<%BANNER%>

Evaluating Transportation Access to Healthy Food Sources

MISSING IMAGE

Material Information

Title:
Evaluating Transportation Access to Healthy Food Sources A Rapid Health Impact Assessment in Alachua County, Florida
Physical Description:
1 online resource (142 p.)
Language:
english
Creator:
Douglas, Amanda M
Publisher:
University of Florida
Place of Publication:
Gainesville, Fla.
Publication Date:

Thesis/Dissertation Information

Degree:
Master's ( M.A.U.R.P.)
Degree Grantor:
University of Florida
Degree Disciplines:
Urban and Regional Planning
Committee Chair:
Steiner, Ruth Lorraine
Committee Co-Chair:
Bejleri, Ilir
Committee Members:
Whitehead, Sandra F

Subjects

Subjects / Keywords:
alachua -- food -- health -- hia -- rts -- transportation
Urban and Regional Planning -- Dissertations, Academic -- UF
Genre:
Urban and Regional Planning thesis, M.A.U.R.P.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract:
This thesis completes a rapid health impact assessment (HIA)of transportation access to healthy food sources in the “Tower Road Triangle”neighborhoods of Alachua County, Florida. The objective of this rapid health impact assessment is to uncover issues related to transportation disparities that exist in low-income and minority neighborhoods and how these barriers can affect access to healthy foods for individuals in those neighborhoods.Specifically, this study looks at the built environment including the presence and/or absence of sidewalks, bicycle lanes, trails, and transit that would allow individuals to access stores where healthy foods can be purchased. Additionally,this research aims to explore some alternative transportation strategies to improve access to healthy foods in Southwest Gainesville. This research uses three different sources to fully understand the transportation barriers that exist for those people trying to reach healthy food sources including analysis of existing health and built environment data, study area resident focus groups, and place-based observations. Through these information sources, the study found that individuals in the Tower Road Triangle have transportation barriers when trying to access healthy food sources. Recommendations are made to improve public health in the community through community design, land use changes, and program strategies that will allow for better access to healthy food sources. Improved access to healthy food sources, in combination with more physical activity,will help improve the overall health of residents in the neighborhoods.
General Note:
In the series University of Florida Digital Collections.
General Note:
Includes vita.
Bibliography:
Includes bibliographical references.
Source of Description:
Description based on online resource; title from PDF title page.
Source of Description:
This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility:
by Amanda M Douglas.
Thesis:
Thesis (M.A.U.R.P.)--University of Florida, 2013.
Local:
Adviser: Steiner, Ruth Lorraine.
Local:
Co-adviser: Bejleri, Ilir.

Record Information

Source Institution:
UFRGP
Rights Management:
Applicable rights reserved.
Classification:
lcc - LD1780 2013
System ID:
UFE0046005:00001

MISSING IMAGE

Material Information

Title:
Evaluating Transportation Access to Healthy Food Sources A Rapid Health Impact Assessment in Alachua County, Florida
Physical Description:
1 online resource (142 p.)
Language:
english
Creator:
Douglas, Amanda M
Publisher:
University of Florida
Place of Publication:
Gainesville, Fla.
Publication Date:

Thesis/Dissertation Information

Degree:
Master's ( M.A.U.R.P.)
Degree Grantor:
University of Florida
Degree Disciplines:
Urban and Regional Planning
Committee Chair:
Steiner, Ruth Lorraine
Committee Co-Chair:
Bejleri, Ilir
Committee Members:
Whitehead, Sandra F

Subjects

Subjects / Keywords:
alachua -- food -- health -- hia -- rts -- transportation
Urban and Regional Planning -- Dissertations, Academic -- UF
Genre:
Urban and Regional Planning thesis, M.A.U.R.P.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract:
This thesis completes a rapid health impact assessment (HIA)of transportation access to healthy food sources in the “Tower Road Triangle”neighborhoods of Alachua County, Florida. The objective of this rapid health impact assessment is to uncover issues related to transportation disparities that exist in low-income and minority neighborhoods and how these barriers can affect access to healthy foods for individuals in those neighborhoods.Specifically, this study looks at the built environment including the presence and/or absence of sidewalks, bicycle lanes, trails, and transit that would allow individuals to access stores where healthy foods can be purchased. Additionally,this research aims to explore some alternative transportation strategies to improve access to healthy foods in Southwest Gainesville. This research uses three different sources to fully understand the transportation barriers that exist for those people trying to reach healthy food sources including analysis of existing health and built environment data, study area resident focus groups, and place-based observations. Through these information sources, the study found that individuals in the Tower Road Triangle have transportation barriers when trying to access healthy food sources. Recommendations are made to improve public health in the community through community design, land use changes, and program strategies that will allow for better access to healthy food sources. Improved access to healthy food sources, in combination with more physical activity,will help improve the overall health of residents in the neighborhoods.
General Note:
In the series University of Florida Digital Collections.
General Note:
Includes vita.
Bibliography:
Includes bibliographical references.
Source of Description:
Description based on online resource; title from PDF title page.
Source of Description:
This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility:
by Amanda M Douglas.
Thesis:
Thesis (M.A.U.R.P.)--University of Florida, 2013.
Local:
Adviser: Steiner, Ruth Lorraine.
Local:
Co-adviser: Bejleri, Ilir.

Record Information

Source Institution:
UFRGP
Rights Management:
Applicable rights reserved.
Classification:
lcc - LD1780 2013
System ID:
UFE0046005:00001


This item has the following downloads:


Full Text

PAGE 1

1 EVALUATING TRANSPORTATION ACCESS TO HEALTHY FOOD S OURCES : A RAPID HEALTH IMPACT ASSESSMENT IN ALACHUA COUNTY, FLORIDA By AMANDA MARIE DOUGLAS A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN URBAN AND REGIONAL PLANNING UNIVERSITY OF FLORIDA 2013

PAGE 2

2 2013 Amanda Marie Douglas

PAGE 3

3 To My Parents

PAGE 4

4 ACKNOWLEDGMENTS I would like to thank all of the University of Planning Department faculty that have helped me and provided me with thoughtful guidance and direction throughout the duration of my graduate career. I would like to thank my wonderful parents, John and Sonia, for always supporting me and encouraging me to pursue my dreams. I love you both and I will be forever grateful for all that you both have done for me I would also like to thank my best friend and other half Larry, for always be i ng there to listen and ease my worries. It has been his constant belief in me throughout my entire college career that has enabled me to be where I am today. I love you. Finally, I wo uld like to thank my good friend and roommate, Paitra for always being w illin g to listen to my thesis rants.

PAGE 5

5 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ .. 4 LIST OF TABLES ................................ ................................ ................................ ............ 8 LIST OF FIGURES ................................ ................................ ................................ .......... 9 ABSTRACT ................................ ................................ ................................ ................... 11 CHAPTER 1 INTRODUCTION ................................ ................................ ................................ .... 13 Problem Statement ................................ ................................ ................................ 13 Research Aim ................................ ................................ ................................ ......... 14 2 LITERATURE REV IEW ................................ ................................ .......................... 17 Healthy Foods ................................ ................................ ................................ ......... 17 Demographics and Food Access Vulnerable Populations ................................ ... 18 Populations Who Cannot Drive A Vehicle ................................ ........................ 18 Low Income and Minorities ................................ ................................ ............... 19 Food Desert ................................ ................................ ................................ ...... 20 Grocery Store Siting and Types of Food Venues ................................ .................... 21 Grocery Store Siting ................................ ................................ ......................... 21 Types of Food Sources ................................ ................................ .................... 23 Built Environmental Factors ................................ ................................ .................... 25 Walkability ................................ ................................ ................................ ........ 25 Crime Real and Perceived ................................ ................................ ............. 26 Food Environment and Health Implications of Healthy Food Access ...................... 27 Food Environment ................................ ................................ ............................ 27 Health Implications Of Healthy Food Access ................................ .................... 28 Summary ................................ ................................ ................................ ................ 29 3 HEALTH IMPACT ASSESSMENT (HIA) ................................ ................................ 30 Three Types of HIAs ................................ ................................ ............................... 30 Rapid HIA ................................ ................................ ................................ ......... 30 Intermediate HIA ................................ ................................ .............................. 30 Comprehensiv e HIA ................................ ................................ ......................... 31 The Roles of Each Step in the HIA Process ................................ ........................... 31 Screening and Scoping ................................ ................................ .................... 32 Assessment ................................ ................................ ................................ ...... 33 Recommendations ................................ ................................ ........................... 33 Evaluation and Monitoring ................................ ................................ ................ 33

PAGE 6

6 Reporting ................................ ................................ ................................ .......... 34 Summary ................................ ................................ ................................ ................ 34 4 METHODOLOGY ................................ ................................ ................................ ... 36 Identifying Pr oposals and a Program That May Impact Health ............................... 36 The Process ................................ ................................ ................................ ............ 38 Screening and Scoping ................................ ................................ .................... 38 Baseli ne and Impact Assessment ................................ ................................ .... 39 Recommendations ................................ ................................ ........................... 40 Evaluation And Monitoring ................................ ................................ ................ 40 Data And Information Used ................................ ................................ ..................... 40 Summary ................................ ................................ ................................ ................ 44 5 BASELINE ASSESSM ENT ................................ ................................ ..................... 45 Study Area ................................ ................................ ................................ .............. 45 Population Characteristics ................................ ................................ ...................... 48 ................................ ................................ ........ 50 ................................ ................................ ................................ 51 Analysis o f Built Environment Walkability and Bikeability ................................ .... 53 Analysis of Available Public Transportation ................................ ............................ 55 Analysis of Access to Healthy Foods ................................ ................................ ...... 56 Food Desert ................................ ................................ ................................ ...... 56 Modified Food Retail Environment Index (mFREI) ................................ ........... 57 Existing Healthy Food Sources and Food Preferences ................................ .... 57 Transit To Healthy Food Resources ................................ ................................ 61 Walking And Biking To Healthy Food Resources ................................ ............. 63 Summary ................................ ................................ ................................ ................ 63 6 IMPACT ASSESSMENT ................................ ................................ ....................... 106 Research Conclusions ................................ ................................ .......................... 106 Tower Road Triangle Study Area ................................ ................................ ... 106 Population Characteristics ................................ ................................ .............. 107 ................................ ................................ 109 ................................ ................................ ........................ 110 Analysis of Built Environment Walkability and Bikeability ............................ 111 Analysis Of Available Public Transportation ................................ ................... 112 Analysis Of Access To Healthy Foods ................................ ........................... 113 Swag Oasis Nutrition Project ................................ ................................ ................ 117 Study Limitations ................................ ................................ ................................ .. 117 7 RECOMMEN DATIONS ................................ ................................ ......................... 122 Suggested Ways to Improve Healthy Food Access ................................ .............. 122 Recommendation 1: More Mixed Use Environment In Future ........................ 123 Recommendation 2: CPTED/Defensible Space Strategies ............................ 123

PAGE 7

7 Recommendation 3: Improved Transportation Infrastructure ......................... 124 Recommendation 4: Prioritized TDP Transit Im provements ........................... 125 Recommendation 5: Bicycle Sharing Program ................................ ............... 125 Recommendation 6: Supermarket Carpool/Supermarket Shuttle ................... 126 Recommendation 7: Neighborhood Farmers Market ................................ ...... 127 Evaluation And Monitoring ................................ ................................ .................... 128 Swag Oasis Nutrition Project ................................ ................................ .......... 128 Mobile Food Market Feasibility Study ................................ ............................. 128 Monitor RTS Transit Improvements ................................ ................................ 129 Future Research ................................ ................................ ................................ ... 129 8 CONCLUSION ................................ ................................ ................................ ...... 132 APPENDI X A SWAG BOARD MEETING AGENDA JANUARY 2013 ................................ ...... 134 B SWAG RESIDENT MEETING AGENDA JANUARY 2013 ................................ 135 LIST OF REFERENCES ................................ ................................ ............................. 136 BIOGRAPHICAL SKETCH ................................ ................................ .......................... 142

PAGE 8

8 LIST OF TABLES Table page 5 1 Index crime offense totals ................................ ................................ ................... 68 5 2 Population characteristics of study area ................................ ............................. 74 5 3 Vehicles available per housing unit of study area ................................ ............... 76 5 4 Mode of transportation to work of tracts surrounding study area ........................ 77 5 5 Death rates by selected causes of death ................................ ............................ 79 5 6 Select behavioral risk factor surveillance system survey (BFRSS) health indicators ................................ ................................ ................................ ............ 79 5 7 Students overweight and/or obese in schools of study area ............................... 79 5 8 Wa lk scores of Tower Road Triangle neighborhoods ................................ ......... 83 5 9 Study area populations with low access to a supermarket and large grocery store ................................ ................................ ................................ ................... 95 5 10 One way trip times, by bus, from study area neighborhoods to the nearest full service grocery store ................................ ................................ .................. 104 5 11 One way trip times and route lengths, by walking and bicycling, from study area neighborhoods to nearest full service grocery store ................................ 105

PAGE 9

9 LIST OF FIGURES Figure page 5 1 A map of the study area, the Tower Road Triangle, in Alachua County, FL ....... 66 5 2 A map of the seven study area neighborhoods (Harbor Cove, Hidden Oaks, Pine Meadow, Holly Heights, Lin ton Oaks, Majestic Oaks, and Tower Oaks) .... 67 5 3 2011 Unincorporated Alachua County Crime Density (Circle indicates study area ................................ ................................ ................................ .................... 69 5 4 Existing zoning in study area ................................ ................................ .............. 70 5 5 Map of future land uses in study area ................................ ................................ 71 5 6 Map of study area and surrounding census t racts ................................ .............. 72 5 7 Alachua County 32607 zip code area (Yellow Indicates Study Area ) ................. 78 5 8 Birth density and count by census block group (2007 2009) (circle indicates study area) ................................ ................................ ................................ .......... 80 5 9 Births to teenagers density and count by census block group (2007 2009) (circle indicates study area) ................................ ................................ ................ 81 5 10 Low birth weight density and count by census block group (2007 2009) (circle indicates study area) ................................ ................................ ................ 82 5 12 Linton Oaks and Majestic Oaks neighborhood street connectivity ...................... 85 5 13 Pine Meadow, Harbor Cove, and Hidden Oaks neighborhood street connectivity ................................ ................................ ................................ ......... 86 5 14 T ower Oaks neighborhood street connectivity ................................ .................... 87 5 15 Existing and proposed bike lanes ................................ ................................ ....... 88 5 16 Existing and proposed trails/ multi use paths ................................ ..................... 89 5 17 Alachua County capital improvement elements ................................ .................. 90 5 18 Tower Road Triangle transit routes and stops ................................ .................... 91 5 19 Route 75 bus stop buffers (0.25, 0.5, and 1 mille) ................................ .............. 92 5 20 Food deserts in Alachua County ................................ ................................ ......... 93 5 21 Food deserts in Alachua County close up showing study are a .......................... 94

PAGE 10

10 5 22 Study area modified retail food environment index (Circle indicates study area) ................................ ................................ ................................ ................... 96 5 23 Florida modified retail food environment index ................................ ................... 97 5 24 Tower Road Triangle nearest healthy food sources ................................ ........... 98 5 25 Tower Road Triangle nearest farmers markets ................................ .................. 99 5 26 Existing healthy food sources in the study area within Linton Oaks ................. 100 5 27 Maa & Paa convenience store located within study area boundaries ............... 101 5 28 Organic produce stand in Maa and Paa store ................................ .................. 102 5 29 Community garden located within study area boundaries ................................ 103 6 1 Terwilliger Elementary School district boundary (Red circle indicates study area) ................................ ................................ ................................ ................. 121 7 1 Proposed Celebration Pointe development near I 75 and Archer Road (Red indicates study area) ................................ ................................ ........................ 131

PAGE 11

11 Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Arts in Urban and Regional Planning EVALUATING TRANSPORTATION ACCESS TO HEALTHY FOOD S OURCES : A RAPID HEALTH IMPACT ASSESSMENT IN ALACHUA COUNTY, FLORIDA By Amanda Marie Douglas August 2013 Chair: Ruth L. Steiner Co C hair : Ilir Bejleri Major: Urban and Regional Planning This thesis completes a rapid health impact assessment (HIA) of transportation County, Florida. The objective of this rapid health impact assessment is to uncover issues r elated to transportation disparities that exist in low income and minority neighborhoods and how these barriers can affect access to healthy foods for individuals in those neighborhoods. Specifically, this study looks at the built environment including the presence and/or absence of sidewalks, bicycle lanes, trails, and transit that would allow individuals to acc ess stores where healthy foods can be purchased. Additionally this research aims to explore some alternative transportation s trategies to improve access to healthy foods in Southwest Gainesville. This research uses three different sources to fully understand the transportation barriers that exist for those people trying to reach healthy food sources including analysis of existing health and built en vironment data, study area resident focus groups, and place based observations. Through these information sources, the study found that individuals in the Tower Road Triangle have transportation barriers when trying to

PAGE 12

12 access healthy food sources. Recommen dations are made to improve public health in the community through community design, land use changes and program strategies that will allow for better access to healthy food sources. Improved access t o healthy food sources, in combination with more physi cal activity, will help improve the overall health of residents in the neighborhoods.

