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Integrating Health and Physical Activity Goals Into
The Federal Highway Administration and Federal Transit Administration
Offices of Planning
U.S. Department of Transportation
Volpe National Transportation Systems Center
Research and Special Programs Administration
U.S. Department of Transportation
NOTICENeither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or use of any information, apparatus, product, or process disclosed. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the United States Government or any agency thereof. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government or any agency thereof.
The roundtable was organized by the Federal Highway Administration (FHWA) and the Federal Transit Administration (FTA) of the U.S. Department of Transportation (USDOT) to bring together transportation and public health professionals to discuss opportunities and strategies to include health and activity goals within the transportation planning process. The premise is that health impacts are typically not considered within transportation planning despite increasing recognition that investment decisions and strategies resulting from this process can have major health impacts. The roundtable considered why this is the case and exchanged ideas about strategies to encourage better integration of health and physical activity goals within transportation planning.
The goals of the roundtable were to: 1) discuss ways to enable transportation planners to incorporate health and activity goals into the transportation planning process; and 2) enable public health practitioners to become more involved in the transportation planning process. Transportation planning and public health experts with experience in integrating public health and activity goals within transportation planning exchanged perspectives and discussed how to expand opportunities to work together. The presentations and discussions during the roundtable were intended to provide participants both from public health agencies and transportation planning and operating agencies with ideas and information to incorporate within their programs and organizations. USDOT will distribute information and insights from the roundtable to a national audience of transportation planners and others interested in transportation through the FHWA and FTA Transportation Planning Capacity Building program. Participants left with a better understanding of how each field operates, areas of mutual interest, and opportunities for future collaboration.
Participants represented different fields and perspectives within transportation planning and public health and provided overviews on research and practice. Since transportation planning is typically undertaken by State Departments of Transportation (DOTs), federally designated metropolitan planning organizations (MPOs), city and county transportation agencies, and transportation providers, representatives from each of these entities participated in the roundtable. Similar to state and local agencies with energy, environment, economic development, and land use responsibilities, public health agencies can also consider transportation trends, issues, and strategies in their planning. Members from city, county, and state departments of health and academic and national public health programs participated to provide the public health perspective on how to improve integration.
The roundtable was by invitation to allow a broad and structured discussion within the space and time allotted (Figures 1 and 2).
The 29 participants represented transportation, public health, and academia from all over the country (Table 1). Additional information on all participants is provided in Appendix A. Each panel began with an overview followed by presentations with examples of applications and experiences for each topic.
* Denotes speaker
† Denotes panelist
Following an introduction and topic overview, the roundtable was divided into two consecutive panels: the first focused on transportation planning; the second focused on health and activity. The agenda is attached as Appendix B. Speakers provided an overview and context for each panel and panelists described their experiences and perspectives on identified sub-topics (Figure 3). Discussions followed the conclusion of each part and a general discussion took place at the end of the roundtable to summarize main points.
The roundtable began with opening remarks by Richard F. Krochalis, FTA Regional Administrator, Region 10, and Dave Cox, FHWA Division Administrator, Oregon. Next, Sherry Ways of the FHWA provided an overview of the topic and of the roundtable, its sponsorship under the FHWA and FTA Transportation Planning Capacity Building program, and the types of support the FHWA and FTA can provide on this topic. This support includes:
William Lyons of the USDOT/Volpe Center discussed the format, themes, and goals of the roundtable. The main themes for discussion included:
Because of the complexity of the topics of transportation and public health, the roundtable began with two critical focuses (Figure 4). These focuses were intended to guide discussion and assist in improving the understanding of potential linkages between the fields of transportation planning and public health:
Figure 4: The focuses of the roundtable (areas in dashed lines).
Each panelist provided a perspective on one of the following topics: incorporating non-motorized travel in transportation planning, regional or MPO-scale transportation planning experiences, planning in state departments of transportation, or public transportation planning. These perspectives were important to share with the participants since many participants from the field of public health had limited knowledge of these topics.
The panelists used the following questions to guide their presentations:
The answers to these questions were intended to provide participants both from public health and transportation planning and operating organizations with ideas and information to incorporate within their own programs and organizations.
