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Health Profile July 2017

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Table of Contents

Introduction 3

Data and Stakeholders 3

Healthy Corridor Typology 4

Health Behaviors and Outcomes 6

Air Quality Report 8

End Notes 18

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In 2016, MetroPlan Orlando completed the first transit Health Impact Assessment in Florida. The experience led to a broader examination of the agency’s efforts to plan for a healthier region. The Corrine Drive Complete Streets Study is a pilot for how the agency can incorporate health considerations into the planning process.

This health profile for the Corrine Drive study relies on a few best-practices reports and guidebooks. MetroPlan Orlando used these resources to inform scope development, data collection, and analysis.

The Federal Highway Administration’s Health in Transportation Corridor Planning Framework helped identify specific points within the scope for including health partners and collecting health data. Also, the framework provided strategic support for how MetroPlan Orlando could best incorporate health considerations into the Corrine Drive study process.

The Urban Land Institute’s Building Healthy Places initiative recently published its Building Healthy Corridors report and audit tool. MetroPlan Orlando’s use of the audit tool identified potential indicators for establishing baseline measurements. The Building Healthy Corridors report includes a Healthy Corridors typology, which the agency used in its analysis.

Data and Stakeholders

MetroPlan Orlando worked with local health partners to collect health data and identify particular health concerns in the corridor. The Florida Department of Health-Orange County provided asthma statistics at the U.S. Census Bureau’s 2010 Census Tract level. Additionally, the agency’s Environment Health division collected air quality data at key locations during the traffic data collection period. The air quality report is at the end of this health profile.

The 500 Cities project, a collaboration between the Centers for Disease Control (CDC), the Robert Wood Johnson Foundation, and the CDC Foundation, provided health data at the Census tract level. The data is reported using statistically modeled, Small Area Estimates from the 2014 Behavioral Risk Factor Surveillance Survey (BRFFSS) datai. All data are reported in crude prevalence. Two of the Corrine Drive study area’s Census Block Groups are in one Census Tract in the City of Winter Park. 500 Cities data is unavailable for that portion of the study area.

Prevalence measures the frequency of existing disease, and is defined as: the proportion of the total population that is diseased (or the respective measure). In this document, the prevalence reported is the proportion of the total population within each respective Census Tract. Prevalence is useful for estimating the needs of facilities or resources for treating people who already have a disease.ii

All other health-related data was obtained through traditional transportation data collection methods and field observations.

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ULI Healthy Corridor Typology

X = Not Currently on Corrine Drive / = partially on Corrin Drive

= Currently on Corrine Drive

Improved Infrastructure Frequent, safe, and well-marked pedestrian crossings x Safe and well-marked bike lanes x Traffic speeds that accommodate pedestrians, bicyclists, and other users The posted 35 mph is sufficient, but the majority of cars are traveling much faster. /

Reduced traffic congestion The travel times and intersection level of service are better than what is allowed in the comprehensive plan. The traffic operations memo contains more details.

Utility lines and traffic signs and signals that are underground or blend in x Sidewalks that link adjacent neighborhoods to the corridor and that are unobstructed, wide enough for a variety of users, and buffered from the street. x

Lighting that improves visibility and safety for pedestrians and cyclists x Features that improve accessibility for all types of users, in compliance with Americans with Disabilities Act standards x

Design and land use patterns that support community needs Vibrant retail environment Businesses directly on Corrine Drive are busy, selling food, drinks, and places to shop. The Mills 50 Main Street district and the Baldwin Park downtown commercial area does have a few vacancies. Businesses includes retail shops, grocery stores, pharmacies, bakeries, produce venders, fitness studios, and restaurants.

Housing options for all income levels x Buildings adjacent or proximate to sidewalks The established commercials plazas have parking lots between the streets and the businesses.

/

Improved parking strategies and shared parking Many businesses employ sharing parking strategies. Notable exceptions include ABC Fine Wine and Spirits.

/

High-quality parks and public spaces Leu Gardens is in the middle of the study area. It is a city-owned park with an admissions fee and regular programming. The study area has public parks all around its edges.

/

Healthy food options Each Monday, the Audubon Park Community Market has fresh produce vendors and participates in the SNAP Benefits program. It attracts visitors from across Orange and Seminole counties.

