Located in the northeast portion of the state of Oklahoma, the Tulsa Health Department serves Tulsa County, which is the second largest county in Oklahoma. About 63 percent of residents live in the city of Tulsa, although there are many quickly growing suburbs surrounding the city. Outside of these suburbs, the region becomes less urbanized and more rural. In general, Tulsa County is more diverse than Oklahoma, with the exception of American Indians/Alaska Natives. The majority of Tulsa County residents are white (71.1 percent). The remainder of the population is blackâ€”10.1 percent, American Indian/Alaska Nativeâ€”4.6 percent, Asianâ€”2.7 percent, Native Hawaiian/Pacific Islanderâ€”0.1 percent, some other raceâ€”3.6 percent, or multiple racesâ€”7.9 percent. Additionally, 11.9 percent of Tulsa County residents are Hispanic, compared to 9.6 percent in Oklahoma. Tulsa County has poor health outcomes. There are worse chronic disease mortality rates than the United States overall and a lower life expectancy overall. Within Tulsa, a ten-mile distance between neighborhoods can result in a ten-year difference in life expectancy. The 2015 Tulsa County Community Health Needs Assessment, a survey done every three years to evaluate health behaviors in Tulsa County, reported that about three-quarters of Tulsa County residents walk or run outside. However, this was lowest in north Tulsa, which is also the region of Tulsa with lowest vehicle access and many of the poorest health outcomes. This indicates that even though this area has a high need for walking or biking as a form of transportation, there are still barriers to walkability. Through our walkability project, we aimed to increase active transportation options, with the anticipated outcome of increasing access to healthy options such as food and physical activity opportunities. Current lack of infrastructure, as well as limited public transit options, makes it difficult to make healthy choices when vehicle access is unavailable.
This project started as part of the Walkability Action Institute (WAI), a three-day training program hosted by the National Association of Chronic Disease Directors (NACDD). As part of this program, a team was formed that included a public health professional (Tulsa Health Department epidemiologist; team lead), Indian Nations Council Of Governments (INCOG) transportation planner, the regional metropolitan planning organization, City of Tulsa traffic engineer, a community advocate from the Accessible Transportation Coalition, and newly elected Tulsa city councilor. Due to the makeup of the group, the project focused on the city of Tulsa initially, with hopes to expand into other municipalities. Our overall goal was to increase the percentage of people in each Tulsa County region who report walking or cycling in the Community Health Needs Assessment (CHNA) survey to 80 percent (walking) and 35 percent (cycling), and increase the percentage of active transportation commuters to 0.6 percent (cycling) and 3 percent (walking).
The Walkability Action Institute team, in conjunction with the newly formed Community Health Improvement Plan (CHIP) Built Environment Alliance Group and Bicycle/Pedestrian Advisory Committee (BPAC), identified multiple strategies to achieve walkability goals: adopt the bicycle/pedestrian master plan (GO Plan) as a City of Tulsa comprehensive plan amendment, conduct pop-up traffic calming demonstrations, and increase active transportation among Tulsa Public School (TPS) students.
These three groups represent a wide variety of organizations and disciplines, which was a main contributing factor to our success. With a diverse team representing different disciplines, we could affect walkability at many other different levels: planning, policy-making, and public health advocacy. Including traffic engineering provided an especially interesting perspective and allowed for opportunities to promote walkability in conjunction with, as opposed to in opposition to, proposed road projects. Additionally, recent changes in city leadership give Tulsa even more opportunities to increase the established momentum and serve as a catalyst to improving coordination among agencies.
To date, the GO Plan has been adopted, the first bike lane ordinance in the state of Oklahoma has been adopted, a GO Plan media campaign is preparing to launch, two traffic calming demonstrations have been completed, and Tulsa Public Schools will begin active transportation data collection in the spring 2018 semester.
While our goal is to increase the percentage of people walking and biking, we believe that these strategies to increase walkability lead to increased accessibility to healthy options such as food, physical activity, education, and employment. The public health impact of increasing residents' access to healthy options includes decreased chronic disease rates for diseases such as diabetes and cardiovascular disease, increased life expectancy, and improved quality of life for Tulsa County residents.
For more information, please visit our website at www.tulsa-health.org.
