In traditional Soviet transit planning, the streetcar was actually at the top of the urban transit hierarchy, above the trolleybus and bus. Generally in city centers the lines ran in mixed traffic, and on the outskirts they ran in reservations along the side of a boulevard. Incidentally, Russia is the only place I know of that had MU trolleybuses. Note that the argument based on likely future improvements to the bus suggests that traditional historical roles of streetcars may not be relevant to the future.
I am a somewhat regular bus rider and occasional MAX rider. Using an iPhone to look up transit directions on-the-fly makes the bus system legible through the virtual world. The fact that Streetcar tracks show where the vehicles travel means little to me but is useful for non-fancy-mobile-phone-owning passengers. This is another example of how current technology is shifting parameters that had previously favored streetcars over buses.
It does seem to me that arguments in favor of streetcar are mostly cultural. Generally speaking, people who own nice condominiums feel streetcar is an acceptable transit mode for people for them. Buses not so much. I apologize if this appears provocative. I like riding streetcars but am not sold on widespread investment in them. I would be curious to see what data TriMet and Portland Streetcar have on ridership demographics between Streetcar, MAX, and bus, and the level of overlap.
If true, this is a bad thing. Passengers should perceive and experience each transit service type as an interconnected part of a larger system. Investing in streetcar at the neglect of bus service, and, more crucially, including the sorts of features people expect from streetcar signal priority, dedicated ROW, etc. I sense a certain amount of self-fulfilling prophecy.
The historical roles of the streetcar in pre-WWII cities was pretty much the same as buses today. Thanks for all your thoughtful feedback. As I mention in the expanded version, I think there's very strong reason to believe that the subjective differences between bus and streetcar will shrink over time, which suggests in turn that all forms of high-quality mobility will become more equal in their ability to stimulate development. It's a speculation but an informed one. However, the difference in the long run may very well remain substantial.
Buses run on roads, and that places a very severe limitation on how smooth their ride can be.
The more buses try to emulate rail, the more high-tech — and consequently expensive — they need to become. At some point you will have to concede that trains are both better and cheaper at being trains. Once you accept that, you can spend some of that futile train-emulating money on providing more frequent and extensive bus service, and on trains where warranted. In , new trains and buses will be worlds apart, just as they are now, and just as they were 50 and years ago. Regarding mixed-traffic streetcars: If cities develop as we now think they should, and if they do get their light rail and streetcars, there is every reason to think that traffic will actually decline.
So mixed-traffic streetcar operation could be a self-fulfilling prophecy, if done right. Public transit needs to get people to where they need to go reasonably quickly and without undue discomfort — else they will avoid using it. I would really love to see more trolleybuses everywhere. Unfortunately, it seems planners are as convinced that the public is allergic to overhead wires as they are that buses are untenable.
Incredible vibration, astonishing noise, comically old-timey fake plastic wood trim. Not different from the earlys low-floor buses, which were noticeably different from the even older high-floor and even louder still buses. The high end is a low average speed for bicycling, if you take it easy plus get unlucky and end up stopped at every red light.
Here is the thing: right now, with the technology and culture we have, streetcars attract more riders than buses. We must consider how long it will take for bus technology to match streetcar technology and consider that streetcar technology will improve too, especially if it becomes more popular , and spread the streetcar capital cost over that time. Then consider how many more riders will have been attracted to streetcars in that same period.
We must also consider cultural issues surrounding buses. Even if you could build a bus that provided just as good an experience for riders as a streetcar, it could take up to a generation for people to lose their cultural aversion to buses. I think it is because people ARE familiar with riding a bus.
A real world experiment would show you why people feel that way. Then ride a bus along the same stretch and compare the two rides. Which is easier to enter and exit? Which has a smoother acceleration? Which has a smoother ride? Which is quieter? Which one shakes and rattles more? As long as your ride is in a rubber tire vehicle on pavement, the ride is going to be jerkier, bumpier and more noisy than riding on rails. There is a reason why the lifetime of a bus is so much shorter than that of a streetcar; running on pavement literally beats them to death.