Engaged and supported people who live, work, and travel along the corridor Engaged residents and local business owners The Audubon Park Garden District won the 2016 Great American Main Street Award for neighborhood commercial district revitalization. An active and engaged citizenry exists as evidenced by the 1,705 community survey responses.

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Organizations that facilitate long term improvements and resident engagement The study area contains numerous neighborhood associations, including the Audubon Park Garden District, the Baldwin Park Residential Owners’ Association, and the Mills 50 Main Street program.

Regular programs in community gather spaces Local businesses or neighborhood associations have regular programming. On any given week, there is an activity each day, including Monday’s Audubon Park Community Market, East End Market’s Wine Wednesday, and Baldwin Park’s First Friday.

Accommodations for pets The study area has a dog park at Lake Druid Park on its southern edge and another in Baldwin Park. Pets are allowed in the other parks and green spaces.

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Accommodations for vulnerable populations, including children, the elderly, and people with disabilities.

x

A defined identity, drawing on the arts and culture of the community and supported by creative placemaking and programming Corrine Drive’s core between Bumby Avenue and General Rees Avenue has a distinct identity, built over the years by the Audubon Park Garden District, an Orlando Main Streets program. The Baldwin Park neighborhood has its own identify, fostered by its New Urbanist origins and residents’ association.

Measures to address safety and perceptions of safety x Linkages to other parts of the city

Well-connected, multi-modal street networks x Safe and easily identifiable connections, including sidewalks and trails x Transit including enhanced bus service or rail x Bike infrastructure on or adjacent to the corridor The Orlando Urban Trail, connecting to downtown Orlando, lies on the western edge of the study area. The Cady Way Trail is on the eastern edge, connecting Baldwin Park to Seminole County.

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Health Behaviors and Outcomes

The health behaviors and outcomes data is grouped into four Census Tracts and identified by neighborhoods: Colonialtown North, Leu Gardens/Rowena Gardens, Coytown/Audubon Park/Colonialtown Center, and Baldwin Park.

Preventive Behavior

Prevalence (%) of Preventive Behaviors

Neighborhood

Current lack of health insurance among adults aged 18–64 Years

Visits to doctor for routine checkup within the past Year*

Cholesterol screening*

Colonialtown North 15.7 66.7 73.8 Leu Gardens/ Rowena Gardens 8.8 73.9 84.4 Coytown/Audubon Park/ Colonialtown Center 11.9 69.5 76.6

Baldwin Park 15.4 66.1 70.4 Average 13.0 20.9 20.9 * Adults aged >=18 Years

Unhealthy Behaviors

Prevalence (%) of Unhealthy Behaviors*

Neighborhood Binge drinking

Current smoking

No leisure-time physical activityiii

Sleeping less than 7 hoursiv Obesity

Colonialtown North 21.8 17.4 18.8 32.6 20.5 Leu Gardens/ Rowena Gardens 18.0 11.6 16.2 27.6 20.9 Coytown/Audubon Park/ Colonialtown Center 21.6 13.1 15.8 30.1 23.1 Baldwin Park 22.0 16.1 17.5 31.8 22 Average 20.9 14.6 17.1 30.5 21.6 *Among adults aged >=18 Years

Health Outcomes

Coronary heart disease among adults aged >=18 Years Neighborhood Prevalence (%) Colonialtown North 4.4 Leu Gardens/ Rowena Gardens 6.7 Coytown/Audubon Park/ Colonialtown Center 4.6 Baldwin Park 3.8 Average 4.875

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Stroke among adults aged >=18 Years Neighborhood Prevalence (%) Colonialtown North 1.9 Leu Gardens/ Rowena Gardens 2.5 Coytown/Audubon Park/ Colonialtown Center 1.9 Baldwin Park 1.7 Average 2

Diagnosed diabetes among adults aged >=18 Years Neighborhood Prevalence (%) Colonialtown North 6.4 Leu Gardens/ Rowena Gardens 7.8 Coytown/Audubon Park/ Colonialtown Center 6.3 Baldwin Park 5.6 Average 6.5

Physical health not good for >=14 days among adults aged >=18 Years Neighborhood Prevalence (%) Colonialtown North 9.3 Leu Gardens/ Rowena Gardens 8.9 Coytown/Audubon Park/ Colonialtown Center 8 Baldwin Park 8.4 Average 8.7

Mental health not good for >=14 days among adults aged >=18 Years Neighborhood Prevalence (%) Colonialtown North 11.6 Leu Gardens/ Rowena Gardens 8.8 Coytown/Audubon Park/ Colonialtown Center 9.5 Baldwin Park 11.1 Average 10.3

