Background: Louisville ranks in the top 20 most challenging places to live with asthma in the US. Local asthma surveillance activities, which rely upon hospitalization reports and national survey prevalence data, do not provide real-time, spatially-explicit information that city leaders need to target the most effective interventions. Objective/Purpose: The study aimed to: 1) identify hotspots of asthma symptoms; 2) evaluate associations between asthma symptoms and environmental covariates in real-time and space; and 3) model the impact of municipal intervention scenarios. Methods: Participants recorded rescue inhaler use with a wireless, GPS-enabled sensor, which passively collected the date, time and location of inhaler use. We modeled normalized daily inhaler use counts and associations with space-time resolved environmental covariates using zero-truncated negative binomial models, and evaluated the potential of three strategic initiatives to reduce asthma inhaler use and cost. Results: Sensors recorded 5,660 inhaler use events in space and time for 140 participants from 06/13/2012 to 02/28/2014. We identified several environmental triggers positively associated with asthma inhaler use, including: AQI, PM10, weed pollen and mold (p< 0.01). Conversely, the spatial distribution of tree cover demonstrated a negative (protective) association with inhaler use (p< 0.01). We identified three interventions that could have the largest impact on asthma: reducing emissions by 20%, increasing tree canopy to 40%, and mitigating weed growth by 50%. By targeting these interventions within specific neighborhoods, 914,000 inhaler uses and $1.8 million of hospitalization costs could be avoided. Discussion/conclusion: Utilizing sensors to capture the spatiotemporal signal of asthma can complement existing surveillance, improve understanding of environmental drivers, and help cities target interventions in neighborhoods where they will have the most impact. This pilot study has expanded and enrolled over 500 participants, generating the largest citizen science asthma dataset ever collected.

Increasingly communities, and in particular environmental justice organizations, are requesting more access to data and the ability to measure contaminants in their own environment. In Southern California, air pollution from living, playing or studying in close proximity to busy roadways is a key concern in the community. In response, academic partners have developed a methodology to train community members in developing research questions, using the instruments and building local capacity to translate research into action. This session describes this methodology and impact of a community-academic partnership to support community-directed monitoring of local air pollution in Southern California. Training of the teams in environmental health topics and developing protocols for collecting data in the field are joint community-academic efforts. This “street science” is paired with workshops on local scientific epidemiologic studies which are the science base for this work, which link traffic exposures to higher levels of asthma and reduced lung function, as well as low birth weight and premature babies. This session will highlight case studies of two environmental justice organizations in Los Angeles County, CA where students using community monitoring to define air pollution, assess the impacts at local schools, brainstorm policies to improve local quality and ultimately work towards installation of air filters on school buildings. Through these case studies, we will share lessons learned and best practices of community-directed monitoring. We will share the qualitative results where members describe higher levels of empowerment a deeper understanding of the science and are more comfortable sharing their results through public speaking.

In early 2015, Health by Design, a coalition working throughout Indiana at the intersection of the built environment and public health, was awarded funding through the American Planning Association Plan4Health initiative. The project included several strategies designed to make Indianapolis more walkable and to get more people walking, anchored by the development and adoption of Indianapolis' first Pedestrian Plan. In addition, the project served to strengthen coalition partnerships and members' skillsets, engaged a diverse set of stakeholders, and explicitly addressed equity and health disparities. The pedestrian planning process incorporated data, methods and engagement strategies intended to further a health in all policies approach and to ensure the right to health for all residents. It used health, safety and equity data as a weighted factor in project prioritization and selection. Beyond looking simply at obesity and chronic disease rates, the process included built environment features, such as access to parks and grocery stores, that have an association with health outcomes. Limitations to the data were discovered and addressed early in the process, given the challenges of self-reported data and the geographic differences between Health Planning Areas, census tracts and block groups. Additionally, equity measures were considered, accounting for age, disabilities, poverty, minority populations, limited English proficiency and no-vehicle households. Combined with more traditional planning methods related to transit access and service, trip generators and street types, these factors were integrated into a prioritization process that identified areas of greatest need for walking infrastructure. This project incorporated extensive public outreach and engagement, intended to help make the case for the need to prioritize limited resources, as well as to seek input on trade-offs, project and program options, and funding allocations. In the end, targeted investments were identified that best achieve the stated goal of a healthier, safer, resilient and economically vibrant community.

Cleveland, Ohio suffers from an auto-centric environment defined by overly wide but low traffic streets, the combination of which encourages speeding. This excess street right-of-way is due, largely, to the outmigration of residents and employers but is also a residual of the abandonment of the city's former 250-mile streetcar network in the mid-1950's. City residents, over half of whom lack access to private automobiles, must navigate these auto-centric streets as pedestrians, public transit riders and bicyclists, and risk injury and death while doing so. Hispanic and African American bicyclists face fatality rates that are higher than rates experienced by white bicyclists by 23% and 30% respectively according to the League of American Bicyclist's 2013 report “The New Majority: Pedaling Towards Equity.” Through the work of an interdisciplinary team of bike advocates who agreed that a city designed for 1 million persons could be fundamentally redesigned as a population health strategy around the concept of active transportation for its current population of 385,000 residents, the vision for the Midway Protected Bike Boulevard network emerged. The Midway is a proposed 80-100 mile, two directional and landscape-buffered bike network that will be located in the center of Cleveland's overly wide streets, connecting city neighborhoods to each other and to key regional assets. In the space of just four years, this vision has moved from a “crazy idea” to a formal project of the Cleveland City Planning Commission which launched a system-wide planning study in the spring of this year. This public health in practice presentation will describe how community volunteers applied the knowledge of their respective fields of urban design, traffic engineering, urban storm water management, law, community organizing, public health and salesmanship to craft an idea and move it to action.