An Audit of a Diverse Community for Safe Routes to Age in Place Environmental Policy Implications Adriana Perez, Phd, ANP-BC, FAAN; Anamarie Garces, MPH; Rebecca H

Public Policy

An Audit of a Diverse Community for Safe Routes to Age in Place Environmental Policy Implications Adriana Perez, PhD, ANP-BC, FAAN; Anamarie Garces, MPH; Rebecca H. Hunter, MEd; and David X. Marquez, PhD

ABSTRACT

Physical and cognitive limitations often accompany aging, increasing the importance of a safe and supportive environment to help older adults maintain mobility. Neighborhood design and maintenance must be evaluated to promote physical activity, mobility, and safety. Audit tools, geographic information system data, and resident interviews are used for this purpose, but often fail to provide information that can be translated to practice. The current project is part of a larger Miami-Dade Age-Friendly Ini- tiative to create a metropolitan area that fosters a healthy environment for diverse adults of all ages and abilities. Safe Routes uses a toolkit based on the 5-E model providing practical © 2015 Shutterstock.com/kamira resources to guide stakeholders in ABOUT THE AUTHORS meeting the needs of the commu- Dr. Perez is Assistant Professor and Southwest Boarderlands Scholar, College of Nurs- nity. Findings include the Centers ing and Health Innovation, Arizona State University, Phoenix, Arizona; Ms. Garces is Partner, Urban Health Solutions LLC, and Executive Director, Urban Health Partner- for Disease Control Healthy Aging ships, Inc., Miami, Florida; Dr. Hunter is Research Associate, University of North Carolina Research Network Audit Tool assess- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Dr. Marquez is Associate Professor, Depart- ment for environmental walkability ment of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois. factors. Results from street segment Dr. Perez received consulting fees from Urban Health Solutions LLC, Urban Health Partnerships, Inc. Ms. Garces received a grant from Health Foundation of South Florida. audits along with input from resi- Dr. Hunter received funding from the Centers of Disease Control and Prevention. The dents can be used to inform sound remaining author has disclosed no potential conflicts of interest, financial or otherwise. environmental policies. [Journal of Address correspondence to Adriana Perez, PhD, ANP-BC, FAAN, Assistant Professor and Southwest Borderlands Scholar, College of Nursing and Health Innovation, Arizona Gerontological Nursing, 41(3), 13-21.] State University, 500 N. 3rd Street, Phoenix, AZ 85004; e-mail: [email protected]. doi:10.3928/00989134-20150205-01

JOURNAL OF GERONTOLOGICAL NURSING • VOL. 41, NO. 3, 2015 13 he aging population in the especially those living with chronic dently for as long as possible (i.e., TUnited States is growing rapidly disease or those with disabilities, education); and expected to double in size to can experience significant health (c) enforcing laws and policies that approximately 90 million by the benefits with a moderate amount of promote safety, whether it is regulat- year 2050 (U.S. Census Bureau, daily physical activity. Programs that ing driving, pedestrian, or criminal 2011). Similarly, ethnically diverse promote walking among older adults laws (i.e., enforcement); and vulnerable populations will also have shown a significant reduction (d) promoting and advocating increase, including those living with in falls in this population (Gillespie, for safe, multimodal transportation disabilities and chronic health con- Gillespie, Cumming, Lamb, & Rowe, and using community resources and ditions (He, Sengupta, Welkoff, & 2000). Older adults are sensitive to services that would facilitate older Debarros, 2005). The World Health the effects of physical activity, and adults’ ability to access daily needs Organization (WHO; 2007) sug- even small amounts of activity are (encouragement); and gests that as the population grows healthier than the alternative. Public (e) using strategies to measure older, so do cities. It is estimated health strategies to promote physi- results (outcomes) of the efforts that the number and proportion cal activity across generations must taken as part of this program (i.e., of urban dwellers will continue to include multilevel approaches that evaluation). rise in the next decade. The aging consider the built environment. The choice to age in place inde- environment and changing demo- Research suggests that the level and pendently is impacted by the ability graphics present both challenges type of physical activity, in which to access goods and services and and opportunities for public health older adults engage, is affected by the engage in daily activities without researchers and clinicians focused design and characteristics of the envi- assistance. on creating communities. For ex- ronment, including the availability of Several measurement approaches ample, the Blue Zones project uses walking paths (Li et al., 2005). have