Northwest Center for Livable Communities Archives

What County-level Factors Influence Covid-19 Incidence in the United States? Findings from the First Wave of the Pandemic

Wang, Lan; Zhang, Surong; Yang, Zilin; Zhao, Ziyu; Moudon, Anne Vernez; Feng, Huasen; Liang, Junhao; Sun, Wenyao; Cao, Buyang. (2021). What County-level Factors Influence Covid-19 Incidence in the United States? Findings from the First Wave of the Pandemic. Cities, 118.

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Abstract

Effective control of the COVID-19 pandemic via appropriate management of the built environment is an urgent issue. This study develops a research framework to explore the relationship between COVID-19 incidence and influential factors related to protection of vulnerable populations, intervention in transmission pathways, and provision of healthcare resources. Relevant data for regression analysis and structural equation modeling is collected during the first wave of the pandemic in the United States, from counties with over 100 confirmed cases. In addition to confirming certain factors found in the existing literature, we uncover six new factors significantly associated with COVID-19 incidence. Furthermore, incidence during the lockdown is found to significantly affect incidence after the reopening, highlighting that timely quarantining and treating of patients is essential to avoid the snowballing transmission over time. These findings suggest ways to mitigate the negative effects of subsequent waves of the pandemic, such as special attention of infection prevention in neighborhoods with unsanitary and overcrowded housing, minimization of social activities organized by neighborhood associations, and contactless home delivery service of healthy food. Also worth noting is the need to provide support to people less capable of complying with the stay-at-home order because of their occupations or socio-economic disadvantage.

Keywords

Pandemics; Covid-19; Covid-19 Pandemic; Infection Prevention; Stay-at-home Orders; Structural Equation Modeling; United States; Communicable Disease Prevention; Influential Factors; Lockdown; Structural Equation Modeling (sem); Prevalence; Disease; Healthy Food; Social Activities; Counties; Neighborhoods; Housing; Built Environment; Prevention; Minimization; Socioeconomic Factors; Intervention; Health Care; Vulnerability; Occupations; Coronaviruses; Food Service; Disease Transmission; United States--us

Review of Health Impact Assessments Informing Agriculture, Food, and Nutrition Policies, Programs, and Projects in the United States

Cowling, Krycia; Lindberg, Ruth; Dannenberg, Andrew L.; Neff, Roni A.; Pollack, Keshia M. (2017). Review of Health Impact Assessments Informing Agriculture, Food, and Nutrition Policies, Programs, and Projects in the United States. Journal Of Agriculture Food Systems And Community Development, 7(3), 139 – 157.

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Abstract

Policies, programs, and projects related to agriculture, food, and nutrition can significantly affect public health. Health impact assessment (HIA) is one tool that can be used to improve awareness of the health effects of decisions outside the health sector, and increasing the use of HIA for agriculture, food, and nutrition decisions presents an opportunity to improve public health. This study identifies and reviews all HIAs completed in the United States on agriculture, food, and nutrition topics. Studies were identified from HIA databases, an Internet search, and expert consultation. Key characteristics were extracted from each study: type of decision assessed, location, level of jurisdiction, lead organization, methods of analysis, and recommendations. Twenty-five eligible HIAs that were conducted between 2007 and 2016 address topics such as regulations on land use for agriculture; food and beverage taxes; and developing grocery stores in food deserts. These HIAs have predominantly supported policy, as opposed to program or project, decisions. Four case studies are presented to illustrate in detail the HIA process and the mechanisms through which HIA findings affected policy decisions. Among other influences, these four HIAs affected the language of legislation and provided guidance for federal regulations. These examples demonstrate several findings: appropriate timing is critical for findings to have an influence; diverse stakeholder involvement generates support for recommendations; and the clear communication of feasible recommendations is highly important. There is substantial scope to increase the use of HIA in the agriculture, food, and nutrition sectors. Challenges include the paucity of monitoring and evaluation of HIAs' effects on health outcomes, and the limited funding available to conduct HIAs. Opportunities include integrating HIAs and community food assessments, and more widely sharing HIA findings to inform related decisions in different jurisdictions and to increase support for additional HIAs that address the food system.

Keywords

Environments; Obesity; Health Impact Assessment; Policy; Food; Nutrition; Agriculture

Review of Education-Focused Health Impact Assessments Conducted in the United States

Gase, Lauren N.; Defosset, Amelia R.; Gakh, Maxim; Harris, Celia; Weisman, Susan R.; Dannenberg, Andrew L. (2017). Review of Education-Focused Health Impact Assessments Conducted in the United States. Journal Of School Health, 87(12), 911 – 922.