PAGE 13

13 CHAPTER 1 INTRODUCTION Problem Statement As of 2010, 36,56 9 supermarkets employing 3.4 million employees were located in the United States (Food Marketing Institute, 2012) Supermarkets a re defined as food retailers who made $2 million dollars or more in annual sales. From these startling numbers, it is hard to imagine neighborhoods and places where groups of people are not able to easily access a grocery store and healthy foods. The true reality of this situation is that these types of places, known as food deserts, do exist and greatly affect access for low income and minority groups to healthy foods What surrounds us or shapes us, especially in the case of healthy food outlets in low income and minority neighborhoods. How can these populations be expected to live a healthy lifestyle a nd raise their children in a healthy atmosphere if fundamental bas ic needs such as healthy foods are not a part of their environmental framework? This lack of available healthy food in some low income and minority neighborhoods usually means that these r esidents must travel further to access these types of foods than other, more economically prosperous populations. This places an extreme burden on those residents may not own a personal vehicle at all or, if they do own a vehicle it is often not reliable d ue to its age (Murakami & Young, 1997) This means that these residents must rely on transit, walking, or bicycling, a m ajority of the time, to access healthy foods. This transportation constraint means that low income and minority populations are less li kely to make as many trips to the grocery store as their higher income counterparts. Low inc ome populations made an average one trip per month to the grocery store (Wilde & Ranney, 2000) while the general population

PAGE 14

14 makes an average of 2.2 trips per week (Food Marketing Institute, 2012) .This severely decreased number of trips to the grocery store for low income populations means that their food consumption and buying patterns will likely involve more foods that are non perishable and less healthy. An incr eased intake of unhealthy foods, typically those high in fat and sugar, in a no healthy foods are more likely to develop diet related illnesses such as obesity, d iabetes, or heart disease. According to the Centers for Disease Control and Prevention (2012), rates of obesity in both adults and children have risen over the last 20 years with more than a third of adults (35.7%) and about 17% of children and adolescents aged 2 19 currently labeled as being obese. This rise in obesity has serious implications for future generations as medical spending related to obesity can place a severe burden on already limited income. On average the per capita medical spending for people who are obese were $1,429 higher than those of normal weight (Finkelstein, Trogdon, Cohen, & Dietz, 2009) Research Aim The objective of this rapid health impact assessment is to uncover issues related to transportation disparities that exist i n low income and minority neighborhoods and show how these barriers can affect access to healthy foods for individuals in those neighborhoods. Specifically, this study examines the built environment including the presence and/or absence of sidewalks, bicyc le lanes, trails, and transit that would allow individuals to access stores where healthy foods can be purchased. These results will then be compared to policy documents impacting transportation options and statistical data derived from neighborhoods in So uthwest Gainesville. Additionally, this thesis aims

PAGE 15

15 to explore some alternative transportation strategies to improve access to healthy foods in Southwest Gainesville. This study will add to the discussion related to coordinated transportation and land use decisions and how the design of the built environment, especially in low income and minority neighborhoods, can impact the health of a community. This research is conducted through a case study of an area of predominantly African American and low in come ne ighborhoods in Alachua County, Florida known as First, a literature reviews issues related to healthy food access including some of the most vulnerable populations, an explanation of grocery store siting, and types of food source s. Additionally, the literature reviews built environment factors including walkability and crime, both real and perceived, and health implications related to healthy food access. Second, the health impact assessment process is described including an expl anation of the three different types of HIAs and the roles of each step in the HIA process. Next, an explanation of the methodology for the rapid health impact assessment in the Tower Road Triangle study area is presented. Then, a baseline assessment of th e study area is presented to show the extent to which alternative transportation access to healthy food sour ces is currently supported. After an impact assessment of the study area discusses research conclusions from the baseline assessment, two healthy food source initiatives within and near the Tower Road Triangle neighborhoods, and limitations to the rapid health impact assessment research.

PAGE 16

16 Finally recommendations to improve transportati on access to healthy food sources for the Tower Road Triang le neighborhoods are presented, as well as, suggestions fo r further research. Followed by a summary of the research is provided.

PAGE 17

17 CHAPTER 2 LITERATURE REVIEW Multi mode transportation access to h ealthy food sources should be a basic human right. Still many people in places all over the state of Florida, and elsewhere are left stranded due to the auto dependent environment that has been created around them and their lack of other transportation opt ions, when they have no vehicle available to them. This chapter provides an overview of the most vulnerable populations, explains the siting aspect of grocery stores and the different types of food sources, discusses built environment factors that can impa ct non automotive trips to a healthy food source, and explains what a food environment is and its impact on human health. Healthy Foods Throughout this paper, the term healthy foods is used and it is important to clarify what exactly is meant by this term considering that it has varying meanings 2010 Dietary Guidelines for Americans and the more re healthy foods consist of fruits, vegetables, whole grains, fat free or low fat milk products, and lean meats such as turkey, chicken, or fish, and other protein sources such as eggs and beans (U.S Department of Agriculture and U .S. Department of Health and Human Services, 2010) These types of foods are nutrient dense, meaning that they provide the proper recommended amounts and types of vitamins, minerals, and other key substances that promote good health while also having relat ively low calories. T hese same foods are considered clean foods (Walters, 2007) Clean foods are foods that have minimal to no processing and typically include just a few key, natural ingredients. Foods such as candy and soft drinks that contain large nu mbers of

PAGE 18

18 ingredients that are hard to pronounce are highly processed, high in calories, and have minimal key nutrients. Demographics a nd Food Access Vulnerable Populations Populations Who Cannot Drive A Vehicle Children, elderly, and disabled individual s tend to be dependent on others for transportation to healthy food sources due to their age and decreased capabilities to operate a motor vehicle (Wolfe, Olsen, Kendall, & Frongillo Jr, 1996) The only transportation options for these populations are tran sit, if it is available; walking and bicycling, assuming the individual is physically capable of navigating their way to a healthy food source; or being driven by another individual. Since these populations depend so heavily on others for their healthy foo d their overall diet and health is highly impacted by the types of food purchased for them by other people in their daily lives. Elderly and disabled individuals with health conditions, such as diabetes, that require special diets and those who are physically dependent on others for shopping are especially likely to experience anxiety about their food situation. Furthermore, decreased mobility increased the risk of food security for those same groups. However, programs which overcome social isolation and transportation difficulties for these groups such as grocery delivers or mobile ma rkets have been found to be very effective programs (Guthrie & Lin, 2002) Children who are dependent upon their parents may have varied access to healthy foods due to the types of food stores located in their its, and whether they are personally allowed to choose healthy food options. The income of parents determines the types of foods available in a household and as such, children may not be given choices. In a study on environmental, parental, and personal fo od choice access among children,

PAGE 19

19 Richards and Smith (2007) quoted one of the children from a low income family as Low Income a nd Minorities Low inco me and minority populations differ slightly from the previous populations discussed because these populations often have the physical and cognitive capability to drive a motor vehicle. However, due to financial reasons, these populations often cannot affor d to buy or maintain a personal, reliable vehicle (Murakami & Young, 1997) Lack of access to a vehicle for low income and minority populations can be detrimental when it comes to shopping. Similar to those populations who cannot drive a vehicle; these ind ividuals must then rely on public transit, rides with others, or use taxi services. Public transit may limit the quant ity and quality of food purchased especially fresh produce. Bus routes may not go directly to grocery stores and may require individuals to to longer trips that may deter individuals from making trips to the grocery s tore as often as they c ould (Dai & Wang, 2011) (Wilde & Ranney, 2000) A person who relies on others for rides may feel less indepen dent and services can be too costly for low income populations and take away money that the individuals could be spending on healthy foods. In addition, the demand of health y foods by low income and minority populations may affect the price of these foods within stores near their neighborhoods. L ow income healthy food is centered on two main areas: income level and the prices of food. Hea lthy food is assumed to be a normal good in which the demand for it increases as income increases. Households in food deserts

PAGE 20

20 who rely upon governmental assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) may be limited in thei r demand for healthy foods due to (Thayer, Murphy, Cook, Ettinger de Cuba, DaCosta, & Chilton, 2008) This mean some SNAP recipients may not be able to purchase as much food as other rec ipients due to variations in food prices across the country and especially in urban areas where food prices tend to be and thereby, increases the price of foods making t hem more out of reach for low income and minority populations. Food Desert Populations who cannot drive and also, those who are low income or a minority populations may not be able to own a personal vehicle, and therefore, may be left unable to access hea lthy food sources. Areas in which a large portion of the population is unable to drive or do not have access to a personal vehicle are known as food deserts. The Healthy Food Financing Initiative (HFFI) campaign, an interagency partnership between the Trea sury Department, Health and Human Services, and the United States Depart low income census tract (poverty rate at 20% or higher/a median family income less than or equal to 80% of the area's median family i ncome) where a substantial number or share of residents has low access ( at least 500 people and/or at least 33 percent live more than (United States Department of Agriculture, 2009) Food deserts often off er easier access to a variety of convenient food sources such as fast food establishments and corner stores. These food sources typically only

PAGE 21

21 offer unhealthy food options full of high levels of fat, sugar, and sodium. In addition, corner stores typically have higher product prices than those found in regular grocery operating practices, weak organizational linkages with suppliers, high rates of labor turnover, and/or greate (King, Leibtag, & Behl, 2004) Food deserts als o can include areas where a grocery store is present in the area but th e price of goods in the store may be out of the income reach for residents in the area (e.g. The Fresh Market ). R egardless of th e many definitions surrounding food deserts, the general concept is that there is a disparity between where food is locat ed and where people live. Grocery Store Siting a nd Types of Food Venues Grocery Store Siting Historically, during the a large number of middle and high i ncome households, particularly w hite populations, fled inner cities to the suburbs in a Their purpose was to take advantage of the availability of larger, less expens ive tracts of land and the perceived less crime in the suburbs. This movement left mostly low income and minority populations within the inner cities resulting in lower tax revenues and declining basic infrastructure that then caused more people to flee f rom the inner city. Grocery stores located in inner cities responded by following the middle and high income populations to the suburbs where they themselves could build larger grocery stores on cheaper land. eventually led to groce ry stores not moving into certain areas of the city due to perceived less profit from the low income populations, smaller tracts of land, and perceived crime. Lois Salisbury, public interest attorney, as quoted in (Eisenhauer,

PAGE 22

22 2001) stores] are pulling out. You have to remember these are neighborhoods populated by the poor, the aged, immigrants, the handicapped, people led low income people to travel further distances for healthier food or travel closer to home and pay more for unhealthy food at nearby convenience stores. Additionally, t he supply of healthy food (i.e. grocery stores) in low income and minority neighborhoods is also determined by severa l other factors including costs of store operation, land availability, and agglomeration economies. Costs of store operation include labor costs, rent, and other ite ms such as store infrastructure. These costs are not likely to be the reason that a store d oes not locate in a low income or minority neighborhood, everything else being equal, because these areas tend to have a large low wage and unemployed populations while also having low er land prices (Besharov, Bitler, & Haider, 2011) The main reason tends to be a low supply of grocery stores in inner city neighborhoods is because of a lack of available land and the tendency for grocery stores to (Schwank, 2011) Neighborhoods typically want a well known chain grocery store to move into their area because they are familiar with it and its products. However, these stores are often 50,000 square feet or larger and require frequent truck deliveries since they typically service areas larger t han just a small neighborhood (Flournoy, 2011) L arger grocery typi cal, modern shopping center because other retail businesses find locating next to a grocery store as an advantage due to the amount of walk by and pass by traffic that they generate In general, grocery stores tend to locate

PAGE 23

23 with complementary uses such as drugstores, banks, and gas stations since these uses are more likely to increase the number of trips customers make to their store. Types o f Food Sources Convenience stores and fast food restaurants are not thought of as healthy food sources. These types of food sources tend to offer higher densities of calorie rich, nutrient poor foods. The variety and quality of fresh fruit and vegetable produce tends to be lower in these types of stores. However, prices tend to be higher than traditional grocery stores due to their convenience to consumers. In addition, products such as low fat milk, low fat and nonfat cheese, soy milk, tofu, whole grain pasta and breads, and low fat meat and poultry items tend to be significantly less available (Sloane et al., 2003) These types of food sources are often located in lower income and predominantly Black neighborhoods (2.4 fast food restaurants per square mile) compared to h igher income and predominantly White neighborhoods (1.5 fast food restaurants per square mile) (Block, Scribner, & DeSalvo, 2004) Traditional grocery stores are thought of as healthy food sources because they tend to stock healthier and more varied optio ns of foods at a lower cost compared to convenience stores and fast food restaurants (Treuhaft & Karpyn, 2010) These stores tend to emphasize more perishable, healthy foods, than convenience stores. The average number of items carried in a grocery store i n 2010 was 38,718 (Food Marketing Institute, 2012) This shows the larger possibility for healthier foods to be present in this type of food source when there are more options available. However, as previously mentioned these stores have increased in size over the years creating the need for larger tracts of land that are most often times located in the suburbs outside of the inner city (Flournoy, 2011) Within the United States, lower income zip codes have 25

PAGE 24

24 percent fewer grocery stores compared to higher income zip codes (Powell et al., 2007) Non traditional types of food sources include mobile grocery stores, community gardens, and farmers markets. A mobile grocery store is a grocery store on wheels. However, it cannot carry everything a normal groce r y store would carry. T hey typically carry fresh fruits and vegetables to underserved communities in large re trofitted vehicles such as a school or city bus. One mobile grocery store program known as The Farm Bus in Washington, D.C. and Richmond, Virginia carries fresh grass fed meat, pastured dairy, soy foods, eggs, and breads as well as fresh produce to its communities (The Farm Bus: From Farm 2 Family, 2011) The only expected requirements of this type of food source are that they carry healthy food, ha ve a shelving system to hold the products, and provide an aisle walkway for customers to browse the products. There are a variety of mobile grocery store programs currently active within the United States (Fresh Moves, 2011) (Jordan's Farms, 2012) (Rural R esources, 2012) A community garden is a green space dedicated to serving the needs of residents within a neighborhood. There may be individual plots for residents or one common plot for all to share. Community gardens allow residents to grow their own fr esh produce, promote healthier communities by improving nutrition and fitness, and can be used as an educational tool (Worden, Hunsberger, & McLaughlin, 2012) The only downside to this type of food source is that there must be land available within commun ities and residents must be willing to participate in the gardening process which may be limited due to lack of time or knowledge.

PAGE 25

25 A farmers market is a flexible community food source that involves local farmers bringing their fruit and vegetable products to residents in an organized festival type atmosphere. Spaces designated for farmers markets must be easily accessible to the community they are intended to serve and the general public. Products sold at farmers markets are often fresher and of better qua lity than those found elsewhere since they are grown in the local food environment and travel smaller distances to their consumers. (Project for Public Spaces, Inc., 2003) Built Environmental Factors Walkability What exactly makes a place walkable? A community is considered walkable and pedestrian friendly if it includes, but is not limited to, a diversity of land uses (Ewing, N.D.) high street connectivity (Berrigan, Pickle, & Dill, 2010) high density with a var iety of housing options (Handy, 1996) and safe walking and bicycling infrastructure facilities. These place characteristics offer individuals different modes of travel without being bound to the automobile. Typical, modern day subdivisions are not very wa lkable, especially to grocery stores, due to terminated streets (i.e. cul de sacs) that have no parallel or equal pedestrian and bicycle network (Handy S. 2004) curvilinear street patterns, and low density People are more likely to be obese when they a re living on a street with no sidewalks or with sidewalks that are available only on one side of the street, living where no shop ping is within walking distance, and where there is a perception that no paths are within walking distance (Giles Cort i Macint yre, Clarkson, Pikora, & Donovan, 2003) However, more traditional neighborhoods offer a more walkable community by having smaller block sizes, gridded street networks, and a variety of land uses that are accessible by foot.

PAGE 26

26 A walkable community typi cally has average block lengths 300 feet or less (Ewing, N.D.) and hundreds of intersections per square mile to promote more direct route options for pedestrians. Standard planning practice suggests that most individuals are willing to walk up between and m ile. Individuals may be willing to walk further distances to reach desirable activities such as shopping or dining. However, most walking trips are typically no longer than 1.83 miles in length (Iacono, Krizek & El Geneidy, 2008) In addition to promotin g physical activity, some researchers suggest neighborhoods that are more walkable exude certain social benefits such as higher levels of trust and community participation among residents than those neighborhoods that are more auto dependent (Rogers, Halst ead, Gardner, & Carlson, 2011) A possible explanation for this is that neighbors may become more familiar with one another on a day to day basis by seeing each other out in their community. Literature suggests that if neighbors are unfamiliar with each ot her, and their environment, their fear of crime, both real and perceived may impact their willingness to travel in their community. Crime Real a nd Perceived Crime in a community can severely deter individuals, especially women and the elderly, from walki ng in their neighborhood due to a fear of being victimized In general women are more likely to participate in some level of walking activity. However, literature suggests that women are less likely to walk longer distances, less likely to walk at night (54% women versus 63% men), and less likely to walk alone than their male counterparts. Women and men are very different in the way that they relate to safety (Clifton & Livi, 2004) safety, the y are more likely to not leave their homes The presence of crime in minority

PAGE 27

27 neighborhoods, especially violent crimes such as murder, robbery, assault, and battery, have been shown to suppress the opportunity for physical activity in these populations tha t would be receive from walking (McDonald, 2008) In addition, the perception of crime in a neighborhood can deter individuals from walking in their neighborhood. Examples of neighborhood factors that may seem to predict crime in an area are trash on the streets, graffiti, abandoned properties, or broken windows. CPTED and DS principle s have shown that areas that lack a sense of territoriality, natural surveillance, access control, and boundary definition are more susceptible to crime (Schneider & Kitchen, 2002) Negative social consequences that can be attributed to the perception of crime in a neighborhood and most often impacting certain subgroups, particularly low income mothers, elderly, and the mentally ill; are underutilization of different neighborh ood spaces during certain times of day lack of cohesion between neighbors, and the disruption of daily activities such as shopping or going to school (Whitley & Prince, 2005) Food Environment and Health Implications of Healthy Food Access Food Environment Another aspect, besides walkability and crime in the built environment that can greatly impact the overall, long term health of a person is the food environment. The term food environment refers to the physical surroundings that impact access to nourishing and sustaining items. Good food environments foster positive relationships between people and food. These places provide access to healthy foods through various venues which are in close proximity to people including but not limited to superm arkets, farmers markets, and community gardens while limiting the amount of access to convenience stores and fast food restaurants. In addition, these places have

PAGE 28

28 a variety of transportation types available to access healthy food sources including both mot orized and non motorized options. On the opposing spectrum, bad food environments foster negative relationships between people and food. These types of places are saturated with unhealthy food options including convenience stores and fast food restaurants. Getting to a healthy food source in these places is often difficult due to distance and unfriendly transportation options. Overall, proximity of supermarkets to communities is associated with lower rates of obesity while the presence of convenience stores is associated with higher rates of obesity (Papas et al., 2007) (Sallis & Glanz, 2009) Health Implications Of Healthy Food Access Healthy foods are a crucial and fundamental component for good health. When access to healthy foods is limited, but consumpt ion of unhealthy foods is high a variety of chronic diseases such as obesity can arise. R ates of obesity in both adults and children have risen over the last 20 years with more than a third of adults (35.7%) and about 17% of children and adolescents aged 2 19 currently labeled as being obese (CDC, 2011) Nearly half of adults, report that eating nine servings of fruits and vegetables (44%) or eating fish at least two times per week (45%) is a rare activity (American Heart Association, 2012) Obesity has det r imental impacts on health because it is often the precursor to other health problems including diabetes, high blood pressure, and high cholesterol. Obesity can also create, less serious problems such as joint problems, sleep apnea, and gastro intestinal r eflux. Childhood obesity is often an indicator of adult obesity that can create a lifelong battle of diseases (Biro & Wien, 2010) On the other side of the spectrum, a lack of access to healthy foods may result in health issues related to hunger. Individuals who experience hunger over a long period

PAGE 29

29 vitamin deficient Long term malnutrition can stunt growth, create poor cognitive development, and c reate a decreased resistance to diseases (National Center for Biotechnical Information ( National Center for Biotechnical Information ( NCBI), 2011) Summary This literature ons who tend to be most at risk are those who cannot drive themselves to healthy food sources and those that are low income or a minority. In general, major grocery stores have tended to move out of the city due to perceived less profit from low income pop ulations, smaller tracts of land, and the perception of crime. Factors associated with the built environment such as the walkability of a neighborhood healthy food sources. Lastly, l ow access to healthy foods can lead to health problems such as obesity and malnutrition on the opposing end.

