Rural Transportation Issues: Research Roadmap (2022)

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

C-1   Annotated Literature Review Annotated Literature Review American Public Health Association (2011). Get the Facts: Health Impact Assessments. 2p. https://www.apha.org/-/media/files/pdf/factsheets/apha_health_impact_assessments_fact_sheet_ jan2011.ashx American Public Health Association (2012). Promoting Active Transportation: An Opportunity for Public Health. Providing safe opportunities for bicycling and walking is one of the best strategies to improv- ing public health with limited resources. Improvements in active infrastructure will not only increase physical activity levels but can reduce unjust risk, improve air pollution, and provide opportunities for community connections. Incorporating public health officials into the trans- portation planning process can make a positive impact on community wellbeing. In Houghton, Michigan, (population 8,000) by working with public health officials, the city was able to pass zoning regulations to require bicycle parking facilities based on the size of the business or multi- family housing complex. Using the momentum from this policy, the health department worked with the city and the Bike Task Force to encourage the city to pass bike-friendly resolutions resulting in a bronze-level Bicycle Friendly Community designation. The city was then able to promote Complete Streets, resulting in a comprehensive Complete Streets ordinance in 2010, in addition to Safe Routes to Schools planning. Houghton shows how incremental steps can be taken to improve multimodal connections in a small rural community. Having public health officials on board was important for encouraging community designs that would promote overall community wellbeing. American Public Transportation Association (2003). The Benefits of Public Transportation: The Route to Better Personal Health. 4p. https://www.apta.com/resources/reportsandpublications/Documents/better_health.pdf The American Public Transportation Association (APTA) summarized examples of how public transportation could provide access to healthcare facilities. An estimated 4 million children from low-income families miss medical appointments due to transportation barriers each year. This report provides some examples of non-emergency medical transportation services across the United States. Amtrak (2016). Amtrak’s Benefits to State and Local Economies. Washington, DC. https://www.amtrak.com/content/dam/projects/dotcom/english/public/documents/corporate/ nationalfactsheets/Amtrak-Economic-Contribution-Brochure-083016.pdf Amtrak issued this report describing the state and local economic development benefits of its services. The report discusses Amtrak’s economic impacts (estimated at $8.3 billion/year A P P E N D I X C

C-2 Rural Transportation Issues: Research Roadmap excluding fares), direct employment (21,000 employees), and indirect job creation. The report highlights trends such as increasing ridership and ticket revenue and details the trip purposes for various corridors. State-by-state statistics are provided for ridership growth, boardings, and percentage of travelers who would not have made the trip if Amtrak was unavailable. The report also includes a list of corridors that receive financial support from state governments. Amtrak (2017). Amtrak Seeks Strategic Partners to Leverage Nationwide Right-of-Way Portfolio. Washington, DC. https://media.amtrak.com/2017/01/amtrak-seeks-strategic-partners-leverage-nationwide-right- way-portfolio/ In 2017, Amtrak issued a Request for Proposals seeking partners to help develop tele- communications, energy distribution, and other activities along 725 miles of track right-of-way, mainly along the Northeast Corridor from Boston to Washington. Previous RFPs addressed intensified development at stations and maintenance facilities. “Proceeds generated from these partnership opportunities can be reinvested back into the vital service Amtrak provides as the nation’s intercity passenger rail operator and the steward of some of the most valued transporta- tion infrastructure in this nation.” Architectural and Transportation Barriers Compliance Board (2011). Proposed Accessibility Guidelines for Pedestrian Facilities in the Public Right-of-Way. Wash- ington, DC, Federal Register. 36 CFR Part 1190. Arcury, T. A., et al. (2005). Access to Transportation and Health Care Utilization in a Rural Region. The Journal of Rural Health 21(1): 31–38. Arcury et al. analyzed data from households in rural North Carolina to examine the relation- ship between transportation and health care utilization. Most respondents accessed medical care via a personal vehicle. An additional 201 respondents report that a member or their family or a friend provided a ride. Only 48 respondents used public transportation to access health care. Respondents who used public transportation, had an average of four more chronic care visits per year than those who did not. Respondents who had a driver’s license had 2.29 times more health care appointments for chronic care and 1.92 times more appointments for checkup care compared with those who do not have a driver’s license. Asbridge, M., et al. (2012). Acute Cannabis Consumption and Motor Vehicle Collision Risk: Systematic Review of Observational Studies and Meta-Analysis. BMJ 344. https://www.bmj.com/content/bmj/344/bmj.e536.full.pdf Atkinson, J. E., et al. (2014). Manual for Selecting Safety Improvements on High Risk Rural Roads. 176p. With limited funding resources, it is important to transportation agencies to select the most effective safety treatments for rural communities. This guidebook describes effective safety treatments and appropriate use and locations for deployment. The higher roadway fatality rate on rural roads is due to many factors: roadway design (lack of shoulders, clear zones), driver behavior (speeding, impaired driving), longer EMS response times, and limited data available on safety. In addition, 80 percent of high risk rural roads are locally owned roads where agencies face limited financial resources and staff. Recommended safety treatments for non-motorized users include marked pedestrian crosswalks, pedestrian signals at signalized intersections, rectangular rapid flashing beacons, pedestrian hybrid beacons, sidewalks, adjacent shared-use pathways, shared-use paved shoulders, bicycle lanes, curb extensions to reduce pedestrian crossing distances, and grade-separated structures.

Annotated Literature Review C-3   Baas, J., et al. (2017). Eisenhower National Historic Site Visitor Transportation and Access Study. Volpe National Transportation Systems Center. National Park Service. https://rosap.ntl.bts.gov/view/dot/32580 https://trid.trb.org/view/1493184 Baas, J., et al. (2017). NPS National Transit Inventory and Performance Report, 2016. Volpe National Transportation Systems Center. National Park Service. Department of the Interior: 69p. https://rosap.ntl.bts.gov/view/dot/34400 https://trid.trb.org/view/1497998 This report summarizes the annual performance of the National Park Service’s 100 transit systems. Performance measures tracked in this report include ridership, service life, emissions, funding, and transit models. These 100 transit systems operated within 64 National Park Service units, providing rides to 43.6 million passengers. Baas, J., et al. (2018). National Park Service Active Transportation Guidebook: A Resource on Supporting Walking and Bicycling for National Parks and their Partners. Volpe National Transportation Systems Center. National Park Service. Federal Highway Administration: 167p. https://www.nps.gov/subjects/transportation/upload/NPS_Guidebook_FINAL_July2018_ lowres-3.pdf https://rosap.ntl.bts.gov/view/dot/36278 https://trid.trb.org/view/1524130 Banta-Green, C., et al. (2016). Cannabis Use Among Drivers Suspected of Driving Under the Influence or Involved in Colli- sions: Analysis of Washington State Patrol Data. Washington, DC. AAA Foundation for Traffic Safety. http://aaafoundation.org/wp-content/uploads/2017/12/CannabisUseAmongDriversInWash ington.pdf Barker, E., et al. (2017). Rail-Suicide Prevention: Systematic Literature Review of Evidence-Based Activities. Asia-Pacific Psychiatry 9(3): e12246. https://onlinelibrary.wiley.com/doi/abs/10.1111/appy.12246 Bayne, A., et al. (2018). Promising Practices for Increasing Access to Transportation in Rural Communities. Rural Evaluation Brief. http://www.norc.org/PDFs/Walsh%20Center/Rural%20Evaluation%20Briefs/Rural%20Evaluation %20Brief_April2018.pdf Transportation access improves the quality of life for rural residents. In particular, having access to transportation improves rural connections to necessary services like medical care, education, employment, etc. Over 90 percent of all trips are by private automobile in rural areas. But for transportation disadvantaged populations, owning or operating an automobile may not be a possibility. Bayne et al. explored how rural communities are meeting the mobility needs of rural residents and identified fifteen promising practices including public transportation, volunteer driver programs, ridesharing, and telehealth. These promising practices are summa- rized in this brief and will be compiled in the Rural Transportation Toolkit on the Rural Health Information Hub website.

C-4 Rural Transportation Issues: Research Roadmap Becker, C. (2014). Rural and Small Urban Multimodal Alternatives for Minnesota. Minnesota Department of Trans- portation, Research Services & Library. Around 83.4 percent of all trips are by private vehicle. Multimodalism provides travelers with modes beyond the vehicle in order to make a trip. In rural areas where there are low popu- lation densities and sprawling land use patterns, there tends to be less multimodalism. Only 3.2 percent of people travel to work using public transportation, 1.8 percent walk to work. Though, for aging population, low-income households, and those unable to drive, having trans- portation alternatives is vital. All rural and small urban communities face transportation access issues, but different types of communities face different demands. Exurban communities tend to need public transportation that includes long distance travel to nearby urban areas for commuters. Destination communities face public transportation and bicycle and pedestrian needs by both residents and visitors to handle seasonal congestion. Production communities typically face challenges providing social services public transportation and intercity bus service. This project identified 65 innovative projects within rural and small urban communities that have been successful in promoting multimodal development including improved public transportation, bicycle and pedestrian improvements, multimodal land use planning, financial incentives for multimodal developments, and alternative vehicles. Beierle, H. (2011). Bicycle Tourism as a Rural Economic Development Vehicle. Department of Planning, Public Policy & Management, University of Oregon. The state of Oregon and Travel Oregon have made bicycle tourism one of the top three priorities for marketing efforts. This report examines bicycle traveler behaviors and preferences to gain an understanding of the factors that attract bicyclists to specific communities in order to maximize the economic benefits that bicycle tourists can bring to a community. Data was collected on riders, route characteristics, and destinations during a 3,500-mile cross-country bicycle ride from Eugene, Oregon, to Washington, DC, in 2010. There tend to be four types of bicycle tourists: 1) self-contained or bicyclists that take their own gear and mainly camp along the way, 2) ride-centered cyclists who tend to stay overnight in one location and cycle during the day, 3) event-center cyclists who like to participate in organized rides or event rides, and 4) urban-cyclists who travel to a community and spend their time traveling within that community by bicycle. Accommodations along the trail including lodging, camping, and public showers are useful for all riders. For rural communities hoping to attract bicycle tourists, efforts to promote an individual community’s uniqueness and culture are desirable, as well as providing lodging and services for cyclists. In addition, historic development strategies can attract visitors while preserving existing infrastructure and maintaining a sense of place. Boone, Colorado, markets local businesses to cyclists along the TransAm through “Cyclists Welcome” signs, providing log books at key destinations, and providing cyclists with maps to local restaurants and businesses. Benckendorff, P., et al. (2010). Tourism and Generation Y. Cabi. This book explores Generation Y (or the Millennial generation) and their attitudes and behaviors in relation to tourism. Generation Y was born between 1977 and 2003. It is charac- terized as being more educated, technology-adapters, and concerned about the environment. Understanding this generation’s characteristics can help leaders and policy-makers shape the future of tourism. Bicycle Alliance of Minnesota (2017). Bicycle Friendly Community Resource Guide: A Toolkit for Minnesota. 36p. Interest in bicycling is increasing across the United States. There is evidence that Bicycle Friendly Communities are able to attract new residents and businesses as well as tourists. This

Annotated Literature Review C-5   guide by the Bicycle Alliance of Minnesota advocates for improving the bike-friendliness of communities to improve public health, economic development, and quality of life. A bike-friendly community has infrastructure that makes bicycling safe and easy for all users. This includes trail networks, bicycle routes, planning and policy guidance that incentivizes bicycle access, etc. These communities tend to follow the six Es regarding bicycle infrastructure: 1) engineering or providing safe and convenient infrastructure for all users, 2) education to improve bicycle safety and skills, 3) encouragement or bicycle promoting events and activities, 4) enforcement or ensuring that law enforcement is aware of laws and enforcement issues that surround bicyclists, 5) continual evaluation of bicycle goals and evaluation metrics, and 6) equity or ensuring that bicycling programs and infrastructure are located fairly and evenly throughout a community. Minnesota has 86 bicycle friendly communities and ranks second in bicycle friendliness in the United States. An estimated 5,880 jobs were created through bicycle-related spending and an estimated $750 million was brought into Minnesota via the bicycle industry. Being bicycle friendly can have a significant impact on the economy of a community, including attracting new residents, visitors, and businesses. To become bicycle friendly, communities need to have bicycle champions to support the movement, in addition to stakeholders from the general public to local politicians to keep the movement going. Bruhaker, K. (2011). Rail for Rural Areas: How Trains Can Help Meet Rural America’s Mobility Needs. RAIL magazine, Community Transportation Association of America: 29–32. http://web1.ctaa.org/webmodules/webarticles/articlefiles/RAIL_27_Rail_for_Rural_Areas.pdf High-speed rail could provide rural Americans with a vital mobility option. Rail stations in rural communities could provide access to education, economic, and health care opportunities in more urbanized areas. This RAIL magazine article examines the potential for passenger-rail services in rural areas. Burakowski, E., and R. Hill (2018). Economic Contributions of Winter Sports in a Changing Climate. https://gzg764m8l73gtwxg366onn13-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/ POW_2018_economic_report-1.pdf Burkhardt, J.E. (2004). TCRP Report 101: Toolkit for Rural Community Coordinated Transportation Services. Trans- portation Research Board of the National Academy of Sciences, Washington, DC. Coordination of transportation services involved two or more transportation providers to interact and jointly provide services. The benefit of coordination of transportation services allows for effective use of limited resources while improving mobility. Strategies to coordinate service include pooling vehicles, combining administrative operations, and centralizing sched- uling and dispatch. Coordination occurs in three phases: 1) cooperation, 2) coordination, and 3) consolidation. Agencies face many challenges when trying to coordinate services, including a lack of information on procedures for organization and a reluctance to use resources for planning and implementation of coordinated services. A better understanding of coordination strategies and the benefits of coordination could help overcome these challenges. Some coordi- nation strategies include human service providers providing ADA paratransit service under contract to a transit authority, human service agencies coordinating or consolidating service to create a more general public transportation system, and a community-wide coordinated dispatching system, which allows any provider to meet a passenger’s need. CA4Health (2014). On the Move: Safe Routes to School Policies in Rural School Districts. Safe Routes to School initiatives have been successful across the United States. Safe Routes to Schools programs can address several challenges seen in rural areas: 1) high rates of childhood

C-6 Rural Transportation Issues: Research Roadmap obesity, 2) low high school and higher education graduation rates, 3) high levels of vehicle crashes with pedestrians and bicyclists, 4) high poverty rates, 5) limited resources. An effective method to support Safe Routes to School initiatives in rural communities is to adopt school district policies that support bicycling and walking. These policies can work to create an encouraging environment for bicycling and walking and help districts become competitive for funding opportunities. Crossing guards can provide means for students to safely cross rural roads. In addition, schools can create maps with recommended walking and bicycle routes that are safe for students. Remote drop-off locations can be established so students can replace a portion of their trip to school with walking or bicycling. Finally, when building newer schools, rural com- munities should consider safe access points for pedestrians and cyclists and have bicycle parking available to promote active transportation. Calimente, J. (2012). Rail Integrated Communities in Tokyo. Journal of Transport and Land Use 5(1): 19–32. https://www.jtlu.org/index.php/jtlu/article/view/280/201 In Japan, intercity passenger rail systems are operated by the private sector with little govern- ment financial support. Railroad companies in the Tokyo area earn much of their revenue from real estate development, retailing, and other businesses near rail stations. The stations function as community hubs served by frequent, all-day, rail rapid transit, with most customers arriving on foot, by bicycle, or by public transit. This study provides case examples of the business activi- ties around two stations owned by Tokyu Corporation. Carliner, H., et al. (2017). The widening gender gap in marijuana use prevalence in the U.S. during a period of economic change, 2002–2014. Drug and Alcohol Dependence 170: 51–58. http://www.sciencedirect.com/science/article/pii/S0376871616309942 Carr, B.G., et al. (2009). Access to Emergency Care in the United States. Annals of Emergency Medicine 54(2): 261–269. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728684/ Access to emergency care is vital for time-sensitive medical conditions. Carr et al. explored access to emergency departments across the United States and found that while 99 percent of the population in rural areas have access to an emergency department within 60 minutes, only 45 to 54 percent of rural Americans have access to high-volume clinics (which tend to have more medical services) within 30 minutes. Timely access to healthcare is critical in emergency situa- tions, it is clear that there is a disparity between rural and urban Americans. As a result of this study Carr et al. suggest further research into identification of strategies to reduce the inequalities in access to healthcare. Carter, D.L., and F.M. Council (2007). Factors Contributing to Pedestrian and Bicycle Crashes on Rural Highways. 86th Annual Meeting of the Transportation Research Board, Washington, DC. A quarter of U.S. pedestrian and bicycle fatal and injury crashes occur on rural highways. Rural highways have specific factors that create a hazardous environment for both pedestrians and bicyclists, including higher vehicle speeds and a lack of active transportation infrastructure like sidewalks, trails, or bike lanes. This study examines pedestrian and bicycle crashes in rural and urban North Carolina to identify challenges on rural highways. The most common bicycle- involved crashes in rural areas included bicyclists turning/merging into the path of a driver and drivers overtaking a bicyclist. The most common pedestrian-involved crashes in rural areas were similar to those seen in urban areas: pedestrians walking on the roadway, pedestrian failing to yield, and pedestrians crossing mid-block. Both bicycle and pedestrian crashes in rural areas were more common at mid-block segments. Rural two-lane roads had the highest number of both pedestrian and bicycle crashes indicating that these roads should be a priority for safety