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Abstract

BACKGROUNDHealth impact assessment (HIA) provides a structured process for examining the potential health impacts of proposed policies, plans, programs, and projects. This study systematically reviewed HIAs conducted in the United States on prekindergarten, primary, and secondary education-focused decisions. METHODSRelevant HIA reports were identified from web sources in late 2015. Key data elements were abstracted from each report. Four case studies were selected to highlight diversity of topics, methods, and impacts of the assessment process. RESULTSTwenty HIAs completed in 2003-2015 from 8 states on issues related to prekindergarten through secondary education were identified. The types of decisions examined included school structure and funding, transportation to and from school, physical modifications to school facilities, in-school physical activity and nutrition, and school discipline and climate. Assessments employed a range of methods to characterize the nature, magnitude, and severity of potential health impacts. Assessments fostered stakeholder engagement and provided health-promoting recommendations, some of which were subsequently incorporated into school policies. CONCLUSIONSHealth impact assessment is a promising tool that education, health, and other stakeholders can use to maximize the health and well-being of students, families, and communities.

Keywords

Decision Making; Elementary Schools; High Schools; Medical Policy; Medline; Nutrition; Online Information Services; Research Funding; Student Health; Systematic Reviews (medical Research); Search Engines; Physical Activity; Health Impact Assessment; United States; Collaboration; Policy; Public Health; Academic-achievement; Programs

Use and Effectiveness of Health Impact Assessment in the Energy and Natural Resources Sector in the United States, 2007 – 2016

Nkyekyer, Esi W.; Dannenberg, Andrew L. (2019). Use and Effectiveness of Health Impact Assessment in the Energy and Natural Resources Sector in the United States, 2007 – 2016. Impact Assessment & Project Appraisal, 37(1), 17 – 32.

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Abstract

Decisions made in the energy and natural resources sector can affect public health. This report reviews the characteristics and assesses the effectiveness of health impact assessments (HIAs) conducted in this sector. A total of 30 HIAs conducted in 14 states in the United States were identified using a targeted literature search. Five HIAs illustrative of the different source and sub-sector categories, and with identifiable impacts on decision-making processes were selected for review. An existing conceptual framework (Wismar) was used to assess the effectiveness of the five selected HIAs on decision-making related to non-renewable energy, renewable energy, mining, and energy conservation. The 30 HIAs were performed for a variety of projects and assessed health impacts ranging from metabolic disorders to community livability. Eight of the 30 reports were incorporated into environmental impact assessments. All five selected HIAs were generally effective and raised awareness of the health effects of the projects being assessed; four were directly effective and led to changes in final project decisions. Their variable effectiveness may be related to the extent of community engagement and consideration of equity issues, differences in the details and quality of monitoring and evaluation plans devised as part of the HIA process, and whether the outcomes of monitoring and evaluation are reported.

Keywords

Health Impact Assessment; Health Equity; Natural Resources; Environmental Impact Analysis; Power Resources; U.s. States; Energy Conservation; United States; Decision-making Effectiveness; Energy And Natural Resources; Wismar Framework; Horizon Oil-spill; Wind Turbine Noise; Quality-of-life; Environmental-health; Gas Development; Mental-health; Exposure; Vicinity; Hazards; Sleep; Environmental Assessment; Public Health; Metabolic Disorders; Renewable Energy; Monitoring; Decision Making; Evaluation; Environmental Impact; Community Involvement; Environmental Impact Assessment; Renewable Resources; Decisions; Impact Analysis; Mining; United States--us

Do Home Buyers Value the New Urbanist Neighborhood? The Case of Issaquah Highlands, WA

Kim, Jinyhup; Bae, Chang-Hee Christine. (2020). Do Home Buyers Value the New Urbanist Neighborhood? The Case of Issaquah Highlands, WA. Journal Of Urbanism, 13(3), 303 – 324.

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Abstract

This study compares Issaquah Highlands‚Äô home prices with those of traditional suburban single-family homes in the city of Issaquah. Issaquah Highlands is a community that was developed using New Urbanism principles. The null hypothesis is that the sale prices of houses in Issaquah Highlands are not different from the conventional suburban neighborhood in the city of Issaquah. The principal database consists of US Census Washington State Geospatial Data Archive, and the King County Tax Assessments. The final dataset contains 1,780 single family homes over the seven-year period from 2012 to 2018 based on sale records throughout the city of Issaquah. This study uses the hedonic pricing technique to assess the impact of New Urbanism on the value of single-family residences. The findings suggest that people are willing to pay a $92,700‚Äì96,800 premium (approximately 7.1‚Äì12.0 percent of the sales prices) for houses in Issaquah Highlands.