And whether it is or that fact is not going to change. In many locales, this is an external cost not borne by the transit agency though ultimately borne by taxpayers who fund both the transit authority and the public works department. If transit agencies were subject to fees in order to allocate this external cost, I suspect the streetcar would be a more attractive compare than it is now. Jarrett, Your post is right on target! Personally I agree with most of your comments and conclusions — including requiring the property owners on the streets where streetcars operate help pay for them.
However I disagree that streetcars are best for Portland. Additionally, there are a few of things that were not said. Streetcars crawling along in mixed traffic and obstructing motor vehicle travel lanes when boarding passengers create additional congestion thereby gumming up the streets on which they operate.
Nationally, motor vehicle engines idling in stop and go traffic wastes 2. Keeping the traffic flowing on a street must be viewed as a priority. Therefore, streetcars do NOT belong on high traffic volume arterial streets. It is highly deceptive and fictitious to suggest that streetcars have promoted private sector development. In actuality, the new development that has occurred along the present Portland Streetcar route is to a large degree due to taxpayer funded subsidies to the developers, property tax abatements and cheap land provided by the Portland Development Commission.
Given those same incentives, new development could easily occur anywhere in the city. Additionally, there is a high degree of fare evasion due to the majority of the operation taking place in Fareless Square. Comprehensive transit planning Portland has been lost.
What is currently happening is that a route is chosen for a specific mode such as light rail or the streetcar by a stacked deck of group pushing their own manipulative agenda. An effort is made to justify that route by wedging the rails into the current transportation infrastructure, then projecting increased and taxpayer subsidized density and reworking other transit operations to feed the system with the purpose of manipulating the numbers so the new service will pass muster with the Feds.
Specific transit planning must start with purpose and need with mode choice coming NOT first, but last. What is missing in Portland is an in-depth comprehensive comparison study of the overall cost effectiveness of all modes for transit for each route before a mode choice is actually made. The best example I can give occurred in the s when planning for Eastside transit alternatives and the Banfield Freeway occurred. Alternatives for transit considered ranged from doing nothing to special treatment on local streets, a HOV lane on the freeway, a bus way and light rail. Alternatives for the freeway included doing nothing, just moving the narrow lanes over to accommodate space for a transit project and various upgrades.
What eventually came out of the four year comprehensive study is what we have today — light rail all the way to Gresham it was originally only planned to go to Gateway , and upgrades to the freeway that included safety improvements and widening the facility and lanes, but to less than full interstate standards. Many of the costs such as grading and over crossings to construct light rail and make freeway improvements were shared thereby making the over all project extremely cost effective. I apologize if someone has already pointed it out and I missed it.
The bumpy ride of buses not only leads to a poor rider experience, but it also costs transit agencies money. Buses cost less than streetcars upfront, but they need to be replaced much more often — and not for free. Paved roads have costs as well, comparable to rail over several decades when you count how often they need to be repaved. If you chalk those costs up as a given for a road driven on by cars, then you concede that transit vehicles will always operate mixed in with cars. Once people stop driving and start taking the bus, transit agencies have to pay for the bus lanes themselves. Being only a little familiar with the city, I opted for the F line instead.
When I first was living in Portland proper it was a similar situation. I now do take buses quite frequently, but it took a while before I was really comfortable crossing to the East side and trying to figure out where I transferred, how many fares the ticket would be, and so forth. Things like a smartphone, Google Maps, or ride. Excellent post and ensuing dialogue.
I believe that bias is reinforced by planners who are so busy with their toy train sets they fail to recognize the desparate need to do what we can with the resources we have. Multimodal makes an interesting point: How do we address the fact that streetcars attract more riders? How should planners treat this difference?
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Should they ignore it completely, or reduce its signficance to give busses a boost? Most transit planners are professionals who take their job seriously, and are not railfans looking to replace bus service with train service to satisfy some fetish or hobby on the public nickel. Probably some of all of these.
Interesting debate and I generally agree with the original posts arguments on streetcar mobility. I just wanted to comment on Terry Parker point number 2. That development was going to happen, whether it was going to happen in that location and in that form is a different story. What transit can do is channel development. A major argument in favour of street car is that they are better at channelling development. The argument to be made then is that areas where the public realm are better cared for will attract development.