Overview and Context
Dr. Susan Handy, Associate Professor, Department of Environmental Science and the Institute of Transportation Studies, University of California, Davis, provided an overview of the transportation planning process. Transportation planning is both top-down, with policies and directions from the federal government and state agencies, and bottom-up, with key plans and decisions implemented at local levels. There are key agencies at different levels of government with a range of responsibilities in the planning process (Table 2). Public health and active living goals must be integrated into the planning process at each of these levels.
|Policies - planning process
Funding - enhancements
Programs - e.g., bikes and pedestrians, livable communities, etc.
|State||DOT||Policies - State Transportation Plan
Funding - federal match, state programs
Implementation - construction, maintenance
|Policies - Regional Transportation Plan
Funding - local sales tax
Implementation - transit system and operations
Policies - General Plan, capital improvements
Funding - general revenues, special taxes
Implementation - construction, maintenance
Research on the link between the built environment and physical activity for utilitarian purposes suggests that residents walk and bike more in communities that provide proximity to destinations, direct connections to destinations, and attractive and safe places. Much of the burden for meeting these goals falls on local governments and on land use planning (Table 3). Thus, efforts to integrate physical activity goals not just into transportation planning but also into local land use planning processes are needed.
|Land Use Patterns||Proximity to destinations||City - general plan, zoning, subdivision review|
|Transportation System||Direct connections to destinations||City - subdivision ordinance, public works
MPO - bike/pedestrian projects
Transit - system design
- Safe places
|City - design guidelines, policing programs, traffic calming|
Dr. Handy concluded her presentation by comparing traditional approaches to key elements of the planning process to emerging approaches that may provide opportunities for incorporating health concerns into transportation planning (Table 4).
|Element||Traditional Approach||Emerging Approach|
|Level of Service (LOS)||Volume/capacity on roads||Accessibility, bike and ped measures|
|Travel Models||Impact of road capacity expansion on LOS||Impact of land use strategies on transit and active travel|
|Public Involvement||Comments on proposed plans||Definition of problems, identification of potential solutions|
|Project Prioritization||Based on costs vs. improvement in LOS||Multidimensional measures of benefits|
|Financing||Projects limited by funds available||Innovative techniques to cover needs|
Incorporating Non-Motorized Travel in Transportation Planning
Dr. Michael Meyer, Professor of Civil and Environmental Engineering, Georgia Institute of Technology, described how aspects of transportation planning and modeling processes significantly limit the serious consideration of non-motorized transportation options in regional and local decision making. After describing how a typical transportation planning process operates, Dr. Meyer made a series of observations:
Some metropolitan areas have taken positive steps to rectify the deficiencies described above and effectively capture non-motorized trips in the transportation planning process. These steps include:
Regional or MPO-Scale Transportation Planning Experiences
Dan Hatley, Planning Director of the Berkeley-Charleston-Dorchester Council of Governments (BCDCOG) in South Carolina, discussed the transportation planning process and experiences from the MPO and regional levels. The Berkeley-Charleston-Dorchester metropolitan area includes three counties, 14 municipalities, an air force base, and a state port and has a population of just over a half a million with 460,000 people in the metro region. The region has an ideal model for a compact mixed-use development pattern in the historic peninsula city of Charleston. While the development patterns of the 1970s and 1980s for the region were mostly low density sprawl, there are now are several high-profile new urbanist/neo-traditional developments as well as a large inner-city/former navy base revitalization/infill compact mixed-use development under way in North Charleston.
ISTEA and TEA-21 changed transportation planning by requiring multimodal transportation planning and by giving MPOs a more significant role in the transportation planning process and a higher amount of funding. These changes in part led to a policy change in the Charleston MPO that required new highway projects or improvements to include bicycle and pedestrian facilities (Figure 5).
BCDCOG recently analyzed growth trends in the region from the 1970s to 2000 using satellite imagery from NASA Mission to Planet Earth. They found that while population increased by 52% from 1973 to 2000, the developed area or urbanization increased by 318%. From analysis of these growth trends, staff realized that most of the MPO projects slated for the 1990s were necessary largely due to poor land use decisions. Accordingly, BCDCOG attempted to link land use and transportation planning through a regional "Growth Options" initiative that was made possible partially with funding from the first year of the FHWA Transportation and Community and System Preservation Pilot (TCSP) Program. Growth Options analyzes various development and growth patterns as well as the costs, both to the environment and to serve with infrastructure. Funding from the National Oceanic and Atmospheric Administration (NOAA) has provided for analysis of alternate development patterns and costs on a site basis. Staff and program partners hope to promote infill and compact mixed-use development with a goal to reduce future infrastructure needs.