Keywords

New Urbanism; Home Prices; Real Property; Sustainable Development; Spatial Analysis (statistics); Hedonic Pricing Model; Property Value; Smart Growth; Spatial Autocorrelation; Neighborhoods; Databases; Taxation; Spatial Data; Suburban Areas; Census; Prices; Housing Prices; Urbanism; Houses; Willingness To Pay; Residential Areas; Null Hypothesis; Cities; Buyers; Hedonism; Sales; Highlands; Tax Assessments

Moving Toward Physical Activity Targets by Walking to Transit: National Household Transportation Survey, 2001-2017

Le, Vi T.; Dannenberg, Andrew L. (2020). Moving Toward Physical Activity Targets by Walking to Transit: National Household Transportation Survey, 2001-2017. American Journal Of Preventive Medicine, 59(3), E115 – E123.

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Abstract

Introduction: Public transportation systems can help people engage in physical activity. This study assesses sociodemographic correlates and trends in the daily time spent walking to and from transit in the U.S. from 2001 to 2017. Methods: This cross-sectional study used data from the 2001, 2009, and 2017 National Household Transportation Survey. Data were analyzed in 2019 to assess the daily level of physical activity attained solely by walking to and from transit. Regression models were used to examine predictors of daily transit-associated walking. Results: Compared with the full National Household Transportation Survey sample, transit users who walked to and from transit tended to be younger, from households earning <$25,000 per year, in areas with rail infrastructure, and did not have a household-owned car. Transit walkers spent a median of 20 minutes per day (95% CI=18.5, 21.5) walking to and from transit in 2017, compared with a median of 19 minutes (95% CI=17.5, 20.5) in 2001. Among transit walkers, daily transitassociated physical activity was 27% higher for those residing in areas with rail infrastructure (adjusted coefficient=1.27, 95% CI=1.11, 1.46) and 34% higher for those from households earning $99,999 per year (adjusted coefficient=1.34, 95% CI=1.15, 1.56). Conclusions: As documented in a growing literature, most public transit trips include at least some walking; thus, efforts to encourage transit use are favorable to public health. Continued monitoring by transportation surveys is important as new forms of mobility and changing demographics may impact future transit use and associated physical activity. (C) 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Keywords

Physical Activity; Household Surveys; Public Transit; Cross-sectional Method; Public Health; Walking; Exercise; Research Funding; Transportation; Replacing Sedentary Time; Public-transit; Travel; Mortality; Adults; Health; Work

The 2019 Conference on Health and Active Transportation: Research Needs and Opportunities

Berrigan, David; Dannenberg, Andrew L.; Lee, Michelle; Rodgers, Kelly; Wojcik, Janet R.; Wali, Behram; Tribby, Calvin P.; Buehler, Ralph; Sallis, James F.; Roberts, Jennifer D.; Steedly, Ann; Peng, Binbin; Eisenberg, Yochai; Rodriguez, Daniel A. (2021). The 2019 Conference on Health and Active Transportation: Research Needs and Opportunities. International Journal Of Environmental Research And Public Health, 18(22).

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Abstract

Active transportation (AT) is widely viewed as an important target for increasing participation in aerobic physical activity and improving health, while simultaneously addressing pollution and climate change through reductions in motor vehicular emissions. In recent years, progress in increasing AT has stalled in some countries and, furthermore, the coronavirus (COVID-19) pandemic has created new AT opportunities while also exposing the barriers and health inequities related to AT for some populations. This paper describes the results of the December 2019 Conference on Health and Active Transportation (CHAT) which brought together leaders from the transportation and health disciplines. Attendees charted a course for the future around three themes: Reflecting on Innovative Practices, Building Strategic Institutional Relationships, and Identifying Research Needs and Opportunities. This paper focuses on conclusions of the Research Needs and Opportunities theme. We present a conceptual model derived from the conference sessions that considers how economic and systems analysis, evaluation of emerging technologies and policies, efforts to address inclusivity, disparities and equity along with renewed attention to messaging and communication could contribute to overcoming barriers to development and use of AT infrastructure. Specific research gaps concerning these themes are presented. We further discuss the relevance of these themes considering the pandemic. Renewed efforts at research, dissemination and implementation are needed to achieve the potential health and environmental benefits of AT and to preserve positive changes associated with the pandemic while mitigating negative ones.