been used to examine environ- a broad systems approach, includ- Safe Routes to Age in Place mental features that are important to ing civic engagement to promote (SRTAP) is a program aimed at health and aging (Weiss, Maantay, healthy communities. The Centers fostering local, accessible, safe, & Fahs, 2010) and consistent with for Disease Control and Prevention comfortable, and appealing active the purpose of the engineering and Healthy Aging Network (CDC- transportation options (e.g., walking, evaluation components of SRTAP. HAN) has more than one decade of biking, taking mass transit) across An audit of the built environment work to better understand place- all adult age groups and abilities can provide a helpful assessment of based determinants of health and in a diverse community. SRTAP these features and their impact on translate that knowledge to real- follows a 5-E (engineering, educa- mobility, including physical activity, world practice, with a focus on envi- tion, enforcement, encouragement, transportation, and safety for older ronmental strategies. The interaction and evaluation) Model (National adults. Audit tools, geographic in- between older adults and the built Center for Safe Routes to School formation system data, and resident environment is especially important, Task Force, 2008) to incorporate interviews are used for this purpose, as a growing body of research sug- multilevel stakeholders in creating an but often fail to provide information gests that a community’s physical environment that enables adults the that can be translated to practice. characteristics can play a major role opportunity to independently live Only a few tools have been tested for in promoting or discouraging physi- in their communities for as long as reliability (Moudon & Lee, 2003). cal activity (Li, Fisher, Brownson, & they desire. Briefly, the 5-E Model Researchers recommend the use of Bosworth, 2005), mobility (Rosso, includes approaches for: both perceived and objective mea- Auchincloss, & Michael, 2011), (a) creating a physical environ- sures to more accurately capture key safety, and ultimately health (Yen, ment that is safer and more con- neighborhood characteristics that can Michael, & Perdue, 2009). venient, with connections to the enhance physical activity and mobil- For the past 20 years, physical community and local resources and ity from the perspective of the target activity has remained a top leading services (i.e., engineering); population (Weiss et al., 2010). health indicator for the nation, as (b) increasing knowledge about noted in the Healthy People 2020 transportation safety and access to BACKGROUND report by the Centers for Disease healthy food, recreational opportuni- SRTAP was developed from a Control and Prevention (CDC; ties, health care, open spaces, librar- larger age-friendly initiative led by 2011). The benefits of moderate ies, and employment and economic multiple partners (i.e., Alliance for intensity physical activity, includ- opportunities so that younger and Aging; Miami-Dade County Parks, ing brief 10-minute episodes, have older residents can live in their com- Recreation and Open Spaces De- been well documented. Older adults, munity confidently and indepen- partment; the Miami-Dade County

14 Copyright © SLACK Incorporated Department of Regulatory and Eco- 19.7% nationwide (U.S. Census nomic Resources; ReServe Miami; Bureau, 2011). As part of Miami- and Urban Health Partnerships) and Dade County, Miami’s Little provides an opportunity to engage Havana, La Pequeña Habana, reflects older residents in this process from the growing older adult population, the start as part of the encouragement with a diverse ethnic community that component of the initiative. The includes >85% Hispanic or Latino collective wisdom of older, diverse (predominantly Cuban) residents residents can help better understand (City of Miami, n.d.). the needs and strengths of the com- Within the Little Havana community and add another dimension munity, a high percentage of adults to the ongoing evaluation compo- 65 and older do not own a car, and nent of this initiative. The current their pedestrian crash rate is among article describes preliminary findings the highest in South Florida, with using the CDC-HAN Environ- more than five pedestrian crashes per A safe environment for mental Audit Tool and focus group square mile among this population data to assess environmental walk- per year (Miami-Dade Metropolitan active transportation ability factors, including (a) safety; Planning Organization, n.d.). This is (e.g., walking, bicycling, (b) comfort and appeal; (c) accessibil- especially significant in a community ity; (d) wayfinding and land use for with a high percentage of Hispanic taking transit) walking, bicycling, and use of transit; older adults, as they are more likely throughout life should and (e) the generation of key indica- to die as pedestrians than White and tor reports to guide environmental Black older adults of the same