Annotated Literature Review C-7   improvements. Countermeasures to decrease pedestrian crashes in rural areas include improved roadway lighting, pedestrian education programs, and installing sidewalks and paved shoulders. Countermeasures to decrease bicycle crashes in rural areas include providing marked bike lanes for bicyclists, paved shoulders, and improved roadway lighting. Chanta, S., et al. (2014). Improving Emergency Service in Rural Areas: A Bi-Objective Covering Location Model for EMS Systems. Annals of Operations Research 221(1): 133–159. Traditional models for locating ambulatory services favor locating ambulances in areas of higher population density. This model results in large disparities in access to emergency services between rural and urban populations. In rural areas, the standard for ambulance response times is 90 percent of calls within 14 minutes and 59 seconds, when compared with the standard for urban areas (90 percent of calls within 8 minutes and 59 seconds. This problem is compounded by lower survival rates in rural areas when compared with urban areas. When every second counts, strategies to reduce response times are a necessity. Chanta et al. propose three promising alternatives to locating ambulance services: 1) minimize the distance between uncovered demand zones (areas where an ambulance cannot respond within the response time standard) and the closest ambulance station, 2) minimize the number of uncovered rural demand zones, and 3) minimize the number of uncovered demand zones. This article explores methods to provide equitable EMS services among different geographic areas. Chaudhari, J., et al. (2016). Wyoming Intercity Bus Service Study. Cheyenne, WY, Wyoming Department of Transportation: 112p. http://surlc.org/wp-content/uploads/2016/09/WYDOT-ICB-Study-Final-Report.pdf Chaudhari et al. explored the current state of intercity bus services within the state of Wyoming to determine if the Wyoming Department of Transportation is meeting the require- ments of the FTA Section 5311(f), which requires that 15 percent of total program funding is used to develop and support intercity bus services unless the transportation needs are being met. Chaudhari et al. examined intercity bus service and local transit services to gain an under- standing of transit connectivity in the state of Wyoming as well as conducted a survey of inter- city bus riders to understand perceptions on the services provided. The researchers recommend that Wyoming explore expanding intercity bus services to seven cities including Cody, Powell, and Riverton in order to provide services to 85 percent of the populated cities in Wyoming. Service expansions could be initiated on a limited basis and grow incrementally based on demand. In addition, it was suggested that Wyoming regularly examine the state of intercity bus services to determine if passenger needs are being met. Chaudhari, J., et al. (2016). Park County Transit Feasibility Study. Small Urban Rural Livability Center. Western Trans- portation Institute. Powell Economic Partnership, Inc. Forward Cody, Inc.: 89p. http://surlc.org/wp-content/uploads/2016/09/Park-County-Mobility-Report_Final-05-31-16.pdf https://trid.trb.org/view/1538516 Park County, Wyoming, initiated this study to understand the feasibility of a public trans- portation system within the county. Park County is a rural area with major industries focused in government, tourism, service, retail, trade, and construction. A public transportation system is being considered to increase economic development within the area. Chaudhari et al. conducted a survey of Park County residents, conducted a literature review, and identified transportation alternatives to provide transportation options to the residents of Park County. Results of the survey indicated that there is a desire for transportation options and a positive attitude towards public transportation. Chaudhari et al. recommended expanding the county’s existing demand- response system, including trips between major cities; working with employers to establish

C-8 Rural Transportation Issues: Research Roadmap vanpool and carpool programs; and creating a Transportation Advisory Committee to continue to work towards improving mobility within Park County. Chiura, S., and G. Li (2017). Trends in Prescription Opioids Detected in Fatally Injured Drivers in 6 US States: 1995–2015. American Journal of Public Health 107(9): 1487–1492. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2017.303902 Circella, G., et al. (2016). What Affects Millennials’ Mobility? Part I: Investigating the Environmental Concerns, Lifestyles, Mobility-Related Attitudes and Adoption of Technology of Young Adults in California. University of California, Davis. National Center for Sustainable Transportation. California Department of Transportation: 119p. http://www.dot.ca.gov/research/researchreports/reports/2016/CA16-2825_FinalReport.pdf https://itspubs.ucdavis.edu/wp-content/themes/ucdavis/pubs/download_pdf.php?id=2630 https://merritt.cdlib.org/d/ark%3A%2F13030%2Fm5324hkb/1/producer%2F2016-UCD-ITS- RR-16-01.pdf https://merritt.cdlib.org/d/ark%3A%2F13030%2Fm5hf2hdv/1/producer%2FCA16-2825.pdf https://trid.trb.org/view/1412918 During the last decade, the United States has seen private automobile use stagnate, vehicle miles traveled declined, and an increasing proportion of the population is living without an automobile. Travelers are becoming increasingly multimodal. Circella et al. examined a sample of young adults (aged 18 to 30) in California to gain an understanding of their travel behaviors. Changes in travel behavior and explanatory factors were examined, including economic activity, gas prices, community design, sociodemographic factors, and generational differences. Under- standing young adults’ travel choices and behaviors will allow researchers and future policy-makers to better prepare for future demands on the transportation system. Clouser, K., and D. Kack (2017). Intercity Bus Stop Analysis. 33p. http://surlc.org/wp-content/uploads/2017/06/Intercity-Bus-Stop-Analysis_Final.pdf https://trid.trb.org/view/1538472 Intercity bus services provide a valuable service to people traveling in rural areas. This report analyzed demographics in each of the forty-eight contiguous states to determine which types of communities have access to the Greyhound bus service network. Greyhound is the nation’s largest network of intercity bus service providers with more than 3,800 destinations nationwide. Greyhound provides rides to 18 million passengers each year. Nationally, a majority of inter- city bus stops are located within a rural area. However, intercity bus services are not reaching a majority of the smallest rural communities with a population less than 4,999 people. Only 10 percent of these communities nationwide has a Greyhound bus stop. Committee on the Future of Emergency Care in the United States Health System (2007). Emergency Medical Services at the Crossroads. Institute of Medicine and Committee on the Future of Emergency Care in the United States Health System. Washington, DC, National Academies Press: 285p. EMS in rural areas face multiple challenges, including limited assets, a skills gap in volunteer EMS personnel, and long travel distances. The Institute of Medicine describes three strategies to address these challenges. Load-responsive deployment of ambulances in which strategically located ambulances are dispatched centrally to reduce response times. This strategy resulted in a 32 percent increase in the number of calls that met the response time standard of 8 minutes. One of the largest examples includes the East Texas Medical Center EMS system which serves a 17-county region in Texas. Regionalization of EMS in this area allows for rural areas to maintain up-to-date equipment and practices while reducing costs. The final strategy includes establishing

Annotated Literature Review C-9   citizen first responders in rural communities. A citizen first responder would be available to provide first aid and CPR while waiting for EMS to arrive on scene. This strategy could improve patient outcome in rural areas where response times tend to be longer. Committee on Future Surface Transportation Agency Human Resource Needs: Strategies for Recruiting, Training, and Retaining Personnel (2003). Special Report 275: The Transportation Workforce Challenge: Recruiting, Training, and Retain- ing Qualified Workers for Transportation and Transit Agencies. Transportation Research Board, Washington, DC. https://www.nap.edu/catalog/10764/the-transportation-workforce-challenge-recruiting-training- and-retaining-qualified-workers-for-transportation-and-transit-agencies As the baby boomer generation reaches the retirement age, state DOTs and public transit agencies are facing a shortage of skilled professionals. This study found six key challenges that need to be addressed immediately: 1) new technologies requiring new skills, 2) balancing growth with budget restrictions, 3) large levels of retirement-age employees, 4) insufficient training opportunities, 5) recruiting and retaining employees, and 6) human resources needs to shift focus to strategically address workforce development needs. Training should be viewed as an investment to fill the knowledge gap. Currently, transportation agencies are insufficiently fund- ing training opportunities. Studies of successful organizations found that on average 2 percent of salaries are spent on training, this is four times more than what transportation agencies are spending. A lack of training opportunities will result in a further skills gap and a potential inefficient use of resources. Another method to reduce the skills gap is for transportation agencies to partner with institutes of higher education to ensure students are gaining the skills required to work within the transportation agency. Finally, workforce development issues require top- down leadership from the federal government to innovate human resources practices, including gathering data on workforce development strategies and increasing federal spending for training opportunities. Failure to address these workforce issues will result in a continued shortage of skilled employees and a potential loss of knowledge in the industry. Community Transportation Association of America (2009). Profiles of Innovative Rural Vanpool Programs. Community_Transportation_Association_of_ America: 25p. http://web1.ctaa.org/webmodules/webarticles/articlefiles/Profiles_of_Innovative_Rural_Vanpool_ Programs.pdf In rural communities where access to public transportation is less likely, transportation dis- advantaged populations can face challenges accessing work, education, and healthcare. Vanpool programs offer a flexible mobility service for rural communities that may have a limited trans- portation budget. This report profiles 23 innovative rural vanpool programs across the United States. Successful vanpool programs have key elements: innovative partnerships; working with key employers; strong political support; emphasizing commuter travel; and ensuring guaranteed rides home. Community Transportation Association of America (2015). Bikesharing: A Solution for All Communities. Community Transportation Magazine: 29–33. Many believe that bikesharing programs are not viable in rural areas, but these programs require minimal infrastructure and can be scaled up to meet the needs of any community. This article shares stories of successful bikeshare programs in small towns across the United States. In Norway, ME (population 5,014) a bikeshare program was implemented in 2015 with donated bicycles and unclaimed stolen bicycles from the local police department. This bikeshare pro- gram uses volunteers to repair and maintain the bicycles as needed. At the time of this article, 40 users have signed up for the program. The bikeshare program has long-term goals to scale up the bikeshare program and support dedicated bicycle infrastructure within region. This model

C-10 Rural Transportation Issues: Research Roadmap was adopted in Machias, Maine, through a Health Maine Street grant from Maine Develop- ment Foundation. The Machias bikeshare was implemented with donated bicycles which are unlocked and available for all interested riders. In resort town Aspen, Colorado, WE-cycle was established in 2013 in coordination with Roaring Fork Transportation Authority’s VelociRFTA bus rapid transit service to provide last mile connections to the bus. WE-cycle usage increased 76 percent in 2014. This program is operated as an independent nonprofit and is available May through October. Bikeshares are increasingly becoming an innovative strategy to provide alter- native modes of travel across the United States, although it is important that communities under- stand that these programs require investment to remain successful long term. Community Transportation Association of America (2018). Community Transportation Association of America. Retrieved 26-September-2018, from http://web1.ctaa.org/webmodules/webarticles/anmviewer. asp?a=23&z=2. Cornwall, G. (2018). How Lack of Access to Transportation Segregates Schools. Retrieved 25-September-2018, from https://www.forbes.com/sites/gailcornwall/2018/05/01/ why-tech-is-prepping-to-overhaul-school-transportation/#52633b0e588a. Over 55 percent of U.S. public K-12 students travel to school via a school bus each day. In “Beyond the Yellow Bus,” a study conducted by the University of California, Berkeley, school transportation funding has been cut over the last decade leading to fewer than 10 percent of elementary-age students riding the bus. Limited school transportation is a barrier to school choice, likely leaving behind more transportation disadvantaged populations. A lack of transpor- tation can lead to segregated schools. Transportation options like public transit or ridesharing can be used to begin breaking down these barriers. Cornwall calls for transportation reform in order to ensure that all students have the same educational opportunities. Cornwall, G. (2018). Will Ride-Sharing Replace Traditional School Buses? Retrieved 25-September-2018, from https://www.usnews.com/news/best-states/articles/2018- 06-06/will-ride-sharing-replace-traditional-school-buses. Cronin, B., et al. (2011). NCHRP Report 685: Strategies to Attract and Retain a Capable Transportation Workforce. Transportation Research Board of the National Academies, Washington, DC. https://www.nap.edu/catalog/14475/strategies-to-attract-and-retain-a-capable-transportation- workforce Transportation agencies across the United States are struggling to attract and retain skilled employees. This issue is compounded by changing demographics within the industry. Approxi- mately 50 percent of the transportation workforce is approaching retirement, but there is a growing shortage of young professionals entering the transportation industry. This gap may result in a large loss of core skills within the industry. In addition, transportation agencies are struggling to compete with the higher salaries and employment opportunities offered in the private sector. A survey of state DOT employees from Nebraska, Maryland, and Utah found that 25 percent of respondents were considering leaving the DOT for other employment oppor- tunities. The demand on the transportation system is expected to continue to grow, and thus, the demand on transportation agencies has increased. With these challenges in mind, NCHRP Report 685 provides information on strategies that transportation agencies can utilize to improve workforce recruitment and retention of skilled employees. Some suggested strategies include developing transportation career pathways, developing interest in transportation careers among K-12 and higher education students, succession planning, mentoring programs, marketing through social media, improving employee growth and workforce development opportunities, and providing alternative employment benefits like flexible scheduling.