Through TEA-21-related enhancement programs, the MPO staff discovered new partners for bicycle and pedestrian planning in the Charleston Area Bicycle Advocacy Group, some of whom come at the issue from the recreational and health perspectives. Through the "Growth Options" program and other urban design initiatives, MPO staff became involved in the Medical University of South Carolina's yearly Urban Design for Healthy and Prosperous Cities Conferences and Community Leaders Environmental Education Conferences. Staff and partners began to investigate South Carolina health statistics and realized that a case could be made for the need to consider health in transportation planning. South Carolina has the highest stroke death rate in the nation and has the third highest rate of diabetes. Seventy-nine percent of the population is considered at risk for health problems related to limited exercise. This led to a partnership of BCDCOG, Charleston Metropolitan Planning Organization (MPO), the Charleston Bicycle Advisory Group, and the Medical University of South Carolina (along with other interested groups of citizens) to submit a proposal to the Robert Wood Johnson Foundation - Active Living By Design Program in 2003. The proposal was funded and will help the transportation planning process in the region evolve yet again in the upcoming years.
Planning in State Departments of Transportation
Julie Mercer Matlick, Community Partnership Program Manager in the Highways and Local Programs Division of the Washington State Department of Transportation (WSDOT), discussed transportation and health-related planning by State DOTs. WSDOT began to educate people of the health benefits of active environmental design in 1995. Through community workshops on urban design that discussed walkable and bikeable communities, trails, downtown revitalization, and bicycling, the public has placed a higher value on bicycling, walking, safe school routes, and safe accessible transit. In addition, training programs within WSDOT, such as design and planning workshops, have strengthened staff understanding of the health benefits of active environmental design. To further strengthen this understanding, WSDOT involved other agencies in the planning of a number of their projects. These agencies included the FTA; FHWA; the Department of Health's nutrition and physical activity advisory team, which developed the state's data-based Health Plan; and the state land use agency, which reviews comprehensive land use plans. Ms. Mercer Matlick advised that it is important to keep these projects non-partisan and to have good data to support decisions.
Developing strong partnerships is key to incorporating health goals into the transportation planning process. Toward this end, WSDOT has worked with the:
This last program was a grassroots initiative with Washington State MPOs and Regional Transportation Planning Organizations (RTPOs) that receives multi-year funding through a partnership with the Department of Health. Under this program, MPOs and RTPOs prioritize transportation projects for funding.
WSDOT is also involved in policy development. Some of the policies that take into account health benefits on which WSDOT has worked or adopted include a:
Additionally, a WSDOT task force is developing an active living policy for their transportation plan update. Having the political support of the Washington State Secretary of Transportation has been key for WSDOT as it develops these programs, partnerships, and policies.
Public Transit PlanningL. Richard Mariani, New Jersey Transit Chief of Customer Resources, shared his perspectives on public transportation planning and insights on the integration of physical activity goals. He observed that instead of integrating physical activity into people's lives, NJ Transit and other transit agencies across America have as part of their mission to minimize the human effort it takes to use public transit. Transit operators strive to:
Transit operators take this approach, which seems contrary to fostering utilitarian physical activity, because of the expectations that fast and easy connections are critical to attract new transit riders and compete with other modes, primarily single occupant vehicles.
However, at the same time, transit agencies are interested in increasing ridership through expanding station access and modal integration and the building of sidewalks and bicycle paths, providing bicycle racks and lockers, and putting bicycle racks on buses and allowing bicycles on board. In turn, these actions can promote health. Coupled with scarce and expensive parking, living within walking distance of stations has become popular, especially with stores locating near transit stations. For transit users who walk or bike to transit stations and no longer have to drive in traffic, transit has made people's lives less stressful.