PAGE 30

30 CHAPTER 3 HEALTH IMPACT ASSESS MENT (HIA) en vironment m any of wh ich are influenced by different proposals, policies, and programming related to varied disciplines such as housing and transportation. Health impact assessments (HIAs) have been proposed as one tool to connect decisions made in various disciplines so that a more complete decision can be made regarding the in the discussion of various proposals, policies, and programs (Scott, Murley, & Jones, 2007) Th is chapter provides an overview of the three main HIA types : rapid, intermediate, and compre hensive. Moreover, the role of each step in the HIA process is explained. Three Types of H IAs Rapid HIA A rapi d HIA is the briefest HIA investigation process. It is typically completed in a shorter amount of time ( days to weeks ), relies heavily upon literature reviews, descriptive analysis, and qualitative analysis and usually only involves minimal public engagement (NACCHO, 2008) ( National Research Council, 2011) During the rapid HIA process, existing and accessible data is typically analyzed whil e new data is rarely collected. A rapid HIA is typically conducted to determine if a full HIA is warranted and to raise awareness of issues within a community that may be impacting the health of its residents. Intermediate HIA An intermediate HIA is, as its name suggests, is a level of HIA investigation falling between a rapid HIA and a comprehensive HIA. It requires more in depth

PAGE 31

31 research on a proposal, policy, or program HIA because it involves more time (week s to months), more stakeholder involvement, and a detailed analysis of available data similar HIAs, and while unlikely, new data collected ( National Research Council, 2011 ). It is the most commonly used HIA because it provides a more thorough investigati on of health impacts which increase s the re liability of the study without involving as much time or resources as a comprehensive HIA. Comprehensive HIA A comprehensive HIA is the highest level of HIA investigation. It is sometimes referred to as a complete or full HIA. It involves the most time commitment (months to years), extensive reviews of existing data and literature collection and analysis of new information, and includes the most in depth look at potential health impacts ( NACCHO, 2008) New data co llected may be quantitative or qualitative or both Comprehensive HIAs generally involves the participation of the full range of stakeholders and in certain proposal, policy or program put in place is improving the overall health of the community (Parry and Stevens, 2001). Comprehensive HIAs provide the most reliability due to their complete evaluation of literature, data, and information However, they are the least used du e to their long time commitment and abundance of resources needed. The Roles of Each Step in the HIA Process This section will explain the role of each step in the HIA process including screening/scoping, assessment, recommendations, evaluation and monito ring, and reporting. While these steps are listed in chronological order, it is important to keep in mind that the HIA process is a fluid process and it may be necessary to revisit previous

PAGE 32

32 steps in the process. An example of needing to revisit a step in t he process would be if there was a major change in the proposal, policy, or program the HIA is expecting to influence, especially if the population affected changed. In that case, it would be important to return to the screening phase, which will now be de scribed. Screening a nd Scoping The screening phase determines whether an HIA for a given proposal, policy, or program is warranted and feasible. All types of HIAs go through a screening process. However, the screening phase may not always be formalized or documented (UCLA HIA CLIC, 2011) In this first phase of the HIA proposal is likely to have health e ffects and whether the HIA will provide information useful to the stakeholders and decision makers ( National Research Council, 2011) Key steps in the screening process include: Defining the proposal, policy, or program to be examined Reviewing existing resources, data, personnel, and time available Making a preliminary assessment on whether to proceed with HIA The scoping phase considered in the HIA, the affected population(s) and the methods to be used in the (UCLA HIA CLIC, 2011) The scoping phase helps provide answers to the following questions: What are the aims and objectives of the HIA? What will be the extent and boundaries of the HIA (resources, time, physical limits of study area, etc.)? What type of HIA should be conducted? Who will conduc t the HIA? Who are the stakeholders and how involved will they be in the process?

PAGE 33

33 Assessment The assessment phase uses a combination of quantitative and qualitative data to assess the impact of a proposal, policy, or program. The assessment phase should wo related (UCLA HIA CLIC, 2011) The National Research Council (2011) suggests the assessment phase should provide baseline condi tions of the affected population with relevant indicators including social, economic, and environmental factors and prevalent health concerns. Also, the assessment should outline any limitations to the HIA conducted. Recommendations The recommendations pha se identifies the best course of actions to minimize the adverse effects and optimize the beneficial ones based upon information analyzed in the assessment. Recommendations should only be based on the findings of the HIA including but not limited to, the l qualitative and/or quantitative data, and other available data used. Additionally, future research topics to improve the HIA conducted and the recommendations provided should be discussed. Evaluation and Monitoring The evaluation and monitoring phase involves tracking the decision and implementation effect on health of the proposed policy or program. The evaluation smoothly t (UCLA HIA CLIC, 2011) Additionally, the monitoring portion of this phase should track the status of the proposed policy or project, whether the recommendations provided in the HIA were implemented. If not,

PAGE 34

34 then why not? If yes, how successful were they in improving the health of the populations affected? And, discuss how future recommendations can be adapted to fit the changing needs of the population. Reporting The reporting phase communicates the findings and recommendations of the HIA to the populations affected by the proposed policy or project, as well as, those involved in influencing the decisi on(s) of the policy or project. offer stakeholders and decisions make rs a meaning opportunity to critically review (Bhatia, 2010) Reporting the findings and recommendations of the HIA may take place during the HIA process (e.g. pub lic meetings with key stakeholders) or may be presented at the conclusion of the HIA in the form of a report that is easily accessible by all those involved or interested in the proposed policy or project. Overall, there are many different ways to report a n HIA including presentations, reports, fact sheets, or websites. Summary This chapter gave an overview of the three types of HIAs including, rapid, intermediate, and comprehensive. A rapid HIA involves the minimal amount of time and relies heavily upon existing data, and typically involves minimal public engagement. An intermediate HIA provides a more detailed picture of the possible health impacts than those that would be identified during a rapid HIA. A comprehensive HIA is the highest level of HIA inv estigation. It involves the longest time commitment and differs from the other two HIAs because it always involves the collection of new data. Additionally, this chapter explained the role of each step in the HIA process including screening/scoping, assess ment, recommendations, evaluation and monitoring, and reporting. This chapter

PAGE 35

35 also noted that the HIA process is fluid and it may be necessary from time to time to revisit a previous step in the process when new information becomes available.

PAGE 36

36 CHAPT ER 4 METHODOLOGY This thesis completes a rapid HIA of transportation access to healthy food sources in the Tower Road Triangle neighborhoods of Alachua County, Florida. This type of research uses three different sources to fully understand the transportati on barriers that exist for those people trying to reach healthy food sources including analysis of existing data, study area resident focus groups, and place based observations. The ultimate goal is to offer a meaningful overview of current food access in residents. Identifying Proposals and a Program That May Impact Health In an effort to inform the City of Gainesville and the Regional Transit System (RTS) as they upd ate their existing Tran sit Development Plan (TDP) and to better understand how the current transportation available to Tower Road Triangle neighborhoods may be impacting their access to healthy foods, a rapid HIA was conducted. The City of Gainesville RTS TDP pub lished in August 2009 shows several TDP Service Priorities projects planned for Fiscal Year 2010 2019 that pertain to the Tower Road Triangle study area, particularly for Route 75, which will be further examined later (Tindale Oliver& Associates, Inc., 20 09) The proposed transit improvements are expected to be implemented in 2016. The TDP Service priorities for Route 75 and their annual operating costs in 2009 dollars include: 35 minute frequency all day ($131,374) Extend weekday evening hours to 10pm ( $35 ,033) E xtend Saturday hours to 7:58 pm ($60,543, this amou nt includes eight other bus routes )

PAGE 37

37 A dd Sun day service (10:03am 4:58 pm) ($28,9 16), and I ncrease weekend frequency to 45 minutes ($46,988) An assessment of transportation access, including transit and other alternative methods to healthy food sources from the Towe r Road Triangle neighborhoods provided to t he City of Gainesville and RTS will help emphasize the importance of putting the Route 75 TDP Service priorities into action, a mong an environment of decreased funding. By implementing the Route 75 TDP Service priorities, residents in the Tower Road Triangle neighborhoods will be able to travel to healthy food sources more frequently and more often with extended hours of service. Having increased transit access to healthy food sources has the potential to improve health for residents in the study area by allowing them more opporunities to access it. Additionally, this rapid HIA is intended to influence a proposed plan to bring a mobile food market to Gainesville. The conducted by two University of Florida students in the College of Agriculture and Life Sciences, one of whom is in the Department of Food and Resource Economics and othe r in the Department of Agricultural Economics. Their study focuses on the food desert areas east of Main Street and south of University Avenue in Gainesville, Florida. The study seeks to bring convenient, healthy, affordable fresh food to those who lack tr ansportation by using a mobile food market that has been successful in cities such as students conducted the study were unsuccessful so the exact details of the feasibili ty study were not available. This type of a program could be used in the Tower Road Triangle in the future if it ever gets up and running in East Gainesville. It is similar in concept to the Mobile Health Clinic that is organized by the University of Flori

PAGE 38

38 College of Medicine. Just as the mobile clinic can bring health care to the residents of the Tower Triangle with barriers to accessing health care, the mobile food truck could provide better access to healthy foods. The Process Screening a nd Scoping T he firs t steps of the rapid HIA are screening and scoping The screening phase identifies the justification for conducting the rapid HIA During this initial step, the author met with the Southwest Advocacy Group (SWAG) Board Members at the SWAG Family Resource Center located in Linton Oaks, a neighborhood in the Tower Road Triangle (Appendix A). SWAG is a grassroots, non profit organizatio n made up of residents of the Tower Road Triangle neighborhoods that works to make the community a better place The organization also provide s services such as counseling, summer food programs for ch ildren, and access to computers for those in need within the community. During this m eeting with the Board Members, the researcher gave a presentation describing the HIA process, the proposed rapid HIA methodology and gather ed feedback on the best way to conduct the HIA. Additional ly, the author attended a SWA G resident m eeting to learn about SWAG Oasis, a nutrition program working to bring healthy food to the Tower Road Triangle (Appendix B). During both of these meetings, Board Members and residents expressed some of the changes they had seen in the neighborh oods and surrounding area including changed transit routes that stopped short of the neighborhoods and reduction of transit services in the area. Both groups communicated that they wanted more transit access in the area so that residents could more easily access destinations such as healthy food resources. It was agreed that a

PAGE 39

39 proposals for more transit within the Tower Road Triangle in the future. The scoping phase answered what to do for the rapid HIA and how to conduct it. the extent and boundaries of the rapid HIA were defined. In addition, some of the health indicators to be e xamined such as obesity were discussed. This also included deciding on when the assessment would be done, how much time would be devoted to the project, and what data sources were available. The rapid HIA was given a time span of approximately five months portion, it was decided that the author would be the sole person co nducting the rapid HIA were no monetary funds available for the research a nd it would be best to remain with a rapid HIA instead of trying to complete a full HIA. Baseline an d Impact Assessment The second step of the rapid HIA wa s to identify existing conditions based on measurable indicators and data, as well as discuss their impacts on access to healthy food. No new data was collected during this step with the exception of focus group data and field observations of healthy food re sources within the study area. The baseline assessment includes an overview of the study area, population characteristics, the environment (walkability and bikeability), analy sis of available public transportation, and analysis of access to healthy foods. The impact assessment provides an overview of the research conclusions discovered from the baseline assessment, discussion of two

PAGE 40

40 programs in the works to bring more healthy f ood to the study area, and the limitations of the study. Recommendations The third step of the rapid HIA was to provide recommendations based upon the baseline and impact assessments of the study area. Recommendations to improve transportation access to h ealthy food sources include: C rime P revention through E nvironment D esign (CPTED)/Defensible S pace (DS) strategies, a more mixed use environment in the future, improved walking/bicycle infrastructure, a bicycle sharing program, a neighborhood farmers market and a supermarket carpool/supermarket shuttle. Evaluation And Monitoring The final step of the rapid HIA was to provide evaluations of programs currently in place, as well as, suggest ways to continue to monitor the health of the residents in the study area and their access to healthy food. Additionally, suggested topics of future research areas are provided. Data And Information Used Demographic social, and economic informati on related to individuals in the study a rea was obtained using 2007 2011 Amer ican Community Survey 5 Year Estimates. U.S. Census tract level data from tracts 22.17 and 22.18 were used because they encompassed the entire Tower Road Triangle study area. Census tracts were chosen because they are designed to be homogenous with respect to population characteristics, economic status, and living conditions (U.S. Census, 2000) Office (ASCO). To provide a broad comparison of the number of crimes in the study to

PAGE 41

41 th e number of crimes within all of Alachua County crime statistics were obtained from the Florida Department of Law Enforcement (FDLE). Only index crimes which include homicide, burglary (business, residence, and conveyance), sexual battery, robbery, robbery armed, stolen vehicle, theft, and assault/battery were examined since these are Office and Florida Department of Law Enforcement is from the time period of January 2011 to December 2011. By looking at crime in a year time span, biases against crime eliminated. Aerial imagery of the study area was obtained from Google Earth and geographic in formation system files (GIS) were ob tained from the Florida Geographic Data Library (F GDL), as well as the Alachua County Planning website. These were used to evaluate environment characteristics such as street connectivity, trail connections, bicycle lan es, sidewalks, existing zoning, future land uses, and to locate existing healthy food stores. Additionally, o ne way trip times and route lengths, by walking and bicycling, from study area neighborhoods to the neare st full service grocery store were determi ned by Google Directions Walkability for each of the seven neighborhoods was extracted using Walk Score. This provided a sense of the built environment atmosphere i ncluding average block lengths and the average number of intersections per square mile within the study area neighborhoods. Walk Score has been shown to be a quite reliable and valid measure of access to neighborhood amenities, such as grocery stores. It is an

PAGE 42

42 inexpensive research tool that helps those interested in walkability to assess the built environment (Carr, Dunsiger, & Marcus, 2010) Food desert information related to the two U.S. Census tracts that comprise the Tower Road Triangle Desert Locator. This provided the number and percentages of populations with low access to healthy foods. Data for the Food Desert Locator was last updated on August 23, 2012. Public transit access for each of the seven neighborhoods was evaluated by using the RTS Global Positioning System (GPS) online website and RTS GIS files The RTS Trip Planner provided o ne way trip times, by bus, from study area neighborhoods to the nearest full service grocery store on various days and times of the week Days and times examined were: Wednesday at 12:00pm, Wednesday at 7:00pm, Saturday at 3:00pm, and Sunday at 3:00pm. The days of the week and times were chosen arbitrarily to see how trip times were impacted by weekdays, weekends, afternoon, and evening trips. Additionally, the City of Gainesville RTS TDP and the City of Gainesville RTS Complimentary Paratransit Service Guide were used to look at proposed future improvements to the existing transit service and available paratransit service in the County. Health data at the Census Tract Level was not available for the study area. However, Alachua County health indicators at the zip code level (32607) were available and provided health data related to the death rates by selected causes of death such as three cancer types, stroke, heart disease, and diabetes. The zip code health data was prepared by the University of Florida Family Data Center. Additionally, maps created

PAGE 43

43 by the University of Florida (CARA) were obtained to illustrate health factors that may b e related to or should be considered in regards to healthy food access such as birth density, low birth weight density, and births to teenagers Using data from Behavioral Risk Factor Surveillance Survey (BRFSS) for years 2002 and 2007 for Alachua County p rovided information about health indicators at the County scale for adults such as cholesterol awareness, diabetes, and being overweight and/or obese. Information for the occurrence of childhood obesity at the county level was provided by the Alachua Count y School. Field observations were used to evaluate the type and quality of healthy food sources located within the study area boundaries. These observations were performed by the author and photographs were taken. Additionally, i nformation from t he Centers for Disease Control and Prevention (CDC) Modified Retail Food Environment Index (mRFEI) was used to get a sense of the number of healthy food retailers in the food environment compared to the total number of healthy food retailers plus less healthy food retailers Data gather from two focus groups facilitated by the SWAG Oasis project as part of an American Medical Association Foundation grant, were used to gain an understanding of access to healthy food for residen ts within the Tower Road Triangle (Bhakta, Pastor, & Wegman, 2013) The two focus groups were held during February and March 2013 at the Southwest Advocacy Group (SWAG) Family Resource Center located at 807 SW 64 th Terrace, Gainesville, Florida 32607. The SWAG Oasis project team wanted the participants to be familiar and comfortable with the focus groups

PAGE 44

44 location. The first f ocus group included 11 volunteer participants and the second focus group included 13 participants, all of whom were residents of the Tower Road Triangle neighborhoods. Focus groups were conducted in a semi structured interview format to elicit in depth discussions about access to healthy foods, including transportation modes to healthy food sources, sales on healthy foods, using fo od stamps or WIC for grocery shopping, prices of healthy foods, preferences of foods, as well as comments on the existing community garden and a potential farmers market in the neighborhood. Summary This chapter focused on explaining how a rapid hea lth impact assessment is applied to the case study area its steps, and the data sources used to determine transportation barriers to healthy food resources in the Tower Road Triangle. A rapid health impact assessment is a tool used to raise awareness abou t programs, policies, or projects that may negatively impact impact assessment include: screening/scoping, baseline and impact assessment, recommendations, and evaluation/monitoring. Data sources used to co mplete the research include: U.S. Census, ASCO/FDLE crime data, spatial data, Walkscore, USDA food desert locator, City of Gainesville RTS, UF CARA, BRFSS, CDC, and S WAG Oasis.