Annotated Literature Review C-11   Dahl, D., and B. Thompson (2017). Proactive Traffic Enforcement Survey and Assessment. Washington Traffic Safety Commis- sion: 48p. https://waspc.memberclicks.net/assets/docs/2017%20final%20traffic%20enforcement%20 assessment%20report%20-%20final.pdf Dalton, D.L. (2018). Expanding Access to Our Communities: A Guide to Successful Mobility Management Practices in Small Urban and Rural Areas. Cambridge Systematics and KFH Group: 138p. http://onlinepubs.trb.org/onlinepubs/nchrp/docs/NCHRP20-65(68)_FR.pdf https://trid.trb.org/view/1511932 Rural communities are increasingly using mobility management practices to establish coordi- nated transportation services for transportation disadvantaged populations. These management practices are critical in rural communities that need to balance an increasing need for mobility services with limited funding resources. This study examined best practices of rural and small urban mobility management programs. Several key themes emerged: a majority of mobility management programs are providing a variety of services to serve multiple population groups; partnerships and stakeholder engagement are critical; and coordination with human services transportation services is a primary focus of many programs. Dalton, M.A., et al. (2011). Built Environment Predictors of Active Travel to School Among Rural Adolescents. American Journal of Preventive Medicine 40(3): 312–319. Most research on active travel to school has focused on urban or suburban communities. Little is understood about the built environment factors that play a role in predicting active travel to school for rural students. Dalton et al. conducted a survey of 1,552 adolescents ages 12 to 17 at 45 school neighborhoods in Vermont and New Hampshire between 2007 and 2008. Less than half (735) of these students lived within three miles of school, and 52.8 percent of these students walked or bicycled to school at least one day per week. Students were more likely to walk or bicycle to school during the fall or spring. Most adolescents (68%) walked, only 7.7 percent bicycled to school. Shorter distances to school were associated with higher likelihood of active travel to school, although 30 percent of the active students lived 2 to 3 miles away from school. Active travel to school was associated with higher residential density, frequent intersections, sidewalks, on-street parking, and areas with building continuity. Sidewalks and building con- tinuity were significantly associated with longer traveling distances to school (up to 2 miles). None of these built environment factors were associated with active travel to school for active students living farther than 2 miles from school. While safe infrastructure to support active travel to school is necessary, other strategies to improve physical activity levels among students include the creation of drop-off points where students could walk or bike a portion of their way to school and opportunities to increase physical activity levels on school grounds. Davis, J.W., et al. (2006). Aggressive Traffic Enforcement: A Simple and Effective Injury Prevention Program. Journal of Trauma and Acute Care Surgery 60(5): 972–977. https://journals.lww.com/jtrauma/Abstract/2006/05000/Aggressive_Traffic_Enforcement__ A_Simple_and.7.aspx DeGood, K. (2011). Aging in Place, Stuck Without Options: Fixing the Mobility Crisis Threatening the Baby Boom Generation. Seniors are increasingly choosing to age in place. After age 55, only 5 percent of seniors move residences, and fewer than 2 percent move between states. As seniors age, their ability to drive decreases over time. Seniors need affordable and safe transportation alternatives including

C-12 Rural Transportation Issues: Research Roadmap public transportation and pedestrian-friendly facilities in order to remain active and maintain independence. Without viable transportation alternatives, seniors face isolation and a reduced quality of life. A 2004 study found that seniors age 65 and older who no longer drive make 15 percent fewer trips to the doctor, 59 percent fewer trips for shopping or entertainment, and 65 percent fewer trips to visit friends and family when compared with drivers in the same age category. These results clarify the needs for transportation alternatives that serve seniors. Seniors have shown a preference for living in communities with walking infrastructure and public trans- portation. Just over half (51 percent) of seniors believe it was extremely or very important to be able to walk within their community. Walking accounts for 8.8 percent of total trips made by seniors; however, the lack of safe walking infrastructure poses a danger to seniors. From 2000 to 2007, 22 percent of pedestrian fatalities were people age 65 and older. This study examined transportation facilities in metropolitan areas in the United States. The results show that seniors lack basic transportation access across the United States, meaning policy changes that promote adequate public transportation are becoming increasingly necessary. Despite the lack of public transportation access, coordinated mobility programs were identified as a best practice to improve accessibility. Del Rio, M., et al. (2017). Transportation Matters: A Health Impact Assessment in Rural New Mexico. International Journal of Environmental Research and Public Health 14(6): 629 (619p). http://dx.doi.org/10.3390/ijerph14060629 http://www.mdpi.com/1660-4601/14/6/629 https://trid.trb.org/view/1477326 Health impact assessment (HIA) is a beneficial tool for understanding the public health impacts of a transportation plan, but so far, most published HIAs have focused on urban areas. To begin to fill this gap, Del Rio et al. conducted a HIA in rural Doña Ana County to inform the decision to expand public transit from Las Cruces to several nearby rural communities to provide access to health care, education, and economic development opportunities. These communities faced limited access to basic services and high poverty rates. This bus service would provide the only form of public transportation to many residents who do not have access to a vehicle or who are unable to drive. South Central Regional Transit District (SCRTD) had previously run a pilot service to these rural communities, but the proposal to increase taxes to continue the service failed, so the service was discontinued. This HIA intended to inform decisions surrounding a new pilot program to provide service to these rural communities. This HIA was conducted from November 2014 to October 2016. Multiple outreach efforts took place to gain an understanding of the public health of the community, the benefits of public transportation, and how residents would use the proposed public transportation system. These outreach efforts included a survey of 1,054 rural community members, a survey of 33 passengers who used the previous pilot program bus service, interviews with 44 key leaders in health, education, business, and economic development, and a focus group of 13 public health officials. Findings from these efforts show that community members were overwhelmingly positive about public transportation. 84 percent of respondents stated they would use the bus to access health services, 83 percent for educational opportunities including higher education or job training, and 81 percent for economic opportunities including job access. Results from the focus groups and interviews identified that although there are concerns with the costs of providing public transportation to rural communities, the system is expected to have positive impacts on access to healthcare, access to fresh food, access to educational opportunities including job training, and access to economic opportunities including jobs, goods and services. Del Rio et al. concluded that providing a public transportation system to rural Doña Ana County communities would have major positive impacts on residents.

Annotated Literature Review C-13   Dickman, D., et al. (2016). Small Town and Rural Multimodal Networks. The Small Town and Rural Multimodal Networks Guide provides street design guidance and best practices to improve access and safety for bicyclists and pedestrians in rural communities. In many rural communities, roadways have long favored the automobile, resulting in high-speed auto-oriented design that has made walking and bicycling unsafe for many road users. This guide provides guidance to create safe and accessible active infrastructure to improve multi- modal transportation in rural communities. Rural communities face several similar challenges, including longer travel distances, health disparities, higher rates of fatal and injury crashes, and income disparities. Creating safe and access multimodal networks in rural communities is a strategy to promote public health and improve access and mobility. The street designs in this guidebook cover everything from yield roadways to bike lanes to bicycle boulevards to sidewalks. The guide also describes multimodal network opportunities, including speed manage- ment designs like median islands, speed humps, or roundabouts. Speed is one of the major factors in crashes of all types, as speed increases, the likelihood of a pedestrian surviving a crash decreases. Another opportunity described is multimodal main streets, which includes creating safe and accessible commercial cores to promote bicyclists and pedestrians, promote more compact design, improve economic development, and create community identity. Multimodal main street projects have been implemented in Imbler, Oregon (population 305), Los Molinos, California (population 2,037), and Willow Creek, California (population 1,710). Dombrowski, K., et al. (2016). Current Rural Drug Use in the US Midwest. Journal of Drug Abuse 2(3:22). http://drugabuse.imedpub.com/current-rural-drug-use-in-the-us-midwest.pdf Eddy, M.M., et al. (2017). Rural Connected Vehicle Gap Analysis: Factors Impeding Deployment and Recommendations for Moving Forward. United States. Dept. of Transportation. ITS Joint Program Office. This study identified potential challenges and solutions for deploying connected vehicles in rural areas. Connected vehicles offer much needed safety and operating improvements, but limited funding resources could make deployment difficult for rural communities. This study aimed to identify factors that could potentially hinder deployment. Eddy et al. suggested the following recommendations: develop connected vehicle plans; support rural connected vehicle pilot projects; and create education campaigns to teach agencies and officials about the benefits of connected vehicles. ElSohly, M.A., et al. (2016). Changes in Cannabis Potency over the Last Two Decades (1995–2014)—Analysis of Current Data in the United States. Biological Psychiatry 79(7): 613–619. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987131/ ENO Transportation Foundation (2008). TCRP Research Results Digest 88: Improving Travel Options in Small and Rural Communities. Transportation Research Board of the National Academies, Washington, DC, 36p. https://www.nap.edu/catalog/23223/innovative-practices-in-transit-workforce-development This digest examines innovative transportation workforce development strategies in Canada, France, and Belgium. Similar to the United States, these countries have recognized the need to become competitive in recruiting and retention of employees. Every agency examined was facing similar concerns with changing workforce demographics, including an aging workforce and need to retain knowledge, an increasingly diverse workforce, and increasing demands for career development opportunities from younger professionals. Agencies in Canada and France were partnering with local K-12 and higher education institutions in order to support interest in the transportation industry and to ensure that upcoming potential employees had the skills

C-14 Rural Transportation Issues: Research Roadmap necessary to do the job. Similar practices to those seen in the United States were described in this digest, including development of training opportunities and the need to improve the transporta- tion industry’s image. This report highlights that the need to implement new workforce develop- ment strategies is not just a U.S. issue, this is an issue agencies across the world are facing as well. Farber, N., et al. (2011). Aging in Place: A State Survey of Livability Policies and Practices. Firestine, T. (2011). The U.S. Rural Population and Scheduled Intercity Transportation in 2010: A Five-Year Decline in Transportation Access. Washington, DC: 22p. https://www.bts.gov/sites/bts.dot.gov/files/legacy/publications/scheduled_intercity_transportation_ and_the_us_rural_population/2010/pdf/entire.pdf Fishman, E., and C. Cherry (2016). E-bikes in the Mainstream: Reviewing a Decade of Research. Transport Reviews 36(1): 72–91. E-bikes are one of the fastest growing transportation modes. A study of e-bike users in California found that e-bike users were generally older, better educated, and had a higher income compared with the general population. One of the key benefits of e-bikes is that a rider can maintain speed with less effort, which is one of the more commonly cited barriers to tradi- tional bicycling. E-bikes have been beneficial for bicycle commuters because they overcome some of the barriers to traditional bicycling to work, including topography, distance, and time. E-bikes have been cited as a way to replace the automobile in Australia and the United States, which could result in reducing congestion and emissions. Although e-bikes require less physical exertion, the levels of physical activity have shown health benefits, particularly because e-bikes seem to promote more frequent use of cycling. Safety concerns are one of the greatest challenges with e-bikes. E-bike users tend to have higher levels of perceived safety, although evidence suggests that e-bike users may be more likely to take risks (running red lights, etc.) when com- pared with traditional bicyclists. Since e-bikes are an emerging trend, further research is needed to fully understand the impact e-bikes will have on mobility. Fix, P., et al. (2018). Collaborative Visitor Transportation Survey: Results from Summer 2016 Alaska Survey. Project Report for the Alaska Long-Range Transportation Planning Team: 312. http://volpe-public-lands.s3-website-us-east-1.amazonaws.com/flma_lrtp_cvts/documents/ AK%20CVTS%20FINAL%20REPORT.pdf Freidel, M., et al. (2015). Drug-Resistant MS Spasticity Treatment with Sativex®Add-On and Driving Ability. Acta Neurologica Scandinavica 131: 9–16. https://onlinelibrary.wiley.com/doi/epdf/10.1111/ane.12287 Gallagher, S., et al. (2018). Comparative Approaches to Fostering an Accessible Transportation Environment in the United States and Russia. 97th Annual Meeting of the Transportation Research Board, Washington, DC. https://trid.trb.org/view/1495238 Accessible transportation standards ensure that people with disabilities have mobility options, but these standards have been adopted differently across the globe. Moscow State University of Transport Engineering, the Russian Federation, and Montana State University conducted a joint research project in order to understand challenges and potential solutions to providing accessible transportation services to people with disabilities within small urban and rural communities. Gallagher et al. conducted surveys and interviews of education providers and examined current transit providers in the United States and Russia to determine how these agencies are

Annotated Literature Review C-15   incorporating accessibility into training programs. This paper discusses the differences in acces- sibility training and education and funding for accessibility transportation services within the United States and Russia. Gallagher, S., and N. Villwock-Witte (2016). Millennials in the Transportation Workforce. Transportation Research Record: Journal of the Transportation Research Board, No. 2552, pp. 43–47. http://dx.doi.org/10.3141/2552-06 https://trid.trb.org/view/1392398 Gettman, D., et al. (2017). NCHRP Web-Only Document 239: Impacts of Laws and Regulations on CV and AV Technology Introduction in Transit Operations. Transportation Research Board, Washington, DC, 119p. http://www.trb.org/Main/Blurbs/176678.aspx https://trid.trb.org/view/1488861 As automated vehicle technologies continue to evolve, public transit agencies will face many changes. Gettman et al. examined how automated vehicle technology will change the public transit industry, potential issues, laws and regulations, and identified research and policy activities that will facilitate the use of automated vehicle technologies in public transit. Givechi, M. (2017). Smarter, Safer Roadways: Road Diets for Rural Communities. Road diets have become an increasingly popular way to improve safety and multimodal road use. Road diets often involved removing or narrowing of vehicle lanes and creating space for other uses, including bicycle lanes, parking, or a left-turn lane. This is a cost-effective strategy to accommodate alternative transportation modes while using existing infrastructure, although a community needs to consider the roadway level-of-service, traffic entry, and driver concerns before implementation. A previous NCHRP study reported crash reduction rates of 19 to 49 percent with a 4-to-3 lane road diet with a center left-turn lane. Although road diets have proven to be an effective safety countermeasure they are not commonly utilized in rural communi- ties. Road diets are one of the nine proven safety countermeasures recommended by the Federal Highway Administration. Governor’s_Development_Council (2017). Rural and Human Services Transportation (RHST) Coordination Overview Presentation. Georgia Rural Development Council. http://www.house.ga.gov/Documents/CommitteeDocuments/2017/HouseRuralDevelopment Council/Presentations/Waycross/Rural_Human_Service_Transportation_Coordination.pdf Grantmakers_in_Aging (2018). Mobility and Aging in Rural America: The Role for Innovation. Almost one quarter of all U.S. senior citizens (around 10 million) live in rural communities. But these communities tend to lack transportation alternatives, which can leave senior citizens isolated within their community, particularly when they choose to cease driving. Only around 80 percent of rural communities have public transportation services available, but these services may miss the most remote senior citizens. Rural public transportation ridership is higher among seniors, veterans, and people with disabilities. Providing transportation options beyond the automobile is keeping seniors active in rural communities. These services include public transportation, paratransit, community demand response transit, and taxis. There is a potential for ride-hailing companies to provide services as well, but only 3 percent of rural residents have used this type of service. Rural communities face financial limitations with implementing transportation alternatives. Less than 10 percent of federal spending on public transportation goes to rural communities. Volunteer driver programs can help fill the gap. One example is

C-16 Rural Transportation Issues: Research Roadmap ITNCountry, which acts as a hybrid volunteer/paid driver program for rural areas. People pay for rides using cash or credits that they earn by volunteering drive time for others. This program has been successful with partnering with local businesses and healthcare providers in rural areas. Upcoming technical innovations like telemedicine and autonomous vehicles may provide solutions in the future. Innovations like GPS and automatic vehicle location can be used to coordinate mobility services, which can reduce the length of time that demand- response riders have to wait for a ride. Coordinated mobility services have been implemented in Vermont. Go Vermont allows users to coordinate rides through bus, carpool, carshare, or volunteer drivers. In addition to providing additional mobility options, rural communities can consider continuing education for senior drivers in order to improve safety of the senior drivers on the road. Gudipudi, P.P., et al. (2017). Impact of Climate Change on Pavement Structural Performance in the United States. Transpor- tation Research Part D: Transport and Environment 57: 172–184. http://www.sciencedirect.com/science/article/pii/S1361920917304030 Hammit, B., and R. Young (2015). Connected Vehicle Weather Data for Operation of Rural Variable Speed Limit Corridors. University of Wyoming, Laramie. Mountain-Plains Consortium: 185p. http://www.ugpti.org/resources/reports/downloads/mpc15-299.pdf https://trid.trb.org/view/1398358 The use of intelligent transportation systems could reduce the number of weather-related crashes that occur each year. Many transportation agencies have utilized road weather informa- tion systems (RWIS) to improve data on current weather conditions on the roadway, but RWIS data is for a specific location. Connected vehicle technologies could provide continuous road weather data to allow agencies to better prepare for weather events. Hammit and Young exam- ined previous projects that examined the usefulness of connect vehicle weather data. Results of this research found that vehicle data needs to be standardized in order to create a complete vehicle data set. Hansen, M., et al. (2015). Promoting Active Living in Rural Communities. Both rural children and adults have disproportionately higher rates of obesity compared with urban populations. Obesity in rural children aged 2 to 18 is 22 percent and among rural adults, 40 percent. Rural populations have been targeted by some as a priority population to improve overall public health. This brief discusses research on the rural built environment and factors related to physical activity. Important barriers to physical activity in rural areas include isolation, lack of safe active infrastructure, lack of recreational areas, cost, and concerns of safety and crime. In rural Georgia, physical activity increased by 20 percent when children had access to a recreational area (park, school grounds, or yard). There are concerns that in very remote rural areas that improvements in active infrastructure would only affect few people, but larger rural communities with an established downtown corridor or with dense neighborhoods have increasingly implemented active transportation infrastructure. In some areas, a regionalization approach may be most beneficial in order to pool limited resources. In addition, working with schools, community centers, and local businesses to encourage physical activity can help create support around active transportation. Harrell, R., et al. (2014). What is Livable? Community Preferences of Older Adults. AARP Public Policy Institute 8: 2014. https://www.aarp.org/content/dam/aarp/research/public_policy_institute/liv_com/2014/what- is-livable-report-AARP-ppi-liv-com.pdf

