Effects of buffer size and shape on associations between the built environment and energy balance

Uncertainty in the relevant spatial context may drive heterogeneity in findings on the built environment and energy balance. To estimate the effect of this uncertainty, we conducted a sensitivity analysis defining intersection and business densities and counts within different buffer sizes and shapes on associations with self-reported walking and body mass index. Linear regression results indicated that the scale and shape of buffers influenced study results and may partly explain the inconsistent findings in the built environment and energy balance literature.

Who do we reach? Campaign evaluation of Find Thirty every day® using awareness profiles in a Western Australian cohort

Mass media campaigns are part of a comprehensive, population-based approach to communicate physical activity behavior change. Campaign awareness is the most frequently reported, short-term comparable measure of campaign effectiveness. Most mass media campaigns report those who were aware with those who are unaware of campaigns. Few campaigns follow awareness in the same respondent, over time, during a mass media campaign to track different patterns of awareness or awareness profiles--"never," "early," "late," or "always"--that may emerge. Using awareness profiles, the authors (a) address any demographic differences between groups and (b) assess changes in physical activity. Find Thirty every day® was a populationwide mass media campaign delivered in Western Australia. The cohort comprised 405 participants, who completed periodic telephone interviews over 2 years. Almost one third (30.4%) were "never aware" of the campaign. More than one third recalled the campaign at one or more time points--"early aware." Ten percent became aware at Time 2 and stayed aware of the campaign across the remaining time. Examining within and across the awareness profiles, only gender was significant. This article provides an approach to profiling awareness, whereby people cycle in and out and few people are "always aware" over a 2-year period. It presents possible implications and considerations for future campaign planners interested in establishing and maintaining campaign awareness with adult populations.

Analyzing and modeling risk exposure of pedestrian children to involvement in car crashes

This paper analyzes the various variables affecting pedestrian children road crashes, placing emphasis on the effect of daily activity patterns and the built environment, including the children's residential neighborhoods and the land use of the places where they conduct their activities. Two complementary data sources from the case study of an Arab town in northern Israel were used to provide a holistic picture of child-pedestrian road crashes: police files providing detailed analyzes of the reason for each crash, its location, and the characteristics of the driver involved; and a survey of 199 households with both involved and not involved children in road crashes, including a one-day travel diary. The study found that a combination of three groups of variables affects child-pedestrian road crashes: socio-economic status, travel patterns, and land use. Most vulnerable are boys from a low socio-economic group who live in areas of high density and mixed land use near a major road and who tend to walk to and from school and additional activities after school.

A sustainable city environment through child safety and mobility-a challenge based on ITS?

Our cities should be designed to accommodate everybody, including children. We will not move toward a more sustainable society unless we accept that children are people with transportation needs, and 'bussing' them around, or providing parental limousine services at all times, will not lead to sustainability. Rather, we will need to make our cities walkable for children, at least those above a certain age. Safety has two main aspects, traffic safety and personal safety (risk of assault). Besides being safe, children will also need an urban environment with reasonable mobility, where they themselves can reach destinations with reasonable effort; else they will still need to be driven. This paper presents the results of two expert questionnaires focusing on the potential safety and mobility benefits to child pedestrians of targeted types of intelligent transportation systems (ITS). Five different types of functional requests for children were identified based on previous work. The first expert questionnaire was structured to collect expert opinions on which ITS solutions or devices would be, and why, the most relevant ones to satisfy the five different functional requests of child pedestrians. Based on the first questionnaire, fifteen problem areas were defined. In the second questionnaire, the experts ranked the fifteen areas, and prioritized related ITS services, according to their potential for developing ITS services beneficial to children. Several ITS systems for improving pedestrian quality are discussed. ITS services can be used when a pedestrian route takes them to a dangerous street, dangerous crossing point or through a dangerous neighborhood. An improvement of safety and other qualities would lead to increased mobility and a more sustainable way of living. Children would learn how to live to support their own health and a sustainable city environment. But it will be up to national, regional and local governments, through their ministries and agencies and public works departments, to promote, fund, and possibly mandate such systems. It is clear that we need to offer an acceptable level of convenience, efficiency, comfort, safety and security to pedestrians but it is less clear if society will prioritize resources toward this.