PAGE 45

45 CHAPTER 5 BASELINE ASSESSMENT This chapter presents the baseline assessment of the Tower Road Triangle neighborhoods. The baseline assessment identifies the study area and provides an overview of issues related to transportation access and healthy food sources. Study Area The Tower Road Triangle was chosen as a case study due to its social demographics particularly income and racial composition that indicate the area may have low transportation access to healthy foods as presented in the research aim and literature review. The Tower Road Triangle (Figure 5 1) is located between Int erstate 75 and Tower Road/NW 75 th Street in unincorporated Alachua County west of the City of Gainesville, Florida. It is bound on the south by SW 20 th Avenue and on the north by State Road 26/ West Newberry Road. The city limi ts of the City of Gainesville are largely located along I 75 and it extends into the commercial area on the north end of the Tower Road Triangle area. The study area is comprised of seven neighborhoods (Figure 5 2) including: Majestic Oaks, Linton Oaks, and Tower Oaks, that are located in the southern portion of the study area; Pine Meadow, Harbor Cove, and Hidden Oaks are located in the northern portion of the study area; and Holly Heights is centrally located in t he study area. Majestic Oaks is centered around the management office located at 5800 SW 20 th Avenue, Gainesville, Florida 32607. This is a 172 unit apartment complex that accepts Section 8 Low Income Housing Assistance Vouchers. These vouchers allow fami rent under the program. A housing subsidy is paid to the landlord directly by the Public

PAGE 46

46 Housing Agency (PHA) on behalf of the participating family. The family then pays the difference between the actual rent charged by the landlord and the amount subsidized by the program. As of 2008, 137 units were using Section 8 Low Income Housing Assistance Vouchers Of the 172 units, 36 units are 1 bedroom and 136 are 2 bedroom apartmen ts. Linton Oaks is centered around the management office located at 6108 SW 10 th Street, Gainesville, Florida 32607. Linton Oaks provides a variety of economical housing with 1 and 2 bedroom apartments, along with, 1 to 3 bedroom duplexes. Tower Oaks i s centered around the management office located at 6900 SW 21 st Lane, Gainesville, Florida 32607. This affordable housing features 110 units ranging in size from 1 to 3 bedroom. Amenities on site include different sports courts. Pine Meadow centered arou nd the management office is located at 7025 West University Avenue, Gainesville, Florida 32607. This 78 unit apartment complex accepts Section 8 Low Income Housing Assistance Vouchers. As of 2009, all 78 units were using Section 8 housing vouchers. Of the 78 units, there are 16 1 bedroom apartments, 46 2 bedroom apartments, and 16 3 bedroom apartments. Harbor Cove is a gated community centered around the management office located at 6815 West University Avenue, Gainesville, Florida 32607. This apartment co mplex accepts Section 8 Low Income Housing Assistance Vouchers and offers 208 units ranging in size from 1 4 bedrooms. Amenities on site include an after school Hidden Oaks is centered around the mana gement office located at 100 Castle Drive, Gainesville, Florida 32607. This is a manufactured home community featuring

PAGE 47

47 both single and double wide homes ranging in size from 2 3 bedrooms. There are approximately 150 180 manufactured homes in the community Holly Heights is centered around the management office located at 604 SW 70 th Terr ace, Gainesville, Florida 32607. Holly Heights has approximately 140 units and provides economical housing with 1 and 2 bedroom apartments, along with, 2 and 3 bedroom to wnhomes. Units start as low as $295 for a 1 bedroom/1 bath up to $700 for a 3 bedroom/2 bath To gain a sense of the neighborhood atmosphere within the different neighborhoods an overview of crime statistics is presented. Index crimes, also known as the most violent and serious types of offenses, that occurred from January to December 2011 in the Tower Road Triangle included: 1 homicide, 168 burglaries, 6 sexual batteries, 14 robberies, 86 thefts, 19 stolen vehicles, and 27 assault/batteries. Index crime offense from January to December 2011 in all of Alachua County included: 12 homicides, 2,023 burglaries, 185 sexual batteries, 281 robberies, 6,485 thefts, 435 stolen vehicles, and 1,090 assa ult/batteries (Table 5 1). Accord ing to the Alachua Tower Road Triangle had the highest density of crimes in all of Alachua County in 2011 (Figure 5 3). Moving away from the crime atmosphere in the community classifications of the study ar ting zoning provides a more detailed sense of the types of land uses dispersed between and around the neighborhoods. Existing zoning within the approximately 822 acres of study area includes: Administrative and Professional AP), Agricultural (A), Business and Professional (BP), Business, Retail Sales, and Services (BR), Highway Oriented Business (BH), Manufactured/Mobile

PAGE 48

48 Home Park (RM), Planned Development (PD), Residential Multi Family (R 2A), Residential Multi Family (R 3), Residential Single Fam ily (R 1B), and Wholesale and Warehousing ( BW ) (Figure 5 4). Approximately, 81% (662 acres) of the existing zoning in the area is devoted to some level of residential. The future land uses within the approximately 822 acres of study area include Commercia l, Institutional, Office, Residential High Density (14 24 du/acre), Residential Medium Density (4 8 du/acre), Residential Medium High Density (8 14 du/acre), Tourist/Entertainment, and UF Campus Master Plan (Figure 5 5). Approximately, 81% (662) acres of t he future land uses in the area is expected to remain some level of residential Population Characteristics According to the 2007 2011 American Community Survey 5 Year Estimates, the total popula tion for census tracts 22.17 and 22.18 (Figure 5 6 a ) combined was 9,084 (Table 5 2). The following Census Tracts surround the study area: 16.04 (east), 17.02 (northeast), 22.04 (northwest), 22.05 (southwest), 22.07 (west), and 22.19 (south) (Figure 5 6b). It should be noted that Census Tracts 16.04 and 17.02 tend to have high college student populations and thus may have more similar demographics and behaviors to the study area than the remaining Census Tracts. (Table 5 2 ) provides a demographics overview of the Census Tracts surrounding the study area for comparison Of the study area population, 5,040 (55.48%) are females and 4,044 (44.52%) males. The age demographics of the total study area population are: 2,776 (30.56%) under 18 years, 5,973 (65.75%) age 18 64 years, and 335 (3.69%) age 65 years and over. The rac ial demographics of the study area are: 4,653 (51.22%) White, 4,270

PAGE 49

49 (47.01%) Black or African American, 302 (3.32%) Asian, 229 (2.52%) Some Other Race, and 919 (10.12%) Hispanic or Latino. It is estimated that a total of 2,733 (30.09%) people are living be low the poverty level within the two study area Census Tracts. (Table 5 2 ) A total of 4,336 housing units are located in the study area. Of these housing units, 3,632 (83.76%) are occupied and 704 (16.24%) are vacant. For the housing units that are occupied the number of units that are owner occupied is 713 (19.63%) while the number of units that are renter occupied is 2,919 (80.37%). A total of 3,632 households are located in the study area. Of these households, 861(23.71%) receive Food Stamps/SNAP benefi ts. The median household incomes of Census Tract 22.17 and 22.18 are $29,695 and $49,112, respectively. The mean household incomes of Census Tracts 22.17 and 22.18 are $31,070 and $68,392, respectively. With almost a quarter of the study area receiving Food Stamps/SNAP benefits, many focus group participants described their difficulties in accessing healthy food due food stamps and Women, Infants, and Children ( WIC ) The co mmon theme from the participants was that food stamps and WIC do not provide enough money to eat healthy. Statements related to the price of healthy food included: have, t you still winds [up] with a lot of tuna fish and Ramen

PAGE 50

50 Transportation is a key element of food access. Unreliable or unavailable private or public transportation can drastically restrict access to healthy food sources. The 2007 2011 American Community Survey (ACS) 5 Y ear Estimates was used to gather transportation information such as the number of vehicles available per housing unit (Table 5 3). The study area (Census Tracts 22.17 and 22.18) had a total of 3,632 occupied housing units. Of those housing units, 373 (10.3 %) had no access to a vehicle, 1,909 (52.56%) had access to 1 vehicle, 1,181 (32.52%) had access to 2 vehicles, and 169 (4.65%) had access to 3 or more vehicles. In comparison, (Table 5 3 ) shows only 7.7% of households in Alachua County have no vehicles an d 51% of households have two or more vehicles available per housing unit. With the exception of Census Track 22.18, adjacent census tracks have less than 3% of households with no vehicle and over 59% with two or more vehicles per households. The study are a (Census Tracts 22.17 and 22.18) had a total of 4,394 workers aged 16 years or over. Of those workers, 3,290 (74.87%) drove alone, 510 (11.61%) carpooled, 438 (9.97%) used public transportation excluding taxicabs, 55 (1.25%)

PAGE 51

51 walked, 74 (1.68%) used anothe r means of transportation, and 27 (0.61%) worked at home. In comparison, (Table 5 4 ) shows the mode of transportation to work in the Census Tracts surrounding the study area. In the surrounding Census Tracts, there are significantly less people using publi c transportation (excluding taxicabs). However, the percentage of people who drove alone in Census Tracts 16.04 and 17.02 is about the same as the study area. This can be expected as this area has a high population of college students who may or may not ha ve personal vehicles. The remaining Census Tracts have higher percentages of people who drove alone than the study area. This can also be expected as this area has a high population of older, more affluent households. Focus group participa nts indicated tha t the expensive price of gas for personal vehicles is a barrier to accessing healthy food. Participants that said the expensive price a big issue. It take like twenty One participant suggested that a service similar to the existing ADA paratransit service be available for grocery shopping by saying, something, like some type of, like that MV can thing. But if it was right here, we could do The study area Census Tracts 22.17 and 22.18 are within Alachua County zip code 32607. The zip code area generally extends from Newberry Road in the north to SW 24 th /SW 20 th Avenue in the south and from Parker Road/SW 122 nd Street in the west to NW 23 rd Street in the east (Figure 5 7). Death rates for selected causes of death

PAGE 52

52 (age adjusted per 100,000 populations ), 2007 2009 in the 32607 zip codes were: 87.40 for all cancers (20.20 for lung cancer, 7.80 for breast cancer, and 6.70 for prostate cancer), 31.40 for strokes, 83.00 for heart disease, and 19.80 for diabetes (Table 5 5). Data from the Behavi oral Risk Factor Surveillance Survey (BRFSS) for years 2002 and 2007 for Alachua County showed that the percentage of adults who had their cholesterol checked in the past 5 years increased from 69.6% to 76.5%, adults who were diagnosed with high cholestero l decreased from 28.9% to 26.8%, adults diagnosed with diabetes increased from 5.1% to 6.3%, adults who were overweight increased from 36.1% to 37.8%, adults who were obese increased from 14.7% to 25.4%, and the total percentage of adults who were overweig ht and/or obese increased from 50.7% to 63.3 % (Table 5 6). Body mass index (BMI) data collected by the Alachua County School Board during the 2008 2009 school years was used to calculate the total number of students who were overweight and/or obese. Chil dren who live in the study area are likely to Elementary School ( 2525 Schoolhouse Road), Hidden Oak Elementary School (2100 Ft. Clarke Blvd.), Terwillinger Elementary School (301 NW 62 nd Street), Ft. Clarke Middle School (9301 NW 23 rd Avenue), and Buchholz High School (5510 NW 27 th Avenue). The total number of students who were overweight and/or obese at these schools was: 231 (30.0%) at Chiles Elementary School, 302 (34.2%) at Hidden Oak Elementary School, 148 (41.6%) at Terwillinger Elementary School, 281 (34.4%) at Ft. Clarke Middle School and 435 (31.2%) at Buchholz High School (Table 5 7). The

PAGE 53

53 number of overweight and/or obese students at Terwillinger Elementary was the h ighest of all the elementary schools. Resource Atlas (CARA) show that the Tower Road Triangle area had a higher birth density, and number of births by teenagers between 2007 2009 by Census block groups than most of the rest of Alachua County, excluding East Gainesville. The approximate total number of births per square mile in the study area, comprised of 2 block groups was 543 births (Figure 5 8). In comparison the area of East Gai nesville which had high birth density had 450 births within 8 bloc k groups The approximate number of births by teenagers per square mile was 32 per square mile (Figure 5 9). In comparison the highest total number of births by teenagers per square mile in East Gainesville ranged from 10 24 births. The study area had the highest number of low birth weights in the County at approximately 74 births per square mile (Figure 5 10). In comparison the highest total number of low birth weights in East Gainesville was 23 births. Analysis o f B uilt Environment Walkability a nd Bikeability Walkability was determined for each neighborhood using Walk Score which calculates average block lengths and the number of intersections per square mile. A score between 0 given for the Tower Road Triangle neighborhoo ds: Majestic Oaks (11/100), Linton Oaks (12/100), Tower Oaks (25/100), Holly Heights (37/100), Harbor Cove (49/100), Pine Meadow (51/100), and Hidden Oaks (54/100 ) (Table 5 8). Neighborhood streets within the Tower Road Triangle are characterized by dead e nds/cul de sacs and loops which

PAGE 54

54 do not provide a gridded network between the seven different neighborhoods (Figures 5 11 to 5 14). Bikeability was based on bicycle lanes that currently exist and those that are proposed in the future within the study area boundaries (Figure 5 15) Bicycle lanes currently exist on Tower Road/NW 75 th Street from Newberry Road to SW 8 th Avenue (1 mile) and SW 20 th Avenue/SW 24 th Avenue from Tower Road/NW 75 th Street to SW 34 th Street (3.41 miles). A bike lane connecting to Tow er Road/NW 75 th Street has been proposed on Newberry Road/SR 26 from Tower Road/NW 75 th Street to NW 110 th Drive (2.27 miles). Walkability and bikeability was also based upon the presence or absence of multi use trails within the study area (Figure 5 16). O ne existing multi use trail, the Split Rock Conservation Area Trail, is located near the study area just south of SW 20 th Avenue/SW 24 th Avenue in the Hogtown area. This trail features an unpaved, multi use 1.52 mile trail. No multi use paths exist within the study area. Multi use paths within and near the study area are proposed for SW 20 th Avenue/SW 24 th Avenue from SW 91 st Street to east of Interstate 75, SW 8 th Avenue from west of Tower Road/NW 75 th Street to SW 20 th Avenue/SW 24 th Avenue, and Tower Road/NW 75 th Street from SW 8 th Avenue to SW 20 th Avenue/SW 24 th Avenue. The Alachua County Capital Improvements Elements show that there are planned transportation projects within the study area. These improvements include: two lane roa d on SW 61 st Street from SW 20 th Avenue to SW 8 th Avenue, two lane upgrades on Tower Road/NW 75 th Street from SW 8 th Avenue to SW 24 th Avenue and on SW 8 th Avenue from Tower Road/NW 75 th Street to SW 61 st Street, four lane road on SW 20 th

PAGE 55

55 Avenue from SW 61 st Street to Interstate 75, and a future dedicated transit line west of Interstate 75 on Newberry Road/ SR 26 (Figure 5 17). Analysis o f Available Public Transportation The study area is serv ed by the RTS, which provides public transit service to the City o f Gainesville and adjacent areas of unincorporated Alachua County. RTS is a an agreement with the University of Florida that allows a portion of student tuition fees t o be dedicated to unlimited RTS bus rides for the students. This has created a higher quality of service for students on the University of Florida campus as a result of UF funding and has created some equity issues between City and Campus public transit ro utes. The study area is served by 44 bus stops that provide access to RTS bus Route 23 (Oaks Mall to Santa Fe via Ft. Clarke Blvd.), Route 75 (Oaks Mall to Butler Plaza), and Route 76 (Santa Fe to Haile Market Square ) (Figure 5 18). Route 23 runs along the northern border of the study area along Newberry Road/SR 26. This route runs Monday through Friday every 22 23 35 45 minutes with the first bus running at 7:15am and the last bus running at 10:00pm. There is no service on Saturday or Sunday. This route is closest to the neighborhoods of Harbor Cove, Hidden Oaks, and Pine Meadow. There is only one bus stop within the study area that is serviced by this route. This stop is located along Newberry Road/SR 26. Route 75 runs Monday through Friday every 35 52 53 minutes with the first bus running at 6:00am and the last bus running at 7:30pm. Service on Saturdays is every 105 minutes with the first bus running at 6:40am and the last bus running at 6:05pm. There is no Sunday service. This route services all seven n eighborhoods within the study area. There are a total of 39 bus stops within the study area that are serviced by

PAGE 56

56 this route. Of the 39 bus stops, 21 are within a quarter mile of the seven neighborhoods (Figure 5 19). Route 76 runs Monday through Friday eve ry 60 minutes with the first bus running at 7:28am and the last bus running at 5:00pm. There is no service on Saturday or Sunday. This route is closest to the neighborhoods of Majestic Oaks, Tower Oaks, and Linton Oaks. There are a total of 10 bus stops al ong the southern boundary of the study area that are serviced by this route. Public transportation options for the disadvantaged in Alachua County include the American Disabilities Act (ADA) Paratransit Service. This service allows those physically unable to reach a bus stop to get to their desired origins and destinations, as long as the origins and destinations are within a mile of a fixed bus route. AD A Paratransit services must be scheduled a day a minimum of one day in advance and services are available on weekdays between 6:00am to 9: 00pm, Saturdays from 6:00am to 7:00pm, and Sundays from 10:00am to 5:00pm. Trip priorities for the Paratransit service have been established and are listed in order of importance: Vital Care Medical Other Medical, Employment, Pharmacy and Grocery Shopping, Education, Social Service Agencies, Shopping, and Recreational Analysis of Access t o Healthy Foods Food Desert Ac cording to the United States Department of Agriculture Food Desert Locator, 10 food deserts can be found in all of Alachua County (Figure 5 20). The study area comprises one of the se food deserts (Figure 5 21). Within the study area it is estimated that 4, 115 (64.6%) people have low access to a supermarket or large grocery store (Table 5 9). Of the total population that is considered low income, 1,292 (20.5%) have

PAGE 57

57 low access to a supermarket or large grocery store. In addition, of the total population, 1,04 5 (16.4%) of children aged 0 17 and 136 (2.1%) of the elderly aged 65 years or older have low access to healthy foods. Approximately 202 (6.9%) of the total housing units in the study area who have low access to a supermarket or large grocery store are wit hout a vehicle. Modified Food Retail Environment Index ( mFREI ) The Centers for Disease Control and Prevention (CDC) report that within the study area census tracts, the number of healthy food retailers in the food environment compared to the total number of healthy food retailers plus less healthy food retailers otherwise known as the modified food retail environment index (mFREI), is between 0.1 5 (CDC, 2013) (Figure 5 10 and the National mFREI score is also a 10 (Figure 5 23). A score just slightly greater than zero, indicates a food environment that has a greater number of less healthy food retailers. Healthy food retailers included in the calculations included supermarkets, larger grocery stor es, supercenters, and produce stores within census tracts or mile from the tract boundary. Less healthy food retailers included in the calculations included fast food restaurants, small grocery stores, and convenience stores within census tracts or mil e from the tract boundary. E xisting Healthy Food S ources a nd Food Preferences Observations of convenience store, one ethnic grocery store, two specialty grocery stores, six large grocery stores, and one retail store that also includes a grocery store, and one community garden (Figure 5 24). While this may seem like a high quantity of healthy food sources, not all of these stores are equally accessible to all neighborhoods within