From 2012 â€“ 2015, there were 183 pedestrian and bicycle collisions in the city of Tulsa. This not only identifies a safety issue within the city of Tulsa, but also a public health issue. By designing streets that are not walkable and/or bikeable, fewer people will be willing to choose active transportation options, which have positive health and environmental associated outcomes. Individuals who do not have the option to choose to drive are forced to walk in dangerous conditions, making it much more difficult to access employment opportunities, school, and other daily needs. In the city of Tulsa, almost 9 percent of households have no vehicle access; however, there is a zip code in north Tulsa where 22.4 percent of households do not have access to a vehicle. This is especially concerning because there is also not comprehensive transit accessâ€”only one-third of individuals in this zip code is within Â¼ mile of a transit stop. This zip code is primarily a community of color and has poor health outcomes, compared to Tulsa County overall. This is true of most areas in Tulsa County with high percentages of minorities.
Additionally, one-third of Tulsa County residents reported no leisure-time physical activity and about two-thirds are overweight or obese in 2015. According to the U.S. Department of Transportation, bicycle and pedestrian facilities create opportunities to exercise and help reduce obesity and risk for chronic conditions such as diabetes and cardiovascular disease. Active transportation options are especially important in low-income, minority, and immigrant communities, as these residents are less likely to own vehicles and unsafe streets can create significant barriers to access.
Historically, there has been a perception that minority communities in Tulsa do not receive the same infrastructure improvements as other parts of Tulsa. The GO Plan aimed to challenge this perception by prioritizing projects based on achieving equity in communities with reduced access to walking. By adopting the GO Plan, there will be many more opportunities to advocate for complete streets in communities with poor walking infrastructure. This plan adoption reaches the approximately 403,000 residents of the city of Tulsa, which is about 63 percent of Tulsa County residents. Since the implementation is funded, our role moving forward is to continue advocating for health equity in project selection.
Traffic calming demonstrations have never been done previously in Tulsa County. Although they are not a new concept, it is uncommon that a health department is the lead on this type of project. Generally, they are coordinated through planning departments or citizens. Citizen groups often engage in tactical urbanismâ€ which is usually not permitted and can cause strife with the city. Pop-up traffic calming demonstrations are a creative new way to engage with the City of Tulsa because it removes the burden from them and allows us to show them the benefits through no use of their own resources. If the design fails, they do not have constituents/citizens to answer to; if it succeeds, they have data and community engagement to continue the project. While there are multiple strategies for pop-up traffic calming demonstrations, we based ours on the â€˜Slow Your Street: A How-To Guide for Pop-Up Traffic Calming' guide that was created by Trailnet in 2016 through the Saint Louis Plan4Health project. This guide provides information on the planning process, community engagement, and site plans for traffic calming demonstrations.
An estimated 6,661 residents (about 1 percent of Tulsa County residents) live within one-half mile of the two traffic calming demonstrations that have been conducted and could reasonably be assumed to benefit from traffic calming in their neighborhood.
A systematic literature review of the built environment effects on physical activity and active transport found that improving neighborhood walkability and providing adequate active transport infrastructure was likely to generate positive impacts on activity in children. (Smith, 2017) In this systematic review, 28 studies were included for review, with findings showing a positive effect of walkability components, and installation of or improvements in active transport infrastructure with visits or use.
A study of active transportation on a complete street found that 12 specific subtypes of walkability items, yielded 81% correct classification of residents' active transportation. (Jensen, 2017) A subset of walkability items including sidewalks, zebra-striped crosswalks, yellow-lined crosswalks, decorative sidewalks, pedestrian signals and blank walls had important impacts on perceived walkability, and perceived walkability was an important prediction of active transportation. A walkability audit used in the study found that the presence of sidewalks and pedestrian crossings related to objectively measured physical activity or self-reported walking.
One method of traffic calming is the installation of speed humps. A study was done to determine is effect of speed humps and the impact on pedestrian-motor vehicle collisions (PMVC.) This study found mixed land use was associated with more collisions, but that after speed humps were installed, PMVC rates decreased, particularly for children. (Rothman, 2015) Speed humps are an easily replicated traffic calming method and have a significant protective effect on PMVC. Jensen, W. B. (2017). Active Transportation on a Complete Street: Perceived and Audited Walkability Correlates. Int J Environ Res Public Health, 1014.
Rothman, L. M. (2015). Installation of speed humps and pedestrian-motor vehicle collisions in Toronto, Canada: a quasi-experimental study. BMC Public Health, 774.