age be considered in the health policy improvements. Re- (Transportation for America, 2011). design of communities sults from street segment audits are A recent Fatality Analysis Report included along with input from older conducted by the National High- that promote healthy adults living in a predominately His- way Traffic Safety Administration aging in place. panic community who participated in found that compared to their peers a series of community-based group of the same age, Hispanic adults 65 sessions that included team walk- and older have a fatality rate that is ing audits. Results were used in the twice that of Black older adults, and refinement of the SRTAP program 173% higher than for White older mixed methods, to examine environ- and contribute to the overall under- adults (Transportation for America, mental walkability factors to design standing of healthy aging and healthy 2011). The oldest (i.e., 75 and older) and implement environmental plan- communities and can ultimately Hispanic adults suffer a pedestrian ning policies that promote health and inform and help shape public policy fatality rate of 8 per 100,000 indi- well-being across generations. that enhances the physical, social, viduals, compared to 3.08 for White psychological, and civic dimensions older adults and 3.84 for Black older Setting and Sampling Approach of positive aging. adults (Transportation for America, A criteria analysis was conducted SRTAP is part of a larger, Miami- 2011). Although many related factors for the selection of the commu- Dade Age Friendly Initiative to may exist, Clifton, Burnier, and Akar nity setting based on three primary create a metropolitan area that fosters (2009) found that environmental con- factors: (a) safety, (b) density, and a healthy environment for diverse ditions are associated with pedestrian (c) need. Safety was determined by adults of all ages and abilities. In injury. Therefore, a safe environ- older adult pedestrian crash density. Florida, 17.3% of the total state ment for active transportation (e.g., Pedestrian crash data for the 7 most population comprises individuals walking, bicycling, taking transit) recent years was measured, with a 65 and older (U.S. Census Bureau, throughout life should be considered threshold of more than five older 2011). Miami-Dade County includes in the design of communities that adult pedestrian crashes per 1 square cities that have been rated as the promote healthy aging in place. mile per year. Density was deter- “Top Ten Places with the Highest mined by the number of older adult Percentage of Their Population METHOD residents per 1 square mile, with a 65 Years and Older” (U.S. Census The SRTAP initiative pilot was threshold of more than 3,000 resi- Bureau, 2011). By 2030, 27.1% of conducted from January to June dents per 1 square mile. Finally, need Florida’s total population is projected 2013 and included community-based was determined by the percentage to be 65 and older, as compared to participatory approaches, including of households with zero automobile

JOURNAL OF GERONTOLOGICAL NURSING • VOL. 41, NO. 3, 2015 15 availability, with a threshold of more residents as part of the audit pro- assistance to senior individuals who than 1,500 households per 1 square vides an opportunity to assess these meet the requirements of the pro- mile with no vehicle available. domains from the perspective of this gram. The Cuban American National A confirmation factor of readiness population. Special considerations Council (CNC; n.d.), which manages was used to narrow the pilot location for older adult populations consist the apartment complex, is a national in the Miami neighborhood of Little of (a) capacity for activity; (b) visual non-profit organization whose mis- Havana. Readiness was determined acuity; (c) sensitivity to loud noises, sion is to provide “human services by a survey with a three-level scale: bright lights, and extreme tem- to persons in need from all racial 1 = not ready, 2 = somewhat ready, peratures; (d) cognitive ability and and ethnic groups” (para. 1). CNC and 3 = ready with leveraging op- memory; (e) slower walking pace; (n.d.) assists individuals to “become portunities present. Further analysis (f) susceptibility to steep inclines or self-reliant and builds bridges among of Little Havana’s community readi- cross-slopes; (g) urgent or more fre- America’s diverse communities” ness indicated that it was a prime site quent need to use the bathroom; and (para. 1). The CNC assisted in par- for implementing the pilot SRTAP (h) gait or balance difficulties that ticipant recruitment and facilitation initiative. increase fall risk (CDC, 2009). of the workshops. More than one Level of Walkability and Safety half of the participants have lived at Measures (LWS) indicators are rated using a the facility or in the neighborhood The CDC-HAN Environmental scoring protocol that ranges from 1 of Little Havana for ≥10 years. Most Audit Tool was designed to provide to 4 for each