Five communities participated in NJ Transit's Station Renewal Program during the 1990s. A key to the success of this program is that before NJ Transit presented a plan, it spoke with people in the community to see what they wanted changed. This minimized local opposition because those in a position to object became involved in the design process, and local and state political leaders became vocal about their support for the projects, which helped raise necessary project funds. The projects that resulted from this program produced benefits beyond simply upgrading a transit facility; they also became integral to communities because they were used for non-transit purposes (for example, farmer's markets, art shows, community meetings, etc.) and, coupled with less stressful commutes, they helped set the stage for the resurgence of downtowns as viable places to live and commute from. ISTEA and TEA-21 helped similar programs in other states come to fruition.
What occurred during the early years of the ISTEA funding program is instructional when considering current interest in the integration of health and transportation goals: if federal transportation program funding criteria are changed to include health goals, then what is built will change accordingly, and the projects that are funded early on will set the tone for the types of projects that will get funded in the future. For instance, representatives of NJDOT, the State Office of Smart Growth, NJ Transit, the Robert Wood Johnson Foundation, Projects for Public Spaces, and Rutgers University, among others, have met on several occasions to discuss how to better collaborate to dovetail their missions to better achieve the objectives of the Governor's Smart Growth Initiative.
For smart growth and related policies to become more widespread, "an overarching vision" needs to be created that ties together disparate smart growth initiatives in a way that is compelling and makes sense to people. To do this, there is a critical need for basic data, on both a macro and personal level, that spell out facts about the downside of current development patterns on children and routine daily life, including health.
In their presentations, each panelist talked about county health agencies, regional health agencies, or Health Impact Assessments. These perspectives were important to share with the participants since most participants from the field of transportation planning had limited knowledge of these topics.
The panelists used the following questions to guide their presentations:
The answers to these questions helped the participants identify experiences, discuss trends, and make observations that they may be able to use in their programs and organizations.
Overview and Context
Dr. Andrew Dannenberg, Associate Director for Science in the Division of Emergency and Environmental Health Services, National Center for Environmental Health at the Centers for Disease Control and Prevention, provided the overview and context for the health and activity portion of the roundtable. The design of communities, such as the connectivity of the street network, affects transportation choices and therefore affects health. The World Health Organization defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Accordingly, health includes physical health, mental health, well-being, and livability. Sprawl can affect health in a number of ways (Table 5).
|Related to land use||
|Related to automobile dependency||
|Related to social processes||
In the last 10 years, obesity rates in the United States have increased by more than 60% among adults (Figure 6); approximately 59 million adults are obese. Physical inactivity is a major risk factor for obesity.
Fifty-five percent of American adults do not participate in the recommended level of regular physical activity needed to achieve health benefits, such as reduced risk of cardiovascular disease, diabetes, and other adverse health outcomes. A sedentary lifestyle increases the risk of overall mortality 2- to 3-fold, cardiovascular disease 3- to 5-fold, and some types of cancer, including colon and breast cancer, and the effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, and even smoking. Increasing weight is associated with an overall increase in risk of:
Because transportation systems affect options available for physical activity, transportation planners can have a substantial impact on the health of their communities. A community designed with sidewalks and bicycle trails that connect people's homes to their neighbors and to schools, stores, offices, parks, and other destinations encourages higher physical activity levels than one where most daily destinations can only be reached by automobile. Well-designed roads, sidewalks, and trails also reduce the risk of injuries to pedestrians. A community with a substantial bus, light rail, and/or heavy rail network is likely to have less motor-vehicle generated air pollution and associated respiratory diseases than a similar community without such a network. In addition, persons who walk to and from transit stops may be able to incorporate physical activity into their daily routines more easily than if they drive to most daily destinations. Increased numbers of roads and parking lots also lead to increased non-point source water pollution and contamination of water supplies that can also impact human health, and increased erosion and stream siltation causes environmental damage and may affect how water treatment plants run. The mental health of individuals and a community's social capital also may be influenced by the design of a community and the transportation options available to its residents.
Dr. Dannenberg discussed the possibility that a formal process for assessing the potential effects of a transportation project on the health of a population might lead to healthier community design choices. This process could be in the form of a health impact assessment, which has similarities to an environmental impact assessment, but with a local health officer performing the assessment and considering health as opposed to environmental aspects. Regardless of whether a formal approach such as an HIA is applied, transportation planners should consider the health impacts on the affected population when planning for roads, transit systems, and walking and bicycling routes. Health should be an important consideration in transportation decisions.