Smith, M. H. (2017). Systematic literature review of built environment effects on physical activity and active transport â€“ an update and new findings on health equity. Int J Behav Nutr Phys Act., 158.
Nutrition, Physical Activity, and Obesity
Our identified strategies were to adopt the bicycle/pedestrian master plan (GO Plan) as a City of Tulsa comprehensive plan amendment, conduct pop-up traffic calming demonstrations, and increase active transportation among Tulsa Public School students, with the goal of increasing walking and biking in Tulsa County. Our initial focus was on the city of Tulsa, but as we begin to collaborate with more partners, our reach has expanded. Strategies have stayed the same, but we hope to implement them in more Tulsa County municipalities.
The initial Walkability Action Institute group has merged with the Community Health Improvement Plan Built Environment Alliance Group and worked closely with the Bicycle/Pedestrian Advisory Committee. Through these groups, a variety of disciplines and organizations are represented: City of Tulsa (Mayor's Office, Traffic Engineering, Planning Commission, and City Council), Tulsa Health Department (epidemiology department and Healthy Living Program), INCOG (land use and transportation planning), Pathways to Health, the non-profit arm of the Tulsa Health Department, and advocacy groups (Accessible Transportation Coalition and Tulsa Hub).
The first strategy, GO Plan adoption, was led by INCOG transportation and land use planners. The plan was completed by an outside consultant and adopted regionally in 2015, but has not been adopted in all municipalities. In August 2016, INCOG planners presented the GO Plan to the Tulsa Metropolitan Area Planning Commission (TMAPC) for recommendation that it was in conformance with the comprehensive plan. One member of our collaborative effort is also a TMAPC planning commissioner and was able to strongly advocate for this positive recommendation. It was then sent to city council, where the champion was the city councilor who attended the WAI training. Voters also approved a sales tax measure in 2016 that will provide dedicated funding for GO Plan implementation, so now that it has been adopted, projects are being initiated. One of the first projects is restriping downtown, which will create safer pedestrian spaces as well as dedicated bike infrastructure. Through BPAC, the Tulsa Health Department will advocate for prioritization of projects that will promote health equity and provide access to active transportation options for vulnerable populations. In conjunction with this, a bike lane ordinance was also adopted to ensure that there are clear rules on how people who walk, bike, and drive should interact with bike lanes. Additionally, the City of Tulsa is preparing to launch a GO Plan media campaign to promote safety and awareness.
Additionally, our group has been reaching out to other municipalities in the region to promote GO Plan adoption. Currently, two Tulsa County municipalities have shown interest and are beginning the process. We have also identified champions in neighboring counties that were also included in the GO Plan to begin the process in those municipalities.
The second strategy, pop-up traffic calming demonstrations, was done in collaboration with Pathways to Health, the Tulsa Health Department and BPAC. Pathways to Health, which is the non-profit arm of the Tulsa Health Department, aims to improve health in Tulsa County by leveraging cross-sector community partnerships. In April 2016, THD/BPAC received a $5,000 grant from Pathways to Health to conduct pop-up traffic calming demonstrations. â€˜Traffic calming' refers to street design elements such as crosswalks, pedestrian refuge medians, roundabouts, and bike lanes, which lead to decreased traffic speed and increased safety for pedestrians and bicyclists. Pop-up traffic calming demonstrations allow community members, elected officials, and city staff to visualize safer streets and identify ways to create healthier communities. This collaborative approach provides an opportunity for multiple stakeholders to talk about how to increase safety and influence policy change.
To date, two pop-up traffic calming demonstrations have occurred, with a third in the planning stages. THD has taken the lead on these demonstrations, although our partnership with the City of Tulsa through the Walkability Action Institute has made the special event permitting process much easier than previously anticipated. In the past, BPAC has been interested in these type of events, but could not receive permits from the City of Tulsa. Demonstrations have been selected based on neighborhood concern and timeliness of a street redesign projectâ€”there is a greater chance of the temporary demonstration becoming permanent if a street already has funding for reconstruction that hasn't started yet. In the future, we plan to be more deliberate about choosing locations that promote health equity and directly impact vulnerable populations. In many instances, this will coordinate with prioritization for GO Plan implementation projects.