PAGE 58

58 the Tower Road Triangle. Physical distances to the different healthy food sources can become a problem for those without reliable transportation access. At the present time, there are no Farmers Markets located directly within the study area. However, there are two in the surrounding area, more than two miles from the study area, including the Haile (5211 SW 91 st Terra ce) and Tioga (13005 West Newberry Road) Farmers Markets (Figure 5 25). Focus group participants were informed that the SWAG Oasis project is trying to bring a farmers market to the Tower Road Triangle neighborhoods in conjunction with Florida Organic Growers (FOG). Participants seemed very supportive of the farmers market. One participant said, the front of right here, collecting it all. Man I would be here sitting with a chair. Other participants suggested that if a farmers market was brought to the neighborhood it shou on food during the beginning of the month and would prefer to shop for fruits and vegetables without thei r children. The only healthy food sources found directly within the study area were the convenience store and the community garden. The convenience store is located at 6410 SW 8 th Avenue (Maa & Paa). The community garden is located at 807 SW 64 th Terrace ( SWAG Family Resource Center). Both of which are located in the Linton Oaks Neighborhood and not accessible to Tower Road Triangle neighborhoods in the north due to a blocked connection on SW 8 th Avenue (Figure 5 26). Upon a site visit to the convenience s to re (Figure 5 27) i n early January 2013, the only healthy food options available were a bowl of bananas near the cash register, a

PAGE 59

59 bin of approximately 10 small onions and red potatoes, and low fat milk in the refrigerated section. In March 2013, the Maa & Paa store added a small organic produce bin as part of an initiati ve by SWAG Oa sis (Figure 5 28) which is a grant funded program working to bring healthy food to the Tower Road Triangle This bin currently only provides onions, potatoes, green onions, and a few varieties of leafy greens from one local organic grower. A site visit to the community garden in early January 2013 revealed that there Resource Center (Figure 5 29). At the time, only two of the raised garden beds were planted. These beds were installed by Florida Organic Growers (FOG) as part of the SWAG Oasis program but are managed by SWAG volunteers. At the end of March 2013, three additional raised beds were insta lled. Produce grown in the beds include strawberries, kale, and a variety of other leafy greens. The community garden is mainly used for educational purposes such as cooking demonstrations and teaching individuals about gardening. However, some produce was given to the Maa & Paa store to sell in their produce stand. There are no spaces in the in the community garden designated for individual residents to grow of produce for their own personal consumption. Most of the focus group participants indicated that they supported the existing community gardens. Within a one mile distance from the northern Tower Road Triangle neighborhoods there are two healthy food sources, a specialty grocer and a

PAGE 60

60 supermarket. The specialty grocer, Mother Earth market is located at 1237 NW 76 th Blvd. and the supermarket, Publix, is located at 1200 NW 76 th Blvd. Both of the stores would require Tower Road Triangle residents, walking or bicycling, to cross a busy multi lane roadway, Newberry Road. The remaining healthy food sources surrounding th e Tower Road Triangle neighborho ods are more than two miles away These include: an ethnic grocer La Aurora Latin Market (3733 W. University Avenue), a specialty grocery store The Fresh Market (4120 NW 16 th Blvd.), a retail grocery store Target (3970 SW Archer Road), and five large supermarkets four Publixes (2755 SW 91 st Street) (3100 SW 35th Blvd) (3930 SW Archer Road) (125 SW 34 th Street) and one Sweetbay Supermarket (2002 SW 34 th Street). Traveling to any of these healthy food resources from the neighborhoods in the study area would be difficult without the use of an automobile due to the distance, lack of connected sidewalks and bicycle lanes, and the length of time it would take to get to the stores via transit. During focus groups, participant s explained where and how they get to healthy food sources. Participants indicated that they shop for groceries at Save A Lot, Dixie, Wal nsportation to grocery stores included: have a car Dixie, and Public we use all transportation from

PAGE 61

61 also indicated that they shop around for the best deals different places to actually be able to hold your household down Dixie. But since Publix is closer to where I stay I go to Publix. Sometime s Fresh Market if I can get over are shopping locally they either take the bus or get a ride. However, some prefer going out to Archer and Newberry where they can get be tter sales. Focus group participants were also asked about the types of food they preferred to eat to try to ga u ge whether or not the possible problem was tastes and not access to healthy foods. Participants responses for types of food they prefer to eat i ncluded: steaks, meats, watermelon, tomato, noodles, chicken, strawberries, squash, brussel sprouts, broccoli, apples, okra, spinach, collard greens, mustard greens, and bananas. Transit To Healthy Food Resources Individuals living in the Tower Road Triangle neighborhoods who use a RTS bus to get to the nearest full service grocery store (i.e. the Publix on 76 th Avenue and Newberry Road ) would take between approximately 24 minutes to 1 hour and 13 minutes as determined by the RTS Trip Planner, one way, depending on the day of week and their desired departure time (Table 5 10). The neighborhoods of Harbor Cove, Hidden Oaks, and Holly Heights do not have any transit access to a full service

PAGE 62

62 grocery store on Sundays. However, these t hree, northern, neighborhoods have the shortest week day one way trip times ranging from 24 to 28 minutes. The rest of the neighborhoods have access to a grocery store on Sundays. However, these neighborhoods would have to use Route 20 whose bus stops are located east of Interstate 75 and more than a of a mile from their initial start location at any of the Tower Road Triangle neighborhoods. Residents using Route 20 would be able to directly access one large grocery store, Sweetbay Supermarket, located at 2002 SW 34 th Street. Individuals using Route 20 to a ccess Sweetbay would have a travel time of approximately 44 minutes to 1 hour and 13 minutes as determined by the RTS Trip Planner, one way, depending on the day of week and their desired departure time. Focus group participants indicated that the one of t he main barriers to accessing healthy food is problems with the existing RTS bus service. Statements related to issues with the existing RTS bus service include: Two participants shared their views of the difficulties of using public transit for grocery shopping: groceri es and putting it on the bus slowly and slowly. Another thing that makes it difficult to take the bus is if you are by yourself have a cart and I have to load it onto the bus.

PAGE 63

63 Ad ditionally important to note, one of the public comments from a TDP public workshop held on May 16, 2009 said, I would like to see a low floor bus or two on Route 75; also, later service on weekdays. My neighbors and I carry a lot of groceries on the bus Many of us have trouble with bus stairs. Anonymous Walking And Biking To Healthy Food Resources Individuals living in the Tower Road Triangle neighborhoods who walk to the nearest full service grocery store Publix, would take between approximately 2 3 minutes to 1 hour and 11 minutes, as determined by Google Directions, and those who bike to the nearest full service grocery store Publix, would take between approximately 7 minutes to 19 minutes (Table 5 11). Walking and bike route lengths to the near est full service grocery store vary between 1.1 miles and 3.6 miles with residents in the Harbor Cove, Pine Meadows, Holly Heights, and Hidden Oaks walking the shortest distances (1.1 to 1.8 miles) and Majestic, Tower, and Linton Oaks walking the longest d istances (2.4 to 3.6 miles) Sidewalks are present on main roads leading to the full service grocery stores. However, they are missing from the interior of the neighborhoods leading to the main roads outside of the neighborhoods. Bicycle lanes are present on NW 75 th Street/Tower Road and SW 20 th Avenue/SW 24 th Avenue. If residents walk or bicycle to grocery stores, they will face even greater challenges carrying their grocery bags from the store to their homes. Summary The study area is comprised of seven n eighborhoods including: Majestic Oaks, Linton Oaks, and Tower Oaks, that are located in the southern portion of the study area; Pine Meadow, Harbor Cove, and Hidden Oaks are located in the northern portion of the study area; and Holly Heights is centrally located in the study area.

PAGE 64

64 mostly renter occupied housing, high Food Stamp/SNAP reliance, and high transit dependence. The total study area population is approximately 9,084, more than half of the popul ation is female and one third of the total population is under 18 years old. Of the housing occupied in the study area, 80% are renter occupied. And, almost of the total population is on Food Stamps/SNAP. Additionally, 10% of the population has no vehicl e access and, coincidentally, approximately 10% of the population uses public transit. Health issues in the neighborhoods include high cholesterol, diabetes, and being overweight and/or obese. Nearly 63% of the population in Alachua County is overweight a nd/or obese. The percentage of individuals with diabetes increased from 2002 to 2007. BMI data collected by the Alachua County School Board during the 2008 2009 school years shows that the percentage of children obese within the study area ranged from 30% to 42%. Additionally, the study area has a high density of low weight births and births to teenagers. The neighborhoods are at risk for not providing good accessibility for the residents to healthy foods. The mix of uses is predominantly residential with little commercial access to healthy foods; only one convenience store and a community garden located in the Linton Oaks neighborhood, only two grocery stores are within a mile of the neighborhoods, and even then they are only easily accessible to neighborh oods in the northern portion. Additionally, most neighborhoods were characterized by dead ends/cul de sacs and loops that do not provide an effective street network, especially where there is no parallel or equal pedestrian and bicycle

PAGE 65

65 network. The Walksco res for the neighborhoods ranged from 11 to 54, indicating a highly automobile centered environment. The study area is served by three RTS bus routes including Route 23, Route 75, and Route 76. However, the service times do not extend to later hours of th e evening, there is limited Saturday service, and there is no Sunday service available For example, neighborhoods in the northern portion of the study area have the shortest weekday one way trip times to a full service grocery store with times ranging fro m 24 to 28 minutes. However, these same neighborhoods have no access to transit at all on Sundays.

PAGE 66

66 Figure 5 1 A map of the study area, the Tower Road Triangle, in Alachua County, FL [Created by Author]

PAGE 67

67 Figure 5 2 A map of the seven study area neighborhoods (Harbor Cove, Hidden Oaks, Pine Meadow, Holly Heights, Linton Oaks, Majestic Oaks, and Tower Oaks) [Created by Author]

PAGE 68

68 Table 5 1 Index crime offense totals Index Crime Offense Totals (2011) Tower Road T riangle A lachua County H omicide 1 (8.33%) 12 Burglary 168 (8.30% 2,023 S exual battery 6 (3.24%) 185 R obbery 14 (4.98%) 281 T heft 86 (1.32%) 6,485 S tolen vehicle 19 (4.38%) 435 A ssault/battery 27 (2.48%) 1,090 Totals 321 (3.05%) 10,511 [Sources: ASCO (Tower Road Triangle) and FDLE (Alachua County), 2011

PAGE 69

69 Figure 5 3 2011 Unincorporated Alachua County Crime Density (Circle indicates study area [Source: ASCO, 2011]

PAGE 70

70 Figure 5 4 Existing zoning in study area [Created by Author]

PAGE 71

71 Figure 5 5 Map of future land uses in study area [Created by Author]

PAGE 72

72 Figure 5 6 Map of study area and surrounding census tracts [Created by Author]

PAGE 73

73 Figure 5 6 Continued.

PAGE 74

74 Table 5 2 Population characteristics of study a rea Population Characteristics Census tract 22.17 Census tract 22.18 Alachua County Florida Total Population 6,096 2,988 246,203 18,688,787 F emales 3,561 (58.4%) 1,479 (49.5%) 126,876 (51.5%) 9,549,968 (51.1%) M ales 2,535 (41.6%) 1,509 (50.5%) 119,327 (48.5%) 9,138,819 (48.9%) U nder 18 years 1,876 (30.77%) 900 (30.12%) 43,963 (17.86%) 4,005,833 (21.43%) 18 64 years 4,030 (66.12%) 1,943 (65.03%) 176,244 (71.58%) 11,476,501 (61.41%) 65 years and over 190 (3.12%) 145 (4.85%) 25,996 (10.56%) 3,206,453 (17.2%) W hite 3,005 (49.3%) 1,648 (55.2%) 179,090 (72.7%) 14,592,164 (78.1%) Black or African American 2,849 (46.7%) 1,421 (47.6%) 52,333 (21.3%) 3,122,969 (16.7%) A sian 155 (2.5%) 147 (4.9%) 15,065 (6.1%) 552,482 (3.0%) S ome other race 229 ( 3.8%) 0 (0.0%) 4,238 (1.7%) 655,522 (3.5%) H ispanic or Latino 712 (11.7%) 207 (6.9%) 20,518 (8.3%) 4,122,759 (22.1%) T otal housing units 3,105 1,231 112,035 8,944,635 O ccupied housing units 2,647 (85.2%) 985 (80.0%) 97,542 (87.1%) 7,140,096 (79.8%) O wner occupied 385 (14.5%) 328 (33.3%) 53,129 (54.5%) 4,928,508 (69.0%) R enter occupied 2,262 (85.5%) 657 (66.7%) 44,413 (45.5%) 2,211,588 (31.0%) V acant housing units 458 (14.8%) 246 (20.0%) 14,493 (12.9%) 1,804,539 (20.2%) T otal households 2,647 985 97,542 7,140,096 Median household income ($) 29,695 49,112 41,373 47,827 Mean household income ($) 31,070 68,392 61,392 67,065 Receiving food stamps/ SNAP 741 (27.99%) 120 (12.18%) 8,354 (8.56%) 701,079 (9.82%) Population below poverty level 2,312 (37.9%) 421 (14.1%) 54318 (23.6%) 2,679,400 (14.34%) [Source: 2007 2011 American community survey 5 year e stimates ]

PAGE 75

75 Table 5 2 Continued. Population characteristics Census tract 16.04 Census tract 17.02 Census tract 22.04 Census tract 22.05 Census tract 22.07 Census tract 22.19 Total population 6,727 4,562 11,112 9,564 3,847 5,302 F emales 3,603 (53.6%) 2,447 (53.6%) 5,608 (50.5%) 5,007 (52.4%) 1,941 (50.5%) 2,802 (52.8%) M ales 3,124 (46.4%) 2,115 (46.4%) 5,504 (49.5%) 4,557 (47.6%) 1,906 (49.5%) 2,500 (47.2%) Under 18 years 369 (5.5%) 721 (15.8%) 2,857 (25.7%) 2,272 (23.8%) 959 (24.9%) 952 (18.0%) 18 64 years 5,946 (88.4%) 2,711 (59.4%) 6,590 (59.3%) 5,839 (61.1%) 2,299 (59.8%) 3,902 (73.6%) 65 years and over 304 (4.5%) 1,079 (23.7%) 1,630 (14.7%) 1,453 (15.2%) 589 (15.3%) 365 (6.9%) W hite 5,295 (78.7%) 3,829 (83.9%) 8,753 (78.7%) 8,442 (88.3%) 3,234 (84.1%) 3,647 (68.8%) B lack or African American 878 (13.1%) 344 (7.5%) 728 (6.6%) 330 (3.5%) 228 (5.9%) 1,234 (23.3%) A sian 260 (3.9%) 136 (3.0%) 1,025 (9.2%) 550 (5.8%) 314 (8.2%) 220 (4.1%) S ome other race 14 (0.2%) 61 (1.3%) 188 (1.7%) 128 (1.3%) 6 (0.2%) 46 (0.9%) Hispanic or Latino (any race) 782 (11.6%) 387 (8.5%) 665 (6.0%) 964 (10.1%) 175 (4.5%) 340 (6.4%) T otal housing units 3,361 2,112 4,819 4,436 1,527 3,185 O ccupied housing units 2,730 (81.2%) 1,880 (89.0%) 4,361 (90.5%) 3,979 (89.7%) 1,464 (95.9%) 2,710 (85.1%) O wner occupied 763 (27.9%) 1,645 (87.5%) 2,861 (65.6%) 3,142 (79.0%) 1,356 (92.6%) 715 (26.4%) R enter occupied 1,967 (72.1%) 235 (12.5%) 1,500 (34.4%) 837 (21.0%) 108 (7.4%) 1,995 (73.6%) Vacant housing units 631 (18.8%) 232 (11.0%) 458 (9.5%) 457 (10.3%) 63 (4.1%) 475 (14.9%) T otal households 2,730 1,880 4,361 3,979 1,464 2,710 Median household income ($) 19,944 79,885 73,026 82,682 93,194 31,580 Mean household income ($) 35,800 106,166 89,732 128,443 110,647 36,693 Receiving food stamps /SNAP 36 (1.3%) 52 (2.8%) 77 (1.8%) 87 (2.2%) 21 (1.4%) 304 (11.2%) Population below poverty level 1,310 (48%) 477 (10.5%) 366 (8.4%) 187 (4.7%) 88 (6%) 550 (20.3%) *Census tracts surrounding study area [ S ource: 2007 2011 American community survey 5 year estimates]

PAGE 76

76 Table 5 3 Vehicles available per housing unit of study a rea Population vehicle availability Census tract 22.17 Census tract 22.18 A lachua County F lorida T otal occupied housing units 2,647 985 97,542 7,140,096 N o vehicles 215 (8.1%) 158 (16.0%) 7,463 (7.7%) 472,695 (6.6%) 1 vehicle 1,472 (55.6%) 437 (44.4%) 39,769 (40.8%) 2,907,041 (40.7%) 2 vehicles 828 (31.3%) 353 (35.8%) 34,767 (35.6%) 2,744,286 (38.4%) 3 or more vehicles 132 (5.0%) 37 (3.8%) 15,543 (15.9%) 1,016,074 (14.2%) [Source: 2007 2011 American community s urvey 5 year e stimates ] Table 5 3 Continued. Population vehicle availability Census tract 16.04 Census tract 17.02 Census tract 22.04 Census tract 22.05 Census tract 22.07 Census tract 22.19 T otal occupied housing units 2,730 1,880 4,361 3,979 1,464 2,710 No vehicles 110 (4.0%) 136 (7.2%) 95 (2.2%) 93 (2.3%) 25 (1.7%) 133 (4.9%) 1 vehicle 1,007 (36.9%) 546 (29.0%) 1,582 (36.3%) 1,345 (33.8%) 338 (23.1%) 1,881 (69.4%) 2 vehicles 1,107 (40.5%) 859 (45.7%) 1,983 (45.5%) 1,898 (47.7%) 673 (46.0%) 504 (18.6%) 3 or more vehicles 506 (18.5%) 339 (18.0%) 701 (16.1%) 643 (16.2%) 428 (29.2%) 192 (7.1%) Census tracts surrounding study area [Source: 2007 2011 American community survey 5 year estimates ]

PAGE 77

77 Table 5 4 Mode of transportation to work of tracts surrounding study a rea Mode of transportation to work Census tract 16.04 Census tract 17.02 Census tract 22.04 Census tract 22.05 Census tract 22.07 Census tract 22.19 Workers 16 years and over 3,433 2,245 5,121 4,735 1,850 2,769 Car, truck, van drove alone 2,474 (72.1%) 1,745 (77.7%) 4,340 (84.7%) 3,954 (83.5%) 1,473 (79.6%) 2,257 (81.5%) Car, truck, van carpooled 283 (8.2%) 172 (7.7%) 410 (8%) 450 (9.5%) 174 (9.4%) 338 (12.2%) Public transportation (excluding taxicabs) 251 (7.3%) 39 (1.7%) 0 (0%) 284 (0.6%) 52 (2.8%) 83 (3%) Walked 127 (3.7%) 72 (3.2%) 22 (0.4%) 24 (0.5%) 17 (0.9%) 0 (0%) Other means 218 (6.4%) 107 (4.8%) 125 (2.5%) 80 (1.7%) 11 (0.6%) 50 (1.8%) Worked at home 80 (2.3%) 110 (4.9%) 224 (4.4%) 199 (4.2%) 126 (6.8%) 39 (1.4%) Mode of transportation to work can be used as a n indicator of mode of transportation to healthy food sources [Source: 2007 2011 American Community Survey 5 Year Estimates ]

