The Heritage Community in Orlando, Florida

The Parramore Heritage Community in Orlando, Florida The Impact of Traffic-Related Pollution on Asthma Rates

A Health Impact Assessment

September 2014

The Parramore Community: The Impact of Traffic-Related Pollution on Asthma Rates

BACKGROUND

The Health Council of East Central Florida (HCECF) conducted a health impact assessment (HIA) on one aspect of the Parramore Heritage community in Orlando. The HIA was conducted in partnership with the University of Central Florida (UCF) College of Public Administration, the City of Orlando and VHB Miller-Sellen (VHB), a local private sector planning and engineering firm. The project was overseen by the Health Impact Assessment Steering Committee convened by the Winter Park Health Foundation, a local health funder.

The Parramore HIA provided valuable community health information for consideration in the planning and visioning process being undertaken by the City of Orlando for the Parramore Comprehensive Neighborhood Plan (Parramore Plan). The goal of the planning process was to develop community's vision for the neighborhoods and make recommendations for improving economic growth, jobs, community health, transportation options, education, housing, and infill development.

UCF assisted by incorporating this HIA into the Planning Healthy Communities course in the Masters of Urban and Regional Planning program during spring of 2014. The students in this class conducted an HIA to determine the impact of traffic-related pollution on the asthma rates of residents and provided recommendations based on HIA theory. These recommendations were submitted to the City of Orlando in May 2014.

Special thanks and recognition: Sarah Stack, HIA Researcher and author Paul Lewis, AICP, Chief Planning Manager, City of Orlando Jim Sellen, MSP, Principal, VHB Curtis M Ostrodka, AICP, LEED AP, Senior Project Manager, VHB Lisa Portelli, Adjunct Instructor, University of Central Florida UCF Masters of Urban and Regional Planning students: Dylan Anderson, Michael Bell, Jeffrey Chamlis, Kathryn Davis, Evan Futch, Michael Nocito, Sony Peronel, Michael Zeorlin

Health Impact Assessment Steering Committee

Harry Barley, MetroPlan Orlando Owen Beitsch, Real Estate Research Consultants Mary-Stewart Droege, City of Orlando Mary Ann Feldheim, Ph.D., University of Central Florida Therry Feroldi, Health Council Tara M. McCue, AICP, East Central Florida Regional Planning Council David Overfield, Orange County Health Department Lisa Portelli, Winter Park Health Foundation Susan Sadighi, Regional Florida Department of Transportation Sarah Stack, HIA Researcher and author Sandra Whitehead, Florida Department of Health Mike Woods, Lake/Sumter Metropolitan Planning Organization

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HEALTH IMPACT ASSESSMENTS What is a Health Impact Assessment? According to the Centers for Disease Control (CDC), a Health Impact Assessment (HIA) is "a tool which can be used to evaluate and assess the impacts a project, program, policy or plan may have on the community's health and provide recommendations to reduce negative impacts." HIAs help community members, policy makers and others to understand those aspects of a community, for example, employment rates, impact of growth and existing built environment, which may have an impact on the health and wellness of both the individual and community. HIAs are also an important, organized way in which to gather both qualitative and quantitative measurable data on the issues potentially impacting health. Below is a social-ecological model of health determinants and the layers of review that may be taken into consideration when conducting an HIA.

The Health Impact Assessment Process Most HIAs follow a methodical, five-step process consisting of, at a minimum: screening, scoping, assessment, recommendations and reporting. The five steps are described below:

1. Screening ? the identification of plans, projects or policies for which an HIA may be a useful tool for policy makers, planners and community members.

2. Scoping ? the identification of which health factors/indicators to take under consideration.

3. Assessment ? the assessment of risks and benefits, and the identification of which people may be affected and how they may be affected by a decision in their community, for example.

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4. Recommendations ? the development of recommendations to proposals which will help to promote positive health effects or to minimize adverse health effects on a population.

5. Reporting ? the reporting of results to decision/policy makers and the community.

An additional 6th step, monitoring and evaluation, may be undertaken. During this step, processes are put in place to determine the effect of the decision on the health and well-being of the residents.