Annotated Literature Review C-17   Hawkins, N., et al. (2012). School Bus Safety Study – Kadyn’s Law. Iowa State University Ames. Iowa Department of Transportation. Federal Highway Administration: 56p. https://trid.trb.org/view/1236954 Kaydn’s Law was passed in Iowa in 2012 to improve school bus safety. This law included adding provisions to use cameras to improve safety and improve enforcement of stop-arm violations; study the feasibility of requiring school children to be loaded/unloaded on the side of the road where their home is located; and include school bus safety in the driver training curriculum. Health Outreach Partners (2017). Rides to Wellness Community Scan Project. Oakland, CA: 40p. https://outreach-partners.org/wp-content/uploads/2017/06/FTA-Comm-Profiles-2.pdf The Health Outreach Partners conducted a national survey of health centers to obtain infor- mation on missed medical appointments. Most health centers (87.1%) stated that missed appointments were a moderate to serious problem. Most health centers (86%) stated that trans- portation barriers were a moderate to serious problem. Only 40% of respondents stated that patients used public transportation to access medical appointments frequently, these respon- dents were more likely to be located in urban areas. This study found that while most health centers keep data on the rate of missed appointments, only 40% of the respondents track data on the reason an appointment was missed. The Health Outreach Partners summarized case studies of communities that had Rides to Wellness programs, including HealthTran in Missouri and Ride Connection in Portland, Oregon. Hendricks, S.J., et al. (2008). Programs that Match Seniors with Volunteer Drivers—Practical Recommendations for Organizations and Policy Makers. National Center for Transit Research. Florida Department of Transportation: 116p. http://www.nctr.usf.edu/pdf/77717.pdf https://trid.trb.org/view/875479 Transportation provides a vital community link to senior citizens who are no longer able to drive, but many seniors may not be able to use public transportation. Volunteer driving pro- grams provide a solution to meet the transportation needs of seniors; however, these programs face many challenges, including recruiting of drivers, service demands, training, and liability. Hendricks et al. provide recommendations on how volunteer driving programs can meet the needs of seniors in rural communities and describe best practices used by successful volunteer driver programs. Hendrickson, C., et al. (2014). Connected and Autonomous Vehicles 2040 Vision. Pennsylvania Department of Transportation. http://www.dot7.state.pa.us/BPR_PDF_FILES/Documents/Research/Complete%20Projects/ Planning/CMU%20WO%20001%20-%20Connected%20and%20Autonomous%20Vehicles %202040%20Vision%20-%20Final%20Report.pdf Pennsylvania Department of Transportation and Carnegie Mellon University conducted this project to assess the impact connected and automated vehicles will have on Pennsylvania’s transportation system. This report examines the effect connected and automated vehicles will have on design and investment, communications, real-time data, existing infrastructure, workforce development, driver licensing, and freight. This examination was used to create a list of recommended actions for Pennsylvania Department of Transportation to plan for these impacts.

C-18 Rural Transportation Issues: Research Roadmap HLB Decision Engineers, Inc. (2003). The Socioeconomic Benefits of Transit in Wisconsin. https://wisconsindot.gov/Documents/doing-bus/local-gov/astnce-pgms/transit/03-07.pdf This study evaluated the economic benefits of public transportation in the state of Wisconsin, with a specific focus on benefits to the healthcare, work, education, and retail, recreation, and tourism sectors. A literature review, survey of public transit riders, data from transit agencies, expert panel, and previous studies were analyzed to determine the benefits of transit. This study found that public transportation played an important role in the state’s economic vitality. Public transit is estimated to save the state around $730 million across the state’s various sectors. Hoekstra, T., and F. Wegman (2011). Improving the Effectiveness of Road Safety Campaigns: Current and New Practices. IATSS Research 34(2): 80–86. http://www.sciencedirect.com/science/article/pii/S0386111211000045 HRSA (2018). Substance Abuse in Rural Areas. Retrieved 06-Sept-2018, from https://www.ruralhealthinfo.org/topics/substance-abuse. Hughes-Cromwick, P., et al. (2005). TCRP Web-Only Document 29: Cost Benefit Analysis of Providing Non-Emergency Medical Transportation. Transportation Research Board of the National Academies, Washington, DC, p. 208. http://onlinepubs.trb.org/onlinepubs/tcrp/tcrp_webdoc_29.pdf https://trid.trb.org/view/778789 An estimated 3.6 million Americans miss or delay medical appointments annually due to transportation barriers. Transportation barriers are more likely to affect elderly, low-income, mobility-impaired, or minority population groups. These transportation disadvantaged popula- tions were likely to have mental health concerns, hypertension, heart disease, asthma, COPD, or diabetes. When people do not have transportation access for regular medical care, they tend to rely on emergency care. Non-emergency medical transportation (NEMT) can work to reduce the number of missed medical trips for disadvantaged populations, which can result in reduced medical costs. The benefits of increasing access to medical care tend to exceed the costs for transportation. Ihs, A. (2002). Winter Maintenance in Sweden: Compiled for COST 344 “Improvements to Snow and Ice Control on European Roads.” Task Group “Best Practice.” VTI SAERTRYCK (351): 28 p. http://www.vti.se/pdf/reports/S351.pdf https://trid.trb.org/view/729846 Institute of Medicine (2012). The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Wash- ington, DC, The National Academies Press. https://www.nap.edu/catalog/13466/the-role-of-telehealth-in-an-evolving-health-care- environment Telehealth uses telephone and communications technology to provide healthcare services and support from a long distance. Telehealth can be utilized in home-based or clinic-based settings. This technology has the ability to reduce the need for traveling to medical clinics and may be particularly useful in rural areas where a clinic or a specialty-care provider may require traveling long distances. In 2012, the Institute of Medicine conducted a workshop to explore emerging telehealth technology and how it can be utilized in the United States. This document summarizes the workshop.

Annotated Literature Review C-19   Iowa Department of Transportation (2000). Implementing Trail-Based Economic Development Programs: A Handbook for Iowa Com- munities. 24. This Iowa Department of Transportation handbook provides strategies for local communities to develop and implement trail-based economic development programs. Trails offer a wealth of economic development opportunities, but no two communities are the same. In order to successfully promote economic development through trail recreation a community will need a clear vision in how they want the trail to help their community. This includes an understanding of community capacity and desires, including determining what accommodations are available for visiting trail users and the willingness of local businesses to accommodate trail users, locat- ing trailhead near desired destinations or businesses to concentrate the economic impact, and creating partnerships among local businesses to attract and plan for trail-oriented development. Communities in Iowa have used three types of projects to promote economic development using trails: 1) regional economic development, 2) tourism development, and 3) main street revitalization. It is important to remember that trails are just one component of the visitor experience, building a community identity, partnering with local businesses, providing attractive accommodations, and promoting the trail through events will go a long way in drawing in trail users. Local resident participation is important to creating a community vision, listening to resident concerns, and ensuring the entire community is onboard is important to ensuring the success of trail-based economic development programs. Jahagirdar, D., and M.-D. Wright (2017). Naltrexone for Opioid Use Disorders: A Review of Clinical Effectiveness, Cost Effectiveness, and Guidelines. Ottawa, ON, Canada, Canadian Agency for Drugs and Technologies in Health. Kennebec County Soil and Water Conservation District and Maine Department of Envi- ronmental Protection Bureau of Land and Water Quality (2010). Gravel Road Maintenance Manual: A Guide for Landowners on Camp and Other Gravel Roads. 104p. http://www.maineroads.org/Resources/Documents/gravel_road_manual.pdf KFH Group, Incorporated. (2017). NCHRP Research Report 861: Best Practices in Rural Regional Mobility. Transportation Research Board, Washington, DC, 184p. http://www.trb.org/Main/Blurbs/176823.aspx https://trid.trb.org/view/1491285 Rural regional transportation services provide services for trips that fall in the middle ground between intercity bus service and local rural bus service. These trips are often too long, time consuming, and expensive to schedule routine trips. Currently, these trips are typically provided through a patchwork of transportation providers, including volunteer driver programs, voucher programs, and paratransit. However, providing a network of rural regional transporta- tion services can improve mobility; improve access to employment, education, and health care; and provide connections to other transportation providers. This report examines strategies to improve regional transportation services, including 12 case studies and a list of steps a transpor- tation agency can use to plan for rural regional transportation services. King, N., et al. (2018). EMS Services in Rural America: Challenges and Opportunities. National Rural Health Associa- tion Policy Brief: 14. https://www.ruralhealthweb.org/NRHA/media/Emerge_NRHA/Advocacy/Policy%20documents/ 05-11-18-NRHA-Policy-EMS.pdf Approximately 20 percent of the U.S. population lives in a rural area. Rural areas are currently facing longer travel distances to medical facilities, funding concerns among rural clinics, and hospital closures, which will further decrease the accessibility to healthcare for rural residents.

C-20 Rural Transportation Issues: Research Roadmap Emergency medical services (EMS) acts as a safety net to ensure access to care for rural areas, but EMS in rural areas have larger service areas and often travel in difficult terrain. This leads to longer response times, and in areas where the only hospital is facing closure, the task of transporting a patient is becoming even more daunting. In rural areas, the total EMS call time (the time from when the unit is dispatched to when the patient arrives at the hospital) is 20 to 30 percent higher than in suburban and urban areas. Travel time and distance is one of the largest factors contributing to patient outcome and survival rates. To compound this issue, 82 rural hospitals have closed since 2010, and many more are facing closure due to financial concerns. In addition, main rural areas rely on volunteers for their EMS workforce more than urban areas (53 percent for rural areas vs. 14 percent for urban areas). Many rural areas have reported issues with recruiting and retaining volunteers primarily because of the time and education required to maintain certifications. With these challenges in mind, many rural areas have turned to coordination of EMS to maximize resources and improve quality of service. Coordination of EMS allows for efficient use of dispatching, administrative costs, prepared- ness, etc. Coordination of EMS is a promising practice to ensure that rural areas have a fully optimized EMS and are able to provide the best quality of care with fewer resources. Klein, S. (2017). Rural Response: The Need for an Effective Rural FirstNet Network. Federal Communications Law Journal 69(1): 53. http://www.fclj.org/wp-content/uploads/2017/04/69.1.3-Stephen-Klein.pdf In this article for the Federal Communications Law Journal, Klein argues that FirstNet needs to work to ensure that rural emergency responders are not left behind. Currently, FirstNet has prioritized urban areas, but rural areas are in critical need of a reliable and effective commu- nications network to support first responders. In this article, Klein provides arguments for FirstNet to work towards implementation in more rural areas where there is a greater need for communications to improve quality of service and reduce the risk of large-scale emergencies (wildfires, floods, etc.). Liebowitz, J. (2004). Bridging the Knowledge and Skills Gap: Tapping Federal Retirees. Public Personnel Management 33(4): 421–448. As many federal employees reach retirement age, the federal government is facing growing knowledge and skills gaps. A poll of 1,589 U.S. adults found that 44 percent of respondents were willing to work part-time after retirement and 14 percent were willing to work full-time. Federal retirees offer a wealth of knowledge and experience that could be shared with current professionals in order to reduce the skills gap. In this report, Liebowitz offers strategies to work with federal retirees. One possible strategy is to bring back federal retirees on a part-time or limited-term basis in order to offset the loss of skilled professionals. This strategy may be difficult to implement due to issues relating to retirees returning to work, including the potential loss of pension benefits. Other methods to utilize retirees in order to begin filling the skills gap include retirees could be utilized as mentors to share their knowledge and experience with younger professionals or agencies can bring retirees into workshops, forums, or other specific knowledge sharing forums in order to share experiences with current employees. Litman, T. (2018). Rural Multimodal Planning: Why and How to Improve Travel Options in Small Towns and Rural Communities. Victoria Transport Policy Institute: 45p. http://www.vtpi.org/rmp.pdf Planning for rural multimodal communities allows residents to travel using multiple modes of transport, including non-motorized modes. Improving multimodal transportation options can improve mobility for all residents, improve public health, and increase economic development.

Annotated Literature Review C-21   This report examines methods to improve multimodal planning for rural and small urban communities. Litman, T., and M. Hughes-Cromwick (2017). Public Transportation’s Impact on Rural and Small Towns: A Vital Mobility Link. Washington, DC, American Public Transportation Association: 48p. http://www.apta.com/resources/reportsandpublications/Documents/APTA-Rural-Transit- 2017.pdf https://trid.trb.org/view/1486036 Lockwood, S. (2004). Transportation in Rural America: Challenges and Opportunities. 10p. http://www.cts.umn.edu/sites/default/files/files/events/oberstar/2004/2004lockwoodpaper.pdf Lococo, K.H., et al. (2018). The Effects of Medical Conditions on Driving Performance: A Literature Review and Synthesis. United States. National Highway Traffic Safety Administration: 85p. https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/13394-mediconlitreview-073018- v3-tag.pdf Loh, T.H., et al. (2012). Active Transportation Beyond Urban Centers: Walking and Bicycling in Small Towns and Rural America. Many believe that bicycling and walking are a “big city” activity and that rural and small urban communities would not benefit from investments in active infrastructure. This is a common misconception. In rural communities with a population between 2,500 and 10,000 residents, people walk for work-related trips at a rate similar to cities and suburbs. Bicycling is just as prevalent in rural areas, the share of work trips via active transportation is almost double that seen in urban areas. In addition, active transportation infrastructure can attract younger generations to a community while promoting economic development, safety for all road users, and improving public health. Rural communities face challenges related to imple- menting active infrastructure, including prevailing land use patterns that have resulted in sprawl, financial constraints, and auto-oriented development that leads to safety concerns for bicyclists and pedestrians. Bicycle and pedestrian investments can be a cost-effective investment to improve safety and improve economic vitality of these community. Bicycling and walking account for less than 2 percent of the federal surface transportation budget, but around 6.9 and 9.6 percent of trips in rural communities are by these active modes, and this number is growing. Three critical programs have helped bring these improvements to rural areas: Transportation Enhancements, Safe Routes to Schools, and Bike/Walk Pilot Program. Investments in bicycling and walking infrastructure have improved the economic development of some communities: Lanesboro, Minnesota, a small town that was seeing a rapid decline in economic vitality, built a trail on an old rail line. This town now sees around $1.5 million annually from bike rides and other trail users. In addition, Lanesboro has attracted new businesses to its thriving main street. In tourist areas, investing in bicycle and pedestrian infrastructure can result in job creation. In North Carolina, a $6.7 million investment in a new trail system created 1,400 jobs. Active infrastructure provides public health benefits to rural communities as well. There is evidence that lack of sidewalks is a leading reason why people do not walk. In Burlington, Wyoming, investments in sidewalks as a part of a Safe Routes to School program have resulted in more students walking or bicycling to school and have provided a benefit to all residents of the small community. While rural communities face many challenges, it is clear that investments in active infrastructure are a cost-effective means to improve safety, create viable transportation alternatives, improve public health, and economic development.

