Publications and Reports

Bridging the Gap (BTG), an RWJF-funded research program, has issued two new research briefs. Income Disparities in Street Features that Encourage Walking examines the prevalence of pedestrian-friendly features and amenities on neighborhood streets, including sidewalks, street lighting, traffic calming devices, and marked crosswalks, in communities throughout the U.S. The brief also summarizes differences in the prevalence of these features by community income. Using Local Land Use Laws to Facilitate Physical Activity examines the extent to which local land use laws in communities throughout the U.S. require structural improvements that facilitate physical activity, such as requirements for pedestrian-oriented provisions, open space, playgrounds, sports fields, trails, and bike lanes. It also shows how requirements vary based on community income.

Bicycling and Walking in the U.S.: 2012 Benchmarking Report is an essential resource and tool for government officials, advocates, and those working to promote bicycling and walking. The Benchmarking Project is an ongoing effort by the Alliance for Biking & Walking to collect and analyze data on bicycling and walking in all 50 states and the 51 largest U.S. cities. This third biennial report reveals data including: bicycling and walking levels and demographics; bicycle and pedestrian safety; funding for bicycle and pedestrian projects; written policies on bicycling and walking; bicycle infrastructure; bike-transit integration; bicycling and walking education and encouragement activities; public health indicators; and the economic impact of bicycling and walking. The report is full of data tables and graphs that show how your state or city stacks up, and provides unprecedented statistics to help support your case for increasing safe bicycling and walking in your community. This report was funded by the Centers for Disease Control and Prevention and made possible through the additional support of AARP and Planet Bike.

Do All Children Have Places to Be Active?
Active Living Research published a research synthesis in November 2011 that examines studies indicating that racial and ethnic minorities and lower-income people live in communities that do not provide as many built and social environmental supports for physical activity and are not as supportive of physical activity. It also summarizes research on racial, ethnic and economic disparities in obesity and physical activity rates among children. The synthesis also highlights policy recommendations for decision-makers who can support physical activity among people in lower-income communities and communities of color. Some key research findings are that racial and ethnic minority and lower-income people:

• are more likely to live in neighborhoods with fewer and lower-quality sidewalks, and fewer
• aesthetic amenities like scenery that make walking safer, easier and more appealing;
• tend to live in neighborhoods with fewer parks and other recreation resources; and
• experience more danger from crime and traffic than others do, and face more barriers from neighborhood physical and social disorder.

School Policies on Physical Education and Physical Activity
Active Living Research published a research synthesis in October 2011 that summarizes the peer-reviewed literature on school physical education and physical activity policies, and offers policy implications and areas where additional research is needed.

The Partnership for Prevention has collaborated with the Safe Transportation Research and Education Center (SafeTREC) at UC Berkeley, Booz Allen Hamilton, and the CDC to produce "Transportation and Health: Policy Interventions for Safer, Healthier People and Communities." This report examines the effects of transportation policies on public health in three key areas-environment and environmental public health, community design and active transportation, and motor vehicle-related injuries and fatalities. The report finds that installing streetlights, new sidewalks, and bicycle-friendly infrastructure can have immediate positive effects, and incorporating bicycle boulevards or greenways into comprehensive community plans will likely bring about changes over time.

The F as in Fat: How Obesity Threatens America’s Future 2011 report is now available. The report, which is produced jointly by the Trust for America’s Health and the Robert Wood Johnson Foundation, shows that adult obesity rates have increased in 16 states and have declined in no states. The report also finds that racial and ethnic minority and lower-income adults continue to have the highest obesity rates. The report includes recommendations for how policymakers can reverse the obesity epidemic among both adults and children, with an emphasis on creating policies and environments that support healthier eating and more physical activity.

The America Needs Complete Streets report written by Dan Burden and Todd Litman was published in the April 2011 edition of ITE Journal. The report discusses issues that can be addressed by the implementation of complete streets policies because of their increasing demand for walking, cycling, and public transit. These issues include: the aging population; rising fuel costs; congestion, health, and environmental concerns; and changing consumer preferences. These trends indicate that an integrated multimodal transportation system is required if we are to meet future travel demands.

The Potential of Safe, Secure and Accessible Playgrounds to Increase Children’s Physical Activity was published by Active Living Reseach (a RWJF program) in February 2011. The report summarizes research on the importance of playgrounds for children’s physical activity. Some highlights of this report are:

• Playgrounds present an opportunity for children and adolescents to be physically active.
• By developing publicly accessible neighborhood playgrounds, designing them to maximize active uses and maintaining their spaces and equipment to ensure safety and reduce the risk of injury, playgrounds can be a benefit to children and communities.
• Well designed and maintained playgrounds can support more physical activity, better health and greater social involvement for children, families and the community.
• Low-income and mostly minority communities tend to have less access to playgrounds and parks, but renovating school playgrounds, maintaining parks and recreational spaces, and developing new resources for play are promising remedies.