Some more money would have made a much better system. Speed of travel is simply not an important argument for or against streetcars, and it is not treated as such. However, the crucial factor is that this prejudice actually is very much related to the pure experience of riding in a bus. For a large proportion of people, such an experience is an unpleasant one primarily due to the stops, starts, jumps, and rattles ignoring the highly variable generic public transit complaints.
Who is willing to go through with this experience? And then also the people who either are dedicated to using transit or the people who have no choice but to use transit. Where I live Waterloo Region, Ontario , the bus riders often are university students or older people. The buses are very clean and reasonably new. The problem is that very very few people here and elsewhere would take any bus when they can drive. I do it mainly due to my convictions. I know that to many, buses are physically nauseating, for reasons unrelated to odors or cultural biases. You may wonder what motivates me to defends streetcars.
My main interest is in getting as many people as possible using transit, for reasons of environment and of urban form. All you are doing is deluding yourself and other planners. Because you will not attract many choice riders with buses. Not now, not in 50 years.
When oil goes through the roof, they might take transit for a bit. Until they buy their electric cars, and revert to being choice drivers. I, personally, am okay with taking buses. But would-be choice riders are not, and they are by far the most important group. How dare they! As near as I can tell, the other comments so far have responses in the post. If you live in Portland you know where Division Street and you understand how the numbered avenues run. One other salient point… you suggest, somewhat, that the authors of the document put the cart before the horse—asking where streetcars could go, as opposed to asking what transit modes would work best.
A fair criticism—except this is their charter. Portland Streetcar is a streetcar operations and advocacy organization; not the be-all and end-all of transit planning in the Portland area. Other actors are taking the wider perspective that you wish; and there are plenty of folks in Portland advocating for busses as well. Portland Stretcar could just as easily be criticized for not examining streetcar opportunities in suburbs like Beaverton or Gresham—both of which are served by MAX, and both of which have urban boulevards with similar characteristics as some of the corridors identified in the draft.
The one exception in the works, the proposed Lake Oswego line, is on an existing unused rail line. Intelligent transit planning requires looking at the issue from numerous different perspectives. Occasionally I will take the bus. If I want to go to my place, I can take 34, 35, 43, If I want to go to Lloyd center, I have no idea which bus to take. The bus maps are almost useless. If we can get a nice bus map like the Kyoto bus map, then I would probably take the bus more often.
I contend that a lot of people do select their transit mode based on mundane matters of travel time and cost, but those tradeoffs differ between cities and even between corridors, depending on the degree of congestion, the costs of driving, and the alternatives being offered. I would love to see some very controlled experiments, e. But the real thrust of my argument lies more in the vector of bus improvement than in current best-practice buses.
Even if the next 20 years of transformation is only as extensive as the last 20 years, that would still be a substantial and consequential change. The names can be somewhat confusing first of all. Until I just looked that route up I had no idea it serves downtown Lake Oswego, or even what south shore it was referring to. Since I live near the 17 I know where it goes, but it makes no mention in the name that it serves St Johns and Sauvie Island. The Germans do a much better job of conceiving transport as a single cohesive system that serves to move the public around the cities, regions, etc.
And while there are certainly plenty of transportation wish list items that one still has here i. However, in the U. Public opinion, in general, is markedly different. In particular, many middle-class people see riding a bus as something they would never do—probably because they have not ridden one in the last 30 years, and as you pointed out, there have been a lot of recent technological improvements. Riding some of the modern articulated buses here in Munich is almost as nice as the trams…almost. Perhaps we need to a lot of money to be put into advertising and demonstrating such new technology, so that your average Joe has an idea of what a modern bus is.
Anyway… I think you have an incredibly valid point here, and I applaud your courage in posting what seems to be quite the unpopular perspective. I also appreciate how specifically you stated what your argument is, however the nature of transportation planning makes it a much less cut and dry case as your example of the hammer and the house. Yes, as you said, such reasons should be cited rather than making false claims that streetcars vs.
For the same reason that many people are able to read without getting motion sick on a train rather than a car or bus, rail may be perceived as more comfortable because it glides forward and never wavers from a relatively linear path. Unless a busway has a guided path, which probably reduces the cost competitiveness with rail, it can waver back and forth a bit more, which may be less comfortable for the riders — though so subtle they may not perceive that to be the reason why.
