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 of- ten 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 activ- ity, 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 abili- ties. 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 com- munity 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