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Scoping
Creation of logic model– Specify how policy and infrastructure changes
will eventually impact health outcomes– Helps in focusing the impact assessment
• Quantitative• Qualitative
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Logic Model
Build sidewalks and crosswalks Safety
Physical activity Obesity
Mortality
Lung disease
CVD
Cancer
Diabetes
Traffic
Land-use
People outside
Depression, anxiety, stressHypertensionOsteoporosis
Air and noise pollution
Permit mixed-use zoning floor/area ratio dwelling units pop. density
Change 60 ft. easement to 40 ft. (thin wall arcade, buildings built closer to sidewalk, Oreo deck)
Social capitalParking requirements
Injury
I-85 traffic
connectivity
Bus ridership
Policy Proximal Intermediate HealthImpacts Impacts Outcomes
parking
Injuries and fatalities
Pop. density
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Risk Assessment
Qualitative– Traffic – Pollution– Social capital– Crime and safety– Economic development – Gentrification
Quantitative– Injury– Physical Activity
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Determining Affected Population
The individuals who live in the study area (N. Druid Hills to Clairmont) – 5 census blocks– Only counted those that lived ½ mile from highway– 14,000 people
Individuals who drive through study area – ADT (23,034) x people per car (1.63)– 37,545 people– No demographic data available
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Demographics for Study Area
Study Area Atlanta
% Male 60.0 49.4
Age
0-17 18.9 26.6
18-29 28.3 18.1
30-39 23.3 18.4
40-49 10.9 15.7
50+ 8.6 21.2
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Demographics for Study Area
Study Area Atlanta
Race
White 47.3 63.0
Black 20.8 28.8
Asian 4.8 3.3
Ethnicity
Hispanic 49.8 6.5
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Demographics for Study Area
Study Area Atlanta
Foreign-born 61.1 10.3
Non-resident 1995 26.6 4.1
Poverty 15.8 9.2
Avg. income $45,511 $51,948
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Household Demographics
Average family size is 3.4 Most families (70%) have 2 or more
workers 12% of households have no car and 48%
have 1 car 17% take transit to work and 3% walk
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Pedestrian Data for All Crashes in DeKalb County, GA
67% of pedestrians hit were males 77% of pedestrian fatalities were males Of the 62 fatally injured pedestrians:
– 47% Black– 36% Hispanic– 17% White
DeKalb Board of Health (2003)
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Severity of Injuries in DeKalb on Buford Highway
Severity N %
Fatalities 12 16.2
Serious Injuries 17 23.0
Visible Injuries 29 39.2
Complaints of Injuries 12 16.2
No Injuries 4 5.4* DeKalb Board of Health
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Number of Injuries and Deaths on Buford Highway
DeKalb Study Area (8 miles) (2.37 miles)
Injuries/year 18.6 6.7Deaths/year 3.6 1.8
DeKalb Board of Health (2003)
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Estimating Changes in Injury
No studies could be located to determine injury reduction based on proposed changes
Hired senior traffic engineers (Hamilton & Associates) to calculate expected changes
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Estimating Crash Reduction
CRFt = CRF1 + (CRF2 ) (1-CRF1) + … (CRFn) (1-CRF1) (1 – CRF2)…(1-CRFn-1)
– Where CRFt = CRF of combined measures– CRF1 = CRF for the first countermeasure– CRF2 = CRF found the second countermeasure– CRFn = CRF for the nth countermeasure
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Improvement Measure All Collisions CRF
Pedestrian Collision CRF
Replacement of two-way left-turn lane with raised median
25% - 45% 55%
Sidewalks 1% 65% - 75%
Added/improved pedestrian crosswalks 13% - 25% 19%
Reduced speed limit 1% - 3% 15% - 30%
Access control: service road/frontage road 5% - 12% 10% - 30%
Combined measures Range 39% - 65% 89% - 94%
Best-guess point estimate 60% 91%
Collision Reduction Factors
Hamilton & Associates (2004)*ranges represent upper and lower bound estimates from studies
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Injuries and Fatalities: Study Area
Current Expected After
Reduction
Pedestrian
Injuries/Year 6.7 .91 (.89- .94) 0.4
Pedestrian
Deaths/Year 1.8 .91 (.89- .94) 0.1
Automobile
Injuries/Year 120 .60 (.39 -.65) 46
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Physical Activity
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Physical Activity
Hard to find study that had good measures of physical activity and the built environment – we chose study with best measure of physical activity
Saelens et al. (2003) found a 72.5 minute difference in total walking per week between neighborhoods in San Diego