Something to research — at the intersection of neuroscience, transit psychology and transport economics how much are people willing to pay for the guided gliding motion? Jarrett, I would love to see buses and their operation improved significantly and think this is a great aim. But with all due respect, I believe it is irresponsible to advocate that long-term infrastructure decisions be made or not made on the basis of a very uncertain prediction about the future of bus technology.
In lieu of controlled experiments, I think it would be useful to track down comparative ridership numbers on routes where a bus replaced a streetcar or vice versa. I think one major advantage is that a streetcar system is a commitment. You are less likely to eliminate entire routes, or lines, or cancel your public transit system entirely, if you have laid rail down in your roads. It will be somewhere along the track, going in the general direction you are walking.
Jarrett: While I also advocate for streetcars where they make sense and often have a positive impact on development patterns, my associate Leroy Demery and I are not knee-jerk rail advocates. I think it is clear that new streetcar lines with low ridership potential are difficult to justify economically, unless they can help leverage a lot of development and other provable benefits. I put in some links, but the computer deleted it!
Some antispam measures are over the top. I would generally agree that the extra expense of streetcars are difficult to financially justify unless there are 1 a relatively high volume of patronage—more than most corridors in U.
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Uh, oh. Just remember, Jarrett, you will never convince the railigious of anything but what they already believe. But there is literally no argument that can be mustered to convince someone who is wedded to the idea of rail that there is any important way buses are superior, except possibly as subordinate feeder service. But Cleveland has rail transit. So does Buffalo. Both cities are economically and demographically in the toilet. Did having rail cause Cleveland to be the 2nd worst performing large metro area in the country?
Of course not. Transportation is important, but rail lines are not the all powerful artifacts their supporters might suggest. Columbus is actually the 2nd fastest growing large metro area in the Midwest. In fact, 3 of the 4 fastest growing and most economically successful Midwest cities do not have any form of rail transit, excepting possibly some lame one train a day Amtrak intercity service that amounts to nothing.
Also, keep in mind that the vaunted permanence of rail lines cuts both ways. Buses are both strategically and operationally more flexible than rail, as anyone who has been stuck in a train caught behind a broken down one with door problems up ahead can attest. Thanks for these links. Have you read Hoffman's paper on Quickways? I think he's a little too obsessed with eliminating transfers, but I have to say, as someone who works in Brisbane a lot, the SE Busway is amazing, ridership is massive, and nobody seriously talks about converting it to rail now.
And it is the middle and upper classes who perceive that the poor taint behavior by virtue of identity. In the U. Wal-Mart is usually located in rural or blighted areas. One store is seen as fashionable and fun. The point is, the poor did not become perceived as loathsome or dangerous because cities took out streetcars and replaced them with buses. Putting streetcars in will not change perceptions if the people we are trying to court harbor the same prejudices of the people who are riding transit now.
If it works, it would serve as an effective counterpoint to Portland. This post and comments have been quite good, by the way! One significant advantage is likely to be energy efficiency. Any metal wheel on rail vehicle benefits from extremely low friction, meaning that it takes very little energy to keep the vehicle moving, and per kilogram or pound less energy to get it started.
Stopping the vehicle through regenerative braking allows the significant mass of the vehicle and its kinetic energy to largely be converted back to electricity for use across the transport system. This is equivalent to hybrid cars and buses , but they have the disadvantage of losing a lot of their rolling energy to rubber tyres on tarmac, leaving less to be regenerated on braking and burning more fuel just to keep going. The additional advantage comes from street cars, and any electric rail system is the electricity that the vehicles use. As everyone knows, this can be generated using a variety of renewable sources, and even if not, the pollution is at the very least remote.
Unfortunately buses rarely have this advantage, accumulating their burnt fuel including LPG and natural gas as particulates, CO and smog in the city, where the density of pollution becomes harmful to the people they are trying to help. Buses, street cars, light rail and heavy rail are all better than SUVs, or even smart cars, for a reduction in traffic and pollution.
Perhaps a bit off-topic, but— The advantage of steel wheels on steel rails is lower friction—meaning it takes less energy to keep the wheels rolling. All else being equal, a traincar will require less fuel or electricity to maintain speed on a flat surface than a bus of the same size and weight. Nothing beats an electric trolleybus for climbing steep hills; as the combination of tires with electric motors generating high torque at idle is ideal for this application.