segment: (83%) participants have lived in the a detailed quantitative and qualita- ● 1 = a pristine crossing environ- community for more than 5 years. tive inquiry into community scale ment, which is safe and accessible and streetscape factors associated for all ages and abilities; Procedures with mobility in older adults. The ● 2 = a lack of some amenities, Three sessions were scheduled tool includes an extensive set of with a few visible but avoidable over the course of 3 weeks, held on environmental factors to enable a problems but still accessible, walk- consecutive Wednesdays at the same detailed assessment of permanent and able, and navigable. Some challenges time in the afternoon when most transient environmental factors that exist for individuals with severe older adult residents were present in may influence older adult safety and visual impairments; the building. As per the request of mobility. The tool has been tested ● 3 = a more demanding level of the participants, the first two ses- for reliability across multiple sites, walkability, with problems or bar- sions were conducted in Spanish, and including qualitative walking inter- riers that are difficult to avoid that the third session was conducted in views with older adults familiar with require attention and may not be Spanish and English simultaneously specific routes (Kealey et al., 2005). suitable for individuals with severe to accommodate participating public The interrater reliability of the most functional challenges; and officials. Sessions 1 and 2 were each recent version of the CDC-HAN ● 4 = the most demanding cross- 60 minutes, and Session 3 was 90 Environmental Audit Tool is based ing environment, with unavoidable minutes. Refreshments, snacks, and on a joint rating of 31 segments and accessibility barriers, safety hazards, raffles were provided following each 27 intersections. The range of kappa or navigational challenges. This is session. All sessions were video- and statistics generally fell into the good/ not suitable for individuals with audiorecorded, transcribed, and fair category (i.e., 0.4 to 0.7 agree- functional challenges and requires translated into English. During the ment) to very good (i.e., ≥0.7), with vigilance of all others. first community session, resident higher levels of agreement for inter- The LWS is assigned per segment participants were informed of the section items and lowest levels for or intersection. For a walking route, SRTAP Initiative and discussed ele- items with a behavioral component the total score can only be as good as ments related to actively commuting (e.g., aggressive drivers). its weakest component. in Little Havana and how to imple- Domains assessed as part of the ment the 5-E Model. CDC-HAN Environmental Audit Community Engagement Prior to Session 2, the Tool include land use/destinations, Older adult residents of a local CDC-HAN Environmental Audit safety and accessibility (e.g., walk- apartment complex of Calle Ocho Tool and protocol was conducted by ways, roadways, public transporta- were invited to participate in a trained facilitators along the Calle tion, comfort order, appeal), and three-part series of local workshops. Ocho corridor during the same time wayfinding, which is described as the This community is part of a U.S. of afternoon that the Viste Alegre process that individuals use to navi- Department of Housing and Urban residents (i.e., the local apartment gate their communities as they move Development Program, which of- complex of residents participating from place to place. Including older fers subsidized housing and rental in the study) would be walking the

16 Copyright © SLACK Incorporated following week. The audit included including the unique experiences of cused on all 5 Es, which included the the use of Google Maps to outline older adults living in this historical walking audit. The residents, both the walking routes based on recom- community. Based on findings, a men and women, were all of His- mendations of older residents as the community action plan was es- panic origin and had been living in most commonly used. The section of tablished, and a Virtual Advisory the neighborhood between 2 and 23 a street between two intersections is Committee comprised of stakehold- years. Several residents are members identified as a segment. Each seg- ers, representing the 5-Es, as well as of the community’s Virtual Advisory ment and intersection was numbered community residents, have guided Committee. Specific to engineer- to facilitate organization and rat- the implementation. ing and evaluation, the CDC-HAN ing of data. The audit is conducted Environmental Audit Tool examines by walking both sides of the street Audit Tool Analysis an extensive set of environmental to obtain a complete impression of Each segment was examined us- factors; however, in addition to LWS attributes and answer all audit tool ing the CDC-HAN Environmental indicators, results reported highlight questions. Photographs were used