C-22 Rural Transportation Issues: Research Roadmap Lohnes, R.A., et al. (2001). Low Water Stream Crossings: Design and Construction Recommendations. Iowa State University, Ames. Iowa Department of Transportation: 55 p. http://www.ctre.iastate.edu/reports/LWSC.pdf https://trid.trb.org/view/718736 Loughran, D.S., et al. (2007). What Risks Do Older Drivers Pose to Traffic Safety? RAND Corporation: 2p. https://www.rand.org/pubs/research_briefs/RB9272.html#related Lyons, W., et al. (2014). Statewide Transportation Planning for Healthy Communities. Volpe National Transportation Systems Center. Federal Highway Administration: 101p. http://www.planning.dot.gov/documents/VolpeFHWA_DOT_Health.pdf https://rosap.ntl.bts.gov/view/dot/12055 https://trid.trb.org/view/1308455 State Departments of Transportation (DOTs) play a leadership role in planning, programming, and implementing transportation projects within their state. This white paper provides a flexible framework for DOTs to incorporate public health into the transportation planning process. DOTs have the ability to incorporate public health related policy initiatives into the planning process by including health goals into statewide long-range transportation plans, providing data on health trends to identify health goals or initiatives that would have the greatest impact, and by leveraging funding to support public health consideration into the transportation planning process. In this white paper, Lyons et al. describe how DOTs in five states have worked to incorporate health into their planning process. Four common health priority areas were found: safety, air quality, activity levels (or increasing non-motorized transportation), and accessibility. DOTs that are currently considering health in their transportation planning activities tend to have legislation or leadership behind the motivation to incorporate health considerations. These DOTs tend to have a good relationship with the state public health agency and are involved in programs that address public health like Safe Routes to Schools or Complete Streets. MacLeod, K.E., et al. (2014). Missed or Delayed Medical Care Appointments by Older Users of Nonemergency Medical Transportation. The Gerontologist 55(6): 1026–1037. https://academic.oup.com/gerontologist/article/55/6/1026/2605437 In this article, MacLeod et al. studied the reasons why older adult Medicaid patients in Delaware canceled non-emergency medical transportation appointments. Data from 125,912 Medicaid NEMT trips provided for 2,913 patients was examined. Most trips were for dialysis appoint- ments (75%), most of these appointments were pre-scheduled. Trips that were not pre-scheduled (25% of all appointments) were more likely to be canceled. Only 6% of all trips were canceled, most (55%) of these were for client reasons (no shows, refusal). Macy, B. (2018). Dopesick. New York, NY, Little, Brown and Company. Maritime Administration and Environmental Protection-Agency (2011). America’s Marine Highway: Report to Congress. 86p. https://trid.trb.org/view/1105315 Markiewicz, A., and J. Andrew (2018). Angeles National Forest Transit Corridor Analysis. Volpe National Transportation Systems Center. U.S. Forest Service: 56p. https://rosap.ntl.bts.gov/view/dot/35975 https://trid.trb.org/view/1515286

Annotated Literature Review C-23   The Angeles National Forest in Southern California provides a variety of outdoor recreation opportunities all within the Los Angeles region. The Angeles National Forest established the Transportation Working Group with the goal of increasing access to low-income, underserved, and zero car households; reduce congestion; and improve safety. As a part of these efforts, Volpe conducted an assessment of three access corridors and identifies opportunities to improve access to the Angeles National Forest. Researchers recommended that the Angeles National Forest consider implementing shuttle services to provide access to Chantry Flat and the Altadena/ Pasadena Trailheads. Maryn Consulting, Inc. (2016). Emergency Communications Centers and the Role of Communications Technologies in Reduc- ing Mortality Rates in the Rural U.S. Washington, DC: 58p. https://www.ems.gov/pdf/advancing-ems-systems/Reports-and-Resources/ECC-Role-of- Communications-Technologies.pdf Improved emergency response is vital to improving mortality on rural roads in the United States. This report by the National Highway Traffic Safety Administration considers the role of emergency communications centers (ECCs) and how improved coordination and communica- tions can improve emergency medical services’ ability to respond to a call. Three ECCs, Alabama Trauma System and the Alabama Trauma Communications Center (ATS/ATCC), the Maryland Institute for Emergency Medical Services System (MIEMSS), and Mississippi MED-COM were interviewed on their communications practices to gain an idea of communications technolo- gies, funding, and structure. NHTSA found similarities between the three ECCs, primarily that each started small and built up to a regional or statewide service and that each has deployed communications technology advancements slowly over time. Improvements in communica- tions technologies allow the ECC to work towards reducing mortality rates, but keeping up with changes in technology can be a challenge due to funding. Matsubayashi, T., et al. (2014). Does the Installation of Blue Lights on Train Platforms Shift Suicide to Another Station?: Evidence from Japan. Journal of Affective Disorders 169: 57–60. https://doi.org/10.1016/j.jad.2014.07.036 Mattson, J. (2017). Rural Transit Fact Book 2017. North Dakota State University: 60p. http://surlc.org/wp-content/uploads/2017/02/2017-rural-transit-fact-book.pdf http://www.surtc.org/transitfactbook/downloads/2017-rural-transit-fact-book.pdf https://trid.trb.org/view/1488788 McAndrews, C., et al. (2017). The Reach of Bicycling in Rural, Small, and Low-Density Places. Transportation Research Record: Journal of the Transportation Research Board, No. 2662, Washington, DC, p. 134–142. Bicycle friendly places tend to have supportive infrastructure, culture, and education programs. Urban areas implement strategies like Complete Streets and on-street bicycle lanes in order to increase work trips by bicycle, whereas rural, small, and low-density (RSLD) areas focus on historic preservation and paved highway shoulders. In rural areas, where travel distances tend to be longer, the automobile is still considered the most viable method of travel. It is clear that one solution does not fit all communities when developing multimodal plans. Further data on the patterns of bicycling in RSLD areas is a necessary component for effecting transportation planning. Data from the 2009 National Household Transportation Survey was used to under- stand bicycling behaviors of RSLD residents vs. urban residents. Younger people living in RSLD areas were more likely to report bicycling one or two times in the previous week. Young people in RSLD areas had twice the odds of bicycling compared with adults in more urban areas. This suggests that policies geared towards increasing commutes to work may be less effective in RSLD

C-24 Rural Transportation Issues: Research Roadmap areas. Women were also more likely than men to report bicycling 1 or 2 times within the previous week in RSLD areas. In addition, people living in recreation or retirement communities had a higher likelihood of bicycling within the previous week, suggesting that urban vs. rural may not be the deciding factor in bicycle mode choice but that social, cultural, and environmental factors are instead. Further research on the patterns and behaviors of bicyclists in both urban and rural communities is necessary to fully understand how these factors play in the decision to bicycle for utilitarian and recreational purposes. McAndrews, C., et al. (2018). Motivations and Strategies for Bicycle Planning in Rural, Suburban, and Low-Density Commu- nities: The Need for New Best Practices. Journal of the American Planning Association 84(2): 99–111. https://doi.org/10.1080/01944363.2018.1438849 Planners view bicycling infrastructure as a critical component to a sustainable multimodal transportation network. But most research has focused on the motivations and behaviors of urban places. McAndrews et al. suggest that rural areas may have vastly different motivations for planning and implementing bicycling infrastructure. This paper examines 10 grantees who received funding from Kaiser Permanente’s Walk and Wheel program which aimed to increase bicycle planning and outreach in rural areas. Four of these grantees had already received national recognition for their bicycle friendliness. Four of the ten rural grantees used funding to pursue recreation-focused bicycling programs, including off-street trail networks, bicycle improvements in parks, etc., whereas the more urban grantees focused on on-street commuter- focused improvements. All grantees faced challenges with education and acceptance of bicycles on roadways and negative beliefs of cyclists. Education programs with the public and govern- ment officials proved necessary to explain the benefits of bicycling on traffic congestion, public health, economic development, tourism, and property values. Most rural communities needed assistance with educational outreach for a variety of stakeholders in order to change the perspective of bicyclists including marketing events like Bike to Work Week. These findings suggest that the traditional bicycle planning model is missing a key component for rural areas—education and outreach. McCoy, K., et al. (2018). Integrating Shared Mobility into Multimodal Transportation Planning: Improving Regional Performance to Meet Public Goals. U.S. DOT, Volpe National Transportation Systems Center, Federal Highway Administration: 56p. https://www.planning.dot.gov/documents/SharedMobility_Whitepaper_02-2018.pdf https://rosap.ntl.bts.gov/view/dot/34689 https://trid.trb.org/view/1503134 Shared mobility services like rideshare, carshare, and bikeshare are becoming increasingly common modes of travel in the United States. Shared mobility services have the opportunity to hinder or complement public transportation services. This report examines a framework and examples to help transportation agencies anticipate and plan for shared mobility services. This report summarizes best practices from 13 metropolitan areas and provides recommendations for future research to improve planning for shared mobility. McGlothin Davis, Inc. (2002). TCRP Report 77: Managing Transit’s Workforce in the New Millennium. Transportation Research Board of the National Academies, Washington, DC. Public transit agencies are facing challenges related to the workforce, including recruiting and retention of employees, limited resources, demographic changes, and technological changes. Managing Transit’s Workforce in the New Millennium examines the state of public transit and the industry’s workforce needs, including necessary workforce skills, best practices for

Annotated Literature Review C-25   recruiting and retaining employees, and strategies to enhance or establish partnerships between management and labor for attracting, training, and maintaining a qualified workforce. Meit, M., et al. (2014). The 2014 Update of the Rural-Urban Chartbook. Bethesda, MD: 153. https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural- urban-chartbook-update.pdf Merrill, D., and L. Leatherby (2018). Here’s How America Uses Its Land. Retrieved 17-October-2018, from https://www.bloomberg.com/graphics/2018-us-land-use/ srnd=premium. Meyer, M.R.U., et al. (2016). Rural Active Living: A Call to Action. Journal of Public Health Management and Practice: JPHMP 22(5): E11. Rural populations in the U.S. face higher rates of health problems associated with lower physical activity levels, meaning these communities are important to target for strategies to increase public health. This paper outlines key gaps in knowledge in promoting active living in rural areas. Evidence suggests that rural residents are more willing to travel longer dis- tances to access parks and trail networks, and trails could be a cost-effective method to promote physical activity. The rails-to-trails programs has successfully created over 22,000 miles of trails across the United States. Since many rural communities are built along rail lines, this program may present a great opportunity to promote active living in rural communities. Given that roadways in rural communities are often designed to accommodate high speed traffic, these areas often do not have bicycle lanes, sidewalks, or paved shoulders. However, the relation- ship between sidewalk access and rural areas may not be as clear at it is in urban areas. Further research is necessary to fully understand the perceived barriers to active transportation among rural residents. Further, little research has been conducted on the social and environmental factors in rural areas. There have been suggestions that aesthetics, perceived safety, and presence of parks, trails, and recreational facilities are commonly associated with higher levels of physical activity in rural adults. Finally, little research has been conducted on implementation and success of active transportation policy adoption in rural communities. Beginning to fill these knowledge gaps will provide researchers and policymakers with the data necessary to begin designing a framework for active living in rural areas. Mjelde, J., et al. (2017). Economics of Transportation Research Needs for Rural Elderly and Transportation Disadvantaged Populations. Washington, DC, Texas A&M University. Texas Transportation Institute: 116p. https://static.tti.tamu.edu/tti.tamu.edu/documents/TTI-2017-1.pdf Mobile Health Map (2013). Mobile Health Clinics in the United States. U.S. Department of Health and Human Services, Office of Minority Health: 36p. https://www.mobilehealthmap.org/sites/default/files/Mobile_Health_Clinics_in_the_United_ States_March_2013.pdf Mobile health clinics use vans, buses, and other recreational vehicles that have been converted into temporary medical clinics. These mobile clinics allow health care providers to bring health- care to areas where they are needed. In 2013, there were between 1,500 to 2,000 mobile clinics in the United States. These clinics provided everything from vaccinations to lab work. Approxi- mately 15 percent of these mobile clinics specifically served rural areas, and 44 percent served both urban and rural areas. Mobile clinics have the ability to bring health care to underserved areas and could work to reduce the healthcare disparities seen in rural communities.

C-26 Rural Transportation Issues: Research Roadmap Monahan, P., et al. (2017). Consolidation of Rural Public Transportation Services Guidebook. Nelson\Nygaard Consulting Associates. I.C.F. International: 70p. http://onlinepubs.trb.org/onlinepubs/nchrp/docs/NCHRP20-65(69)_Guidebook.pdf https://trid.trb.org/view/1511931 Consolidation of public transportation systems is one way transportation providers can integrate services to improve efficiency, maximize limited resources, and improve customer satisfaction. This guidebook explores consolidation of public transportation systems in a rural context including benefits, strategies, lessons learned, and a step-by-step process for consolida- tion. Four case studies examined consolidation efforts in detail in New Mexico, North Carolina, Vermont, and Pennsylvania. Moreno-Long, A. (2017). Riding the Trail to Revitalization: Rural and Small Town Trail-Oriented Development. Retrieved 16-September-2018, from https://www.rural-design.org/blog/riding-trail-revitalization- rural-and-small-town-trail-oriented-development. Designing rural communities to be welcoming and attractive is key in developing an econo- mically vibrant future. Creating access to trail networks is one strategy that has been proven to improve the economic success of rural and small towns. Trail-oriented development uses trails to provide transportation and recreation to residents and tourists, improve quality of life, and contribute to the economic wellbeing of a community. Creating a trail network that connects rural communities with destinations can improve business development, increase property values, provide safe active infrastructure, attract visitors, and promote public health. The pres- ence of trails is a known factor in influencing homebuyers to purchase a home. Trails can also encourage tourism and attract businesses to support trail users. Trails can also serve as a com- ponent of a main street or downtown revitalization project. The Trace Trail is Louisiana’s first rail trail. This 27-mile-long trail connects five rural communities in St. Tammany Parish, Louisiana. Each community serves as a trailhead and hosts multiple events throughout the year that attract thousands of visitors and locals. In 2013, an estimated 426,000 visitors stayed in hotels along the Trace Trail. The Trace Trail had an average of 197,219 trail users annually between 2008 and 2014 and is widely seen as a valuable community asset. An estimated $2,816,924 is spent each year by Trace Trail users. The Trace Trail has had a significant impact on the economic wellbeing and health on the rural communities along the trail. Morrow, S., and M. Coplen (2017). Safety Culture: A Significant Influence on Safety in Transportation. United States. Federal Rail- road Administration. Office of Research, Development, and Technology: 63p. https://rosap.ntl.bts.gov/view/dot/32538 Safety culture or “the shared values, actions, and behaviors that demonstrate a commitment to safety over competing goals and demands” has increasingly been recognized as having an impact on safety outcomes. A review of publications across multiple industries was conducted to gain an understanding of the critical components of a strong safety culture. Ten components stood out: 1) strong leadership committed to safety, 2) open communication, 3) employees feel a personal responsibility or take ownership of safety, 4) the organization is continually learning and updating safety procedures, 5) all employees are safety conscious, 6) reporting systems are clear, 7) safety is prioritized over competing demands, 8) there is trust among employees and leadership, 9) there are consistent responses to safety concerns, and 10) safety is supported by training and resources. Mueller, L.R., et al. (2016). National Characteristics of Emergency Medical Services in Frontier and Remote Areas. Prehospital Emergency Care 20(2): 191–199. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853204/