Keywords

Improving Arterial Roads; Physical-activity; Cost-effectiveness; Built Environment; Autonomous Vehicles; Walking; Behavior; Impact; Active Transportation; Covid-19; Climate Change; Physical Activity; Public Health; Pandemics; Public Transportation; Collaboration; Transportation; Economic Models; Environmental Impact; Outdoor Air Quality; Vehicle Emissions; Coronaviruses; Hispanic Americans; Fatalities; Systems Analysis; African Americans; Infrastructure; Medical Research; Committees; Land Use; Economic Analysis; New Technology; United States--us

Use of Health Impact Assessments in the Housing Sector to Promote Health in the United States, 2002-2016

Bever, Emily; Arnold, Kimberly T.; Lindberg, Ruth; Dannenberg, Andrew L.; Morley, Rebecca; Breysse, Jill; Pollack Porter, Keshia M. (2021). Use of Health Impact Assessments in the Housing Sector to Promote Health in the United States, 2002-2016. Journal Of Housing And The Built Environment, 36(3), 1277 – 1297.

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Abstract

Housing affects health, yet health is seldom considered in housing decisions. Health impact assessment (HIA) is a tool that can improve housing-related policies, plans, programs, and projects by bringing together scientific data, health expertise, and stakeholder engagement to identify the potential health effects of proposed decisions. We systematically identified and reviewed HIAs of housing decisions in the United States, yielding 54 HIAs between 2002 and 2016. Two examined federal proposals; the others explored decisions in 20 states. A variety of organizations led the HIAs, including non-profits, public health departments, and academic institutions. The primary decision-makers each HIA sought to inform were housing, planning, and/or elected officials. Eighteen HIAs focused on housing policies, codes, design elements, and utilities in residential structures. The remaining 36 HIAs included housing as one element of broader community development and transportation planning decisions. HIA recommendations changed decisions in some cases, and the assessment process helped strengthen connections between public health and housing decision-makers. To illustrate key characteristics of housing HIAs, we purposefully selected three HIAs and described the decisions they informed in detail: off-campus student housing in Flagstaff, Arizona; a rental housing inspections program in Portland, Oregon; and revitalization plans for a major thoroughfare in a suburb of St. Louis, Missouri. With a few exceptions, federal, state, and local agencies in the U.S. are not required to consider the health impacts of housing decisions, such as where housing is sited, how it is designed and constructed, and policies for ensuring that it is affordable and safe. HIA has emerged as a tool for advocates, health and housing practitioners, and policymakers to fill this gap. However, few studies have examined whether HIAs do in fact change housing decisions, shift the way that decision-makers think, or ultimately shift determinants of health (e.g., housing affordability and quality). This review demonstrates that HIAs can facilitate the consideration of health during housing decision-making. Housing HIAs can also help decision-makers address commonly overlooked effects, such as changes to social cohesion, and improve civic participation by engaging communities in the decisionmaking process.

Keywords

0; Community Development; Decision-making; Healthy Housing; Health Impact Assessment; Housing Policy; Stakeholder Engagement; Health Promotion; Public Health; Exceptions; Impact Analysis; Nonprofit Organizations; Affordability; Suburban Areas; Profits; Housing; Policy Making; Transportation Planning; Decision Making; Rental Housing; Public Officials; Policies; Regeneration; Utilities; Social Cohesion; Inspections; Community Involvement; Decision Makers; Community Participation; United States--us

Does the Built Environment Have Independent Obesogenic Power? Urban Form and Trajectories of Weight Gain

Buszkiewicz, James H.; Bobb, Jennifer F.; Hurvitz, Philip M.; Arterburn, David; Moudon, Anne Vernez; Cook, Andrea; Mooney, Stephen J.; Cruz, Maricela; Gupta, Shilpi; Lozano, Paula; Rosenberg, Dori E.; Theis, Mary Kay; Anau, Jane; Drewnowski, Adam. (2021). Does the Built Environment Have Independent Obesogenic Power? Urban Form and Trajectories of Weight Gain. International Journal Of Obesity, 45(9), 1914 – 1924.