Predicting discharge placement and health care needs after lumbar spine laminectomy

OBJECTIVE

To explore factors associated with discharge placement (DP) and need for skilled assistance after patients are discharged from hospital following lumbar laminectomy.

METHODS

A retrospective analysis of 339 patients who underwent lumbar laminectomy was conducted. We used multivariable logistic regression analysis to identify significant covariates and to construct two regression models: a primary model to predict DP, home vs inpatient rehabilitation/skilled nursing facility (IR/SNF), and a secondary model to predict the need for skilled assistance once patients are discharged to home.

RESULTS

The sample included 48.7% females, 68.2% married, 56.3% independent in daily activities, and 85.2% discharged to home. Subjects were a mean 56.06 ± 12.75 years old and had a BMI of 31.35 ± 6.2. Of those discharged to home, 17.7% needed skilled assistance. Patients stayed 4.41 ± 3.55 days in the hospital and walked 203.38 ± 144.87 ft during hospital stay. Age, distance walked during hospital stay, and length of hospital stay (LOS) were significant positive predictors for discharge to home vs IR/SNF, whereas single living status, diminished prior level of function, and longer LOS were predictors of need for skilled assistance after discharge to home.

CONCLUSION

Age, mobility, marital status, prior level of function, and LOS are key variables in determining healthcare needs following lumbar laminectomy.

Falls in older persons with intellectual disabilities: fall rate, circumstances and consequences

BACKGROUND

Falling is a common cause of injuries and reduced quality of life. Persons with intellectual disabilities (ID) are at increased risk for falls and related injuries. As the number of elderly persons with ID is growing rapidly, it is imperative to gain insight into the quantity of the problem of falling, the circumstances that precipitate falls and to better understand their aetiology in persons with ID. This is the first study to prospectively investigate fall rate, circumstances and fall consequences in older adults with mild to moderate ID.

METHOD

Eighty-two individuals with mild to moderate ID, 50 years and over [mean age 62.3 (SD = 7.6), 34 male], participated in this study, which was conducted at three service providers for persons with ID in the Netherlands. Falls were registered for 1 year with monthly fall registration calendars to determine the fall rate (mean number of falls per person per year). Information on fall circumstances and consequences was obtained from questionnaires completed by caregivers and study participants after each fall.

RESULTS

We determined that the fall rate in this sample was 1.00 fall per person per year. Thirty-seven participants reported at least one fall (range 1-6). Sex and age were not related to falls. Most falls occurred while walking (63.3%), outside (61.7%) and in familiar environments (88.9%). Importantly, 11.5% of falls resulted in severe injuries, approximately half of which were fractures.

CONCLUSION

The circumstances and consequences of falls in persons with ID are comparable to those of the general elderly population, but the rate is substantially higher. As such, appropriate fall prevention strategies must be developed for individuals with ID.

Pedestrians' estimates of their own nighttime conspicuity are unaffected by severe reductions in headlight illumination

INTRODUCTION

At night pedestrians tend to overestimate their conspicuity to oncoming drivers, but little is known about factors affecting pedestrians' conspicuity estimates. This study examines how headlamp intensity and pedestrians' clothing influence judgments of their own conspicuity.

METHOD

Forty-eight undergraduate students estimated their own conspicuity on an unilluminated closed road by walking in front of a stationary vehicle to the point at which they judged that they were just recognizable to the driver. Unknown to the participants, high beam intensity was manipulated between subjects by placing neutral density filters on the headlamps.

RESULTS

Estimated conspicuity distances did not significantly vary with changes in headlamp intensity even when only 3% of the illumination from the headlamps was present.

