Matthew J. Trowbridge

Urban Sprawl and Miles Driven Daily by Teenagers in the United States

BACKGROUND Urban sprawls association with increased automobile reliance and daily mileage is well established among adults. However, sprawls specific impact on teen driving exposure is unknown. Teen driver fatality rates per mile driven are significantly higher than adults, making the identification of environmental influences on travel behavior particularly important in this age group. METHODS Driving and demographic data for 4528 teens (weighted=10.5 million) aged 16-19 years were obtained from the 2001 National Household Transportation Survey (NHTS). County-level sprawl was measured using an index developed by Ewing et al. The association between daily miles driven by teens and sprawl, controlling for demographic characteristics, was modeled using ordinal logistic regression. The predicted probability of driving >20 miles in counties with varying degrees of sprawl also was calculated. RESULTS Of the surveyed teens, 48% did not drive, 27% drove <20 miles/day, and 25% drove >20 miles/day. Of the 52% of teens who reported driving, the average distance driven was 15.6 miles/day. More-pronounced sprawl was associated with increased daily mileage (p<0.001). Overall, teens in sprawling counties were more than twice as likely to drive >20 miles/day than teens in compact counties. This trend was most prominent among the youngest drivers. For example, the predicted probability of boys aged 16-17 years driving >20 miles per day varied from 9% to 24% in compact versus sprawling counties. CONCLUSIONS Sprawl is associated with increased daily mileage by teen drivers. Given the stark relationship between driving exposure and fatality risk among teens, increased efforts to understand and modify the effects of sprawl on adolescent driving behavior are necessary.

Does the built environment affect when American teens become drivers? Evidence from the 2001 National Household Travel Survey

PROBLEM Motor vehicle crashes are the most common cause of death for American adolescents. However, the impact of where teens live on when they begin driving has not been studied. METHOD Data from the 2001 National Household Travel Survey were used to estimate the effect of residential density on the driver status of teens aged 16 to 19 years after matching on demographic characteristics. RESULTS Controlling for demographic characteristics, 16 and 17 year old teens in high density neighborhoods had driver rates 15 percentage points below teens living in less dense areas (p<0.001). The effect for 18 and 19 year olds was a 9 percentage point decrease (p<0.001). SUMMARY These results suggest teens living in less dense and more sprawling communities initiate driving at a younger age than comparable teens in compact areas, placing them at increased risk for crash related injuries. IMPACT ON INDUSTRY The role of environmental factors, such as neighborhood walkability and provision of transit, should be considered in young driver programs.

Urban Sprawl and Delayed Ambulance Arrival in the U.S.

BACKGROUND Minimizing emergency medical service (EMS) response time is a central objective of prehospital care, yet the potential influence of built environment features such as urban sprawl on EMS system performance is often not considered. PURPOSE This study measures the association between urban sprawl and EMS response time to test the hypothesis that features of sprawling development increase the probability of delayed ambulance arrival. METHODS In 2008, EMS response times for 43,424 motor-vehicle crashes were obtained from the Fatal Analysis Reporting System, a national census of crashes involving > or =1 fatality. Sprawl at each crash location was measured using a continuous county-level index previously developed by Ewing et al. The association between sprawl and the probability of a delayed ambulance arrival (> or =8 minutes) was then measured using generalized linear mixed modeling to account for correlation among crashes from the same county. RESULTS Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival (p=0.03). This probability increases quadratically as the severity of sprawl increases while controlling for nighttime crash occurrence, road conditions, and presence of construction. For example, in sprawling counties (e.g., Fayette County GA), the probability of a delayed ambulance arrival for daytime crashes in dry conditions without construction was 69% (95% CI=66%, 72%) compared with 31% (95% CI=28%, 35%) in counties with prominent smart-growth characteristics (e.g., Delaware County PA). CONCLUSIONS Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival following motor-vehicle crashes in the U.S. The results of this study suggest that promotion of community design and development that follows smart-growth principles and regulates urban sprawl may improve EMS performance and reliability.

A design thinking framework for healthcare management and innovation

The business community has learned the value of design thinking as a way to innovate in addressing peoples needs--and health systems could benefit enormously from doing the same. This paper lays out how design thinking applies to healthcare challenges and how systems might utilize this proven and accessible problem-solving process. We show how design thinking can foster new approaches to complex and persistent healthcare problems through human-centered research, collective and diverse teamwork and rapid prototyping. We introduce the core elements of design thinking for a healthcare audience and show how it can supplement current healthcare management, innovation and practice.

