measures
Aikaterini Deliali, University of Massachusetts, AmherstShow Abstract
Sarah Esenther, Yale University
Christine Frisard, University of Massachusetts Medical Center
Karin Goins, University of Massachusetts Medical Center
Stephenie Lemon, University of Massachusetts Medical Center
Krystal Pollitt, Yale University
Eleni Christofa, University of Massachusetts, Amherst
Federal planning requirements dictate that state Departments of Transportation (DOT) prepare 20 year statewide long-range transportation plans. In addition, MAP-21 requires that plans be performance-based, utilizing performance measures data for several categories including operations, safety, and air quality. However, performance-based assessment of transportation projects as related to many determinants of health is often missing. This paper reviews performance measures associated with five factors documented to heavily influence health: air quality, accessibility, equity, physical activity, and safety. All of these metrics have been reviewed through a transportation lens, i.e., the focus has been on how these factors are affected by transportation projects and what the best way to quantify those influences is. Understanding how to measure the impact of transportation on these health-related outcomes is critical for designing and managing sustainable transportation systems while ensuring healthy communities. Ultimately, this review can contribute to improvements in decision making by introducing health-related performance measures and therefore, scoring criteria in department of transportation and local agency project prioritization processes.
E-Bikes and Physical Activity: A Systematic Review
Marx Paris, McGill UniversityShow Abstract
Kevin Manaugh ANF10, McGill University
The growing sales of e-bikes worldwide, especially in China and Europe, has led to questions over whether they will have the same positive health outcomes as conventional bicycles. E-bikes add an electric motor to a bicycle to require less effort from the rider. This paper used a systematic realist review logic to determine whether e-bikes still allow riders to meet recommended physical activity guidelines. Key findings include the fact that, while physical activity is less intense than on a bicycle, e-bike riders can still achieve moderate- to vigorous-intensity physical activity, but will need to ride their e-bikes for longer than a bicycle. Further discussion of the included studies suggests that riders find e-bikes easier to use than bicycles and are less likely to shower after completing an e-bike trip, which could allow them to be used for more trip types than a regular bicycle.
Autonomous Vehicles and Public Health: A Conceptual Model and Policy Recommendation
Soheil Sohrabi, Texas A&M University, College StationShow Abstract
Haneen Khreis, Texas A&M Transportation Institute
Dominique Lord, Texas A&M University
Supporting policies are required to govern the unintended consequences of Autonomous Vehicles (AVs) implementation and maximize their benefits. The first step towards formulating policies is identifying the potential impacts of AVs . While the impacts of AVs on the economy, environment, and society are well explored, the discussion around their beneficial and adverse impacts on public health is still in its infancy. This study provides a review of the literature on AVs and public health and develops a framework to clarify the potential impacts. The proposed model, first, summarizes the potential changes in transportation after AVs implementation into seven points of impacts: transportation infrastructure, land-use, and the built environment, traffic flow, transportation mode choice, transportation equity, jobs related to transportation, and traffic safety. Second, the transportation-related risk factors that affect public health are outlined. Third, we formulate the pathways between AVs and public health using the knowledge gained from two previous steps. The review of the literature shows that the discussion around AVs impacts on public health is gaining increasing research attention in recent years but still needs more attention. Using the proposed model, we found that AVs can be associated with public health through 32 pathways, where they can adversely impact health through 24 of those. The health impacts of AVs are contingent upon supporting policies . Equipping AVs with electric motors, regulating urban area development, implementing traffic demand management, controlling AVs ownership, and imposing ride-sharing policies are the strategies that can reinforce the positive impacts of AVs on public health.
Opportunities for Incorporating Health Considerations in Transportation Decision Making
Laura Sandt, UNC Highway Safety Research CenterShow Abstract
Meg Bryson, University of North Carolina, Chapel Hill
Lauren Blackburn, VHB
Alyson West, University of North Carolina
Daniel Rodriguez, University of California, Berkeley
Sagar Shah, American Planning Association
An emerging body of research demonstrates the effects that transportation decisions—including policies, programs, projects, and mode choice—have on community and individual health. Agencies responsible for transportation decision-making, such as state Departments of Transportation (DOTs), have many opportunities to integrate health considerations into their practice to achieve positive health outcomes and mitigate harmful impacts. This paper describes various agency practices in the United States with regard to health in transportation and identifies needs for data, tools, and guidance to more routinely implement health considerations. This research, conducted under NCHRP Project 20-112, consisted of an extensive literature review and interviews with more than 20 stakeholders from the transportation and public health sectors, including state DOTs, state health departments, city and regional agencies, the United States Department of Transportation, and the Centers for Disease Control and Prevention. The researchers identified noteworthy practices, as well as noteworthy challenges, in the areas of interagency collaboration, policymaking, equity, and project-level evaluation. In these and other areas—such as data collection and data sources, public engagement, and data visualization—there is a need for further guidance and resources for agencies. Recommendations for research priorities to support health integration into DOT practices are provided in the NCHRP 20-112 Research Roadmap.
Health Impact Assessment of Automated Vehicles in San Francisco Bay Area Using the Integrated Transport and Health Impacts Model
Elham Pourrahmani, University of California, DavisShow Abstract
Miguel Jaller, University of California, Davis
Neil Maizlish, University of California, Davis
Caroline Rodier, University of California, Davis
This paper evaluates the potential human health impacts from connected and autonomous vehicles (CAVs) scenarios in the the San Fracisco, Bay Area. The study concentrates on impacts derived from AVs’ effects on travel demand, safety, and environmental emissions. The paper combines an extensive literature review about the extent of such effects, expert judgement, and results from activity-based travel modeling, to quantify the human health impacts of CAVs using the Integrated Transport and Health Impacts Model (ITHIM). Specifically, ITHIM estimates the impacts considering changes in travel demand (e.g., vehicle miles traveled) and levels of physical activity. The results show significant opportunities for road traffic injury reductions, as well as mitigation of environmental emissions. However, reduced physical activity from the mode shift to passenger vehicles (from active travel) could increase the cases of human health issues (e.g. diabetes and lung cancer). Moreover, the paper explores a set of scenarios that could mitigate some of the health-related disbenefits from CAVs.
Understanding Potential Exposure of Bicyclists on Roadways to Traffic-Related Air Pollution: Findings from El Paso, Texas, Using Strava Metro Data
Kyuhyun Lee, Korea Land and Housing CorporationShow Abstract
Ipek Sener, Texas A&M Transportation Institute
As bicycling on roadways can cause adverse health effects, there is an urgent need to understand how bicycle routes expose bicyclists to trafﬁc emissions. Limited resources for monitoring reveal that bicycle travel patterns may constrain such understanding at the network level. This study examined the potential exposure of bicyclists to trafﬁc-related air pollution in El Paso, Texas, using Strava Metro data that revealed bicycle patterns across the city networks. An initial spatial mapping analysis was conducted to explore the spatial patterns of bicycling and trafﬁc pollutant emission, followed by exploratory descriptive statistics. A spatial bicycle model was then developed to explore factors inﬂuencing bicycling activity in El Paso. Analysis results indicated signiﬁcant associations between greater bicycle volume and both higher levels of particulate matter (PM 2.5 ) emissions and more frequent bus services, implying adverse health concerns related to trafﬁc-related air pollution. The results also indicated signiﬁcant effects of various environmental characteristics (e.g., roadway, bicycle infrastructure, topography, and demographics) on bicycling. The ﬁndings encourage extending this study to provide guidance to bicyclists whose regular trips take place on heavily trafﬁcked roads and during rush hours in this region and to evaluate the net health impacts of on-road bicycling for the general population.