Annotated Literature Review C-27   Few studies have considered emergency medical services in isolated and low-density frontier and remote (FAR) areas in the United States. EMS in FAR areas is challenging due to longer travel distances, sparse populations, and reduced resources. Mueller et al. studied data from the 2012 National Emergency Medical Services Information System (NEMSIS) for 40 states in an effort to characterize EMS responses in FAR areas. FAR areas were identified as a region of census tracts where a resident would have to drive 60 or more minutes to reach an urban area with a popu- lation of 50,000 people or more. Around 7 percent of EMS responses were in FAR areas. FAR areas had longer response times compared with non-FAR (17 minutes vs. 13 minutes) and patient transport times (42 minutes vs. 28 minutes). Emergency responders in FAR areas tend to institute advanced medical procedures when compared to non-FAR respondents. This could be due to FAR responders anticipating longer patient transport times. EMS responses in FAR areas were more likely to result in hospitalization or death. The results of this study indicate that EMS responders in FAR areas have unique needs which may require improved EMS technology and training. Muir, C., et al. (2018). Evolution of a Holistic Systems Approach to Planning and Managing Road Safety: The Victorian Case Study, 1970–2015. Injury Prevention 24(Suppl 1): i19-i24. https://injuryprevention.bmj.com/content/injuryprev/24/Suppl_1/i19.full.pdf Murphy, C. (2016). Shared Mobility and the Transformation of Public Transit. Shared-use mobility services are increasingly being implemented in urban areas. These services can complement existing public transportation systems to create a full network of mobility options for residents. This study surveyed 4,500 shared-use mobility service users in seven metro- politan areas. Respondents who used shared-use services had lower rates of vehicle ownership and decreased household transportation spending. Shared-use services were used for the following trips: recreational or social (54%), commuting (21%), and shopping or errands (16%). These services were frequently used during evenings and weekends when public transportation systems were not in operation. Some respondents stated that they used shared-use services due to alcohol usage, meaning these services could help reduce drunk driving accidents. Public and private sectors should collaborate in order to provide effective services that will meet residents’ needs. Shared-used services could be considered as a cost-effective way to provide paratransit type services. Services like SilverRide, which provides services to seniors, has hired and trained drivers to be able to accommodate their customers’ needs including first aid and training on how to properly lift or transfer riders. This type of service can effectively meet the mobility gaps within a community, but partnerships between public and private mobility providers are necessary for long-term success. Nash, L., et al. (2017). National Park Service Digital Transit Data Sharing Pilot Results and Discussion. U.S. Department of Transportation Volpe Center. National Park Service: 16p. https://rosap.ntl.bts.gov/view/dot/12454 https://trid.trb.org/view/1466722 This report summarizes the National Park Service’s 2015 pilot project to convert their transit schedules into General Transit Feed Specification (GTFS) format. The National Park Service has approximately 121 transit services including ferries, buses, and other vehicles in units across the country. Converting these schedules into a digital format will make visitor trip planning information more accessible. National Academies of Sciences, Engineering, and Medicine (2016). Exploring Data and Metrics of Value at the Intersection of Health Care and Transportation: Pro- ceedings of a Workshop. Washington, DC, The National Academies Press. https://www.nap.edu/catalog/23638/exploring-data-and-metrics-of-value-at-the-intersection- of-health-care-and-transportation

C-28 Rural Transportation Issues: Research Roadmap This report summarizes the proceedings of a joint workshop hosted by the National Academies of Sciences, Engineering, and Medicine, the Health and Medicine Division, and the Transporta- tion Research Board in 2016. The goal of the workshop was to explore partnership opportunities between transportation and public health, opportunities and challenges faced by all stakeholders, and transportation models that have been successful for providing access to healthcare. Partici- pants were from the transportation and public health industries. While the number of insured Americans has increased in recent years, access to healthcare is still an ongoing issue. Annually, 3.6 million Americans miss or delay medical care due to transportation barriers. Common bar- riers or challenges included difficulty defining return on investments; limited funding; missing data on patients and transportation challenges; rural geography; lack of communication between transportation and health care; transportation services gaps for Medicaid, Medicare, and VA transportation; and the need for technology to track transit trips. Although improving the con- nection between transportation and healthcare faces many barriers, participants explored many potential solutions including grant funding; creating opportunities for sharing knowledge and guidance; starting small and making incremental changes; interviewing patients to understand their needs and how to meet them; mobile health clinics; and data sharing to improve access to care. In addition, there is a research need to explore what transportation models have been successful in improving access to healthcare to create awareness for stakeholders. National Academies of Sciences, Engineering, and Medicine (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommenda- tions for Research. Washington, DC, The National Academies Press. https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the- current-state National Academies of Sciences, Engineering and Medicine (2018). Achieving Rural Health Equity and Well-Being: Proceedings of a Workshop. Washington, DC, The National Academies Press. https://www.nap.edu/catalog/24967/achieving-rural-health-equity-and-well-being- proceedings-of-a Rural counties contain 80 percent of the U.S. land area, but less than 20 percent of the U.S. population resides in a rural county. Rural communities each have unique culture, economies, and histories. These differences play a role in understanding how to improve health and reduce health disparities in rural communities. The National Academies of Sciences, Engineering, and Medicine held a workshop, “Achieving Rural Health Equity and Well-Being: Challenges and Opportunities” in June 2017. This workshop discussed improving public health and reducing health disparities. Highlights from discussions include an understanding of how poverty plays a role in creating challenges for rural communities and a role in health, a need for data on pro- grams that have worked in rural areas, rural communities having the ability to create innovative programs to address health care inequalities, and technology, like mobile health clinics and telehealth, that can provide vital services to the most disadvantaged populations. National Aging and Disability Transportation Center (2018). National Aging and Disability Transportation Center. Retrieved 26-September-2018, from https://www.nadtc.org/. National Center for Mobility Management (2018). National Center for Mobility Management. Retrieved 26-September-2018, from https://nationalcenterformobilitymanagement.org/. National Center for Safe Routes to School (2014). Walking and Bicycling in Indian Country: Safe Routes to School in Tribal Communities. 6p. Tribal communities face particular challenges to implementing active transportation infra- structure or policy. Native children may attend numerous types of schools: state-funded public

Annotated Literature Review C-29   schools, schools operated by the Bureau of Indian Education (BIE), and tribal-funded schools. Each type of school may face challenges with Safe Routes to School initiatives. For example, students at BIE-operated schools or tribally-funded schools may have to travel long distances to school, meaning programs that improve physical activity for all students on campus or remote drop-off locations may be the most beneficial strategies. Depending on the tribe, multiple agencies may be responsible for roads and land that affect the ability of children to bicycle or walk to school. On reservations, roads may be owned and operated by the tribe, but state or county roads may cross the reservation. Collaboration with the agency responsible for roads is key to success for Safe Routes to School programs in these cases. Tribes face challenges similar to other rural communities: limited resources, limited staff, long travel distance, and lack of active infrastructure. Many tribal communities have successfully implemented pedestrian and bicycle safety improvements. In Ronan, Montana, the Parks and Recreation Department obtained Safe Routes to School funding to create paths that connected the local school with a centrally located park. This worked to increase physical activity levels among students and provide recreational opportunities to all community members. In addition to these efforts, Ronan received additional Safe Routes to School funding to improve safety through lighting, signage, crosswalk improve- ments, and trail connections to tribal housing. National Conference of State Legislatures (2018). Autonomous Vehicles Self-Driving Vehicles Enacted Legislation. Retrieved 26-September-2018, from http://www.ncsl.org/research/transportation/autonomous- vehicles-self-driving-vehicles-enacted-legislation.aspx. This website describes states that have passed legislation regarding autonomous vehicles. As of 2017, 33 states have introduced legislation related to autonomous vehicles, and this number is expected to increase as the technology continues to develop. National Highway Traffic Safety Administration (2018). Automated Vehicles for Safety. Retrieved 26-September-2018, from https://www.nhtsa.gov/technology-innovation/automated- vehicles-safety. National Highway Traffic Safety Administration (2018). Road Safety Topics: Teen Driving. Retrieved 27-September-2018, from https://www.nhtsa.gov/road-safety/teen-driving. National Highway Traffic Safety Administration (2018). Traffic Safety Facts: Rural/Urban Comparison of Traffic Fatalities. Washington, DC, National Highway Traffic Safety Administration National Center for Statistics and Analysis: 7p. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812521 National Research Council (2011). Improving Health in the United States: The Role of Health Impact Assessment. The National Academies Press. The United States ranks 32nd in the world in life expectancy. There is a growing understand- ing that the built environment has an impact on public health. Factors like housing quality, accessibility, exposure to pollution, and safe active infrastructure all play a role in the health of a community. Health impact assessments (HIAs) are a promising method to incorporate health considerations into the decision-making process. HIA is a process that uses data and stakeholder input to determine the effects of a plan or policy on the health of a population and the distribution of those effects. A HIA will provide recommendations to minimize the negative health impacts of a plan or policy and provide recommendations on how to monitor and evaluate effects. There is a growing effort to address the health impacts of planning and policies. HIA is one approach to do so but can be hindered by data constraints and stakeholder expectations.

C-30 Rural Transportation Issues: Research Roadmap National Rural Transit Assistance Program (2018). National Rural Transit Assistance Program. Retrieved 27-September-2018, from https://www.nationalrtap.org/. Nelson\Nygaard Consulting Associates (2014). MOVE Central Arkansas State of the System. 114p. https://rrmetro.org/wp-content/uploads/2016/01/MCANovember2014StateoftheSystemReport.pdf Nelson\Nygaard Consulting Associates (2015). Initiative: Human Service and Public Transportation Coordination. Ohio Department of Transportation. 41p. A lack of transportation is a primary barrier to health care and human services programs, which has led to the creation of human services transportation (HST) networks. HST programs transport people to specific program activities only, but these programs often result in increasing costs and possible duplication of services. Coordination of HST and public transportation can provide a better transportation service to all residents while maximizing limited resources. Ohio Department of Transportation examined strategies to better coordinate transportation systems within the state to address service gaps and reduce costs. Nelson\Nygaard Consulting Associates and Fitzgerald & Halliday, Inc. (2011). Sussex County Public Transportation Study. 53p. https://www.sussex.nj.us/documents/transit/transportationstudyfinalreportsussex091311.pdf Sussex County, New Jersey, invited Nelson\Nygaard to evaluate Skylands Ride transit service and make recommendations for improvement. Skylands Ride’s schedules, routes, fleet, market- ing, and funding were analyzed, and results from a previous survey of Sussex County residents were used to create recommendations. Nelson\Nygaard recommended service changes and expansions as well as creating a new marketing campaign to rebrand the service. NHTSA (2018). 2017 Fatal Motor Vehicle Crashes: Overview. Washington, DC, U.S. Department of Transpor- tation, National Highway Traffic Safety Administration. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812603 Nutley, S. D. (1996). Rural Transport Problems and Non-Car Populations in the USA: A UK Perspective. Journal of Transport Geography 4(2): 93–106. http://www.sciencedirect.com/science/article/pii/0966692396000026 OECD (1999). Safety Strategies for Rural Roads. Paris, OECD Publishing. https://www.oecd-ilibrary.org/content/publication/9789264172913-en Orton Family Foundation (2017). Fostering a Vibrant Local Economy. Orton Family Foundation: 13p. https://www.orton.org/wp-content/uploads/2017/03/fostering-a-vibrant-economy.pdf Paul, H.R. (2008). The Louisiana Model for Transportation Workforce Development: Integrating Technical Assistance, Structured Training, Continuing Education, and Technology Transfer. TR News, No. 257, July–August, pp. 7–13. In 2001, the state department of transportation and development created policy that stated training was key to maintaining a skilled transportation workforce. The DOTD created a structured training program that requires work-related trainings be completed at each level of a career path. Trainings covered three main focus areas: 1) construction and materials,

Annotated Literature Review C-31   2) maintenance, and 3) management development. In 2004, the state began construction on the Transportation Training and Education Center (TTEC) which would allow the public and private sector to partner and enable workforce development. In addition to the TTEC, the Louisiana DOTD hosts a Louisiana Transportation Engineering Conference bi-annually to share best practices and recent innovations. This event attracts nearly 1,600 attendees. Peterson, D., and T. Rieck (2017). Aging in Place in Small Urban and Rural Communities. Public transportation provides mobility and freedom to aging senior citizens who would otherwise have to give up their lifestyle. But seniors in rural communities are increasingly deciding to age in place. Peterson and Rieck examine aging in place in small urban and rural communities and quantify the costs for residents to age in place and utilize public transportation vs. moving into an assisted living facility. Nearly 90 percent of seniors want to age in place (remain in their home). Transportation is an important factor in whether aging in place can occur. Providing transportation alternatives for seniors is important as people age 75 and older have the highest rate of driving fatalities of any age group. In many rural communities, public transportation is often not available or deficient. Many seniors will reduce their activity levels due to transporta- tion concerns, leaving a significant proportion of the population socially isolated. The costs for aging in place vs. living in an assisted living facility were calculated for eight primarily rural states, including Montana, Missouri, Maine, Mississippi, Wisconsin, New Mexico, Pennsylvania, and North Carolina. In a 10-year period, seniors could save between $10,000 and $100,000 by aging in place. Cost savings depended on living arrangements and total mortgage amounts. These results should be considered by planning policymakers. Many seniors could save tens of thousands by aging in place and using public transportation, but without viable transportation alternatives, seniors could be forced to relocate against their wishes. Transportation alterna- tives could allow seniors to age in place and remain active within their community. Quatt Associates and B.H. Vogel (2001). TCRP Research Results Digest 45: Identification of the Critical Workforce Development Issues in the Transit Industry. Transportation Research Board of the National Academies, Washington, DC. Public transportation agencies are facing issues with attracting and retaining employees. This study conducted a survey and in-depth interviews with American Public Transportation Association (APTA) members and outside industries facing similar problems to identify work- force challenges and strategies to address them as well as next steps to handle long-term work- force development in the transportation industry. Results from this survey found that workforce development was a critical issue faced by public transportation agencies. Interviews found common issues among public transportation agencies including: the retirement tsunami, succes- sion planning, difficulty recruiting skilled employees, misperceptions about the industry, and changes in technology and workforce demographics. Suggested strategies to face these issues include everything from succession planning, to providing training programs in multiple languages, to public outreach to improve the public transit image. Suggested long-term efforts include ongoing benchmarking with other agencies to identify innovative workforce development strategies and longer-term workforce planning to continually update human resources practices. Rasmussen, B., and L. Deaderick (2016). White River National Forest Hanging Lake Visitor Transportation Survey - Summary of Results. Volpe National Transportation Systems Center. U.S. Forest Service: 46p. https://rosap.ntl.bts.gov/view/dot/12406 https://trid.trb.org/view/1458085 This report summarizes the results of a U.S. DOT Volpe Center visitor transportation survey at the Hanging Lake recreation site in the White River National Forest in 2016. The goals of this

C-32 Rural Transportation Issues: Research Roadmap survey were to understand visitor behavior, experiences on the parking lot and trail, evaluate economic impact on surrounding communities, and evaluate opinions on future transportation options. Results of this survey found that 70 percent of visitors were visiting Hanging Lake for the first time. Most respondents were aware of parking issues and trail crowding, especially during peak visitation periods. Most visitors (79 percent) would be likely to use a shuttle to travel to the recreation site. These results will be used to help the White River National Forest determine which transportation management practices will be considered in the future. Rasmussen, B., and L. Deaderick (2017). White River National Forest Hanging Lake Transportation and Operations Study. Volpe National Transportation Systems Center. Forest Service: 35p. https://rosap.ntl.bts.gov/view/dot/12499 https://trid.trb.org/view/1471607 The Hanging Lake recreation site within the White River National Forest has been increasing in popularity. Due to increased visitation, the U.S. Forest Service worked with the Volpe Center to develop transportation options to improve visitor access. Goals of these transportation options are to protect natural resources, manage congestion, improve safety, improve the visitor experience, and support local tourism. This report studies four transportation options to create long-term solutions for current transportation issues like parking congestion, trail crowding, and environmental decline. Rasmussen, B., et al. (2017). Mississippi National River and Recreation Area Water Trail Plan. Volpe National Transportation Systems Center. Mississippi National River Recreation Area. National Park Service: 71p. https://rosap.ntl.bts.gov/view/dot/12478 https://trid.trb.org/view/1466670 Reno, A., and G. Weisbrod (2009). Economic Impact of Public Transportation Investment. 77p. https://www.apta.com/resources/reportsandpublications/Documents/economic_impact_of_ public_transportation_investment.pdf This report examines public transportation’s impact on the economy. Findings from this study determined that around 36,000 jobs are supported for one year, per billion dollars of annual spending on public transportation. Public transportation can decrease transportation costs and reduce travel times, which have an impact on business operations. This study did not account for social and environmental costs and benefits of public transportation. These benefits could provide a further look into the overall societal benefits. A more holistic understanding of the costs and benefits of public transportation can help planners and policy-makers with future investment decisions. Rodler, C., and L. Podolsky (2017). Opportunities for Shared-Use Mobility Services in Rural Disadvantaged Communities in California’s San Joaquin Valley: Existing Conditions and Conceptual Program Development. Shared-use mobility services like carshare, bikeshare, and rideshare are becoming increasingly common in urban areas. But these services may provide cost-effective transportation options to rural communities. This study examines the cost-effectiveness of an existing public transportation system in rural communities in the San Joaquin Valley in California and compares the cost of potential shared-use mobility services. This study examined ridesourcing (Uber/Lyft type service), ridesplitting (Waze Carpool/UberPool), carsharing (Zip Car), and split-carsharing. If ridesourcing replaced the existing public transportation system in 52 to 67 percent of the com- munities, it could result in average cost savings of $19 to $27 per trip. In 78 percent of the communities, ridesplitting could save an average of $27 per trip. Carsharing and split-carsharing have the greatest potential to reduce transportation costs in rural communities, these services