Depending on what you are doing, rolling friction is either your friend or your foe. In many cases, streetcars ride on tracks embedded in pavement, as opposed to tracks laid on crossties on a railbed. For such applications, has anybody ever considered building a streetcar with the equivalent of landing gear—a motor-driven tire or two which can be raised or lowered as necessary to aid with acceleration, breaking, or climbing?
Or has this idea been tried somewhere and discarded as impractical or useless? Anyone care to consider the costs of obtaining ROWs in modern city environments? Who pays for this? The thing that streetcars have and that bus routes do not is permanence. And permanence begets investments. Businesses will open along a streetcar route or near a streetcar stop where they would not invest to be near a bus route or a bus stop.
Cities need to include this in consideration of public transit because density of potential riders is critical to long term viability and streetcars may do better in this measure. This photograph demonstrates possibility of cars striking passengers. East side lines were changed over to busses from cars Sunday.
This is a big reason streecars are going. You yourself have a very clear and long-running agenda. Regarding the first point, what do you say to the million tires discarded every year in America? To discard 9 billion pounds of tires that require an additional several hundred billion dollars of gas to destroy is, what, exactly? If we can replace rubber with steel, why not? To the second, several areas have received similar funding in the past to no great development — Hollywood, Old Town, the Sandy Corridor to 50th, and the biggest, 82nd. None of these areas have seen the boom that you see in the Pearl District.
Land there was certainly much cheaper than core-adjacent land in the Pearl area with high remediation costs. To the third, free as it may be in the FS, a bulk of the riders are residents of the area. Using local fixed-route service ensures that the neighborhood and not anyone else gets first jab at the benefits and prevents the need for hopping a bus to go to the Safeway on Hawthorne or the Burlingame Fred Meyer.
Finally, comprehensive transit planning has been going on in Portland for years. They attempted to fix roads, paint bridges, install new sidewalks, but those processes are stopped up frequently by the same people who thumb their nose at other transportation initiatives. Take a look at the Burnside Bridge or the Sandy Blvd projects. Check out how traffic got worse on 82nd, even with widening and restriping. Thanks for the great post. We should be advocating for better transit of whatever type. The world is too full of mode chauvinists.
Ride quality. No matter how good your roads and busses, the ride is better on the streetcar. I say this as someone who has ridden very nice buses on recently paved roads — and old streetcars on old, poorly maintained track. I get motion-sick in buses. Not in streetcars. That is huge. This is, I think, a somewhat odd post. Leaving aside the fact that mobility is not the same as speed, the core of the post seems to be the claim that improvements in buses will bring them on par with rail-based street cars, and thus eliminate the perceptual differences in terms of ridership and development.
Now of course the first objection to that is that streetcars work NOW. But looking past that, I think it would be illuminating to look at what sort of improvements are required: 1. Absolutely smooth, even streets, and possibly a guideway of some kind mechanical? This is necessary to try to replicate the smooth ride of rail, to try to reduce or eliminate the jolts, jerks, and sways inherent to a rubber-tired, human-steered vehicle moving on rough streets through traffic, swerving in and out to make stops. This is also necessary to reduce wear and tear on the vehicle, both to reduce traffic costs, and the perception of decrepitude that accompanies buses as they rapidly develop creaks and rattles.
Larger, sturdier buses would also help. Of course, good luck managing to make maintenance of ultra-smooth streets a long-term city funding priority. Very easy to let that slip, or to object to the expense of repaving a whole block after a sewer line is repaired, etc. And there goes ride quality again.
Dedicated stations, and a clearly designated, permanent-looking right of way of some kind. Fully separated would help, but the special smooth streets and guideway might be enough. All of this serves as a key signal to developers, as well as a helpful cue for users, visitors, and potential users. Smooth, electric motive power.
Note that any future improvements, in e. Larger, wider, lower vehicles. Steel-on-steel streetcars seem to have something of a fundamental advantage here, with inherently smaller wheels, and a much wider base and reduced suspension needs.
The result is higher capacity and a much more spacious, pleasant interior. Best case, I guess you end up building buses that resemble rubber-tired streetcars. Possibly you could even chain them together. So what, exactly, is the point? I think we all agree that some routes are best served by buses, and city planners should be paying attention to that.