PRACTICAL APPLICATIONS

These findings underscore the need to educate pedestrians about the visual challenges that drivers face at night and the need to minimize pedestrians' exposure to traffic flow at night.

Steps/day and metabolic syndrome in African American adults: the Jackson Heart Study

OBJECTIVE

To examine the relationship between pedometer-measured step count data and the Metabolic Syndrome (MetS) in African American adults.

METHOD

379 African American adults (mean age 60.1 years; 60% female) enrolled in the Jackson Heart Study (Jackson, MS) from 2000 to 2004 provided sufficient pedometer data for inclusion in this analysis. MetS was classified according to the International Diabetes Federation Task Force on Epidemiology and Prevention.

RESULTS

Using steps/day categorized as tertiles (<3717 (referent), 3717-6238, >6238), participants taking 3717-6238 (Odds Ratio (OR)(95% Confidence Interval (CI))=0.34 (0.19, 0.61)) and >6238 steps/day (OR(95% CI)=0.43 (0.23, 0.78)) had lower odds of having MetS compared to participants in the lowest tertile. Using previously suggested steps/day cut-points (<2500 (referent), 2500-4999, 5000-7499, ≥7500), the odds of having MetS were lower for participants taking 2500-4999 (OR(95% CI)=0.32 (0.14, 0.72)), 5000-7499 (OR(95% CI)=0.22 (0.09, 0.53)), and >7500 (OR(95% CI)=0.26 (0.11, 0.65)) steps/day compared to those taking <2500 steps/day.

CONCLUSION

Compared to lower levels, higher levels of steps/day are associated with a lower prevalence of MetS in this older African American population.

Safely active mobility for urban baby boomers: The role of neighborhood design

Many urban designers and researchers argue that walkable urban environments can encourage older residents' walking activities that benefit their physical health. However, walking also exposes older adults to safety risks, including due to traffic accidents. This study seeks to reveal the interactions between urban form and safety affecting urban baby boomers' walking behavior. Spatial analysis reveals traffic collision patterns in urban Boston neighborhoods, detecting hotspots around activity centers. Structural equation modeling, estimated on individual data collected from a mail-back survey and utilizing numerous measures of neighborhood urban form and accessibility, then attempts to reveal the causal, interacting relationships between neighborhood-level urban form, traffic crashes, and baby boomers' walking behavior. The analysis identifies significant effects of walkable urban forms (e.g., mixed use, well-connected streets, and good access to potential destinations) on older adults' walking. Yet, accessibility to retail, as well as traffic speed and volume, are positively associated with the traffic collision frequency. The results suggest more cautious approaches may be necessary for designing urban spaces for walkability and also call into question prescriptions based on the "safety in numbers" hypothesis.

Children, parents and pets exercising together (CPET): exploratory randomised controlled trial

BACKGROUND

Levels of physical activity (PA) in UK children are much lower than recommended and novel approaches to its promotion are needed. The Children, Parents and Pets Exercising Together (CPET) study is the first exploratory randomised controlled trial (RCT) to develop and evaluate an intervention aimed at dog-based PA promotion in families. CPET aimed to assess the feasibility, acceptability and potential efficacy of a theory-driven, family-based, dog walking intervention for 9-11 year olds.

METHODS

Twenty-eight families were allocated randomly to either receive a 10-week dog based PA intervention or to a control group. Families in the intervention group were motivated and supported to increase the frequency, intensity and duration of dog walking using a number of behaviour change techniques. Parents in the intervention group were asked to complete a short study exit questionnaire. In addition, focus groups with parents and children in the intervention group, and with key stakeholders were undertaken. The primary outcome measure was 10 week change in total volume of PA using the mean accelerometer count per minute (cpm). Intervention and control groups were compared using analysis of covariance. Analysis was performed on an intention to treat basis.