PAGE 78

78 Figure 5 7 Alachua County 32607 zip code a rea (Yellow Indicates Study Area ) [Created by Author]

PAGE 79

79 Table 5 5 Death r ates by selected causes of d eath Death rates by selected causes of death (age adjusted per 100,000 population), 2007 2009 32607 Alachua C ounty Florida All cancers 87.40 165.70 211.20 Lung cancer 20.20 45.50 61.80 Breast cancer 7.80 11.50 14.20 Prostate cancer 6.70 7.80 11.00 Stroke 31.40 35.20 44.60 Heart disease 83.00 129.60 218.10 Diabetes 19.80 29.10 20.60 (Age adjusted per 100,000 p opulation ) [Source : http://familydata.health.ufl.edu/community outreach/cara project/alachua county health report card/ ] Table 5 6 Select behavioral risk factor surveillance system survey (BFRSS) health i ndicators BRFSS health indicators* Alachua C ounty 2002 Alachua C ounty 2007 Florida 2007 Adults who have checked cholesterol levels in past 5 years 69.60% 76.50% 78.50% Adults diagnosed with high cholesterol 28.90% 26.80% 37.30% Adults diagnosed with diabetes 5.10% 6.30% 8.70% Adults overweight 36.10% 37.80% 38.00% Adults obese 14.70% 25.40% 24.10% Adults overweight and/or obese 50.70% 63.30% 62.10% C omplete analysis of statistical signifi cance of these BRFSS estimates available at www. floridacharts .com [Source: Florida Department of Health, Division of Disease Control, Bureau of Epidemiology, Chronic Disease Epidemiology Section, 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS) Data Report.] Table 5 7 Students overweight and/or o bese in school s of study area Alachua county zoned schools for study area Total students Number of students overweight and/or obese Percent overweight and/or obese Chiles E lementary 771 231 30.00% Hidden Oak E lementary 882 302 34.20% Terwillinger E lementary 356 148 41.60% Ft. Clarke M iddle 816 281 34.40% Bucholz H igh 1,396 435 31.20% [Source: School Board of Alachua County, 2009]

PAGE 80

80 Figure 5 8 B irth d ensity and count by c ensus b lock group (2007 2009) (c ircle indicates study area) [Source: http://familydata.health.ufl.edu/community outreach/cara project/maps/ ]

PAGE 81

81 Figure 5 9 B irths to teenagers density and count by c ensus b lock group (2007 2009) (c ircle i ndicates study area) [Source: http://familydata.health.ufl.edu/community outreach/cara project/maps/ ]

PAGE 82

82 Figure 5 10 Low birth weight density and count by c ensus b lo ck group (2007 2009) (c ircle indicates study area) [Source: http://familydata.health.ufl.edu/community outreach/cara project/maps/ ]

PAGE 83

83 Table 5 8 Walk s cores of T ower Road Triangle n eighborhoods Neighborhood Walk S core Average block length Number of intersections Majestic O aks 11/100 545 feet (poor) 46/sq mile (poor) Linton O aks 12/100 440 feet (good) 75/sq mile (poor) Tower O aks 25/100 597 feet (poor) 39/ sq mile (poor) Holly H eights 37/100 456 feet (good) 107/sq mile (poor) Harbor C ove 49/100 486 feet (good) 108/sq mile (poor) Pine M eadow 51/100 515 feet (fair) 85/sq mile (poor) Hidden O aks 54/100 548 feet (poor) 79/sq mile (poor) [Source: http://www.walkscore.com/ ]

PAGE 84

84 Figure 5 11 Holly Heights neighborhood street c onnectivity [Created by Author]

PAGE 85

85 Figure 5 12 Linton Oaks and Majestic Oaks neighborhood street c onnectivity [Created by Author]

PAGE 86

86 Figure 5 13 Pine Meadow Harbor Cove, and Hidden Oaks neighborhood street c onnectivity [Created by Author]

PAGE 87

87 Figure 5 14 Tower Oaks neighborhood s treet c onnectivity [Created by Author]

PAGE 88

88 Figure 5 15 Existing and proposed bike l anes [Created by Author]

PAGE 89

89 Figure 5 16 Existing and proposed trails/ multi use p aths [Created by Author]

PAGE 90

90 Figure 5 17 Alachua County capital improvement e lements [Created by Author]

PAGE 91

91 Figure 5 18 Tower Road Triangle transit routes and s tops [Created by Author]

PAGE 92

92 Figure 5 19 Route 75 bus stop b uffers (0.25, 0.5, and 1 mille) [Created by Author]

PAGE 93

93 Figure 5 20 Food deserts in Alachua County [Source: http://www.ers.usda.gov/data products/food desert locator/go to the locator.aspx ]

PAGE 94

94 Figure 5 21 Food deserts in Alachua County close up showing study area [Source: http://www.ers.usda.gov/data products/food desert locator/go to the locator.aspx ]

PAGE 95

95 Table 5 9 Study area populations with low access to a supermark et and large grocery store Population Total number Percentage Low access 4,115 64.60% Low income, low access 1,292 20.50% Children (0 17), low access 1,045 16.40% Elderly (65+), low access 136 2.10% Low access, no vehicle 202 6.90% [Created by Author]

PAGE 96

96 Figure 5 22 Study area modified retail food environment i ndex (Circle indicates study area ) [Source: ftp://ftp.cdc.gov/pub/Publications/dn pao/census tract level state maps mrfei_TAG508.pdf ]

PAGE 97

97 Figure 5 23 Florida m odifie d retail food environment i ndex [Source: ftp://ftp.cdc.gov/pub/Publications/dnpao/census tract level state maps mrfei_TAG508.pdf ]

PAGE 98

98 Figure 5 24 Towe r Road Triangle nearest healthy food s ources [Created by Author]

PAGE 99

99 Figure 5 25 Tower Road Triangle nearest farmers m arkets [Created by Auth or]

PAGE 100

100 Figure 5 26 Existing healthy food sources in the study area w ithin Linton Oaks [Created by Author]

PAGE 101

101 Figure 5 27 Maa & Paa c onvenience store located within study area bo undaries [Source: Author, January 2013]

PAGE 102

102 Figure 5 28 Organic produce stand in Maa and Paa store [Source: SWAG Oasis, 2013]

PAGE 103

103 Figure 5 29 Community garden located within study area boundaries [Source: Author, January 2013]

PAGE 104

104 Table 5 10 One way trip times, by bus, from study area neighborhoods to the nearest full service grocery store To: nearest P ublix /Sweetbay Day of week Departure time Route Shortest total time (one way) F rom Harbor C ove Wednesday 12:00PM 75 24 minutes Harbor C ove Wednesday 7:00PM 75 24 minutes Harbor C ove Saturday 3:00PM 75 24 minutes Harbor C ove Sunday 3:00PM N/A N/ A Hidden O aks Wednesday 12:00PM 75 28 minutes Hidden O aks Wednesday 7:00PM 75 28 minutes Hidden O aks Saturday 3:00PM 75 28 minutes Hidden O aks Sunday 3:00PM N/A N/ A Holly H eights Wednesday 12:00PM 75 25 minutes Holly H eights Wednesday 7:00PM 75 25 minutes Holly H eights Saturday 3:00PM 75 25 minutes Holly H eights Sunday 3:00PM N/A N/ A Linton O aks Wednesday 12:00PM 75 24 minutes Linton O aks Wednesday 7:00PM 75 24 minutes Linton O aks Saturday 3:00PM 20 54 minutes Linton O aks Sunday 3:00PM 20 54 minutes Majestic O aks Wednesday 12:00PM 75 29 minutes Majestic O aks Wednesday 7:00PM 75 29 minutes Majestic O aks Saturday 3:00PM 20 44 minutes Majestic O aks Sunday 3:00PM 20 44 minutes Pine M eadow Wednesday 12:00PM 75 -> 62 53 minutes Pine M eadow Wednesday 7:00PM 75 52 minutes Pine M eadow Saturday 3:00PM 75 52 minutes Pine M eadow Sunday 3:00PM 20 1 hour 13 minutes Tower O aks Wednesday 12:00PM 75 29 minutes Tower O aks Wednesday 7:00PM 75 29 minutes Tower O aks Saturday 3:00PM 75 29 minutes Tower O aks Sunday 3:00PM 20 1 hour 8 minutes

PAGE 105

105 Table 5 11 One way trip times and route lengths, by walking and bicycling, from study area neighborhoods to nearest full service grocery store To nearest grocery store Shortest walking route total time (one way) Shortest bicycling route total time (one way) Length of routes Notes on route From Harbor C ove 25 minutes 8 minutes 1.3miles No sidewalks or bic ycle lanes present except on NW 75th Street/Tower R oad; requires crossing major road ( Newberry R oad) Hidden O aks 28 minutes 9 minutes 1.4 miles No sidewalks or bic ycle lanes present except on NW 75th Street/Tower R oad; requires crossing major road ( Newberry R oad) Holly H eights 36 minutes 10 minutes 1.8 miles Sidewalks present majority of trip except leading out of neighborhood; bicycle lanes present on NW 75th Street/Tower R oad; requires crossing major road ( Newberry R oad) Linton O aks 1 hour and 9 minutes 19 minutes 3.5 miles Sidewalks present on portion of trip except leading out of neighborh ood; bicycle lanes missing on NW 75th street/tower road from SW 8th avenue to SW 24th A venue; requires crossing major road ( Newberry R oad) Majestic O aks 48 minutes 12 minutes 2.4 miles Sidewalks present on portion of trip except leading out of neighborhood and on SW 42nd street; bicycle lanes present on SW 20 th Avenue Pine M eadow 23 minutes 7 minutes 1.1 miles Sidewalks present on majority of trip except leading out of neighborh ood; bicycle lanes present on NW 75th Street/Tower R oad; requires crossing major road ( Newberry R oad) Tower O aks 1 hour and 11 minutes 18 minutes 3.6 miles Sidewalks present on portion of trip except leading out of neighborhood and on SW 42nd S treet; bicycle lanes present on SW 20 th Avenue

PAGE 106

106 CHAPTER 6 IMPACT ASSESSMENT This chapter presents the impact assessment phase of the rapid health impact assessment in the Tower Road Triangle neighborhoods. The research conclusions show individuals residing in the neighborhoods are at risk for not be ing able to access healthy food Conc environment, public transit access, access to healthy foods, and themes and statements from focus groups. Additionally, one UF program and one UF study that are trying to increase access to he althy foods are discussed to provide insight into programs that have the potential to positively impact health in the community. Additionally, limitations of the study are provided. Research Conclusions Tower Road Triangle Study Area The Tower Road Triang le study area, at the present time, is not a community that promotes a safe built environment from a crime perspective due to high crime r ates The study area had a very high numbers of Index Crimes in 2011, including 1 homicide, 168 burglaries, 6 sexual b atteries, 14 robberies, 86 thefts, 19 stolen vehicles, and 27 assault/batteries, making it the highest density of crimes in all of Alachua County in that year Assuming that 2011 was a typical year, the high rate of crime could have a significant impact on the willingness of certain members of the community to walk in the neighborhood. Previous research indicates that individuals, especially women, are less likely to walk at night or longer distances when violent crimes such as murder robbery, assault, and battery are present in the neighborhood (McDonald, 2008) The study area includes 5,040 females or approximately 55% of the population.

PAGE 107

107 Additionally, the existing zoning and proposed future land uses of the area are predominantly residential. Residential densities are expected to remain at 4 8 dwelling units/acre (Medium Density), 8 14 dwelling units/acre (Medium High Density), and 14 24 dwelling units/acre (High density). Commercial activity within the study area is limited to mostly highway oriented businesses along Newberry Road, with the exception of the Maa & Paa store. Previous research indicates that neighborhoods that lack a divers ity of land uses are not friendly for pedestrians or bicyclists (Ewing, N.D.) For some of the seven neighborhoods, such as those in the northern part of the study area, the access to healthy food sources is better with a specialty grocer and large superma rket within one mile However, they need to walk along a corridor that is not pedestrian friendly and that will require the crossing of a major corridor (Newberry Road). The southern neighborhoods, on the other hand, have the convenience store and a commun ity garden but these food sources do not offer a full range of services like those closer to the other neighborhoods. With an area of predominantly residential, the opportunity to bring more healthy food retail into the study area is limited. Population C haracteristics The Tower Road Triangle is characterized by a large number of minorities with high numbers of children and high rates of poverty. The study area is comprised of approximately 48. 8% minorities that includes Black/African American, Asian, Othe r Races, and 10.1% Hispanic/Latinos. Approximately one third of the study area population is under 18 years old, or 2,776 individuals. A t otal of 2,733 individuals (30.1 %) in the study area population are living below the poverty line and 861 households ar e receiving Food Stamps/SNAP benefits. Additionally, since children rely on their parents, or primary caretakers, for most of their dietary needs they may have

PAGE 108

108 varied access to healthy foods due to the types of food stores located in their immediate neighb choose healthy food options. Also, the one third of individuals in the study area who rely upon Food Stamps/SNAP may not be able to purchase as much food as other Food Stamps/SNA P recipients due to regional variation in food prices (Thayer, Murphy, Cook, Ettinger de Cuba, DaCosta, & Chilton, 2008) Focus group respondents generally believed that households relying on Food Stamps/SNAP or WIC did not receive enough money to eat hea lthy. Some participants said they and their children had desires to eat fruits and vegetables but could not afford it and so they walked right past it in the store. Other participants said that their monthly food stamp allotment ran out in two weeks and so they tended to eat out at fast food restaurants , during the latter half of the month. Previous research shows that there tend to be more fast food restaurants in low income and minority neighborhoods (2.4 fast food restaurants per squa re mile) compared to higher income and predominantly White neighborhoods (1.5 fast food restaurants per square mile) (Block, Scribner, & DeSalvo, 2004) While there are no fast food restaurants directly in the study area, there are multiple fast food estab lishments accessible from the neighborhoods along Newberry Road. Additionally, if individuals do not have healthy food readily at home, due to lack of access to get it, they may resort to food sources that are more easily accessible, but not necessarily he althy. One of the most staggering statements came from a participant who mentioned that they felt they needed to have more children just so that they could get more in government assistance benefits like Food Stamps/SNAP.

PAGE 109

109 Of the 3,362 occupie d housing units in the Tower Road Triangle only 373 (10.3%) had no access to a vehicle 1,909 (52.56%) had access to at least one vehicle 1,181 (32.52%) had access to 2 vehicles, and 169 (4.65%) had access to 3 or more vehicles. Additionally, the Tower Road Triangle had a total of 4,394 workers aged 16 years or over. Of those workers, 3,290 (74.87%) drove alone, 510 (11.61%) carpooled, 438 (9.97%) used public transportation excluding taxicabs, 55 (1.25%) walked, 74 (1.68%) used another means of transportation, and 27 (0.61%) worked at home. While this seems to indicate that the study area population has relatively high access to personal v ehicles, it is likely that many of these vehicles are not being maintained as best as they could due to financial constraints or are unreliable, as suggested in previous research, since approximately 90% of the occupied housing units has access to a vehicl e, but only about 75% of workers drove alone to work With nearly 10% of the working population using public transit and another approximately 3% walking or using other means of transportation, it is likely that these individuals may not be making as many trips to healthy food sources as desired due to the difficulty of the trips. Focus group participants mentioned the price of gas as a barrier to accessing healthy foods. Like many Americans, the rising price of gas is putting a strain on households. Low in come households who cannot afford gas to the grocery store may try to make their food at home last as long as possible until they can afford to go to the store again, as indicated by one participants statement. Additionally, money spent on high gas prices for low income households is money that is taken away from the budget for healthy foods.

PAGE 110

110 D eath rates by selected causes of death (age adjusted per 100,000 population ) for cancers, stroke, heart disease, and diabetes for years 2007 200 8 were lower in the study area zip code (32607) than the rest of Alachua County. As this zip code includes a large portion of the University of Florida student population east of I 75, it is likely that this may have skewed the death rates data since this population tends to be younger and healthier. The BRFSS health indicators do seem to suggest that Alachua County as a whole is becoming less healthy when considering adults with high cholesterol, adults with diabetes, and adults who are either overweight o r obese since these percentages all increased between the years 2002 2007. An alarming indicator that children in the study area need better access to healthy foods is the fact that in the 2008 2009 school years t he number of overweight and/or obese stude nts ( 148 or 41.6%) at Terwillinger Elementary was the highes t of all the elementary schools in Alachua County. Since about one third of the elementary that some of th e students who are overweight and/or obese at the school came from neighborhoods in the Tower Road Triangle (Figure 5 1). However, it is important to note that diet is only part of the problem with overweight and/or obese students. Research on overweight a nd/or obese students at the school needs to consider both parts of the energy balance diet (intake of energy) and access to physical activity (output of energy). High numbers of births in the study area, especiall y low weight and births to teenagers seem s to indicate a need for better access to healthy food sources. In order for babies to be developed full term and healthy, mothers need to have diets that are

PAGE 111

111 varied in healthy foods such as fruits, vegetables, and lean meats. Mothers who are not eating en ough healthy food and key nutrients are putting both their own health and their due to their age or without access to a vehicle, are restricted to food that can be reach ed on foot, accessed by transit, or brought to them by others. This may lead teenage mothers, in the study area, to eat foods that are most easily accessible, such as at the Maa & Paa store. Even then, the Maa & Paa store is only accessible to residents of Linton and Majestic Oaks and has a limited availability of fresh fruits and vegetables For those living in the northern neighborhoods, Publix is more ac cessible but would require the teenage mothers to cross a major intersection. Analysis o f B uilt Envir onment Walkability a nd Bikeability Walka bility analysis for each of the Tower Road Triangle neighborhoods showed that the n eighborhoods in the study area were all deemed highly auto oriented due to their low Walk scores: Majestic Oaks (11/100), Linton Oak s (12/100), Tower Oaks (25/100), Holly Heights (37/100), Harbor Cove (49/100), Pine Meadow (51/100), and Hidden Oaks (54/100) It is no surprise that neighborhoods in the northern boundaries, Harbor Cove, Pine Meadow, and Hidden Oaks, of the study area rec eived higher walkability scores since they are nearer the highway oriented commercial uses of Newberry Road. However, all neighborhoods were characterized by dead ends/cul de sacs and loops which do not provide an effective street network, especially where there is no parallel or equal pedestrian and bicycle network as stated in previous research (Handy S. 2004) Furthermore, even though some of the commercial uses are accessible on the same side of the street, many of the businesses would require a long