The first demonstration was on a residential street that was planned for redesign. At the time, the current design of the street allowed for people to coast through the intersection while barely slowing down. The pop-up traffic calming demonstration used chalk, cones, and hay bales to decrease the turn radius and add a median. Driver behaviors were observed before traffic calming and with multiple configurations, with the most successful configuration increasing compliance from 45 percent (no traffic calming) to 75 percent (with cones, hay bales, and chalk). After the demonstration, a brief report was sent to the City of Tulsa Traffic Engineering with recommendations, one of which was included in the permanent redesign plan.
The second demonstration was at a school that is eligible for safety improvements within the next three to five years. The school driveway, which parents use to pick up students, is 78 feet wide with no crosswalks or pedestrian infrastructure. The temporary traffic calming project used chalk to draw crosswalks and cones and hay bales to create two pedestrian refuge islands. These islands also created lanes, instead of one big expanse of asphalt that had no clear direction for vehicles. Observationally, almost two-thirds of drivers correctly navigated the new configuration without driving over the paint during school pick-up. Two teachers reported that it was much calmer than usual and drivers were making much slower turns. While people did seem confused, there was no anger, and multiple people were appreciative of the demonstration.
The third strategy, increasing the number of students who use active transportation options to get to school, is in the preliminary stages. We have partnered with Tulsa Public Schools to develop a survey that will be distributed in spring 2018 to identify students who currently walk/bike to school, as well as perceived barriers and concerns from parents regarding walking/biking to school. This will help us to partner with City of Tulsa, which has funding for school safety improvements over the next three to five years. This survey will be completed annually and will help determine activities for the next year.
All of these strategies have taken place starting in April 2017 and are ongoing. The GO Plan adoption and walk to school promotion are currently happening with in-kind donations of time from THD, City of Tulsa, INCOG, and TPS staff. Pop-up traffic calming events have a budget of $5,000â€”currently two events have been conducted for $249.67 total. We hope to increase the scale of these events in 2018, which will be more expensive. However, larger scale events will require more community engagement and investment from area property owners and/or institutions, which we hope will lead to partnerships either through in-kind or monetary donations.
Our first strategy, GO Plan adoption, was evaluated through a policy change. The GO Plan was recommended for adoption to Tulsa City Council by the Tulsa Metropolitan Area Planning Commission on 8/16/17 and was adopted as a comprehensive plan amendment on 8/30/2017. As policy change is a short-term outcome, we plan to continue evaluation throughout the implementation phase. Our goal, in coordination with BPAC, is to encourage and oversee implementation of 10 percent of projects by 2019. We will evaluate this through an increase in number of miles of sidewalks and bike lanes. Additionally, bicycle and pedestrian crashes in the city of Tulsa will be analyzed to identify long-term safety impacts of GO Plan infrastructure. This will be done in conjunction with the transportation safety planner at INCOG. We are also evaluating GO Plan adoption based on other municipalities. Currently, there are four municipalities that we are working with to adopt the GO Plan, although none have them have done this yet.
Our second strategy, pop-up traffic calming demonstrations, has been evaluated through some events and observational/anecdotal data on the day of events (short-term outcomes), and permanent infrastructure changes, decreases in bicycle/pedestrian crashes, and an increase in active transportation (long-term outcomes). Thus far, two events have been conducted.
The first event was evaluated by keeping a tally of drivers observed failing to come to a safe stop of the intersection's stop signs during four different intersection configurations. Configuration 1 (normal conditions, no traffic calming) had a 45 percent compliance rate. Configuration 2 (relocate curb with hay bales and cones) had a 75 percent compliance rate. Configuration 3 (add a median with cones) and configuration 4 (remove cones and create median with chalk lines) both had a 50 percent compliance rate. This data was collected by THD and BPAC volunteers. The observers took care to stand away from the intersection while observing, for a group of people in orange vests to not upset the results. Unfortunately, there were no speed measurements taken with a radar gun. Multiple residents walked by the demonstration and asked questions and expressed excitement about the possibility of permanent traffic calming. Many residents had voiced concerns at a neighborhood association meeting about the speed and safety of this intersection. The city councilor for this neighborhood helped with the demonstration, which gave the residents an opportunity to advocate for traffic calming to a policy maker. Additionally, several large vehicles (fire truck and yard-work trucks with long trailers) passed through the configurations and did not have trouble navigating the hay bales and cones.