BACKGROUND AND SCOPE OF THE PARRAMORE COMMUNITY HEALTH IMPACT ASSESSMENT

An HIA was conducted in the Parramore community to determine the impact of traffic-related pollution on the asthma rates of residents. The community is bordered by four major roadways: Interstate-4 (I-4), the East/West Expressway (State Road 408), Orange Blossom Trail (OBT) and Colonial Drive (State Road 50). The HIA was conducted in partnership with the graduate students of the University of Central Florida's Healthy Community Design course in the Master's Degree Planning Program. Graduate students were offered this hands-on learning experience during the 2014 Spring semester. While steps one and two (screening and scoping) were conducted as a classroom exercise, each student was assigned factors and indicators to research (step three), provide recommendations (step four) and present to the client, the East Central Florida Health Planning Council (ECFHPC). The Parramore community HIA was conducted in conjunction with a broader planning effort in the Parramore community by the City of Orlando. This broader planning effort, the Parramore Comprehensive Neighborhood Plan, will "set the direction for creating a 21st Century Parramore neighborhood that is fully integrated and connected into and supportive of SunRail and Downtown Orlando in an environmentally, socially, and economically sustainable manner. The Parramore Plan will have a 30-40 year time horizon," according to the City's Request for Proposal narrative. Key to the City's redevelopment efforts is assessing the right mix of land uses proposed for the community given the alternative modes of transportation (SunRail and an expanded free shuttle service, the Lymmo) that are programmed to service the community and downtown Orlando Central Business District.

The scope of this HIA was to conduct an in-depth literature review on the connection between people, especially vulnerable populations such as those who are lower income, minorities, the elderly and children, and the prevalence of traffic-related asthma; to research code violations

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contributing to poor air quality; assess the quality of the housing stock; review policies for pollution abatement along major roadways; conduct air quality assessments; determine asthma rates in the community and broader population; and, offer recommendations on creating an environment that contributes to the health and well-being of the Parramore residents.

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I. LITERATURE REVIEW

Exposure to air pollution may cause serious adverse health effects with symptoms ranging from respiratory illnesses that are non-critical to cancer and even premature death. Exposure to air pollution similarly does not affect every subpopulation. The groups at risk for reactions that are more severe include those that have preexisting respiratory diseases like asthmatics or emphysemas. Pregnant women, children and the elderly are also vulnerable populations to consider. Traffic-related air pollution is a major contributor to air quality that is unhealthy, especially in urban areas with high traffic volume.

Within these urban areas, the main source of the local variability concerning air pollution levels is traffic. The largest concentration and risk of exposure to air pollution occurs near major roads. Emissions from motor vehicles represent the complex criteria of air pollutants including nitrogen oxides, carbon monoxide, and particulate matter including hydrocarbons that react with nitrogen oxides and sunlight leading to formation of ground-level ozone. Individually, each pollutant is a suspected or well-known cause of adverse health effects.

Also, a mixture of traffic-related pollutants can be difficult when measuring or modeling. For this reason, several epidemiologic studies depend on a variety of traffic measures. Studies may include proximity to major roads, traffic density that has accumulated within a buffer and traffic density that is on the nearest road. These measures are substitutes of exposure and account for traffic volume (e.g. number of vehicles per day). The measures are markers of concentration of emissions from the vehicle and type of emission.

These measures also account for the distance that addresses air pollution gradients near the road. Traffic emissions are greatest at a point of release and they typically reduce near background levels which are within a range of 150 to 300 meters of a major roadway. Within the U.S., minority and economically disadvantaged populations share a highly disproportionate burden of contact with air pollution and risk. There is evidence demonstrating that minorities and citizens with low socioeconomic status experience greater residential exposure to traffic generated air pollution. This exposure is less for a population of non- minorities and greater socioeconomic status. Kebbede (2004) suggested that an increase in traffic-related air pollution can result in an increased risk of adverse health outcomes such as asthma.

The percentage of a population exposed to air traffic-related pollution is larger in urban areas due to more roads, higher population density and higher traffic volume. Gurney (1998) stated that demographic and social disparities exist in relation to residential proximity to main

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highway roads. Larger disparities are viewed more as indicators of the minority status including race or ethnicity, language spoken at residential homes and nativity, than for indicators of socioeconomic status like educational attainment and poverty.