Audit Tool by two trained team the major themes that emerged as to document the barriers that older members (A.P., A.G.). Data for audit concerns for older adults living in residents identified while actively results were entered into SPSS version this community, including safety, commuting to daily destinations and 21 for preliminary descriptive analy- comfort, and wayfinding. obtain the detail necessary to specify sis. This analysis provides insights desirable changes for a safe route. into the basic quality and LWS indica- Level of Walkability and Safety The findings were used to develop tor for each segment and ultimately Intersection LWS ratings ranged the Session 2 facilitation guide and for the walking route assessed. between 2 and 4, with the most informal walking audit. Participants (44%) rated as 4, indicating that were divided into two groups. Both Qualitative Analysis along this route most intersections groups traveled the same street; how- Focus group interviews were con- represent the most demanding envi- ever, one walked along a segment of ducted in Spanish, then transcribed ronment. None of the intersections the corridor on the east side, whereas and translated to English. Transcripts were rated 1 (pristine crossing envi- the other traveled a corridor seg- and audio- and videorecorded ses- ronment). In comparison, segments ment on the west side of the starting sions were compared to ensure accu- along this route were rated either a 1 point. In partnership with older adult rate translation and documentation. (20%) or 4 (80%). residents, Session 2 informed which Qualitative content analysis barriers and facilitators identified guided the description of participant Pedestrian Infrastructure and Traffi c through the walking audit were a verbal responses (Hsieh & Shannon, Safety priority to address in Session 3. 2005) focused on environmental con- Sidewalks were present on at least Session 3 was aimed at translat- cerns during the walking audit. This one side of the street in 80% of the ing the walking audit findings into a analysis was also used to capture and segments audited. Buffers between platform for discussion among older extend knowledge and understand- the sidewalk and street were ob- resident participants, with public of- ing of cultural contextual issues that served in 40% of the segments, and ficials, a Virtual Advisory Commit- impact mobility, including physical few sidewalks were less than 3 feet tee, and other community stakehold- activity among older residents in a in width. In 100% of segments, the ers. The Virtual Advisory Committee predominantly Hispanic community. sidewalks were continuous within comprises policy leaders, such as To ensure methodological rigor, the segment and continued into the those from the Department of Trans- techniques outlined by Lincoln and adjacent segments. However, poor portation, and City officials, healthy Guba (1985) were used to ensure sidewalk maintenance was common. aging clinical experts, residents, and credibility of findings and included Of the 8 block faces (i.e., one side other community stakeholders, who “member check” sessions to discuss of the street in a segment) that had a join from remote locations through pictures taken during the walk and sidewalk, 100% had poorly main- Skype® and conference calls. The obtain feedback from resident par- tained sections. On 80% of these sec- session highlighted items of impor- ticipants related to the conclusions tions, the extent of poor maintenance tance to older residents, including drawn from the focus group sessions, was judged to be moderate or major community barriers for mobility, as well as “peer debriefing” with the (as opposed to minor). physical activity, and transportation. project team. With regard to sidewalk de- Field notes and written transcripts sign features, 20% of block faces were used as a basis for data analysis. RESULTS had a moderate or steep slope that The use of qualitative methods was Eighteen older adult residents made it difficult to walk, and 80% necessary to explore cultural context, participated in the public forums fo- had a moderate or steep cross-

JOURNAL OF GERONTOLOGICAL NURSING • VOL. 41, NO. 3, 2015 17 some two-way lane blocks. Volume two segments and all segments had a of traffic is relatively high, approxi- railing or barrier where needed and mately 19,500 vehicles on average, none were noted to have temporary with a speed limit of 30 miles per obstructions. The neighborhood has hour. The width of the roadway, little elevation, so walkway slope was