Obesity and its Relation to Mortality and Morbidity Costs, prepared by Donald Behan and Samuel Cox of the Society of Actuaries
The report is a review of almost 500 research articles on obesity and its relation to mortality and morbidity, focusing primarily on papers published from January 1980 to June 2009. The study’s most convincing results concern the effect of overweight and obesity on cardiovascular disease, diabetes, and certain cancers. The study estimated the total annual economic cost of overweight and obesity in the United States and Canada at approximately $300 billion in 2009. That $300 billion total cost includes:

• Total cost of excess medical care caused by overweight and obesity: $127 billion
• Economic loss of productivity caused by excess mortality: $49 billion
• Economic loss of productivity caused by disability for active workers: $43 billion
• Economic loss of productivity caused by overweight or obesity for totally disabled workers: $72 billion

Short and Sweet: Analysis of Shorter Trips Using National Personal Travel Survey Data, prepared by the Victoria Transport Policy Institute, December 2010
This paper summarizes information on shorter trips, based on 2009 National Household Travel Survey data. This analysis indicates that a significant portion of total personal travel consists of shorter trips. About 10% of reported trips are a half-mile or less, about 19% are a mile or less, and 41% are three miles or less. Since shorter trips tend to be undercounted, the actual share of short trips is probably higher than these figures indicate.

Pedestrian Safety Strategic Plan, prepared by the Federal Highway Administration, October 2010
This is a 15-year plan for pedestrian safety research and technology transfer. It was developed to address pedestrian safety concerns and equip professionals and other stakeholders with proper knowledge, resources, and information needed to identify problems and implement solutions related to the roadway environment. The Strategic Plan also recommends updates to 17 current FHWA technology transfer tools and more than 20 technology transfer resources and the development of innovative dissemination methods. Recommendations for research and product development are intended to be addressed through a collaborative approach between various agencies and offices. A cooperative effort is required to properly address the variety of crash problems discussed in the Strategic Plan. This report will be of interest to engineers, planners, researchers, and practitioners who have an interest in implementing pedestrian treatments, as well as city, State, and local agency officials who have a responsibility for public safety.

Commentary: Dedication of Additional Resources to Evaluation and Low-Income Schools is Critical to Increasing Levels of Safe Walking and Bicycling to School, prepared by Margo S. Pedroso.
This commentary was published in the Journal of Applied Research on Children: Informing Policy for Children at Risk 2010: Vol. 1, Article 9.

Abstract: The commentary suggests two primary policy issues that must be addressed nationally. First, State Departments of Transportation, which administer the federal Safe Routes to School program, should track the income level of schools and communities that apply for and receive Safe Routes to School funding to assess whether low income schools are being adequately served. Second, as Safe Routes to School continues to expand, evaluation becomes even more essential for determining how and in what circumstances Safe Routes to School initiatives can be most effective. Examinations of the different approaches and impacts on children of different ages, races, income levels, geographic regions, and cultures are also indispensable.

Fostering Physical Activity for Children and Youth: Opportunities for a Lifetime of Health, prepared by the Prevention Institute.
The publication is described as providing research about the current state of physical activity in the nation and highlights organization practices and public policies to improve physical activity among children and youth. The report serves as a launching pad for action for practitioners and advocates who are interested in engaging in systems and environmental change approaches in four key arenas: schools, early childcare and education settings, out-of-school time programs, and communities.

Addressing the Intersection: Preventing Violence and Promoting Healthy Eating and Active Living, prepared by the Prevention Institute.
The publication makes a compelling case for embedding safety strategies into community efforts to promote healthy eating and physical activity. Across the country, healthy food and activity leaders have identified violence and the fear of violence as major roadblocks to the success of chronic disease prevention strategies. The impact of violence in communities is far-reaching: when people don’t feel safe in their communities, they are less likely to use local parks and community centers and access services such as public transportation. When parents don’t feel safe in their communities they are hesitant to let their children play outside or walk to school. Also, communities perceived as being unsafe are less likely to benefit from investments such as grocery stores.

Addressing the Intersection provides an explanation of the inter-relationship between violence and healthy eating and activity. The findings and recommendations offered in this paper can support practitioners and advocates in their work to prevent chronic disease in communities heavily impacted by violence.

The Economic Impact of Obesity in the United States, prepared by Ross A Hammond & Ruth Levine
This review was published in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2010:3 285–295.
Abstract: Over the past several decades, obesity has grown into a major global epidemic. In the United States, more than two-thirds of adults are now overweight and one-third is obese. In this article, we provide an overview of the state of research on the likely economic impact of the US obesity epidemic at the national level. Research to date has identified at least four major categories of economic impact linked with the obesity epidemic: direct medical costs, productivity costs, transportation costs, and human capital costs. We review current evidence on each set of costs in turn, and identify important gaps for future research and potential trends in future economic impacts of obesity. Although more comprehensive analysis of costs is needed, substantial economic impacts of obesity are identified in all four categories by existing research. The magnitude of potential economic impact underscores the importance of the obesity epidemic as a focus for policy and a topic for future research.