Environmental justice literature provides evidence that a socially disadvantaged population may experience a phenomenon referred to as triple tragedy. Gurney (1998) noted first, minority and poorer groups suffer adverse health effects from behavioral and social determinants of health like psychosocial stress, poor nutrition and inadequate access to hospitals. Second, certain populations such as those who speak a language other than English at home might be at a greater danger for exposure to air pollution due to residential proximity to main highways. Third, there is an interaction between these two factors, which implies that underprivileged groups undergo disproportionately greater negative health outcomes from air pollution exposure.

Asthma is a chronic condition used when taking into account environmental justice and inequality issues associated with adverse effects of health from traffic-related pollution from major highways. According to studies conducted by Gustavsson (2008), asthma is an increasingly growing problem among the overall U.S population. Prevalence of asthma has increased by 75% since 2004.

Motor Vehicle Pollution The exhaust from a motor vehicle is a major source of air pollution. The most widely known pollutants from a vehicle exhaust include sulfur and oxides, carbon monoxide, particulate matter, polycyclic aromatic hydrocarbons and unburned hydrocarbons from crankcase and fuel. Gurney (1998) further noted that while the transformation and transport of these pollutants, particularly in places where both human exposure and pollutant concentrations are elevated, has gained much attention while minimal attention focuses on measuring the exposures and pollutants near the heavily trafficked highways.

In reference to Gustavsson (2008), a variety of evidence today suggests that a steep gradient of some pollutants exist near highways that are heavily travelled and that living around these increased pollution zones may cause detrimental effects of health. It is thus important to note that, heterogeneity of amounts and types of vehicles using highways may be significant. The typical fleet of vehicles in America is comprised of sports utility vehicles, motorcycles, vans, buses, trucks and passenger cars. The size and composition of this fleet on any given highway can vary depending on day of week, use restrictions, and time of day for various classes of vehicles. These are but a few factors that will influence amounts and kinds of pollutants from tailpipe emissions.

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Recent interest has focused on investigating different compositions of substances in polluted air while assessing toxicity. In reference to American Thoracic Society and American Lung Association (1994), the mechanisms via which air pollution produces adverse health effects related to asthma, involve a study that links air pollutants with methylation of a gene associated with asthma. The asthma pathway is comprised of a variety of genes, coding for proteins associated with asthmatic responses. Increased exposure to substances in polluted air is greatly associated with the hypermethylation of Foxp3 locus, which is a regulatory T cell with impaired function in people with asthma. Sulfate and black carbon particles are highly associated with methylation of this gene in asthmatic patients.

Asthma and Major Highway Exposures Asthma is a disorder that involves airflow limitation and variable airway inflammation in response to a variety of triggers. Whereas most asthmatic children achieve better symptom control with minimal doses of corticosteroids, some remain asymptomatic despite treatment with larger doses of both inhaled and oral corticosteroids. These children with more severe inhaled corticosteroid refractory asthma use a large proportion of healthcare related resources and may end up suffering morbidity. Previous studies conducted by American Thoracic Society and American Lung Association (1994) have found associations between development of the asthma symptoms in preschoolers and infants and traffic-related air pollutants. In addition, school age children may develop asthma. Recent studies have shown an increase in respiratory symptoms in children with asthma residing in a close proximity to major roads, associated with amount of emissions from tailpipes of vehicles.

Under this group, a much higher risk occurs near major roads and diminishes to lower rates with a range of 150 meters to 200 meters from main roads. According to studies conducted by American Thoracic Society and American Lung Association (1994) greater risks of asthma in association with long-term housing within a distance of 75 meters from main roads adversely affect children.

Moreover, according to National Research Council (1998), children highly endangered with incident asthma associated with exercising in high-ozone environments may not have any parental history of the asthma. A relationship between traffic-related exposures and asthma is biologically plausible, since particulate matter has indicated eliciting of responses relevant to pathogenesis of asthma for people living near major highways. Studies that monitor air pollution on the scale orders of magnitudes not less than near highway gradients, have discovered associations between prevalence of asthma and traffic generated pollution.

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