Use of health impact assessment in the U.S.: 27 case studies, 1999-2007.

OBJECTIVES: To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions. METHODS: Using multiple search strategies, 27 HIAs were identified that were completed in the U.S. during 1999-2007. Key characteristics of each HIA were abstracted from published and unpublished sources. RESULTS: Topics examined in these HIAs ranged from policies about living wages and after-school programs to projects about power plants and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Concerns about health disparities were especially important in HIAs on housing, urban redevelopment, home energy subsidies, and wage policy. The use of quantitative and nonquantitative methods varied among HIAs. Most HIAs presented recommendations for policy or project changes to improve health. Impacts of the HIAs were infrequently documented. CONCLUSIONS: These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes.

Conducting environmental assessments for physical activity: determining traffic volume in walkability audits in two West Virginia communities.

BACKGROUND: In this article, we examine the possibility of reducing time to conduct traffic volume audits through (1) reducing time for manual traffic counting and (2) using Department of Transportation (DOT) information. METHODS: In audits of 824 road segments in 2 West Virginia (WV) communities, manual traffic counts were recorded for 1, 2, and 5 min in duration. Annual Average Daily Traffic (AADT) was calculated from counts. Available AADT from DOT was also collected. Percent agreement and a weighted kappa were calculated between 5-min count and 1- and 2-min count AADT categories and between 5-min count and DOT AADT categories. RESULTS: One- and 2-min counts produced identical AADT categories as 5-min counts in 93.4% and 95.0% of segments, respectively. Weighted kappa was 0.79 (95% CI = 0.74-0.85) and 0.85 (95% CI = 0.80-0.89), respectively. Forty-two segments (5.1%) had DOT data. CONCLUSIONS: DOT AADT was available for a small percentage of road segments assessed. The high agreement between AADT categories produced by 1- and 2-min counts and 5-min counts makes it reasonable to consider using 1- or 2-min manual traffic counts if time or staffing constraints make it necessary. Possible generalizability of this methodology to other communities, particularly larger urban and suburban areas, will require further research.

Growing the field of health impact assessment in the United States: an agenda for research and practice.

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public's health.

Examining the relationships among built environment, physical activity, and body mass index in El Paso, TX.

OBJECTIVE: The current study examined the relationships among built environment, physical activity, and body mass index (BMI) in a primarily Hispanic border community in El Paso, TX. METHODS: Data from a 2001 community-wide health survey were matched to environmental data using geocoding techniques in ARC VIEW software. A total of 996 adults were surveyed by phone and 452 were successfully geocoded. RESULTS: The sample was 71% female, 79% Hispanic, 42 +/- 17 years old, moderately acculturated, and had socioeconomic status (SES) levels of semi-skilled workers. Increasing BMI was related to less moderate intensity physical activity (P = 0.05), higher SES (P = 0.0003), worse overall health (P = 0.0004), and living in areas with greater land-use mix (less residential; P = 0.03). The relationship between overall health and BMI was in part mediated by higher numbers of barriers to physical activity in those with poor health, which lead to a decrease in moderate physical activity. These variables explained 20% of the variance in BMI. CONCLUSIONS: This is one of the first studies to find a positive relationship between land-use mix and BMI in a predominantly Hispanic, low-income community. The positive association between BMI and land-use mix may be due to the inclusion of individual SES as a controlling variable in the analyses, suggesting that SES may have a differential effect on how the built environment influences BMI in low- to moderate-income minority communities.