PAGE 112

112 walk to a signalized intersection or an unsafe crossing of a five lane section of Tower Road. Formalized bikeab ility within the Tower Road Triangle neighborhoods is non existent due to the lack of bicycle lanes in the internal network. Bicycle lanes currently only exist on the western and southern boundaries of the study area. This lack of formalized bicycle lanes means that individuals who use this method of transportation must ride in the street, which is both dangerous for the bicyclists and drivers, or ride property. Additional ly, there are no multi use paths in the internal network of the study area. Analysis Of Available Public Transportation The Tower Road Triangle is served by the RTS though the 44 bus stops within the neighborhoods that provide access to three bus routes: Route 23, Route 75, and Route 76. Route 23 runs every 35 to 45 minutes from 7:15am to 10:00pm on weekdays with no weekend service. Route 75 runs from every 35 52 53 minutes 6:00am to 7:30pm on weekdays and every 105 minutes from 6:40am to 6:05pm on Saturda y with no Sunday service. Route 76 runs every 60 minutes from 7:28am to 5:00pm on weekdays with no weekend service. The limited times and days of the week of the RTS service can make traveling to healthy food sources difficult especially when factoring in other daily activities such as work or tending to younger children. RTS planned improvements for Route 75 include s : P roviding 35 minute frequency all day ($131, 374) E xtend weekday ev ening hours to 10pm ($35,033)

PAGE 113

113 E xtend Saturday hours to 7:58 pm ($60,543,The amount to extend Saturday hours was priced collectively and includes 8 other RTS bus routes Individual route costs to extend Saturday hours were not available. ) A dd Sunday service (10:03 am 4:58 pm), ($28,916), and I ncrease weekend frequency to 45 minutes ($46,988) These improvements are expected to be implemented in 2016. However, in 2012 2013 fiscal years which began October 1 st Alachua County cut $120,000 in RTS funding which has resulted in proposed cuts to bus services outside the Ci ty limits, except those routes currently funded by Santa Fe College, the University of Florida, and the Florida Department of Transportation (Mallard, 2012) These budget cuts may negatively impact funding needed for Route 75 improvements in the future. Ho wever, at the present time none of the bus routes in the neighborhood are likely to be affected. Analysis Of Access To Healthy Foods store, one ethnic grocery store, two specialty grocery stores, six large grocery stores, and one retail store that also include a grocery store, and one community garden The on ly food sources located directly within the study area are the convenience store and the recently installed community garden. indicated a preference for a wide variety of fruits and vegetables including watermelon, tomat o, strawberries, squash, brussel sprouts, broccoli, apples, okra, spinach, collard greens, mustard greens, and bananas. However, it seemed that the focus group statements. Wh ile the Maa & Paa convenience store includes a recently installed produce bin, the store does not include an adequate amount of produce to meet the

PAGE 114

114 needs of the entire community. Additionally, the produce currently available at the store does not contain a wide variety of produce types since the p roduce available is donated from the SWAG community garden. This may impact whether residents in the neighborhood buy the items available due to their varying food preferences. Focus group data indicates that res idents shop around for the best deals on needs. The main theme for participants seemed to be that transportation played a key role in determining what store the reside nts shopped at. For one participant who relied upon the bus or getting a ride, that person usually went to Sweetbay or Publix but stated that they preferred to go to Winn Dixie that is located further away. As previous research indicates, the person reques ting a ride may be visiting closer stores because they feel like they are inconveniencing the driver or may have conflicting schedules which do not allow them adequate time to visit further stores. Surprisingly, participants seemed to be traveling to stor es much further from the study area than anticipated by the researcher. The researcher assumed participants would be travelling to those closest to their place of residence. Some stores mentioned th Street 8 (24220 W Newberry Road 10 miles), Fresh Market (4120 NW 16 th Blvd. 5 miles), rd Avenue 8 miles). The SWAG community garden is mainly used for educational purposes such as cooking demonstrations and teaching individuals about gardening with excess produce sometimes given to the owner of the Maa & Paa to sell in his store. T he purpose of the community garden is to educate and not necessarily provide designated plots for

PAGE 115

115 : a s such the community garden, per se, does not increase physical access to healthy foods but rather mental access to healthy foods since residents are learning how to use different types of fruits and vegetables. The focus groups were held at the SWAG Famil y Resource Center so participants were able to see the existing community gardens in person. Participants in the focus groups generally agreed that the community gardens were beneficial to the community. oncern, previously mentioned, that they do not believe the com munity garden is adequate to feed the entire community. As with the community garden, the focus group participants agreed that a farmers market would be beneficial to the community and that it w ould be well perceived. Participants did stress their desires to have access to a farmers market at the beginning of the month and when they could shop without their children being present Participants likely have more income at the beginning of the mont h with Food Stamps/SNAP than during the latter half of the month. Additionally, the statements suggest that picking out fruits and vegetables is a hassle while attending to children. While this may be true, it is important that parents and caregivers recei ve some sort of input on the preferences of fruit and vegetable types so that children in the study area are more likely to consume them. It is likely that the time it takes bus riders to load/unload their groceries, especially if there are a lot of people creates frustration for the bus driver because they are trying to maintain their daily route schedules which dictate that they need to be at certain locations at a specified time. This angst from bus drivers on routes that service grocery carrying partic ipants may cause mental stress for the riders since they may feel

PAGE 116

116 that they are inconveniencing others. One focus group participant mentioned this frustration from bus drivers as riders are loading or unloading their groceries. Focus group participants i nd icate that one of the barriers to accessing healthy food is problems with the existing RTS bus service. Assumptions, made by the researcher, about problems with public transit such as frequencies, lack of weekend service, the times buses run, and the diffi culty in transporting groceries were confirmed by statements from participants. Individuals living in the Tower Road Triangle neighborhoods who use a RTS bus to get to the nearest full service grocery store, Publix, would take between approximately 24 min utes to 1 hour and 13 minutes, one way, as determined by the RTS Trip Planner, depending on the day of week and departure time, with limited to no bus service on the weekends. As such, these residents do not have a convenient access to healthy foods. Addit ionally, people who rely on the bus for grocery shopping may have other limits on when they can access healthy food sources due to their work schedules or ongoing family obligations (e.g. the need to care for children). Walking or bicycling to shopping is not much more convenient than for transit users. For individuals living in the Tower Road Triangle neighborhoods who walk to the nearest full service grocery store would take between approximately 23 minutes to 1 hour and 11 minutes, as determined by Google Directions, and those who bike to the nearest full service grocery store would take between approximately 7 minutes to 19 minutes The types of foods purchased may be impacted by the transportation mode used, especially in the case of meats or frozen fruits and vegetables which may spoil or melt during a 1 hour and 13 minute bus ride or 1 hour and 11 minute walk unless

PAGE 117

117 adequate freezer type bags are used for transport. The quickest alternative mode of transportation seems may be to use a bicycle which can be accessed in as few as 7 minutes. However, this access by bicycle would require a trailer or the operator would have a limit on the amount of food that can be carried on one trip. Swag Oasis Nutrition Project The SWAG Oasis Nutrition Project is funded through an American Medical Association Foundation grant. The project is run by undergraduate and graduate e and College of Public Health and Health Professions. The project is run out of the SWAG Family Resource Center in the Linton Oaks neighbor hood. The purpose of the nutrition project is to bring access to healthy foods to residents within the Tower Road Triangle neighborhoods. SWAG Oasis, along with Florida Organic Growers, are responsible for the community gardens and the produce bin at the M aa & Paa store. The group also holds nutrition education classes that cover a variety of topics including: cooking demonstrations, healthy eating/shopping on a budget, my plate/my pyramid, weight management, healthy dining out, and nutrition labels. The cl asses show individuals that eating healthy right can help them maintain a healthy weight. Study Limitations Data used for the resear ch is mostly secondary data with some place based observations o f the study area and its surroundings. Therefore, all secondary data sources are assumed to be reliable since the original data sets were not available to the researcher. For example, the median and mean household incomes for census tract 22.18 seem to hig her than they should be considering the number of households

PAGE 118

118 receiving Food Stamps/SNAP. In this case, the irregularity in the median and mean household income may be due to the Portofino New Home Development just south of the study area which is comprised of single family luxury homes. Department of Law Enforcement includes only reported crimes within the unincorporated portions of Alachua County. Crime data from local municipali ties is not included in the crime data collected and, as such, crime density may or may not be higher in other portions of the County compared to the study area. Also, often times, crimes go unreported due to the fear of prosecution from the assailant. As such, the study area may have had mor e crimes during the time period examined. Additionally, focus group participants were not asked about how crime impacts their travel modes so this data was unavailable to the researcher. The locations and distances for the Tower Road Triangle neighborhoods are accurate way to calculate distance of neighborh oods to transit and healthy food sources. The Walkscore program provides information about the walkability of different places and neighborhoods, mostly to destinations such as restaurants, grocery stores, and other popular comm ercial opportunities. Walks core has been validated as a way to measure the relative walkability of neighborhoods (Duncan, Aldstadt, Whalen, Melly, & Gortmaker, 2011) However, t he Walkscore algorithm uses a general set of assumptions about the walkabilit y of neighborhoods that are admittedly biased towards

PAGE 119

119 urban environments. As such places that are more suburban may be scored lower even if they provide opportunities for walking The purpose of Walkscore is to gain a ilt environment. However, any information gathered from the program should be confirmed with field data collection to determine its correctness and the quality of walking environment, especially regarding access to sidewalks, bicycle lanes, and transit. L astly, Walkscore does not consider informal walking or biking paths that are availa ble to individuals in the Tower Road Triangle neighborhoods. Evidence of informal paths to the bus stops and the Maa and Paa convenience store can be found throughout the Tower Triangle area. Healthy food resource preferences of specific individuals in the Tower Road Triangle neighborhoods were not recorded nor considered during the course of this research. As such, it is difficult to explain why individuals in the focus groups were traveling to healthy food resources much further away from their neighborhoods, to distances ranging from 5 10 miles away. Specific i ndividuals suggested, as part of the focus groups, that prices of perishable products had a lot to do with their decision about where to shop However, other factors such as atmosphere, quality of products, and store loyalty programs may have impacted the ir decision of where to shop and were not discussed. Lastly, due to time constraints and data availability, the study only included healthy food sources that could be identified outside the building, known to the researcher or that could be found through data searches. Other potential healthy food sources such as pharmacies (i.e. CVS and Walgreens), roadside markets, temporary markets, or smaller, lesser known grocery stores outside of the neighborhood were not

PAGE 120

120 included. Additionally, a specialty grocery s Archer Road, Gainesville, Florida, was built during the time of research was not would not have signific antly altered the analysi s because it is located about 4 miles from the neighborhoods in the same shopping plaza as two of the Publix stores and the Target store examined.

PAGE 121

121 Figure 6 1 Terwilliger Elementary School district b oundary (Red circle indicates study area) [Source : http://www.schoolsiteonline.com/schoolsitelocator/ ?districtCode=58364 ]

PAGE 122

122 CHAPTER 7 RECOMMENDATIONS One of the most important phases of a rapid health impact assessment is the recommendations section. Recommendations help provide an effective plan for improving community health. This chapter provides advice on how to create better transportation access t o healthy food sources in the Tower Road Triangle neighborhoods. The recommendations provided are intended to improve public health in the community through community design, land use, and program strategies. Additionally, the last step in the Rapid HIA pr ocess, evaluation and monitoring will discuss strategies in two programs working to increase healthy food sources in the study area Lastly, some possible future research topics on the subject are discussed. Suggested Ways to Improve Healthy Food Access The seven recommendations suggested hope to provide some key ways to improve access to healthy food sources for individuals in the Tower Road Triangle. These recommendations present ways to remove barriers to accessing healthy food sources by creating a sa fer and more convenient environment They start with a broader overview and then work to specific programs. Recommendation 1 suggests thinking about the long term future of the neighborhoods and how it may be impacted by other development projects in the a rea. Recommendations 2 and 3 are intended to make the built environment in the neighborhoods safer, both from a crime and pedestrian/bicyclist perspective. Recommendation 4 highlights the top three TDP improvements that should be prioritized. Recommendatio ns 5 and 6 are programs intended to increase transportation access to healthy food sources outside of the

PAGE 123

123 neighborhoods. Lastly, recommendation 7 is a program intended to bring more healthy food into the neighborhoods. Recommendation 1: More Mixed Use Envi ronment In Future While the study area is expected to remain mostly residential, it is worth considering a redevelopment plan for the study area that includes a more mixed use and multi modal environment. Future plans for the areas surrounding the Tower Ro ad Triangle include a potential bus rapid transit (BRT) and Celebration Pointe, one of f our mixed use transit oriented developments (TODs) approved in future growth and transportation (Figure 7 1) Under that plan the Tower Road Tria ngle would be surrounded by more high end subdivisions and TODs in the future. These changes would leave it vulnerable to pressure for redevelopment to create a similar development pattern. The redevelopment situation could leave residents within the study area displaced to other more affordable neighborhoods that may have even worse access to healthy foods. Recommendation 2: CPTED /Defensible Space Strategies A high number of index crimes in the study area suggest the need for CPTED/Defensible Space i mprovements to the surrounding residential uses, as well as, the Maa & Paa st ore within the Tower Road Triangle. Improv ements to the Maa & Paa store c ould include removing the tint and signage that currently exist in the storef ront windows as seen in Figur e 5 27. These store improvements would increase natural surveillance into and out of the store and help foster a positive social environment that possibly more people would be willing to shop at, hopefully for healthy foods. Additionally, increasing main tenance, such as trash removal, within the surrounding areas of the residential neighborhoods would be easy to accomplish with the help of

PAGE 124

124 residents or SWAG volunteers. Areas that provide natural surveillance and that are better maintained are less suscept ible to crime. Recommendation 3: Improved Transportation Infrastructure One of the ways to improve transportation access to healthy foods is to improve the existing transportation infrastructure with in the internal network of the Tower Road Triangle This would be accomplished by adding sidewalks and designated bicycle lanes to streets within the Tower Road Triangle, with the emphasis on major streets such as SW 8 th Avenue. In this particular case, SW 8 th Avenue has sidewalks but no bicycle lanes. Addition ally, there is a segment of SW 8 th Avenue that is blocked near the Linton Oaks neighborhood, making connectivity between the southern and northern neighborhoods non existent. The Alachua County Public Works Department is currently working to remedy the sit uation and connect SW 8 th Avenue with SW 61 st Street (where the existing Maa & Paa store is located) to provide better connectivity for the neighborhood. As of July 9 th 2013, the County is still trying to acquire private property from Yes! Communities (ow ners of the Hidden Oaks neighborhood). In coordination with the street connection, there are plans to provide a 6 foot sidewalk on the north side of SW 20 th avenue from SW 61 st to the I 75 overpass. For those individuals with no car access providing streets with adequate sidewalks and bicycle lanes ensures that these residents can safely and effectively get to their healthy food destinations both within and outside of their neighborhood The biggest challenge in constructing new sidewalks and bicycle lanes is funding. At the present time, there are no other identified projects for sidewalk or bicycle lane improveme nts for the Tower Road Triangle. Desired sidewalk and bicycle improvements in the study area will likely have to be accomplished through fe deral or state grants.

PAGE 125

125 Recommendation 4: Prioritized TDP Transit Improvements The RTS TDP shows five Service Priorities planned for Route 75 in 2016. In the possible event that funding decreases, it is important to prioritize the existing planned programs so that those projects that would be most beneficial to individuals living in the Tower Road Triangle are implemented. The first priority should be adding Sunday service to Route 75. C urrently, individuals living in the northern neighborhoods do not have direct access to a Sunday transit service. Residents living in the southern neighborhoods can walk over a to reach Route 20 bus stop but a one way trip to a grocery store on this rout e is around 1 hour or more. The second priority should be to increase weekend frequency to 45 minutes. Currently, the weekend frequency is around 105 minutes. Buses running more often on the weekend means that instead of only approximately six buses bein g available on a Saturday there would be around 15 buses available. This would more than double the opportunity for individuals to access healthy food resources. The third priority should be to extend weekday evening hours to 10:00pm. Route 75 currently r uns from 6:00am to 7:30pm on weekdays. Allowing the route to run two and a half hours longer would provide individuals time in the evening after work to shop for healthy foods instead of, possibly, picking up some other fast food that is more convenient du e to a lack time and transportation available. Recommendation 5: Bicycle Sharing Program A second generation bike share program is recommended for the Tower Road Triangle. Second generation, or bike corrals, are more formal than an Ad Hoc systems but requ ires no automated management. In this type of system, bikes are kept locked up in a central location. Keys for the locks are managed by a person at the centralized

PAGE 126

126 location. Users who would like to use a bike must check the bike out while providing some mi nor details, to the person in charge of checking a bike out, for accountability purposes. This type of system is easy to start up and does not require a lot of money or infrastructure. The bicycling sharing program could be run out of the SWAG Family Reso urce Center since it is a well known and formalized location within the Tower Road Triangle. Student volunteers and existing staff could maintain the check out of bicycl es to individuals. T he third annual Bicycle Rehabilitation day was held in 2013 at the SWAG Family Resource C enter where volunteers helped clean, pump, grease, and repair bikes. On that occasion, 25 bikes were donated to children in the SWAG neighborhoods. Bicycles and bicycle locks could potentially be donated from the same local businesses or perhaps a deal with the University of Florida could be worked out so that aba ndoned student bikes are sold to SWAG a discounted price. These bikes could be fitted with baskets to make transporting groceries easier and safer. However, currently under Fl orida state law, it is illegal to donate unclaimed bikes to charity. Abandoned bikes collected by the University of Florida Police Department are sold in an online auction, generally the bikes at a group rate for prices ranging between $40 to $140. Recom mendation 6: Supermarket Carpool/Supermarket Shuttle A supermarket carpool or supermarket shuttle programs are alternative strategies to deal with transportation barriers to healthy foods. The study area (Census Tracts 22.17 and 22.18) had a total of 4,39 4 workers aged 16 years or over. Of those workers, 510 (11.61%) carpooled to work. Creating a supermarket carpool program would be beneficial to these 510 individuals who already carpool to work.