County Health Agencies
Bruce Bragg, Director of Ingham County Health Department, talked about county health agencies. Ingham County Health Department (ICHD) became involved in land use planning when the Tri-County Planning Regional Planning Commission (TCPRPC) invited them to do so. TCPRPC serves the three county area around Lansing, Michigan, and is the federally designated metropolitan planning organization for transportation.
Community engagement in envisioning regional growth can be useful. TCPRPC's Regional Growth Project, which involved hundreds of citizens, helped develop land use scenarios to accommodate the region's projected growth. This planning technique made transportation and growth interesting to the general public. Through public education, people have become interested in the impacts of land use on health.
Public education and cooperation with other agencies in the region are important. Public health practitioners need to coordinate with planners and others to describe transportation planning and health impacts and to disseminate information to the public to influence change. Data sources need to be identified to help educate the public; geographic information systems (GIS) are key tools in this process because they help demonstrate to citizens that their efforts make a difference. An indicator of land use change over time (such as loss of open space) can be informative and energizing. Valid indicators to measure value and monitor change over time should also be developed to help educate the public.
Transportation and land use plans need to be synchronized and the land use vision needs to reflect community values, such as continuing investment in urban/village centers, preserving open space, and avoiding strip development and sprawl. To implement the vision, there needs to be a mechanism, such as a Health Impact Assessment, that could provide clear and understandable information. Currently, transportation and other projects are being developed with little consideration of health impacts. Health Impact Assessments could help decision makers evaluate the health impact of projects.
Regional Health Agencies
Carol Maclennan, Environmental Health Policy Coordinator for the Tri-County Health Department in Denver, talked about insights she developed while working at a regional health agency. As part of her work, Ms. Maclennan reviews county land use plans and makes recommendations to the counties on how their plans can foster public health. With respect to the health and activity impacts of transportation decisions that transportation planners need to know about, Maclennan mentioned six points:
There are a number of barriers to participation by health practitioners in transportation planning. The general perception of both planning and health agencies is that health practitioners do not have a legitimate role in transportation planning. Health practitioners are often unfamiliar with the transportation planning process and do not know how or where to intervene effectively. MPOs and state and local transportation planning agencies do not invite health practitioners to participate in the process. Where health agencies do see a role for themselves, statutory and funding limitations may exist. Statutes do not specifically mandate or address participation in broad land use or transportation planning activities. Current budget realities limit health agency resources and agencies are often challenged to meet minimum programs mandated by statute. Additionally, there is a lack of quantitative data to more fully describe the relationship between transportation planning and public health outcomes. These data are needed to support health-related criteria for transportation policies or project funding for strengthened pedestrian or bicycle elements of transportation programs and projects.
Ms. Maclennan concluded by providing advice for health practitioners seeking to participate in transportation planning. First, stay abreast of research linking transportation decisions and health and educate key policy makers on Boards of Health, in local governments, and in transportation planning agencies to secure support for public health's role in the transportation planning process. Second, educate or hire staff with a working understanding of the transportation planning process. This knowledge is critical for credibility and effective intervention. Third, build relationships with, and request participation in, local and regional transportation planning activities as appropriate. These activities take place within MPOs and city and county master/transportation planning processes.
Health Impact Assessments
Dr. Catherine Ross, Director of the Center for Quality Growth and Regional Development at the Georgia Institute of Technology, discussed Health Impact Assessments (HIA) and the status of their development. Much as health professionals seek to promote health and know little about transportation, transportation professionals seek to promote transportation and know little about health. Additionally, transportation planners typically seek to promote economic growth. Speed and convenience may be priorities ahead of promoting health, which is the purpose of an HIA. HIA is designed to bring health effects into wider discussions and to assist in balancing transportation and economic objectives with health objectives.