o k s a R traffic volume, and speed collectively not an issue. a n y r /I m increase risk of pedestrian–vehicle Additional observations relevant o c k. c to rs crashes or near misses. Some features to personal safety included windows, e tt u h S 5 1 were noted to help compensate for porches, or other “eyes on the street” 0 2 © these challenges, including sidewalks evident in a majority of segments and some walkway buffers (including (58.6%). Benches were present on on-street parking). 25% of segments. Working public The quality of crossing features, restrooms or water fountains were whether at intersections or mid- scarce (20%, respectively). Call block, is of particular importance boxes, also important for safety, were to older adults, who often move also scarce (20%). The quality of crossing more slowly than their younger counterparts and are at high risk of Comfort Supports features, whether at death or injury at crossings, with Along this route, most segments intersections or mid- Hispanic older adults at the high- were found to provide adequate est risk of all groups (Weiss et al., marked bus transit stops with route block, is of particular 2010). Along this walking route in information available. Sixty percent importance to older Little Havana, 66.7% of intersections were noted to provide places to had some form of traffic movement rest (e.g., a bench) with trees offer- adults, who often move control (e.g., stop sign, traffic signal). ing shade. Of particular interest for more slowly than their Pedestrian walk signals were pres- older adults, only 20% were found to younger counterparts. ent at 66.7% of the nine intersec- provide restroom amenities or work- tions audited; 66.7% of these had a ing drinking fountains. Most (80%) countdown signal. However, 66.7% segments provided opportunities for of intersections with walking signals pedestrians to be seen when walking, were noted to provide inadequate which addresses both comfort and crossing time, ranging from 18 to perceived safety. 27 seconds. slope. Permanent obstructions (e.g., Walkways are also important to Comfort Problems telephone poles, trees) were common older adult safety. Poorly designed Specifically problematic for older (100% of segments). Temporary ob- or maintained walkways reduce ac- adults was the loud noise along this structions (e.g., seasonal debris) were cessibility and increase risk of falls route (100% of segments). Although also common (100%). Curb ramps and other injuries. On the route 20% of segments were found to be were present in 100% of block faces audited, paved sidewalks of adequate crowded or chaotic, 80% of walk- with sidewalks. width were consistently present. ways had competing use with other With regard to roadway design, There were three segments with one types of transit or stationary items 100% of segments audited had to three trip hazards or barriers, and (e.g., bicycles, skateboards, retail marked lanes. The volume of traffic two segments with four or more trip shop signs, utility poles, trees). was rated as mostly moderate (80%) hazards or barriers. Twenty percent Regarding daytime crime rate, in and heavy categories, with high- of the poor maintenance was classi- a 6-month period (December 2012 to speed traffic on 100% of the seg- fied as minor, 60% as moderate, and June 2013), 135 crimes were reported ments and aggressive drivers on 20% 20% as major. Moderate problems overall, with 83 crimes in the corri- of the segments. are those that cannot be easily seen dor. The majority of crimes (16.3%) or avoided, whereas major problems were related to liquor law violations Neighborhood Safety Features make the section inaccessible or (Miami-Dade Police Department, Pedestrian safety is strongly as- extremely dangerous, highlighting 2014). sociated with the nature of adjacent the need for immediate correction In terms of aesthetics, only 20% roadways. In the route audited in by public works. Other safety issues of segments had pleasant features. Little Havana, Southwest 8th Street highlighted by the audit per seg- Although buildings were noted to be is predominately three lanes, with ment included slipping hazards on well-maintained, 60% of segments

18 Copyright © SLACK Incorporated included graffiti along this route. Problems related to wayfinding residents identified the narrow side- Broken glass and broken windows included poor or inconsistent way- walks as a hazard, especially when were found along some of this walk- finding aids (20% of segments) and cyclists ride by quickly, displac- way (40% of segments), and litter poor, dirty, or obstructed wayfinding ing pedestrians, in particular older was noted along the entire (100%) aids (20% of segments). Of specific residents. Most residents also shared walkway and street. Regarding importance to older adults and those concern for uneven sidewalks, tree extent of physical disorder, the entire with poor or low vision, problems stumps or vacated tree wells, and walkway (100%) was found to have included signs with text too small for trees with no protection base or grat- some physical disorder, whereas 40% easy reading (100% of segments) and ing, which can increase the tripping of segments had some social disorder poorly lit streets (100% of segments). hazards and number of falls along a (e.g., stray dogs, gangs, hostile be- Many segments did not appear to corridor. haviors). However, people of all ages conform to the U.S. Department