Are you? If you replace a bus with a streetcar on the same route, nobody will be able to get anywhere any faster than they could before. I think you are right on most accounts in regards to street cars especially in the slow lane as they are never able to avoid vehicles that might be parked or worse double parked. It is my general understanding that due to the multiple factors the costs of keeping up a street running light rail as apposed to a bus is considerably less. Light rail can also be used as has been seen to very efficiently move cargo through out a city. You describe it as having usurped the 8-Market bus line, but the larger history is that the 8-Market and other tire-based vehicles took space away from a streetcar system which had a headway that was measured in seconds, not minutes.
As with the 8-Market, most longstanding U. For me, the bottom line is the environment. All other things being equal, apples-to-apples, a steel wheel on a rail has less environmental impact than a rubber tire on a road. Less fuel, fewer emissions, and less damage to the vehicles and their surfaces. As has been mentioned, they attract more riders and promote more sustainable development patterns, which multiply their environmental benefit.
While there is no perfect map, there are many good ones and cartographers by training have devised ways of delivering as much information with as little overload as possible. The frequency issue is one that has been solved easily. Transit systems usually point out discrepancies in service if they are very infrequent, like a tripper route that is dotted or broken-striped to show that it only runs a limited span of service.
Likewise, for systems that sell frequency Portland, Minneapolis, San Antonio, etc. Do you really want for these stations not to be marked? That would be bad mapmaking. Safer streets mean safer neighborhoods and more transit use. Anyway, check it out, and hopefully it will serve as an extension of the discussion that has emerged here.
Therefore, I am interested in how to make lower cost types of service more attractive to choice riders. The thing is, even in cities with massively complex tram networks Melbourne! In practice, rails seem to bring out the best in mapmakers. The map of my local bus system is quite simply out of date, showing wrong routings and stops. If you turn up at your tram stop but instead of a tram you find an air-conditioned, low-floor, high capacity articulated bus with four wide double-doors allowing easy entry and exit from all doors; an interior configuration with generous circulation space with lots of grab rails; large windows; electronic displays and audio announcements.
Could you say that that vehicle offering would be significantly inferior to that of a modern tram vehicle? If that vehicle is part of a frequent service that takes you reliably to other stops along an exclusive bus lane with priority over other traffic, giving you the same journey times as a tram but with the exception of a smooth gliding sensation while travelling, and a greater need to hold on if standing — would that experience be unattractive enough to the majority of passengers that the significant additional expense of building a tramway system could be easily justified?
The availability these days of vehicles in the style of the Las Vegas Max buses demonstrates the new directions being taken to increase the capacity and improve the attractiveness of buses which are narrowing the operational and perceived gaps between trams and buses. Finally, depending on the size of a city and its growth trajectory, introducing trams on major corridors may prove to be an expensive interim measure and delay introduction of faster and more comfortable modes by decades.
Would you wager that Toronto should close its streetcars and rip out the tracks? For all its faults, Toronto was lucky enough to preserve them as much as Melbourne kept their trams, something I wish we did more in North American cities, only for GM and the road lobby, aided by unwitting government bureaucrats, to bring it down. Oh, and that graphic at the top looks like the O-Train. Certainly, there needs to be adequate population density and adequate ridership to justify rail of any kind. But saying BRT is superior to rail and can do better makes me mad.
It was quite mad to when they ended the train services in my native province of Newfoundland and Labrador. Thank you very much, P. Brian Mulroney. Even if electrically powered rail is dependent on coal burning power plants, I would prefer it more than diesel buses, even with a technological change far in the future, and it would be more environmentally beneficial.
Like I said, it was a bunch of shit that we disposed of perfectly good streetcars. This has been true in Philadelphia and Chicago, which both once had two of the five largest streetcar systems in the world. Philadelphia kept only a few lines, but Chicago completely disposed of theirs, even with as many as PCC streetcars. I wish several but certainly not all of those that were gone other than when new subway or light rail lines opened had stayed, if such was fair enough. Sorry I was late with commenting.