Hidden Health Costs of Transportation, prepared for the American Public Health Association by Urban Design 4Health, Inc. (February 10, 2010)
This report explores how dependence on automobiles and roadways has profound negative impacts on human health (decreased opportunities for physical activity, and increased exposure to air pollution, and the number of traffic crashes) and how the health costs associated with these impacts, including costs associated with loss of work days and wages, pain and suffering, and premature death, may be as high as several hundred billion dollars. Providing convenient alternatives, encouraging active modes of transport, and a establishing a transportation system that fosters connectivity and social interaction can not only offset health impacts and costs, but generate health benefits. Health impacts and costs have typically not been considered in the transportation policy, planning, and funding decision-making process. There are few standards or models for estimating health costs. However, existing research can be used to estimate the population at risk, the magnitude of the health impact, and the health costs associated with those impacts. Growing recognition of the connection between transportation, land development and health has resulted in some studies and examples where health impacts and costs have been considered and assessed. These examples not only demonstrate that health costs should be a significant factor in decision-making, but also show that calculating such costs is indeed possible.

Shape of the Nation, Status of Physical Education in the United States, conducted by the National Association for Sport and Physical Education and the American Heart Association, 2010
The purpose of this Shape of the Nation Report is to provide current information about the status of physical education in each of the 50 states and the District of Columbia in the following areas:

• Time requirements
• Exemptions/waivers and substitutions
• Class size
• Standards, curriculum and instruction
• Student assessment and program accountability
• Physical education teacher certification/licensure
• National Board Certification in physical education
• State physical education coordinator requirements
• Body mass index (BMI) collection

This report not only brings attention to the importance of quality, daily physical education programs for all school-age children, it also will provide information that can be used as a basis for expanding and improving physical education programs in those states that need assistance. Quality physical education programs for all of our children are the foundation for healthy, physically active lifestyles as adults. The vision is that every student will become physically educated and thus possess the knowledge, skills and confidence to be physically active and healthy for a lifetime.

Effective Transportation Policies Require Injury Prevention Strategies, prepared by the Safe States Alliance in Atlanta, Georgia on September 2009.
The Safe States Alliance is a national non-profit organization whose mission is to serve as the national voice in support of state and local injury and violence prevention professionals engaged in building a safer, healthier America. In September 2009, the Safe States Alliance released a report highlighting the importance of prevention in transportation injuries. The report ends with policy recommendations and policies for State and local governments to improve the overall health and wellness of their communities, including:

• Adopting “Complete Streets” policies that require the implementation of engineering enhancements, traffic calming strategies, and design characteristics to make new and existing roadways safer for pedestrians and cyclists.
• Increasing funding for programs that encourage walking and biking (e.g., Safe Routes to School) to increase the safety of pedestrians and cyclists, promote physical activity, and reduce motor vehicle use.
• Revising school siting policies to support the construction and renovation of community-based schools that are accessible by walking or biking.
• Increasing investments in public transportation systems to reduce traffic fatalities and provide communities with enhanced transit options.
• Requiring the use of Health Impact Assessments (HIAs) during transportation and land-use planning processes to accurately assess the impact of proposed projects on the health of surrounding communities.
• Developing transportation and land-use practices that result in the construction and revitalization of mixed-use communities to encourage active transportation and make the utilization of public transit feasible.
• Adopting traffic safety laws that have been proven effective in preventing injuries and fatalities associated with motor vehicles (e.g., primary enforcement seat belt laws, helmet laws, child booster seats, GDL programs, etc.).
• Providing training opportunities for public health practitioners, transportation/land-use planners, and other professionals to better understand the overall impact of planning decisions on communities.

“Travel and Environmental Implications of School Siting”, prepared by the U.S. Environmental Protection Agency, October, 2003
This study is the first to empirically examine the relationship between school location, the built environment around schools, mode choices for trips to school, and air emissions impacts of those choices. It finds that:

1. School proximity to students matters. Students with shorter walk and bike times to or from school are more likely to walk and bike.
2. The built environment influences travel choices. Students traveling through higher-quality environments are more likely to bicycle and walk.
3. Because of travel behavior differences, school location has an impact on air emissions. Centrally located schools that can be reached by walking and bicycling reduce air pollution.

The results suggest that actions to improve students’ walking environments, and to support communities that wish to locate schools in neighborhoods, will result in increases in student walking and biking to school. Increased walking and biking can reduce emissions related to auto travel and improve environmental quality.