MissionMissionMissionMission:

To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

Rick ScottRick ScottRick ScottRick Scott

Governor

John H. Armstrong, MD, FACSJohn H. Armstrong, MD, FACSJohn H. Armstrong, MD, FACSJohn H. Armstrong, MD, FACS

State Surgeon General & Secretary

VisionVisionVisionVision: To be the Healthiest State in the Nation

Florida Department of HealthFlorida Department of HealthFlorida Department of HealthFlorida Department of Health in Orange County in Orange County in Orange County in Orange County

Program Evironmental Health 1001 Executive Center Dr. #200, Orlando, FL 32803 PHONE: 407-858-1497 • FAX 407-228-1467 www.orchd.com

www.FloridasHwww.FloridasHwww.FloridasHwww.FloridasHealth.comealth.comealth.comealth.com

TWITTER:HealthyFLA FACEBOOK:FLDepartmentofHealth

YOUTUBE: fldoh

Limited Outdoor Air Quality Assessment

Conducted at: Corrine Drive Complete Streets Study

Date: 5/4/2017

Complaint: Air Quality

Prepared for: Orlando Metroplan

Issue Date: May 24, 2017

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Temperature oF 89 89 91 93 93 91 89

Relative Humidity % 36 36 31 32 32 34 34

CO (ppm) 2.3 2.3 2.6 3.8 3.1 2.8 2.4

CO2 (ppm) 390 337 335 397 416 414

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VOC (ppm) 4.5 4.8 3.8 2.5 2.1 1.2 1.2

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Temperature oF 91 91 91 91 91 91 89

Relative Humidity % 33 34 33 34 34 34 33

CO (ppm) 2.8 2.5 2.6 2.9 2.6 2.3 2.8

CO2 (ppm) 342 334 379 458 329 367

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VOC (ppm) 1.1 0.6 0.7 0 0.4 0 0

Relative Humidity & Mold The following chart shows the results of the relative humidity readings in the air compared to the recommended levels:

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Mold and mold spores are all around us. The uncertainties associated with the effects of mold growth on human health make mold different from other environmental hazards affecting real estate. Mold is a naturally occurring part of the environment. Humans tend to each react differently to exposure to mold. The impact of mold on human health depends on several factors, including: the particular susceptibility of the person, the type of mold, the concentration of the mold, the duration of the exposure and the current stage of the mold's life cycle. The science on the health effects of mold remains relatively undeveloped. Mold exposure does not always present a health problem. However some people are sensitive to molds. These people may experience symptoms such as nasal stuffiness, eye irritation, wheezing, or skin irritation when exposed to molds. The term “toxic” mold is not accurate. While certain molds are toxic, meaning they can produce toxins (specifically mycotoxins), the molds themselves are not toxic, or poisonous. Hazards presented by molds that may produce mycotoxins should be considered the same as other common molds. There is always a little mold everywhere in the air and on many surfaces. There are very few reports that toxic molds can cause unique or rare health conditions such as pulmonary hemorrhage or memory loss. The clinical relevance of these mycotoxins and irritants under realistic airborne exposure levels is not fully established. Further, some or much of the supporting evidence for these other health effects is based on: case studies rather than controlled studies; studies that have not yet been reproduced; or involves

symptoms that are subjective. These case reports are rare, and a causal link between the presence of the toxic mold and these conditions has not been proven. The following types of people may be affected sooner and more severely than others:

• Babies and Children • Elderly persons • Individuals with chronic respiratory conditions or allergies or asthma • Persons having weakened immune systems (for example, people with HIV or AIDS,

chemotherapy patients, or organ transplant recipients) Mold growth is dependent on a moisture source. Whenever there is sufficient moisture present in the air (Relative Humidity of >60%) or substrate moisture there will be mold growth. Mold can grow on virtually all surfaces with a water source present. Controlling the source of moisture is the key to controlling mold growth. Particle Matter Particle Count (µg/m³)

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2.5 <35 7.69 7.82 6.04 5.46 6.82 6.72 6.56 10.0 <150

32.74 33.88 31.30 34.26 29.29 33.41 34.45

Particle Count (µg/m³)

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2.5 <35 6.19 6.32 6.29 7.0 7.09 7.64 8.91 10.0 <150

22.58 27.65 32.40 37.38 37.41 53.81 61.24

Air quality is determined by the level of pollutants in the air. Air quality is affected by the types and amount of pollutants released into the air, weather conditions like wind speed, precipitation (rain and snow), and temperature, and topography, such as local mountains.