A few questions: —Have the studies comparing bus vs. I suspect that where a market is overwhelmingly dependent, the difference will be small or negligable. It puts a severe dent in streetcar service. That system gets stuck in its own traffic in the downtown tunnel.
And I rode when there was the aforementioned streetwork which forced a transfer and we certainly lost at least 10 minutes. Just to comment on what was said about riding new versus old buses—if ride quality is an issue, the new buses are not always better. I live in L. In contrast, the brand-new sleek 45 and 60 foot low-floor modern marvels tend to be the bounciest pieces of sh-t I have ever ridden…and yes I am comparing them on the same routes. But the question is how much of that development was subsidized?
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Stay informed. In breakout sessions participants discussed strategies for integrating environmental health into education and practice as well as training other faculty members. Faculty champions also developed individual action plans describing opportunities, barriers, strategies, and planned activities for both training faculty and students and integrating environmental health into practice and curricula.
A reader analyzed all qualitative data by reviewing for common themes, and a second reader validated the findings. The evaluation included a section for comments. NEEF provided faculty champions with several tools to be used for future lectures, workshops, or training sessions. Throughout the project period, NEEF provided ongoing support to the faculty champions in several ways, including creating a listserv to facilitate communication and networking among the faculty champions, informing faculty champions of PEH literature and training opportunities, providing planning and implementation support, and providing materials for use and distribution at their trainings.
Investigators developed a pretest and posttest tool from questions and answers submitted by workshop instructors based on the six topic areas presented at the workshop and reflecting the competencies, for a total of 20 questions. Five health professionals pilot-tested the pretest for content validity, and the pretest was revised and distributed to all workshop participants via email 1 week before the workshop. Faculty champions completed the first posttest at the conclusion of the workshop to measure knowledge gained, and completed the second posttest 3 months after the workshop to measure knowledge sustainment.
Competency assessments were then averaged. The progress assessment form included several additional questions, including the number of faculty members trained on PEH topics and number of PEH referrals made. The form included a section to provide two to three examples of how faculty champions incorporated PEH into curricula and practice. NEEF staff electronically mailed forms to participants, who then returned the forms electronically or by fax.
Faculty champions completed the initial baseline assessment form within 1 month after the workshop and completed ongoing progress assessment forms 4 and 8 months after the workshop.
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Investigators developed an assessment form for telephone interviews to obtain direct information about methods used for incorporation of PEH into curricula and practice, including the development of any institutional intervention and materials, such as policies and protocols, as well as feedback and suggestions for program improvement.
A trained research assistant and NEEF staff conducted interviews at 6 and 12 months after the workshop. Interviewers asked faculty champions about the sustained use and degree of incorporation of PEH history taking into curricula, individual practice, and institutional practice protocols, procedures, and policies. The faculty champions also provided two or three examples of strategies used in practice that resulted in specific behavioral changes in parents and children, as well as institutional changes. The interviewer handwrote responses and later transcribed them into a typed document.
During the telephone interview at 12 months, participants reviewed their responses from the interview at 6 months. The interviewers asked participants for updates on their progress and asked about future plans to sustain efforts regarding PEH inclusion in curricula and practice. Average scores for individual topic areas ranged from 1. During the workshop, 27 of the 28 faculty champion participants completed an action plan to identify opportunities, barriers, strategies, and planned activities for training faculty members and integrating environmental health into education and practice.
The common themes identified are shown in Appendices 1 and 2. Faculty champions completed a pretest and two posttests related to the workshop content on environmental health. A total of 82 tests 28 pretests, 28 first posttests, and 26 second posttests were completed for analysis evaluating the difference in means between the examinations using two-way ANOVA. Concurrently, the average percentage correct for each of the 20 individual questions increased by Average scores for the second post-test, completed by 26 participants 3 months after the workshop, increased significantly by Faculty champions provided baseline data within 1 month of the workshop and ongoing data at 4 time 1 and 8 time 2 months after the workshop.
Rating scores for each of the five competencies were averaged for each participant on both professional practice self-assessments and curricula assessment, giving a composite rating for each participant and time interval. All competency areas combined showed improvement except for reporting exposure incidents in the practice setting, as seen in Table 1. Faculty champions reported integration of PEH content into curricula and practice in several ways as shown in Appendix 3. Additionally, the faculty champions reported on the number of health professionals they trained within the project period.