Saelens et al. (2004) found 124 minute difference in walking for transport In low-income neighborhoods in Seattle
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Walkability Audit Results
Neighborhood Score Grade
San Diego High Walkable 1.4 A-
San DiegoLow Walkable 2.0 B
Buford Before 4.1 D
Buford After 2.4 B-1=A to 6=F
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Estimating Increases in Walking
Since there were only 2 data points to serve as the source for the effect parameter there is uncertainty with respect to the shape of the relationship– Linear increase (204 minute increase/week)– Dichotomous function (76.2 minute
increase/week)– Curvilinear relationship (11 minute
increase/week)– No effect
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Buford Highway Post-Project – Seattle Estimate = 200 mins/week
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Qualitative Analysis
Traffic – Probably decrease along Buford Highway with
increases along other Atlanta Highways
Noise Pollution– Increase during construction then decrease
afterwards due to slower and less traffic
Air Pollution– Small decreases in local area but not
significant enough to affect entire Atlanta area
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Social capital– Increase in social capital due to increased
walkability and greenspace Crime and safety
– Literature to mixed to make any predictions on direction
Economic development and Gentrification– Due to central location inside Atlanta next to
exclusive neighborhoods economic development as well as gentrification are likely
Qualitative Analysis
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Assumptions for Estimating PA
Their were several limitations in the Saelens et al (2003) study which may affect the expected increases in pa predicted in this HIA
Walkability and not other factors explain the differences found in the Saelens et al (2003) study
The built environment aspects that were correlated with differences in pa in the San Diego neighborhoods will have the same effect along Buford Highway
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Assumptions for Estimating PA
The Ft. Collins LOS instrument was able to capture the elements of the built environment related to physical activity
Increases in walking that are predicted represent increases in total pa and not a substitution
The relationship between the built environment and pa is not only correlational but causal
For the CEA analysis it was assumed that the walking bouts will be at least 10 minutes in length so that they will have health impacts
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Assumptions for Estimating Injury
Traffic calming measures used in other parts of the county will have the same effect along Buford Highway
The effects of the crash reduction factors are additive
The best available estimates for CRFs were used, which included personal communication with local DOTs, and the predictive certainty of most of the CRFs are unknown
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Assumptions for Estimating Injury
Traffic may be diverted onto other streets and there may be a change in injuries along those streets
The residents will use the medians and crosswalks
For the CEA It was assumed that the same number of people will be driving and walking along Buford Highway despite the projected increases in population
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Evaluation of Impact
Sections of Buford Highway (Shallowford to I-285) will be redeveloped starting in the spring of 2005– Changes will not be as extensive as those
proposed by Georgia Tech– Decision made before HIA was completed– Discussing placing full medians with
sidewalks in the southern section of Buford Highway
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Key Challenges of HIA
Uncertainties (data, models, policy) Timeliness Relevance to stakeholders and decision
makers– Political context– Importance relevant to other factors
Capacity to conduct HIAs
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Next Steps for HIA
Adapting HIA to the unique policy-making environment of the U.S.
Moving from research to practice– Methods to sort through bills/initiatives to find
those for which HIA is most suitable– Standardizing and streamlining impact
estimation– Determine feasibility of different types of tools
in various settings– Training
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Summary
HIA is a new and evolving science in the U.S., however it is a promising new approach to quantify health impacts of a wide variety of policies and projects
HIA provides only one piece of information (health) in complex decisions and stakeholders may have different priorities
HIA provides an outlet for health to be appropriately factored into complex decisions
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