of Given the high pedestrian mortal- were noted to be walking along the Transportation (2009) mandate that ity rate in this community, concern route (i.e., 60% of segments included states that street name signs shall be was noted regarding the lack of children, 40% included teenagers, in uppercase and lowercase letters enforcement laws, particularly traffic 100% included adults, and 80% when replaced, instead of permitting speed and pedestrian rights, as well included older adults). signs to be made in capital letters. as drivers who do not watch out for Speeding traffic and air pollut- The Federal Highway Administra- pedestrians when they make turns. ants were found along 100% of the tion claims the switch will improve Regarding the crime rate, most route, which is especially problem- drivers’ ability to identify words residents discussed a perceived lack atic for vulnerable residents living more quickly, whereas the Depart- of crime enforcement and loitering with asthma, cardiovascular disease, ment of Transportation argues that by individuals who appear home- or other respiratory diseases (e.g., studies show motorists find it easier less as contributors to their fear of chronic obstructive pulmonary to read lowercase signs (Transporta- physical harm in the neighborhood. disease). Segments had mixed land tion for America, 2011). Although Some residents voiced concern that use, including (a) 40% residential the community is predominantly vacant buildings encouraged loitering (i.e., apartments/condos and senior Hispanic/Latino, most (60%) seg- and other intimidating behaviors by housing), (b) 100% industrial and ments included wayfinding aids or homeless individuals. commercial (i.e., office buildings), signs in only English language. Prob- The experience of living in this and (c) 40% had schools. Although lems were identified with limited or community provided older residents the entire route was noted to include no boundary definition along 100% with a unique perspective on feasible green spaces/parks, most (60% of of segments, as well as limited sight solutions to address many of the segments) included underdeveloped distances, which make it difficult to safety concerns along this route. Po- land/vacant lots. see the next corner or beyond im- tential solutions discussed included mediate buildings. additional crosswalks that could act Wayfi nding as signals for drivers to slow down Wayfinding features to support Focus Group Data and help in crossing safely. They sug- orientation and walking along the Qualitative results illuminate a gested organizing forums to educate route were found among 100% of more detailed description of environ- other residents about SRTAP, and segments. These included direc- mental concerns from the perspective in particular, to help educate drivers tional signs, neighborhood flags/ of older residents, who also shared in this community. Other education markers, informational boards with collective solutions to many of these and communication recommenda- maps, or “you are here” cues. Calle issues. Regarding safety, comfort, tions included sharing ideas in local Ocho is considered a cultural/ and wayfinding for SRTAP, residents newspapers and with community historical landmark that is often shared concerns about the following partners. shut down for celebrations and issues during the walking audit and Comfort. Most older residents festivals. The entire route (100% of public forum sessions. substantiated the audit findings segments) included text and icons Safety. Most residents discussed that sidewalks along this route are paired on signs or the pavement, concern for bicycles on the sidewalk, extremely polluted. Although streets whereas 40% of segments included many of which do not have bells or are consistently cleaned, sidewalks advance street name signs. Ad- horns, travel very fast, and do not are not, and residents noted the ditional supports included aids for stop for pedestrians. According to inundation of sidewalks caused by low vision and hearing (i.e., audible many residents, cyclists generate fear poor drainage due to accumulation or Braille directions) among 100% and discourage many older residents of leaves. They also shared concern of segments. from walking on sidewalks. Most for the lack of garbage cans and law