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Abstract

Objective To determine whether selected features of the built environment can predict weight gain in a large longitudinal cohort of adults. Methods Weight trajectories over a 5-year period were obtained from electronic health records for 115,260 insured patients aged 18-64 years in the Kaiser Permanente Washington health care system. Home addresses were geocoded using ArcGIS. Built environment variables were population, residential unit, and road intersection densities captured using Euclidean-based SmartMaps at 800-m buffers. Counts of area supermarkets and fast food restaurants were obtained using network-based SmartMaps at 1600, and 5000-m buffers. Property values were a measure of socioeconomic status. Linear mixed effects models tested whether built environment variables at baseline were associated with long-term weight gain, adjusting for sex, age, race/ethnicity, Medicaid insurance, body weight, and residential property values. Results Built environment variables at baseline were associated with differences in baseline obesity prevalence and body mass index but had limited impact on weight trajectories. Mean weight gain for the full cohort was 0.06 kg at 1 year (95% CI: 0.03, 0.10); 0.64 kg at 3 years (95% CI: 0.59, 0.68), and 0.95 kg at 5 years (95% CI: 0.90, 1.00). In adjusted regression models, the top tertile of density metrics and frequency counts were associated with lower weight gain at 5-years follow-up compared to the bottom tertiles, though the mean differences in weight change for each follow-up year (1, 3, and 5) did not exceed 0.5 kg. Conclusions Built environment variables that were associated with higher obesity prevalence at baseline had limited independent obesogenic power with respect to weight gain over time. Residential unit density had the strongest negative association with weight gain. Future work on the influence of built environment variables on health should also examine social context, including residential segregation and residential mobility.

Keywords

Body-mass Index; Physical-activity; Food Environment; Structural Racism; Obesity; Neighborhoods; Associations; Health; Walkability; Exposure; Environment Models; Minority & Ethnic Groups; Urban Environments; Regression Analysis; Regression Models; Residential Density; Body Mass Index; Property Values; Body Weight Gain; Government Programs; Body Weight; Electronic Medical Records; Electronic Health Records; Fast Food; Buffers; Real Estate; Body Mass; Body Size; Socioeconomics; Health Care

Differential Associations of the Built Environment on Weight Gain by Sex and Race/Ethnicity but Not Age

Buszkiewicz, James H.; Bobb, Jennifer F.; Kapos, Flavia; Hurvitz, Philip M.; Arterburn, David; Moudon, Anne Vernez; Cook, Andrea; Mooney, Stephen J.; Cruz, Maricela; Gupta, Shilpi; Lozano, Paula; Rosenberg, Dori E.; Theis, Mary Kay; Anau, Jane; Drewnowski, Adam. (2021). Differential Associations of the Built Environment on Weight Gain by Sex and Race/Ethnicity but Not Age. International Journal Of Obesity, 45(12), 2648 – 2656.

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Abstract

Objective To explore the built environment (BE) and weight change relationship by age, sex, and racial/ethnic subgroups in adults. Methods Weight trajectories were estimated using electronic health records for 115,260 insured Kaiser Permanente Washington members age 18-64 years. Member home addresses were geocoded using ArcGIS. Population, residential, and road intersection densities and counts of area supermarkets and fast food restaurants were measured with SmartMaps (800 and 5000-meter buffers) and categorized into tertiles. Linear mixed-effect models tested whether associations between BE features and weight gain at 1, 3, and 5 years differed by age, sex, and race/ethnicity, adjusting for demographics, baseline weight, and residential property values. Results Denser urban form and greater availability of supermarkets and fast food restaurants were associated with differential weight change across sex and race/ethnicity. At 5 years, the mean difference in weight change comparing the 3rd versus 1st tertile of residential density was significantly different between males (-0.49 kg, 95% CI: -0.68, -0.30) and females (-0.17 kg, 95% CI: -0.33, -0.01) (P-value for interaction = 0.011). Across race/ethnicity, the mean difference in weight change at 5 years for residential density was significantly different among non-Hispanic (NH) Whites (-0.47 kg, 95% CI: -0.61, -0.32), NH Blacks (-0.86 kg, 95% CI: -1.37, -0.36), Hispanics (0.10 kg, 95% CI: -0.46, 0.65), and NH Asians (0.44 kg, 95% CI: 0.10, 0.78) (P-value for interaction <0.001). These findings were consistent for other BE measures. Conclusion The relationship between the built environment and weight change differs across demographic groups. Careful consideration of demographic differences in associations of BE and weight trajectories is warranted for investigating etiological mechanisms and guiding intervention development.

Keywords

Body-mass Index; Socioeconomic-status; Food Environment; Obesity; Health; Outcomes; Scale; Risk; Minority & Ethnic Groups; Urban Environments; Etiology; Demographics; Sex; Residential Density; Supermarkets; Age; Race; Ethnicity; Property Values; Body Weight Gain; Electronic Medical Records; Fast Food; Electronic Health Records; Real Estate; Subgroups; Demography; Trajectory Analysis; Weight