Annotated Literature Review C-33   cost less than public transportation in 90 to 100 percent of the rural communities studied, with an average cost savings of $25 to $28 per trip. Pilot services were implemented in the San Joaquin Valley as part of this study. Victor Valley Transit Authority partnered with Enterprise CarShare to implement a carsharing program in Needles, California. This service provided car rentals for $5 per hour. The results of this study show that shared-use mobility services could be a cost- effective method to improve mobility in rural communities. Rosenbloom, S. (2009). Meeting Transportation Needs in an Aging-Friendly Community. Generations 33(2): 33–43. By 2030, there will be an estimated 72 million seniors in the United States. In order to main- tain the quality of life for seniors, communities need to consider transportation alternatives to driving. The alternatives include public transportation, walking infrastructure improvements, and community transportation programs. It should be noted that many seniors are unfamiliar and uncomfortable with traditional public transportation. Efforts to familiarize seniors with public transportation, such as travel training and providing driver assistance, are methods to over- come these concerns. The need for transportation alternatives for seniors is clear. To make steps in the right direction, communities need to consider adopting policies and programs that will help support transportation alternatives. Rural Health Information Hub (2016). Transportation to Support Rural Healthcare. Retrieved 27-September-2018, from https://www.ruralhealthinfo.org/topics/transportation# strategies. The Rural Health Information Hub website provides information on strategies to make public transportation an option for people to access healthcare. These strategies include (1) streamline trip scheduling and dispatch; (2) centralize staff for trip eligibility determination and reservation requests; (3) set schedules for medical trips to specialty care centers to reduce travel times and provide consistent service; (4) reminder calls the night before to confirm/cancel trip requests; and (5) disseminate information about existing public transportation services. Rural Health Information Hub (2018). Volunteer Models. Retrieved 28-September-2018, from https://www.ruralhealthinfo.org/toolkits/transportation/2/ models-to-improve-access/volunteer-models This website is part of the Rural Transportation Toolkit provided by the Rural Health Informa- tion Hub. These driver programs use volunteer drivers to provide door-to-door or curb-to-curb transportation. These programs have been utilized in rural communities to meet transportation needs in areas without public transportation. In particular, these programs are helpful to senior citizens and to people with disabilities. The toolkit provides examples of successful volunteer driver programs as well as resources for further information. Saarenketo, T., and S. Aho (2005). Managing Spring Thaw Weakening on Low Volume Roads: Problem Description, Load Restriction, Policies, Monitoring and Rehabilitation. The Roadex II, Northern Periphery. 130. http://www.roadex.org/wp-content/uploads/2014/01/2_3-Spring_Thaw_Weakening_l.pdf Safe Routes to School National Partnership (2014). Safe Routes to School: How States Are Adapting to a New Legislative Framework. The Safe Routes to School program provides federal funding to make walking and bicycling to school safer for more children. Eligible projects include infrastructure projects and non- infrastructure activities. Projects across all fifty states and the District of Columbia have involved sidewalk construction, crossing improvements, crossing guard training, and bicycling training events. From 2005 to 2012, Safe Routes to School funds were allotted to state DOTs, which then

C-34 Rural Transportation Issues: Research Roadmap provided grants (i.e., no local match necessary). This allowed rural and small communities with limited financial resources to take advantage of the program. In 2012, the Safe Routes to School program was combined with the Transportation Enhancements and Recreational Trails pro- gram under the Transportation Alternatives Program (TAP). This funding structure required a state or local match of 20 percent, which resulted in a financial barrier for smaller communities. In 2012, more than 22,000 children were injured by cars and an additional 270 were killed by cars while bicycling or walking. The availability of sidewalks cuts the risk that a pedestrian will be hit by a car in half. In New York City, where Safe Routes to School projects were implemented, pedestrian injuries among children declined 33 percent overall. These improvements in active infrastructure for children do not just improve safety but have been effective in increasing activity levels among children. Safe Routes to School programs have increased bicycling and walking to school by 37 percent. This report explores the implementation decisions made by state DOTs to understand the impact on Safe Routes to School funding. At the time of the report, Florida and Ohio were the only states that were providing 20 percent match funds required for Safe Routes to School projects to ensure that this program could be implemented in low income and rural communities. These funds were coming from state tolling revenues. The Safe Routes to School program has had a positive impact on the safety and health of school age children, but recent changes to funding will have a negative impact on the program, particularly in low- income and rural communities. Safe Routes to School National Partnership (2016). Safe Routes to School in Small Rural Communities: Challenges and Strategies to Accessing Funding. 7p. In 2012, MAP-21 required that states set aside a portion of Transportation Alternatives Program funding for communities of 5,000 people or less, including small rural communities, tribal communities, and unincorporated communities. However, small communities within an urbanized area with a metropolitan planning organization are not eligible to receive these funds. Each state is responsible for selecting projects within rural communities as part of a competi- tive process. Small rural communities face many challenges with using these funds, including limited staff, limited financial resources, low competitiveness of small scale projects, compet- ing priorities, and lack of awareness. State DOTs are utilizing numerous strategies to support rural communities to obtain and implement bicycle and pedestrian projects. Supporting bicycle and pedestrian projects at a regional level is one strategy. Some state DOTs have provided pre- application technical assistance to help rural communities with limited staff to prepare competi- tive applications for project funding. This technical assistance may include identification of best practices or help with prioritizing locations for projects, cost estimation, and other application requirements. This strategy has been used successfully in Oregon and Minnesota. State DOTs may also provide post-award technical assistance, including education on project implementa- tion, design, and construction administration. This shifts the administrative burden onto the state DOT instead of the local agency. Some states have also encouraged combining projects within a community or within multiple communities to better pool resources. Sakaria, N., and N. Stehfest (2013). Millennials and Mobility: Understanding the Millennial Mindset and New Opportunities for Transit Providers. As the largest generation, Millennials will leave a lasting impact on society. A previous study of six metro areas found that Millennials prefer to choose the best transportation mode based on the trip they are making (i.e., they are not tied to their cars and more willing to try other modes). Also, Millennials are attracted to communities with transportation choices. Around 46 percent of Millennials state that cost drives their transportation choices. This study conducted by Sakaria and Stehfest conducted interviews and a survey to understand Millennials’ travel choices and identify key barriers and opportunities for mobility options. Most respondents prefer to walk (79%) or drive (63%). Walking was perceived to be beneficial because it was affordable and

Annotated Literature Review C-35   good for the environment, whereas driving a car allowed for flexibility in schedule. Just over half (60%) of respondents owned a vehicle. When choosing an area to live, Millennials valued ease of getting around (42%), work proximity (38%), city culture (37%), and public transportation options (36%). These results provide key opportunities to attract Millennials to a public trans- portation system, including offering wireless internet, making transit affordable, and providing real-time information. Salisbury, M. (2013). Economic Benefits of Transit Systems: Colorado Case Studies. Southwest Energy Efficiency Project: 27p. https://rtpo.mesacounty.us/globalassets/rtpo/plans-reports--studies/transit/economic-benefits-of- transit---2013.pdf Public transportation provides a wide array of economic benefits to a community, but these benefits are not often quantified, resulting in little information on whether public transportation is cost-effective or a beneficial investment. These benefits vary depending on the community. Small communities can see significant benefits from investing in public transportation. In this report, Salisbury examines three public transportation systems in Colorado to gain an under- standing of these benefits. Transfort in Fort Collins provided over 2 million rides in 2011. Transfort primarily serves Colorado State University students. This system provided an estimated $5.1 million in benefits to the community compared with estimated costs of $5.4 million; however, considering the additional benefits of the system, it is still considered an economic benefit to the community. Roaring Fork Transportation Authority provides regional service to three counties and 10 communities. This system mostly serves commuters and people accessing recreational ski destinations. This service had an estimated $52.1 million to $63.4 million in benefits compared with total costs of $13.5 million in 2011. The greatest benefit of this service is providing rides to people with long commute distances. Grand Valley Transit provides service to commuters, students, and others in Grand Junction. In 2011, this service provided an estimated $3.9 million in benefits compared with $1.8 million in costs. These case studies emphasize the overall eco- nomic benefits of public transportation to a variety of communities. Five economic benefits were identified across case studies: 1) fuel savings, 2) reduced congestion resulting in time and fuel savings, 3) income from jobs that are now accessible by public transportation, 4) public benefits saved due to employment, and 5) reduced demand for parking. Additional benefits that were not quantified included reduced isolation for seniors, health benefits from lowered emissions and increases in active transportation, and increased property values. Clearly, public transportation can generate a number of benefits for a community, further understanding of how to quantify these benefits will help planners and policymakers in the future. San Francisco Safe Routes to School (2017). Carpool. Retrieved 25-September-2018, from http://www.sfsaferoutes.org/carpool/. Kid CarPool is a free smartphone application that connects families within the same school to facilitate travel (carpool, walking, bicycling, etc.) to school in San Francisco. Sander, D.E., et al. (2014). ACRP Report 113: Guidebook on General Aviation Facility Planning. Transportation Research Board of the National Academies, Washington, DC, 148p. http://www.trb.org/Publications/Blurbs/171315.aspx https://trid.trb.org/view/1323213 Schooley, B., and T. Horan (2015). Emerging Digital Technologies in Emergency Medical Services: Considerations and Strategies to Strengthen the Continuum of Care. Washington, DC. https://www.ems.gov/pdf/advancing-ems-systems/Reports-and-Resources/Emerging_Digital_ Tech_In_EMS.pdf

C-36 Rural Transportation Issues: Research Roadmap Recent advances in communications technologies have the opportunity to have a positive impact in the way emergency medical services (EMS) operate. Communications technology can improve the detection of medical conditions through personal monitoring devices, notification through next generation 911 and automated collision notifications, dispatch through the use of geographic information systems, and mobile data terminals responders can use to quickly communicate critical patient information in-route and on-the-scene so that the emergency department is ready to receive the patient and is up-to-date on the patient’s status. Schultze, M.L. (2017). Ride Hailing in Rural America: Like Uber With A Neighborly Feel. Retrieved 18-September-2018, from https://www.npr.org/sections/alltechconsidered/2017/ 04/17/524339669/ride-hailing-in-rural-america-like-uber-with-a-neighborly-feel. Liberty Mobility Now is providing rideshare services to rural communities in Ohio, Nebraska, and Texas. In communities that typically do not have access to other transportation alternatives, Liberty Mobility Now is providing a much needed service. People are able to schedule a ride through a smartphone app or a call center, rides cost $1.25 to book and $1 per mile, making it a cheaper option than cab companies. Schwieterman, J.P., and B. Antolin (2018). Driving Demand: 2018 Outlook for the Intercity Bus Industry in the United States. Chaddick Institute for Metropolitan Development, DePaul University. https://las.depaul.edu/centers-and-institutes/chaddick-institute-for-metropolitan-development/ research-and-publications/Documents/2018%20Intercity%20Bus%20Outlook.pdf The intercity bus industry has seen recent growth. Five major service trends have emerged among intercity bus providers: 1) providers are expanding service, including adding new routes and schedules; 2) revenues are increasing, particularly among short-haul routes; 3) technology improvements, including e-ticketing and crowdsourcing, have allowed intercity bus providers to coordinate with each other and with other transportation providers, including Uber or Lyft to provide better coordination of services to customers; 4) providers are rolling out “premium services,” including first or business class services like sleeper pods; and 5) intercity providers are expanding coordination with Amtrak, including Greyhound opening ticketing counters in rail depots. With rising fuel prices and recent service expansions, intercity bus service providers have the opportunity to continue to grow. Scott, M., and K. Dedel (2006). Street Prostitution 2nd Edition. Washington, DC: 90p. https://ric-zai-inc.com/Publications/cops-p011-pub.pdf Shared-Use Mobility Center (2016). Shared-Use Mobility Reference Guide. Chicago, IL, Shared-Use Mobility Center: 51p. http://sharedusemobilitycenter.org/wp-content/uploads/2016/10/Reference-Guide-Editsweb- version-10.24.2016.pdf With emerging smartphone technology, the shared mobility landscape is increasing expo- nentially. These services improve mobility, offer first and last mile public transit connections, reduce congestion, reduce transportation costs, and increase efficiency. This Shared-Use Mobility Center report provides information on shared-use mobility trends and impacts as well as recom- mendations and suggestions to incorporate shared-use mobility services with public transit and methods to provide shared-use mobility services in your community. Shared-Use Mobility Center (2018). What is Shared Mobility? Retrieved 25-September-2018, from http://sharedusemobilitycenter.org/what-is-shared-mobility/. The Shared-Use Mobility Center defines shared mobility as, transportation services and resources that are shared among users, either concurrently or one after another. Shared-use

Annotated Literature Review C-37   mobility includes public transportation, ridesharing, carpooling, and more. This website describes the different types of shared mobility and their benefits. Sharfi, T., and D. Shinar (2014). Enhancement of Road Delineation Can Reduce Safety. Journal of Safety Research 49: 61.e61-68. http://www.sciencedirect.com/science/article/pii/S0022437514000292 Shetty, K., and R. Hansman (2012). Current and Historical Trends in General Aviation in the United States. Cambridge, MA, Massachusetts Institute of Technology International Center for Air Transportation: 93p. https://dspace.mit.edu/bitstream/handle/1721.1/72392/ICAT%20REPORT%20SHETTY.pdf? sequence=1 Shladover, S.E., and D. Gettman (2015). Connected/Automated Vehicle Research Roadmap for AASHTO. University of California, Berkeley. Kimley Horn: 47p. http://onlinepubs.trb.org/onlinepubs/nchrp/docs/NCHRP20-24(98)_RoadmapTopics_Final.pdf https://trid.trb.org/view/1515685 Connected and automated vehicle technologies are continually advancing. Over 10 states have implemented connected vehicle pilot programs, allowing automated vehicles to be tested on public roads, or planning for automated and connected vehicle programs. The Connected/ Automated Vehicle Research Roadmap for AASHTO [from NCHRP Project 20–24 (98)] examined the issues and needs related to institutional and policy, operational, legal, and planning, and identified future research projects ranked by needs. Spy Pond Partners et al. (2019). NCHRP Research Report 898: A Guide to Developing Financial Plans and Performance Measures for Transportation Asset Management. Transportation Research Board of the National Acad- emies, Washington, DC. https://www.nap.edu/catalog/25285/a-guide-to-developing-financial-plans-and-performance- measures-for-transportation-asset-management Stanojević, P., et al. (2013). Influence of Traffic Enforcement on the Attitudes and Behavior of Drivers. Accident Analysis & Prevention 52: 29–38. https://doi.org/10.1016/j.aap.2012.12.019 The effects of non-enforcement on traffic safety were demonstrated by an unintentional experiment in Central Europe. In the 1990s and 2000s, the territory formerly known as Yugoslavia split into seven countries (Kosovo, which declared independence from Serbia in 2008, is the newest). A peculiar aspect of this division was that for a period of 13 years, there was essentially no traffic enforcement in Northern Kosovo, while enforcement continued in Serbia (the two areas are similar in terms of culture, ethnic background, and institutions). This provided a natural opportunity to study the effect of enforcement on driver attitudes and behavior. Traffic safety researchers conducted driver surveys to assess attitudes toward speeding, seat-belt use, alcohol- impaired driving, and aggressive driving. In addition, field observations of speed and mandatory daytime headlight use were conducted. The results show substantial differences between the two areas. Without enforcement, drivers in Northern Kosovo drove faster, exceeded speed limits more frequently, drove while intoxicated more often, committed aggressive and ordinary violations more frequently, and reported being involved in more near-misses compared with their counterparts in Serbia. Additionally, the long-term absence of enforcement appeared to foster pro-speeding attitudes and general disdain for traffic laws among Northern Kosovo drivers. The authors suggested that, as a result of the lack of enforcement in Northern Kosovo, drivers