JOURNAL OF GERONTOLOGICAL NURSING • VOL. 41, NO. 3, 2015 19 enforcement regarding littering. This Results reported herein are parking), traffic calming devices, and problem was noted to be worse with consistent with the purpose of the well-designed crossing features (e.g., bushes and tall ground cover that SRTAP Initiative, which focuses on refuge islands, center median strips, reportedly increased the accumula- making walking safer and accessible curb extensions, advance stop lines). tion of trash and large boxes. for residents of all ages and abili- Long-term, LWS scores or profiles Also consistent with the audit, ties. Results provide a quantitative on the different audit tool domains residents discussed their concern that assessment of the existing physical can be compared to determine envi- the route does not include adequate attributes and factors amenable to ronmental improvements over time. benches or sitting opportunities for change as a future guide for potential Only specific key indicators trigger rest or working drinking fountains. targets of urban design and plan- changes to the LWS score. Pedestrian Wayfinding. Older residents high- ning interventions. Focus group data crash rates and future Virtual Advi- lighted the current landmarks that captured environmental concerns that sory Committee data can be used to are also considered important social were important to older Hispanic evaluate positive changes related to resources and attractions along Calle residents along Calle Ocho, a histori- safety, comfort, and wayfinding. Ocho, including colorful murals, cal route that brings the community towering city clocks, local grocery together and is commonly used as a LIMITATIONS stores, churches, restaurants, and route for access to food, banks, health The incorporation of the CDC- theaters that make this route enjoy- care, social services, and community HAN Environmental Audit Tool into able to walk. They emphasized the resources. Some studies suggest that the SRTAP pilot was assessed in a convenience, low-cost, and opportu- inequality in the built environment dense urban environment among older nity for exercise that walking to their might contribute to important ethnic adults accustomed to walking as a daily destination provides. and sociodemographic health dispari- means of transportation. The general- Little Havana is considered a ties (Gordon-Larsen, Nelson, Page, & ization of these findings to suburban or major tourist destination. Although Popkin, 2006). rural settings may not hold true. In ad- tour buses and tourists can promote Older residents shared a sense dition, translation of these findings and economic opportunities, they also of empowerment with the level of subsequent action items are relevant contribute to drivers not looking engagement and encouragement to similar communities of high density where they are supposed to, in addi- component of this process. This where older adults are currently walk- tion to “outsiders” coming through empowerment was noted during ing to commute to their activities. on their way to work. To facilitate public forums and meetings with The tool continues to be refined and wayfinding and promote mobility, public officials. The residents’ stories tested, and a scoring algorithm is under residents talked about the need for and concerns captured the attention development. signage in English and Spanish or of local media, which also helped This pilot was conducted among universal pictures that could be inter- identify the importance of safe routes a predominately Hispanic com- preted by any cultural and linguistic across generations, demonstrating munity in which most participants preference. the potential influence and mutual were native Cubans. The inclusion of benefit of including older adults in shade and protection from the sun, DISCUSSION environmental walking audits. In ad- which has previously been identi- Walking continues to be the most dition to voicing the most significant fied as an age-friendly commodity, commonly accepted leisure time concerns, they were knowledgeable was not a concern for this group of physical activity in the United States, of current community strengths, participants. On the contrary, the especially among older adults (Raf- including the presence of the SRTAP participants enjoyed being exposed ferty, McGee, Petersmarck, & Miller, Initiative, as well as partnerships with to sun during their daily commutes 2004). However, opportunities for stakeholders, the Virtual Advisory on foot. Therefore, conducting walking or other physical activities, Committee, local policy and planning this study among distinct cultural especially from the perspective of agencies, and non-profit leaders in this groups of other Hispanic, non-Island older adults, are not always fostered community, which provide guidance subgroups may provide consistent by the physical environment. Indeed, and commitment for improving the results with previous research and others have found that older residents’ walking conditions. support the need for shade to protect perceptions of specific community The audit and focus group data also older adults from heat-related illness. features, such as access or proxim- highlighted helpful features for pedes- ity to places for physical activity and trian infrastructure and traffic safety ENVIRONMENTAL POLICY walking, are significantly related to help compensate for many of the IMPLICATIONS to neighborhood walking (Li et al., challenges identified, including side- The 5-E Model provided practical 2005). walks, walkway buffers (e.g., on-street resources to help guide stakeholders

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