HIA makes use of both existing quantitative and qualitative knowledge. It provides a structured approach and is rigorous, but it does not generate absolute answers. The method used for HIA should be simple, rapid and structured, include all relevant elements, and be presented in a logical, consistent manner. The health impacts of transportation plans can be gauged for aspects of public health other than physical activity. These aspects include crashes/accidents, air and water pollution, noise, community disruption, and access to community services. The procedure for conducting an HIA can be as follows:
|Scanning||A broad overview.|
|Screening||Determine what kind of policies should be assessed. The criteria for this may be known hazards, magnitude and severity of likely effects, sensitive sites, and public concerns.|
|Scoping||This is a procedure for bounding assessment in time and space and consulting all stakeholders about their concern.|
|Risk Assessment||This characterizes the nature and magnitude of harmful and beneficial factors involved in the project. It should address how many and which people will be affected and how they will be affected.|
HIA efforts outside the United States are receiving increasing worldwide attention. These efforts are usually focused at the local project level and are almost always linked to community participation. The macro level policy environment in Europe is moving in the direction of taking health effects into consideration in all policy-making. Key challenges to HIAs include:
To address these shortcomings, an international conference in 1999 called for countries to adopt HIA procedures to appraise transport plans, programs, and strategies; develop methods, tools, and capacity to conduct HIA and estimate the economic costs of transport-related health effects; and improve the evidence base for HIA. The European experience shows that:
In the United States, lessons for HIA practice can be learned from experiences with Environmental Impact Assessments (EIA). While EIA has provided an avenue for public participation, it also results in large complex documents, is time-consuming and expensive, frequently involves litigious processes, tends to focus on projects and not policies, and does not fully (if at all) consider health outcomes. Even if HIA is not applied as a complete and stand-alone methodology, health concerns can be considered in many areas of the planning process by means of:
The goals of the roundtable were to discuss methods and approaches that transportation planners could use to incorporate health and activity goals into the transportation planning process and that public health practitioners could use to more actively and successfully participate in the transportation planning process. Consistent with the themes for the roundtable, participants used presentations and discussions to identify obstacles, promising methods, and steps necessary to reach these goals.
Participants identified the following ideas for next steps to encourage the integration of health and activity goals in transportation planning.
Appendix A - Participants in Roundtable (* Denotes speaker)Participants
Pre-Conference Session for 3rd Annual New Partners
For Smart Growth: Building Safe, Healthy and Livable Communities Conference
|Date and time:||Thursday, January 22, 2004
2:00 to 6:00 p.m.
|Title:||"Integrating Health and Activity Goals into Transportation Planning - Building the Capacity of Planners and Practitioners"|
|Location:||Broadway I/II Meeting Room
|Format:||Expert panel in three parts, with moderator|
|Participants:||Transportation planning and public health experts and invited participants in the New Partners for Smart Growth Conference.|
Background: As part of the Transportation Planning Capacity Building Initiative, the FHWA and the FTA are sponsoring an expert roundtable to discuss opportunities and strategies to include health and activity goals within the transportation planning process conducted by state departments of transportation, metropolitan planning organizations (MPOs), transportation providers, and other transportation agencies. The premise is that health impacts are typically not considered within transportation planning, despite increasing recognition that investment decisions and strategies resulting from this process have major health impacts. This session will consider why this is the case and exchange ideas about strategies for change. Transportation planning and public health experts with experience in integrated planning will exchange perspectives and discuss opportunities to work together.
USDOT will use insights from this roundtable to inform Transportation Planning Capacity Building efforts.
2:00 - 2:25 pm
Richard F. Krochalis Regional Administrator Region 10 USDOT/Federal Transit Administration
Dave Cox Division Administrator Oregon Division USDOT/Federal Highway Administration
Introduction to Roundtable and FHWA/FTA Transportation Planning and Capacity Building Program:
Sherry Ways, USDOT/Federal Highway Administration
Introduction to FHWA/FTA Transportation Planning and Health/Activity Initiative and Context for Roundtable:
Moderator - William Lyons, USDOT/Volpe Center
Introduction of Roundtable Participants
2:25 - 3:40 pm
Part 1: A focus on Transportation Planning.
3:40 - 3:50 pm
3:50 - 5:00 pm
Part 2: A Focus on Health and Activity
5:00 - 5:50 pm
Facilitated discussion with all panelists and audience.
5:50 - 6:00 pm Wrap up
Sherry Ways, FHWA
William Lyons, USDOT/Volpe Center