The levels of pollutants in the air can vary greatly from one location to the next and from 1 hour to the next. Several pollutants are measured at outdoor monitoring stations in the province and compared against standards and guidelines.

Particulate matter (PM) refers to small solid or liquid particles floating in the air. These particles can be made up of different substances, including carbon, sulphur, nitrogen and metal compounds.

Generally, smaller particles are thought to be more harmful to health than larger particles because they can move deeper into the respiratory tract, including the lungs. For this reason, fine particles which have diameters less than 2.5 micrometers (PM2.5) are linked to more serious health effects than larger particles. PM2.5 is about one-eighth the diameter of a human hair.

The following picture illustrates the size of a particle 10 µm or smaller compared to the diameter of a human hair.

PM10 includes fine particles as well as coarse particles that range in size from 2.5 to 10 micrometers in diameter. The coarse particles tend to stay in the upper parts of our respiratory tract, such as the nose and throat.

Any form of burning, also known as combustion, can lead to particle pollution.

Wood smoke may come from sources such as a fireplace or wood stove in a home, all open burning of vegetative matter, backyard burning or certain sources at wood products industry facilities. Other sources of particulate matter include all mobile vehicles, especially those with diesel engines, road dust, certain industries, furnaces, and tobacco smoke.

Both short and long-term exposures to PM can lead to the worsening of heart and lung disease. It can also cause premature (early) death, particularly among people who have a higher risk of being affected by particle pollution.

Those most likely to be affected by particle pollution include:

• children;

• older adults; and

• Those with heart or lung disease, such as asthma and chronic obstructive pulmonary disease (COPD).

You can reduce the levels of particulate matter pollution by reducing the amount of particulate matter produced through smoke, and by reducing vehicle emissions.

Reduce the amount of particulate matter produced through smoke:

• Stop smoking; if you do smoke, do not smoke indoors.

• Mulch garden refuse instead of burning it.

• Limit the use of fireplaces and wood stoves; when using these appliances, make sure that wood is being burned properly. Wood that is well seasoned instead of wet or green

should be used. Stoves should also meet EPA (Environmental Protection Agency) emission standards.

• Switch to cleaner burning appliances. For example, pellet stoves produce less particulate matter than traditional wood stoves.

• Take action to reduce wildfires. Practice safe backyard burning and careful use of campfires.

Reduce vehicle emissions and increase fuel efficiency:

• Diesel vehicles, including trucks, are a key source of fine particles. Reduce diesel emissions by replacing older engines with newer and cleaner engines.

• Walk, cycle, take public transit and carpool whenever possible.

• Pay attention to recommended maintenance schedules for your vehicle.

Carbon Monoxide (CO) Carbon Monoxide is an odorless, colorless and toxic gas. At lower levels of exposure, CO causes mild effects that are often mistaken for the flu. These symptoms may include headaches, dizziness, disorientation, nausea and fatigue among others. The effects of CO exposure can vary greatly from person to person depending on age, overall health, the CO concentration and length of exposure. At low concentrations, healthy people may experience fatigue. Chest pain could be one of the symptoms in people with heart disease. At higher concentrations, you may have impaired vision and coordination; headaches; dizziness; confusion; nausea. It can cause flu-like symptoms that clear up after going to the outside and it could be fatal at very high concentrations. On the other hand, the U.S. National Ambient Air Quality Standards for outdoor air are 9 ppm for 8 hours, and 35 ppm for 1 hour. These standards were set to protect public health, including the health of "sensitive" populations such as asthmatics, children, and the elderly.

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The readings of CO obtained are used to calculate the Air Quality Index using the formula and categories established by the EPA. The results are showed in the following table:

Air Quality Index (AQI)

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26 26 30 43 35 32 27

Air Quality Index (AQI)

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Carbon Monoxide (CO) ppm

32 28 30 33 30 26 32

*These results do not represent the average concentration, just the readings at the time of the assessment. Some activities like mowing the grass, construction or been close to highways or roads with heavy traffic can affect these readings.