The second event was evaluated by keeping a tally of drivers observed failing to correctly navigate the new driveway configuration. A total of 65 cars were observed coming into the parking lot during school pickup. Twenty four of them were observed driving over the paintâ€ (about 37 percent). One person hit a cone, and a bus driver ran over a hay bale. However, everyone was able to make it through the new design. Four pedestrians were observed using the newly painted crosswalks.
Observationally, it seemed like parents were used to aiming for the middle of the large driveway, instead of it being used as a two-lane entrance, which was the new design. This change forced them to make much slower turns. At least two parents were observed with their phone in their hands, but then putting the phone down because they had to be more cognizant of the new lanes. No one appeared upset at the new design, although there was some confusion. Two teachers told us that it was much calmer than normal and multiple people stated that they appreciated our efforts.
Long-term outcome evaluation indicators for both traffic calming demonstrations and GO Plan adoption/implementation include the percentage of people who report walking and biking in the Community Health Needs Assessment (walking: 80 percent; biking: 35 percent) and the percentage of people who report commuting on foot or via bicycle in the American Community Survey (walking: 3 percent; biking: 0.6 percent). Current baseline values are walkingâ€”72.2 percent, bikingâ€”25 percent (CHNA), commuting on footâ€”1.3 percent, and commuting on bicycleâ€”0.3 percent (ACS 2015 5-year estimates). However, since no new data is available since we began our initiative, we will evaluate these changes in the coming months.
Changes in infrastructure will be evaluated through the number of miles of bike lanes and sidewalks, and any other permanent traffic calming infrastructure installed as a result of these pop-up demonstrations. This data can also be analyzed by zip code or region of pop-up demonstration to identify any changes in target areas. To date, the City of Tulsa has included one recommendation from the first traffic calming demonstration into the street reconstruction design, although construction is not yet complete.
The third strategy, increasing the number of students who use active transportation options to get to school, is in the preliminary stages. We have partnered with Tulsa Public Schools to develop a survey that will be distributed in spring 2018 to identify students who currently walk/bike to school, as well as perceived barriers and concerns from parents regarding walking/biking to school. This will help us to partner with City of Tulsa, which has funding for school safety improvements over the next three to five years. We will conduct the survey annually to evaluate City of Tulsa school safety infrastructure improvements, as well as changes in parent perceptions regarding walking/biking to school. This will help us to develop materials to increase parent/child knowledge and awareness. This will be done in coordination with Bike Club, a local non-profit, which teaches fifth-graders to ride bikes as a form of transportation.
Currently, political will in the City of Tulsa is strong for walkability. This has led to increased policy adoption that promotes safety for people who walk and bike. Policy adoption is low cost and sustainability is only dependent on decision makers to uphold the policy. Because of this, we are continuing to focus on policy adoption in other local municipalities. Additionally, there are many individuals working together on the advocacy of these policy changes, but as it is a collaborative effort, this work is not dependent on a single funding stream. The Tulsa Health Department has also made a commitment to built environment/chronic disease work and recently switched funding streams for this from grant funding to levy funding. This affords the position more stability and opportunity for sustainability.
Our collaboration through this project with the City of Tulsa has proved invaluable. On a very simple level, it is easier to obtain permits for traffic calming demonstrations because one of the reviewers participated in this project. On a larger scale, our relationships have led to more communication about infrastructure projects. In the past, the Tulsa Health Department has not had opportunities to advocate for healthier design options until the design phase was already complete. By building relationships with engineers and neighbors, we have been successful at creating an avenue to look at traffic calming before new infrastructure is completed.
Throughout the traffic calming project, we have learned that many community partners and neighborhood organizations are interested in walkability and traffic calming, although they may not have the resources to pursue these types of events. In the future, we plan to develop a lending libraryâ€ as we conduct more events so that other groups can utilize the same tools and supplies. Additionally, by partnering with the Tulsa Health Department, other organizations have access to in-kind donations such as utilizing our liability insurance and already existing supplies, such as cones. Liability insurance specifically can be quite cost prohibitive for small organizations, especially neighborhood groups, but by acting as a lead organizing partner, we can help mitigate this.
Additionally, traffic calming demonstrations are building our advocacy base. For example, our traffic calming demonstration in the Hoover neighborhood gave residents and parents concrete ideas to take to their city councilor or school administration to ask for improvements. This area is not planned for a redesign for a few years, but when it happens, advocates will be prepared, as opposed to continually trying to catch up to the process.