The project goal was set at health providers trained, or 10 trainees per each of the 28 faculty champions. As shown in Figure 1 , 1 , health professionals were trained in the 12 months after the workshop: physicians, nurses, and others primarily medical students, residents, and physician assistants. The faculty champions were successful in training their colleagues and community members, substantially exceeding the goal of trainees, with a rate of Figure 1 Health care professionals trained by faculty champions within 12 months of the train-the-trainer workshop, by total number and discipline.
Faculty champions were contacted via telephone interview at 6 and 12 months after the training workshop. Twenty-four of 28 faculty members completed the first telephone interview. Activities for curricula integration ranged from presenting environmental health topics at lectures, grand rounds, noon conferences, and national conferences of health professional organizations to more sustainable efforts, such as developing online courses and modules for PEH topics, integrating PEH topics into required courses, creating a center for environmental health, and forming a PEH residency certification program in which residents complete 18 PEH modules.
New integrated content focused on taking an environmental history, targeting toxic exposures, and evaluating findings. Only The amount of time committed to PEH content was varied, ranging from 0. In the second telephone interview, 20 of 28 faculty champions participated and reported building on the activities mentioned in the first interview and continuing to add PEH content into lectures and courses. Faculty champions provided examples of additional PEH activities. These included working with migrant workers and their families, teaching high school students interested in health careers about PEH, and working with state officials to make environmental health policy recommendations.
The second telephone interview included a request for feedback on the program. Many participants indicated that they found the overall program valuable. Participants reported feeling more confident about their knowledge of environmental health issues and ability to teach the material more effectively. Faculty champions also indicated they would continue their PEH efforts even after the project period ended.
Faculty champions reported an interest in participating in future training to share lessons learned from their experiences and serve as mentors for a new group of faculty champions. The initiative resulted in increased PEH knowledge among faculty champions, the education of a significant number of health care providers in PEH, and sustained changes in knowledge, practice, curricula, and institutional policies.
The train-the-trainer workshop attended by the faculty champions was an effective strategy for initiating the program, educating participants, providing tools and resources to faculty champions, and developing individual action plans to achieve the program goals. In the workshop evaluation, the sessions were rated highly effective by the participants, many of whom have had little previous exposure to the content provided. The significant change in pre- and posttest scores provided objective evidence of the limited knowledge health care professionals began with in PEH and supports the contention of several investigators that environmental health content is lacking in medical and nursing school curricula Balbus et al.
Progress assessments indicated that the areas in which participants reported being the most competent were taking a PEH history and resource use for environmental health hazards. These topics are more basic components of PEH and were a main focus of the workshop. This result is particularly important and demonstrates the potential impact of this workshop, as previous studies have found a lack of consistent and comprehensive environmental health history-taking Balbus et al. Areas in which participants reported being moderately competent were making referrals and involvement with the community.
Participants reported being the least competent in reporting incidents in order to comply with regulatory requirements. To properly submit a report of an incident-related exposure, one must first detect an environmental toxicant-related disease. Regulatory-required reporting usually follows accurately detecting environmental toxicant—related disease—a complex skill.
The complexity involved may explain the decreased comfort of practitioners in these areas.
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Also, there could have been uncertainty about what to report or where to report, or that specific incidents did not present themselves. It is also possible that respondents forgot some of the incidents they reported, or did not want to get involved with regulatory issues. Consequently, this may suggest an increased need for training regarding regulatory requirements and reporting incidents. Review of the action plans completed at the workshop resulted in seven themes for training faculty members and eight themes for practice and education integration.
Except for one action plan strategy—discussion with certification boards about incorporating PEH content questions on examinations—all strategies were achieved, demonstrating the remarkable effort and commitment by the faculty champions in achieving their goals. Over a period of 12 months, faculty champions reported continuing efforts to integrate PEH into curricula and implement policy changes at their respective institutions.
Faculty champions also reported changes to protocols and procedures, including the adoption of environmental health history—taking forms at their institutions and instituting chart audits to evaluate whether PEH histories were being performed. Five respondents reported changes related to smoking cessation, including the development of a smoking cessation clinic, second hand smoke training, and audits to ensure that environmental tobacco smoke exposure screenings were being performed.