The Air Quality Index (AQI) is another guide established by the EPA to categorize the quality of the outside air. These standards were developed to protect the public health. The AQI focuses on health effects you may experience within a few hours or days after breathing polluted air. Using the readings for Carbon Monoxide and after some calculations, this index will assign a value from 0 to 500. The higher the AQI value, the greater the level of air pollution and the greater the health concern for the population as shown in the following table:

Air Quality Index (AQI) Levels of Health Concern

Numerical Value

Meaning

Good 0 - 50 Air quality is considered satisfactory, and air pollution poses little or no risk

Moderate 51 – 100 Air quality is acceptable; however, for some pollutants there may be a moderate health concern for a very small number of people

who are unusually sensitive to air pollution Unhealthy for Sensitive Groups 101 – 150 Members of sensitive groups may experience health effects. The

general public is not likely to be affected. Unhealthy 151 - 200 Everyone may begin to experience health effects; members of

sensitive groups may experience more serious health effects. Very Unhealthy 201 - 300 Health alert: everyone may experience more serious health

effects. Hazardous 301 - 500 Health warnings of emergency conditions. The entire population

is more likely to be affected

Volatile Organic Compounds (VOC’s) Even though no standards have been set for Volatile Organic Compounds (VOC’s) in non industrial settings either, OSHA, HUD and other government agencies have established standards for specific contaminants. VOC’s are usually chemicals added to the air that can cause chronic and acute health effects like irritation in eyes and respiratory system, headache, fatigue, nausea, dizziness and cancer. They are usually founded in some cleaners, paints, solvents, glues, photocopiers, pesticides, gasoline vapors, cigarette smoke, cosmetics, construction materials and other household products. The ability of organic chemicals to cause health effects varies greatly from those that are highly toxic, to those with no known health effect. As with other pollutants, the extent and nature of the health effect will depend on many factors including level of exposure and length of time exposed. Eye and respiratory tract irritation, headaches, dizziness, visual disorders, and memory impairment are among the immediate symptoms that some people have experienced soon after exposure to some organics. At present, not much is known about what health effects occur from the levels of organics.

Carbon Dioxide (CO 2) Carbon Dioxide is a product of our breathing process. When CO2 is over this concentration the air feels heavy and many people experience breathing difficulties.

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Instruments used in the assessment:

1. Graywolf IAQ Calc,Serial # 80432

2. Industrial Scientific MX6 VOC MeterSerial # 18106765

3. Graywolf Handheld 3016 IAQ Particulate MeterSerial # 101244002

For your information consider the following references and resources:

1. FL Dept. of Health – Indoor Mold and Healthhttp://www.myfloridaeh.org/community/indoor-air/mold.htm

2. US Dept. of Health and Human ServicesCenters for Disease Control and Prevention Molds in the Environment http://www.cdc.gov/mold/

3. Environmental Protection Agency http://www.epa.gov/mold/

If you have additional or unanswered questions about mold, indoor air quality or public health please let me know. Thank you,

Wanda J. Back Environmental Specialist II Orange County Health Department Phone: 407-858-1497 x 2262 www.orchd.com www.orchd.mobi VISION:

- Exceeding the expectations of today

- Developing Environmental Health leaders of tomorrow

- Promoting and sustaining safe, healthy communities for the future

Protecting Your Health... It's What We Do

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End Notes

i “BRFSS is used to collect prevalence data among adult U.S. residents regarding their risk behaviors and preventive health practices that can affect their health status.” CDC (2013). Retrieved from: https://www.cdc.gov/brfss/data_documentation/pdf/userguidejune2013.pdf ii Aschengrau and Seage (2008) Essentials of Epidemiology in Public Health. pg. 48-51. iii According to the CDC, “Regular physical activity can improve the health and quality of life of persons in the United States of all ages, regardless of the presence of a chronic disease or disability. Among adults and older adults, physical activity can lower the risk for early death, coronary heart disease, stroke, high blood pressure, type 2 diabetes, breast and colon cancer, falls, and depression. The 2008 guidelines state that some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.” iv According to the CDC, “Insufficient sleep is associated with numerous chronic diseases and conditions, such as diabetes, cardiovascular disease, hypertension, obesity, and depression. Insufficient sleep is associated with the onset of these conditions and also poses important implications for their management and outcome. Moreover, insufficient sleep is responsible for motor vehicle crashes and industrial errors, causing substantial injury and disability each year. Sleepiness can also reduce productivity and quality of life.”iv