PAGE 127

127 A supermarket shuttle could be established with a private p artnership between SWAG and one or more of the nearby grocery stores or it could be organized with other social service organizations. Shuttles could potentially be run on Sundays from noon to 4:00pm when there is no RTS bus service available. Residents c ould schedule rides and be picked up at a centralized location such as the SWAG Family Resource Center. Alternatively, the shuttle could enforce that individuals find their own way to the grocery store but the shuttle will provide them a ride home to minim ize the hassle of picking up individuals. Other shuttle policies could include a minimum purchasing amount from place of residence to the store. It is likely that s maller grocery stores would use their own employees and vehicles available for such a service while more corporate grocery stores could contract shuttle service out to a transportation agency. Recommendation 7: Neighborhood Farmers Market A neighborhood fa rmers market would greatly decrease the transportation barrier to healthy foods since it would bring the foods directly to the individuals living in the Tower Road Triangle. The SWAG Oasis group is currently working on bringing a farmers market to the Towe r Road Triangle Their plan is to set up a farmers market with the help of Florida Organic Growers (FOG). The farmers market will likely be able to provide produce from one grower weekly and will provide more growers as the interest for the farmers market grows. As with other farmers markets in Gainesville, the neighborhood farmers market will be setting up Electronic Benefit Transfer (EBT) services. SWAG Oasis originally wanted to host the farmers market in the parking lot of the Maa & Paa store. However, the owner was concerned with liability. As an alternative, SWAG Oasis wanted to host the farmers market at the SWAG Family

PAGE 128

128 Resource Center. However, due to zoning and City/County ordinances this is not possible. At the present time, no location has been id entified within the Tower Road Triangle to host a farmers market. Finding a suitable location within the Tower Road Triangle and working with City/County officials to bring a farmers market is a highly recommended next step in making this market become a r eality. Evaluation And Monitoring The last step in the rapid HIA process, evaluation and monitoring, discusses strategies in two programs working to increase healthy food sources in the study area continue to monitor RTS transit improveme nts in and near the study area but particularly Route 75 since it main transit route in the Tower Road Triangle neighborhoods. Swag Oasis Nutrition Project The SWAG Oasis nutrition project is currently up and running within the study area. It is important to develop an evaluation and monitoring process for the project to see if efforts currently in place are making a difference in the health of the community or if other types of programmed activities are needed. Of the residents participating in the SWAG Oasis nutrition project, it would be beneficial to monitor health factors (i.e. weight, blood pressure, and diabetes), daily food intake, an d food shopping behaviors to see if participants understand and use the information that provided to them through SWAG Oasis. Mobile Food Market Feasibility Study Part of the reason for this rapid HIA is to influence decision makers to create a mobile foo d market in Gainesville. It is difficult to evaluate the potential success that a mobile market in Alachua County would have in mitigating the current healthy food

PAGE 129

129 access issue of the Tower Road Triangle neighborhoods. There are many cities across the Uni ted States that have had success with this food access program type. If such as program type were available to the Tower Road Triangle neighborhoods it would be important to track data including the demographics of the people buying, how much they are spen ding, what types of healthy foods are being bought, how often people from the neighborhoods shop at the mobile market, and if people have noticed a difference in their health after shopping at the mobile market over an extended period of time. Providing a mobile food market would make healthy foods more accessible to those who most need it. Monitor RTS Transit Improvements The other reason for this rapid HIA is to influence decision makers of the City of Gainesville and the Regional Transit System (RTS ) as they update their existing Transit Development Plan (TDP) Five TDP Service Priorities have been identified for Route 75 within the Tower Road Triangle neighborhoods. It is important that these projects, including their funding, continue to be monitor ed to ensure that these priorities are implemented. While RTS has not announced service cuts in this neighborhood, they could and if they did the neighborhoods would need to activate a plan to ensure that this did not happen because it would impact so many individuals who rely on transit. Future Research Future research should focus on neighborhood crime and its connection to the impacts it may have on individuals who walk or ride their bikes in the Tower Road Triangle since this type of research was not conducted during focus groups. An increased understanding of how individuals in the Tower Road Triangle, especially women, view crime around them will allow for rec ommendations to be made that will

PAGE 130

130 increase the quality of life and access to healthy foods for these individuals in a predominantly low income and minority community. Additionally, it would be beneficial to conduct research on the use of the RTS Transloc application that allows smartphone users to track and locate their desired bus route. A Pew Research Center survey conducted in 2010 found that the percentage of low income groups in the United States with access to a mobile Web devices at 46%, up from 35% in April 2009 (Hamblen, 2010) The study also found that nearly two thirds of African Americans and English speaking Latinos are wireless Internet users. Research on the RTS Transloc application would be useful in seeing if it needed to be more user frie ndly or simply showing how important the application is for those individuals relying on bus schedules to access healthy food resources. Lastly, it would be advantageous to know how often residents in the Tower Road Triangle go to different types of food sources (i.e. convenience stores, supermarkets, fast food restaurants, etc.) and how they travel to specific store locations. This would help identify key transportation corridors that could be modified and improved to bette r serve those who often use it.

PAGE 131

131 Figure 7 1 Proposed Celebration Pointe d evelopment near I 75 and Archer Road (Red indicates study area) [Source: Google Earth]

PAGE 132

132 CHAPTER 8 CONCLUSION The aim of this rapid health impact assessment was to uncover issues related to transportation disparities that exist in low income and minority neighborhoods in a portion of Alachua County and show how these barriers can affect access to healthy foods for individuals in those neighborhoods. The Tower Road Tr iangle was chosen as a case study due to its social demographics particularly income and racial composition which would indicate that the area might have low transportation access to healthy foods as presented in the research aim and literature review. Th demographics, built environment, public transit access, and access to healthy foods was examined in order for the researcher to identify obstacles individuals face in the neighborhoods when trying to achieve a healthy food sources. The Towe r Road Triangle study area is at risk for not providing good accessibility for the residents to healthy foods. The mix of uses is predominantly residential with little commercial access to healthy foods; only one convenience store and a community garden lo cated in the Linton Oaks neighborhood, only two grocery stores are within a mile of the neighborhoods, and even then they are only easily accessible to neighborhoods in the northern portion. Additionally, most neighborhoods were characterized by dead ends/ cul de sacs and loops that do not provide an effective street network especially where there is no parallel or equal pedestrian and bicycle network. The study area is served by three RTS bus routes including Route 23, Route 75, and Route 76. However, the service times do not extend to later hours of the evening, there is limited Saturday service, and there is no Sunday service available. For

PAGE 133

133 example, transit access is available on a Saturday to Publix on Route 75 from Pine Meadow but then the frequency is only every 105 minutes and only until 6:05 p.m. Additionally, on e way trip times can take up to 52 minutes. Individuals within the Tower Road Triangle face various barriers when it comes to obtaining healthy food. Focus group statements verified some of t he difficulties related to grocery shopping such as patching together multiple routes, preferable store locations that were unavailable due to distance, and the prices of healthy foods that may not be compatible with the budgets of those on Food Stamps/SNA P. Solutions to improve transportation access to healthy foods include : a more mixed use environment in the future, CPTED/defensible space strategies, improved transportation infrastructure, prioritized TDP service improvements, a bicycle sharing program, a supermarket carpool/supermarket shuttle, and a neighborhood farmers market. The Tower Road Triangle has great potential to become a healthy community in the future with some help. The findings of this research provide examples of transportation recommen dations that can be made at the neighborhood level to increase the opportunities for low income and minority groups in the Tower Road Triangle to access healthy food sources within Alachua County, Florida.

PAGE 134

134 APPENDIX A SWAG BOARD MEETING A GENDA JANUARY 2013

PAGE 135

135 APPENDIX B SWAG RESIDENT MEETIN G AGENDA JANUARY 2013

PAGE 136

136 LIST OF REFERENCES American Heart Association. (2012). My Life Check Retrieved October 10, 2012, from http://mylifecheck.heart.org/Community.aspx?NavID=4&CultureCode=en us Berrigan, D., Pickle, L. W., & Dill, J. (2010). Associations Between Street Connectivity and Active T ransportation. International Journal of Health Geographics Besharov, D. J., Bitler, M., & Haider, S. J. (2011). An Economic View of Food Deserts in the United States. Journal of Policy Analysis and Management 153 176. Bhakta, M., Pastor, D., & Wegman, M. (2013). SWAG Nutrition Project Preliminary Focus Group Results. University of Florida (Unpublished). Bhatia, A. (2010). A Guide for Health Impact Assessment San Francisco: California Department of Public Health. Biro, F., & Wien, M. (2010). Childhood Obesities and Adult Morbidities. The American Journal of Clinical Nutrition 1499S 1505S. Block, J. P., Scribner, R. A., & DeSalvo, K. B. (2004). Fast food, race/ethnicity, and income: a geographic analysis. American Journal of Preventative Medicine 211 217. Carr, L. J., Dunsiger, S. I., & Marcus, B. H. (2010). Validation of Walk Score for estimating access to walkable amenities. Journal of Sports Medicine 1144 1148. CDC. (2011, May 26). Centers for Disease Control and Prevention (CDC) Retrieved October 23, 2011, from http://www.cdc.gov/chronicdisease/resources/publications/aag/obesity.htm CDC. (2012, August 22). Health Impact Asse ssment Retrieved December 8, 2012, from Center for Disease Control and Prevention: http://www.cdc.gov/healthyplaces/hia.htm CDC. (2013). Census Tract Level State Maps of the Modified Retail Food En vironment Index (mRFEI). Atlanta, GA: Centers for Disease Control and Prevention. Clifton, K. J., & Livi, A. D. (2004). Gender Differences in Walking Behavior, Attitudes About Walking, and Perceptions of the Environment in Three Maryland Communities. Rese arch on Women's Issues in Transportation (pp. 79 88). Washington, D.C.: Transportation Research Board. Dai, D., & Wang, F. (2011). Geographic disparities in accessibility to food stores in southwest Mississippi. Environment and Planning 659 677.

PAGE 137

137 Duncan, D., Aldstadt, J., Whalen, J., Melly, S., & Gortmaker, S. (2011). Validation of Walk Score for Estimating Neighborhood Walkability: An Analysis of Four US Metropolitan Areas. International Journal of Environmental Research and Public Health 4160 4179. Eisenhauer, E. (2001). In poor health: Supermarket redlining and urban nutrition. GeoJournal 125 133. Ewing, R. (N.D.). Pedestrian and Transit Friendly Design: A Primer for Smart Growth Pembrook Pines, Florida: Smart Growth Network. Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual Medical Spending Attributable To Obesity: Payer and Service Specific Estimates. Health Affairs w822 w831. Flournoy, R. (2011). Policy Link. Retrieved December 5, 2011, from Healthy Food, Healthy Communities: Promising Strategies to Improve Access to Fresh, Healthy Food and Transform Communities: http://www.policylink.org/atf/cf/%7B97c6d565 bb43 406d a6d5 eca3bbf35af0%7D/HFHC_FULL_FINAL.PDF Food Marketing Institute. (2012). Supermarket Facts: Industry Overview 2010 Retrieved September 10, 2012, from Food Marketing Institute: http://www.fmi.org/research resources/supermarket facts Fresh Moves. (2011). Fresh Moves: Mobile Produce Market Retrieved April 11, 2012, from http:// freshmoves.org/ Giles Cort i B., Macintyre, S., Clarkson, J. P., Pikora, T., & Donovan, R. J. (2003). Environmental and Lifestyle Factors Associated With Overweight and Obesity in Perth, Australia. American Journal of Health Promotion 93 102. Guthrie, J F., & Lin, B. H. (2002). Overview of the Diets of Lower and Higher Income Elderly and Their Food Assistance Options. Journal of Nutrition, Education, and Behavior S31 S41. Hamblen, M. (2010, July 9). Computer World Retrieved June 8, 2013, from Pew st udy finds rapid increase in mobile Internet use by low income Americans: http://www.comp uterworld.com/s/article/9179049/Pew_study_finds_rapid_increas e_in_mobile_Internet_use_by_low_income_Americans?taxonomyId=15&pageNu mber=1 Handy, S. (2004). Community Design and Physical Activity: What Do We Know? and what DON'T we know? Davis: University of California Davis.

PAGE 138

138 Handy, S. L. (1996). Urban Form and Pedestrian Choices: Study of Austin Neighborhoods. Transportation Research Record 135 144. Human Impact Partners. (N.D.). Introduction to HIA. Retrieved January 5, 2013, from Health Impact Partne rs: http://www.humanimpact.org/doc lib/finish/11/44 Iacono, M., Krizek K., & El Geneidy, A. (2008). Access to Destinations: How Close is Close Enough? Estimating Accurate Distance Decay Functions for Multiple Modes and Different Purposes. Minneapolis, Minnesota: University of Minnesota. Jordan's Farms. (2012). Jordan's Farms: Fresh Vegetables Grown in Cape Elizabeth, ME Retrieved September 6, 2011, from Mobile Farm Stand: http://www.jordansfarm.com/MobileFarmStand.html King, R. P., Leibtag, E. S., & Behl, A. S. (2004, December). United States Department of Agriculture. Retrieved December 5, 2011, from Supermarket Characteri stics and Operating Costs in Low Income Areas: http://www.peoplesgrocery.org/brahm/wp content/uploads/2006/10/USDA%20Supermarket%20study.pdf Mall ard, A. (2012, October 24). RTS Plans to Keep Route 2. Gainesville Sun McDonald, N. C. (2008). The Effect of Objectively Measured Crime on Walking in Minority Adults. American Journal of Health Promotion 433 436. Merriam Webster. (2012). Retrieved October 5, 2012, from Merriam Webster: http://www.merriam webster.com/dictionary/environment Murakami, E., & Young, J. (1997). Daily Travel by Persons with Low Income. NACCHO. (2008). Health Impact Assessment: Quick Guide. Washington, DC: National Association of County & City Health Officials (NACCHO). National Center for Biotechnical Information (NCBI). (2011, June 14). Malnutrition Retrieved Octob er 28, 2012, from National Center for Biotechnical Information (NCBI): http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001441/ National Research Council. (2011). Improving Health in the Uni ted States: The role of Health Impact Assessment. Washington, DC: The National Academies of Sciences. Papas et al. (2007). The Built Environment and Obesity. Epidemilogical Reviews 129 143. Parry, J., & Stevens, A. (2001). Prospective health impact assessments: pitfalls, problems, and possible ways forward. British Medical Journal 1177 1182.

PAGE 139

139 Powell et al. (2007). Food Store Availability and Neighborhood Characteristics in the United States. American Jo urnal of Preventive Medicine 189 195. Project for Public Spaces, Inc. (2003). Public Markets & Community Based Food Systems: Making them work in lower income neighborhoods. New York. Richards, R., & Smith, C. (2007). Environmental, parental, and persona l influences on food choice, access, and overweight status among homeless children. Social Science and Medicine 1572 1583. Rogers, S. H., Halstead, J. M., Gardner, K. H., & Carlson, C. H. (2011). Examining Walkability and Social Capital as Indicators of Quality of Life at the Municipal and Neighborhood Scales. Applied Research in Quality of Life 201 213. Rural Resources. (2012). Rural Resources: Connecting Farms, Food, & F amilies Retrieved September 8, 2011, from Mobile Farmers' Market: http://www.ruralresources.net/ Sallis, J., & Glanz, K. (2009). Physical Activity and Food Environments: Solutions to the Obesity Epidemic. Mi lkbank Quarterly 123 154. Schneider, R. H., & Kitchen, T. (2002). Chapter 4: Basic Theories and Principles of Place Based Crime Prevention Planning. In R. H. Schneider, & T. Kitchen, Planning for Crime Prevention: A TransAtlantic Perspective (pp. 91 118) London and New York: Routledge. Schwank, A. (2011). Grocery anchored shopping centers: a better retail investment? Boston, MA: Massachusetts Institute of Technology. Scott, J., Murley, J. F., & Jones, R. M. (2007). The Florida Planning Toolbox. Fort La uderdale: Center for Urban and Environmental Solutions at Florida Atlantic University. Sloane et al. (2003). Improving the Nutritional Resource Environment for Healthy Living Through Community based Participatory Research. Journal of General Internal Medi cine 568 575. Supermarket Facts: Industry Overview 2010 (2012). Retrieved September 10, 2012, from Food Marketing Institute: http://www.fmi.org/research resources/supermarket facts

PAGE 140

140 Thayer, J., Murphy, C., Cook, J., Ettinger de Cuba, S., DaCosta, R., & Chilton, M. (2008, September). Children's Health Watch. Retrieved December 5, 2011, from Coming Up Short: High food costs outstrip food stamp benefits: http://www.childrenshealthwatch.org/upload/resource/RCOHD_Report_Final.pdf? PHPSESSID=6f607716d6f8ae921582923e483647f4 The Farm Bus: From Farm 2 Family ( 2011). Retrieved October 22, 2011, from http://thefarmbus.com/ Tindale Oliver& Associates, Inc. (2009). City of Gainesville Regional Transit System (RTS) Transit Development Plan. Gainesville, FL: RTS and City of Gainesville. Treuhaft, S., & Karpyn, A. (2010, March 15). Policy Link. Retrieved November 12, 2011, from The Grocery Gap: Who Has Access to Healthy Food and Why It Matters: http://www.policylink.org/site/apps/nlnet/content2.aspx?c=lkIXLbMNJrE&b=5136 581&ct=8079863 U.S. Census. (2000). United States Census Bureau Retrieved Novemeber 14, 2012, from Census Tracts and Bl ock Numbering Areas: http://www.census.gov/geo/www/cen_tract.html United States Department of Agriculture. (2009). Food Desert Locator Retrieved December 5, 2011, from http://www.ers.usda.gov/data/fooddesert/fooddesert.html U.S Department of Agriculture and U.S. Department of Health and Human Services. (2010). Dietary Guidelines for Americans, 2010. W ashington, DC: U.S. Government Printing Office. Walters, T. (2007). Clean Food: A Seasonal Guide to Eating Close to the Source with more than 200 recipes for a healthy and sustainable you. Avon, CT: Sterling Publisher Co., Inc. Whitley, R., & Prince, M. (2005). Fear of crime, mobility and mental health in inner city London, UK. Social Science & Medicine 1678 1688. Wilde, P. E., & Ranney, C. K. (2000). The Monthly Food Stamp Cycle: Shopping Frequency and Food Intake Decisions in an Endogeneous Switching Regression Framework. American Journal of Agricultural Economics 200 213. Wolfe, W. S., Olsen, C. M., Kendall, A., & Frongillo Jr, E. A. (1996). Understanding Food Insecurity in the Elderly: A Conceptual Framework. Journal of Nutrition Education 92 100.

PAGE 141

141 Worden, E. C., Hunsberger, A., & McLaughlin, J. (2012). University of Florida IFAS Extension Retrieved September 25, 2011, from Starting a Community Garden: http://edis.ifas.ufl.edu/ep124

PAGE 142

142 BIOGRAPHICAL SKETCH Amanda Marie Douglas grew up mostly in Pin ellas Park, Florida, graduating from Pinellas Park High School in 2007. She earned her Bachelor of Arts in geography with a minor in urban and regional p lanning from the University of Florida i n 2011 with the distinction of cum l aude. Immediately after her undergraduate career, Aman da began her Master of Arts in urban and regional p lanning at the University of Florida in fall 2011. and access to healthy foods. Amanda hopes to help create cities that are functional but also enjoyable f or everyone who lives in them