Healthy eating design guidelines for school architecture.

We developed a new tool, Healthy Eating Design Guidelines for School Architecture, to provide practitioners in architecture and public health with a practical set of spatially organized and theory-based strategies for making school environments more conducive to learning about and practicing healthy eating by optimizing physical resources and learning spaces. The design guidelines, developed through multidisciplinary collaboration, cover 10 domains of the school food environment (eg, cafeteria, kitchen, garden) and 5 core healthy eating design principles. A school redesign project in Dillwyn, Virginia, used the tool to improve the schools’ ability to adopt a healthy nutrition curriculum and promote healthy eating. The new tool, now in a pilot version, is expected to evolve as its components are tested and evaluated through public health and design research.

Rear-seat motor vehicle travel in the U.S. using national data to define a population at risk

BACKGROUND Recent studies suggest that the relative protection offered by rear seating in motor vehicle crashes has decreased, potentially reflecting disproportionate advancements in front-seat safety technology. Safe adaptation of advanced front-seat restraint systems for the rear-seat environment will require exposure data that are currently unavailable. PURPOSE This study uses national data to quantify rear-seat occupancy patterns, restraint use, and annual travel exposure in the U.S. in order to support the development of advanced crash protection systems for rear-seat motor vehicle occupants. METHODS Data from the 2000-2006 National Automotive Sampling System Crashworthiness Data System and 2001 National Household Transportation Survey were analyzed in 2008 to quantify occupancy patterns (e.g., seat position, restraint use) and annual person-trips for rear-seat passengers in the U.S. RESULTS The overall proportion of person-trips by rear-seat occupants is relatively low (12.9%); however national at-risk exposure remains significant (approximately 39 billion annual person-trips). Annual rear-seat travel exposure is similar among children < or = 12 years and adults (18.9 vs 19.1 billion person-trips) despite the fact that children are proportionally much more likely to ride in rear positions (79.3% vs 7.4%). Restraint use among adult rear-seat occupants was also much lower than among front-seat occupants (50.4% vs 82.2%). CONCLUSIONS While rear-seat occupancy is relatively low compared with front-seat occupancy at-risk rear-seat travel by both child and adult passengers in the U.S. remains significant. Restraint use by rear-seat occupants is much lower than that among front-seat passengers, particularly among adults and older children, substantially increasing injury risk. Development of future crash protection systems for rear-seat passengers must account for these exposure patterns to ensure safe and effective integration into production vehicles.

Built environment and physical activity promotion: place-based obesity prevention strategies.

This paper seeks to encourage continued innovation in translating built environment and transportation-focused physical activity research into practice. Successful strategies, policies, and tools from across the U.S. and globally that demonstrate potential for wider-scale implementation are highlighted. The importance of building practice and translational research partnerships with groups and organizations outside traditional public health spheres, such as those who work in real estate and land-use development, is also discussed.

Public Health and the Green Building Industry Partnership Opportunities for Childhood Obesity Prevention

Improving the design of the built environment to promote health and well-being is an emerging priority within public health, particularly as a component f efforts to address the ongoing epidemic of childhood besity. Research suggests that environmental design at multiple spatial scales, ranging from regional land use and transportation planning, to accessibility of public transit, to building characteristics such as stair placement, and even the design of food trays in contexts such as school cafeterias, can influence dietary choices and physical activity. Moreover, because the built environment is amenable to change, the environmental design process provides a tangible mechanism for influencing health-related social norms at a population level. This advantage is critical, given growing consensus that individual-level interventions will not be sufficient to reverse the growth in the prevalence of childhood obesity.

Physical Activity Design Guidelines for School Architecture

Increasing children’s physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students’ physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment’s impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards.

Green Health Urban Planning and the Development of Healthy and Sustainable Neighborhoods and Schools

A growing body of evidence demonstrates that alterations in individual behaviors alone are not sufficient to change the course of the enduring public health epidemics such as childhood obesity. Instead, environmental factors that influence what, when, where, and how much people eat and drink and how physically active they are must be addressed at a population scale to promote healthy behaviors. Urban planners have a direct role to play in this work. This focus issue centers on a vision for the role urban planning can play to advance green health by paying careful attention to schools as a critical community resource, meeting place, and organizational feature.