C-38 Rural Transportation Issues: Research Roadmap did not self-monitor their speeds, resulting in unawareness of speed violations. Even the daytime use of headlights, which requires minimal driver effort, was far lower in Northern Kosovo than in Serbia. Starkey, P., et al. (2002). Improving Rural Mobility: Options for Developing Motorized and Nonmotorized Transport in Rural Areas. Washington, DC: 70p. https://trid.trb.org/view/642932 Sullivan, J. (2018). On the Road to Zero, We Cannot Ignore Rural. 97th Annual Meeting of the Transportation Research Board, Washington, DC. https://trid.trb.org/view/1496936 Syed, S.T., et al. (2013). Traveling Towards Disease: Transportation Barriers to Health Care Access. Journal of Community Health 38(5): 976–993. Syed et al. reviewed 61 studies related to transportation barriers to primary care or chronic care medical appointments. Transportation barriers to medical appointments can result in delayed or missed care, which can exacerbate a medical condition or result in a lack of necessary treatment. Overall these reports note that transportation barriers are barriers to health care, specifically among transportation disadvantaged populations (seniors, low-income, people with disabilities, etc.). Technology Enterprise Group (2018). About the National Model Program. Retrieved 16-October-2018, from http://www.teginc.com/nationalmodel/nm_about.html# Membership. Tefft, B.C., et al. (2016). Prevalence of Marijuana Involvement in Fatal Crashes: Washington, 2010–14. Washington, DC, AAA Foundation for Traffic Safety. Thrive Allen County (2017). Thrive’s Innovative Approach to Rural Bike Share. Retrieved 15-September-2018, from http://thriveallencounty.org/news/thrive-innovative- rural-bike-share/. Over the last decade, Allen County, Kansas, made significant investments in active infrastruc- ture with the goal of getting people outside to bike or walk. These investments resulted in Iola, Kansas, being voted the Top Kansas Trail Town and in an increase in the number of people riding bicycles. But barriers to bicycle access still remained a problem, particularly for visitors and tourists. Allen County Bike Share was created using a bike library model, which allows anyone to check out a bicycle for free. This program was created through a grant from Blue Cross Blue Shield of Kansas. The program provided bicycles throughout the county and allowed users to check out bicycles for short- and long-term periods. In addition, all bicycles were maintained by a local bike shop, this support was critical to the success of the program. In 2017, the bike share had a fleet of 20 bicycles available at four locations (a local non-profit, two retail stores, and a local community college). In three months, the bicycles had been checked out over 100 times even though no marketing efforts were utilized. The program has long-term goals of expanding to additional locations throughout the county as additional funding permits. Transport Canada (2009). Improving Travel Options in Small & Rural Communities. Ottawa ON: 42p. https://www.publichealthgreybruce.on.ca/Portals/0/Topics/HealthyCommunities/Conference/ Active_Trans/Resources/Improving_Travel_Options_for_Small_and_Rural_(Industry_ Canada).pdf

Annotated Literature Review C-39   TranSystems Corporation et al. (2004). TCRP Report 105: Strategies to Increase Coordination of Transportation Services for the Transportation Disadvantaged. Transportation Research Board of the National Academies, Washington, DC. Coordination among transportation services is an effort to improve mobility among trans- portation disadvantaged groups. Many of these services still face challenges related to duplica- tion of services/staff, limited funding, poor service quality, and lack of interagency coordination. This report examines strategies to improve coordination of transportation services. A total of 22 case studies were conducted to examine successful and innovative transportation coordina- tion practices. Building an organized coalition can effectively coordinate transportation services. A coalition can be organized around a particular goal (e.g., improving mobility for disadvantaged populations or improving job access among residents). Creating a coalition is one component of larger coordination efforts and can work toward building trust among all partners. Strong leader- ship is the key to coordination efforts. Two main challenges were common among case study participants: long-term sustainability of coordination efforts and building trust among partners. Efforts to improve coordination, communication, and leadership among partner organizations are important to overcoming these challenges. TRIP (2017). Rural Connections: Challenges and Opportunities in America’s Heartland. Washington, DC: 45p. https://trid.trb.org/view/1472519 United Nations Economic Commission for Europe (2018). Resilience to Disasters for Sustainable Development. 24p. https://www.unece.org/fileadmin/DAM/trade/wp6/AreasOfWork/RiskManagement/DRR/ Brochure_DRR_updated_Feb2018.pdf U.S. Census Bureau (2011). Urban Area Criteria for the 2010 Census. Federal Register 76(164): 53030–53043. https://www.gpo.gov/fdsys/pkg/FR-2011-08-24/pdf/2011-21647.pdf U.S. Census Bureau (2013). Government Organization Summary Report: 2012. Washington, DC, U.S. Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2013/econ/g12-cg-org.pdf U.S. Census Bureau (2016). Measuring America: Our Changing Landscape. Washington, DC, U.S. Census Bureau. https://www.census.gov/library/visualizations/2016/comm/acs-rural-urban.html U.S. Department of Agriculture (2017). Rural America at a Glance—2017 Edition. Economic Information Bulletin. Washington, DC, U.S. Department of Agriculture. Economic Research Service. https://www.ers.usda.gov/webdocs/publications/85740/eib-182.pdf?v=0 U.S. Department of Agriculture (2018). Population & Migration—Overview. Retrieved 09-Sep-2018, from https://www.ers.usda.gov/topics/rural-economy-population/ population-migration/. U.S. Department of Justice (2000). ADA Guide for Small Towns. Washington, DC, U.S. Department of Justice. https://www.ada.gov/smtown.pdf U.S. Department of Justice (2000). Project Civic Access Fact Sheet. Retrieved 15-Oct-2018, from https://www.ada.gov/civicfac.htm.

C-40 Rural Transportation Issues: Research Roadmap U.S. Department of Transportation. Connected Vehicle Pilot Deployment Program: Wyoming. Retrieved 25-September-2018, from https://www.its.dot.gov/factsheets/wyoming_cvpilot.htm. This website summarizes the U.S. DOT Connected Vehicle Pilot Deployment Program in Wyoming. Interstate 80 (I-80) is located in southern Wyoming and is a vital freight corridor. The connected vehicle pilot project used vehicle-to-vehicle and vehicle-to-infrastructure tech- nology to improve communications, safety and efficiency along I-80. This project is one of three projects by the U.S. DOT Intelligent Joint Program Office to deploy and test connected vehicle technologies. U.S. Department of Transportation (2017). Older Drivers Set Record for Second Year: Licensed Drivers Over 65 Continue to Increase, Teen Drivers Remain at Near-Record Lows. Retrieved 27-September-2018, from https://www.transportation.gov/briefing-room/fhwa2017. Nearly 20 percent of U.S. drivers are aged 65 or older, and this age group is expected to grow faster than any other. FHWA has provided research and funding to support safety enhancements to meet the needs of aging road users. This FHWA Briefing Room post provides additional information on road users and a link to the FHWA Handbook for Designing Roadways for the Aging Population. U.S. Department of Transportation Federal Transit Administration (2015). FTA Circular 4710.1 - Americans with Disabilities Act (ADA): Guidance. 306. https://www.transit.dot.gov/sites/fta.dot.gov/files/docs/Final_FTA_ADA_Circular_C_4710.1.pdf U.S. Department of Transportation Maritime Administration (2018). America’s Marine Highway Program. Retrieved 16-October-2018, 2018, from https://www.marad.dot.gov/ships-and-shipping/dot- maritime-administration-americas-marine-highway-program/. U.S. Environmental Protection Agency (2011). Supporting Sustainable Rural Communities. 52. https://www.epa.gov/sites/production/files/documents/2011_11_supporting-sustainable-rural- communities.pdf#page=9 U.S. Geological Survey (2018). Short-Term Induced Seismicity Models. Retrieved 17-October-2018, from https://earthquake.usgs.gov/hazards/induced/index.php#2018. U.S. Travel Association (2018). U.S. Travel and Tourism Overview—2017. Washington, DC, U.S. Travel Association. https://www.ustravel.org/system/files/media_root/document/Research_Fact-Sheet_US-Travel- and-Tourism-Overview.pdf University Transportation Research Center (2018). Connected, Autonomous, and Shared Vehicle Impacts Study. Retrieved 26-September-2018, from http://www.utrc2.org/research/projects/connected- autonomous-and-shared-vehicle-impacts. UNWTO (2013). Sustainable Tourism for Development Guidebook. Madrid, Spain, United Nations World Tourism Organization. http://cf.cdn.unwto.org/sites/all/files/docpdf/devcoengfinal.pdf Villwock-Witte, N., and K. Clouser (2016). Mobility Mindset of Millennials in Small Urban and Rural Areas. Minnesota Department of Transportation, Research Services & Library.

Annotated Literature Review C-41   The Millennial generation is now the largest generation in the United States. This generation is having an increasing impact on planning policy. Research has shown that Millennials have different lifestyles compared with other generations that have an impact on current and future transportation planning needs. This includes obtaining higher levels of education, preferring urban areas, driving less, and being more open to non-motorized transportation. Currently, most research on Millennials has been focused on urban areas. There is little understanding of Millennials in rural and small urban communities. This study begins to fill this knowledge gap. This study conducted a survey of 2,519 residents living in rural and small urban communities in Minnesota, Montana, Washington, and Wisconsin. Sixty percent of the respondents were Millennials. The automobile was the most commonly reported mode of travel in a typical week. The automobile was the preferred mode of travel for rural Millennials (85%) traveling to work. There was a higher number of households in rural areas with an income of less than $20,000 annually. This is likely to limit transportation options for these households. Rural respondents were less likely to report expectations of moving. Villwock-Witte, N., and K. Clouser (2016). Mobility Mindset of Millennials in Small Urban and Rural Areas: Technical Memorandum Survey Findings-Transportation. Montana State University. http://surlc.org/wp-content/uploads/2016/10/Transportation_09262016_FINAL.pdf Villwock-Witte, N., and K. Clouser (2018). Generational Access Preferences to National Wildlife Refuges in California, Colorado & Texas. Western Transportation Institute: 266. https://westerntransportationinstitute.org/wp-content/uploads/2016/07/4W5801-Generation- Access_20180102.pdf Wang, Y., et al. (2016). Health Impacts of Active Transportation in Rural Communities: A Case Study in Ennis, Three Forks, and Townsend, Montana. Wang et al. conducted a survey to examine how active transportation networks and the perceptions of these networks affect travel behaviors and health of 185 rural residents in Ennis, Three Forks, and Townsend, Montana. Each community had a downtown core with mixed- use development. Three Forks has an 8.1 mile paved trail network (Headwaters Trail System). Townsend had only a limited trail system. Ennis did not have a trail system and lacked both sidewalks and bicycle lanes. Results of the survey found that residents strongly supported new bicycling and walking infrastructure and improvements. Availability of bicycle and walking infrastructure was associated with higher activity levels and health benefits (lower BMI). Safety concerns were one of the highest factors influencing transportation mode choice. Travel dis- tance was the most commonly reported challenge, more than half of respondents stated that they did not walk or bike for purposeful travel trips (work, school, etc.). Ward, N. (2016). A Strategic Approach to Transforming Traffic Safety Culture to Reduce Deaths and Injuries [Project]. http://apps.trb.org/cmsfeed/TRBNetProjectDisplay.asp?ProjectID=3662 Warne, T.R. (2003). NCHRP Synthesis of Highway Practice 323: Recruiting and Retaining Individuals in State Transportation Agencies. Transportation Research Board of the National Academies, Washington, DC. https://www.nap.edu/catalog/22024/recruiting-and-retaining-individuals-in-state-transportation- agencies Recruiting and retaining skilled employees are two of the largest issues the transportation industry faces today. In 2002, a survey of 27 state DOTs was conducted to gain an under- standing of recruitment and retention efforts. Findings from this survey suggest that there is

C-42 Rural Transportation Issues: Research Roadmap no one-size-fits-all solution to recruitment and retention. Instead, each state DOT needs to consider their own needs and operational characteristics to determine what programs would best fit into their agency. A variety of recruiting programs were described, including benefits packages and training programs. Retention programs consisted of training programs, schedule flexibility, and employee recognition programs. Many DOTs faced challenges with their recruit- ment and retention programs as a result of limited funding. A second survey of 950 DOT employees in Maryland, Nebraska, and Utah examined workforce needs. Many employees state that they were attracted to working for the DOT by stable employment opportunities and benefits packages, but approximately a quarter of the respondents stated that they were con- sidering leaving the state DOT due to stagnant salaries and few opportunities for promotion. Most employees rated their agency as average for employee morale. The results of this training highlights issues surrounding recruiting and retaining employees within the DOT. Agencies that incorporate their employee input into recruitment and retention strategies have the ability to make an impact. Wisconsin Department of Transportation (2018). Wisconsin Northwoods Freight Rail Study. Wisconsin Department of Transportation. Northwoods Rail Transit Commission: 192p. https://wisconsindot.gov/Documents/projects/multimodal/rail/northwoods2018.pdf World Road Association (2016). Transport Strategies for Climate Change Mitigation and Adaptation. Paris, France: 66p. http://www.piarc.org/en/order-library/25772-en-Transport%20Strategies%20for%20Climate %20Change%20Mitigation%20and%20Adaptation.htm?catalog&catalog-size= https://trid.trb.org/view/1453762 Young, J., and D. Daddio (2016). Natchez Trace Parkway Bicycle Planning Study. Research and Innovative Technology Administration National Park Service: 54p. http://ntl.bts.gov/lib/59000/59600/59600/Natchez_Trace_Bicycle_Planning_Study.pdf https://rosap.ntl.bts.gov/view/dot/12330 https://trid.trb.org/view/1425496 Natchez Trace Parkway (Parkway) has become an increasingly popular destination for bicyclists. But the Parkway is primarily a 2-lane road with no shoulders or existing bicycle lanes with a vehicle speed limit of 50 mph. These factors have created potentially dangerous conditions for bicyclists. To improve multimodal safety, the National Park Service brought in Volpe researchers to examine existing conditions and make recommendations to the Parkway. Site visits, interviews with cyclists, and focus groups were conducted to gain an understanding of how bicycling and bicycle safety were perceived on the Parkway. Researchers found that current signs and lane markings made motorists more aware of bicyclists but that the signs could be confusing. In addition, the Parkway needed greater speed enforcement and educa- tion campaigns on bicycles. Based on the analysis of existing conditions, the researchers made recommendations to improve multimodal safety. These recommendations focused on physical roadway interventions, such as new signs and removal of confusing lane markings, education campaigns and community engagement, and data collection, including bicycle and pedestrian counts and further crash information to gain an understanding of the crash factors involved with bicycle-involved crashes. Zwerling, C., et al. (2005). Fatal Motor Vehicle Crashes in Rural and Urban Areas: Decomposing Rates into Contributing Factors. Injury Prevention 11(1): 24–28. https://injuryprevention.bmj.com/content/injuryprev/11/1/24.full.pdf