RESULTS

Twenty five families were retained at follow up (89%) and 97% of all outcome data were collected at baseline and follow up. Thirteen of 14 (93%) intervention group parents available at follow up completed the study exit questionnaire and noted that study outcome measures were acceptable. There was a mean difference in child total volume of PA of 27 cpm (95% CI -70, 123) and -3 cpm (95% CI -60, 54) for intervention and control group children, respectively. This was not statistically significant. Approximately 21% of dog walking time for parents and 39% of dog walking time for children was moderate-vigorous PA.

CONCLUSIONS

The acceptability of the CPET intervention and outcome measures was high. Using pet dogs as the agent of lifestyle change in PA interventions in children and their parents is both feasible and acceptable, but did not result in a significant increase in child PA in this exploratory trial.

TRIAL REGISTRATION

ISRCTN85939423.

Fatalities of pedestrians, bicycle riders, and motorists due to distracted driving motor vehicle crashes in the U.S., 2005-2010

OBJECTIVE

Distracted driving is an increasingly deadly threat to road safety. This study documents trends in and characteristics of pedestrian, bicycle rider, and other victim deaths caused by distracted drivers on U.S. public roads.

METHODS

We obtained data from the Fatality Analysis Reporting System database from 2005 to 2010 on every crash that resulted in at least one fatality within 30 days occurring on public roads in the U.S. Following the definition used by the National Highway Traffic Safety Administration, we identified distracted driving based on whether police investigators determined that a driver had been using a technological device, including a cell phone, onboard navigation system, computer, fax machine, two-way radio, or head-up display, or had been engaged in inattentive or careless activities.

RESULTS

The rate of fatalities per 10 billion vehicle miles traveled increased from 116.1 in 2005 to 168.6 in 2010 for pedestrians and from 18.7 in 2005 to 24.6 in 2010 for bicyclists. Pedestrian victims of distracted driving crashes were disproportionately male, 25-64 years of age, and non-Hispanic white. They were also more likely to die at nighttime, be struck by a distracted driver outside of a marked crosswalk, and be in a metro location. Bicycling victims of distracted crashes were disproportionately male, non-Hispanic white, and struck by a distracted driver outside of a crosswalk. Compared with pedestrians, bicyclists were less likely to be hit in early morning.

CONCLUSIONS

Distracted drivers are the cause of an increasing share of fatalities found among pedestrians and bicycle riders. Policies are needed to protect pedestrians and bicycle riders as they cross intersections or travel on roadways.

Who uses new walking and cycling infrastructure and how? Longitudinal results from the UK iConnect study

OBJECTIVE

To examine how adults use new local walking and cycling routes, and what characteristics predict use.

METHODS

1849 adults completed questionnaires in 2010 and 2011, before and after the construction of walking and cycling infrastructure in three UK municipalities. 1510 adults completed questionnaires in 2010 and 2012. The 2010 questionnaire measured baseline characteristics; the follow-up questionnaires captured infrastructure use.

RESULTS

32% of participants reported using the new infrastructure in 2011, and 38% in 2012. Walking for recreation was by far the most common use. In both follow-up waves, use was independently predicted by higher baseline walking and cycling (e.g. 2012 adjusted rate ratio 2.09 (95% CI 1.55, 2.81) for >450 min/week vs. none). Moreover, there was strong specificity by mode and purpose, e.g. baseline walking for recreation specifically predicted walking for recreation on the infrastructure. Other independent predictors included living near the infrastructure, better general health and higher education or income.

CONCLUSIONS

The new infrastructure was well-used by local adults, and this was sustained over two years. Thus far, however, the infrastructure may primarily have attracted existing walkers and cyclists, and may have catered more to the socio-economically advantaged. This may limit its impacts on population health and health equity.

Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009

Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention.

Too far to walk or bike?

Only 25-35% of Canadian children and youth regularly engage in active transportation (AT; e.g., non-motorized travel modes such as walking and cycling) to/from school. Previous research shows that distance between home and school is the strongest barrier to AT. Based on social ecological theory, we describe several strategies to overcome this barrier. At the individual level, children and youth could engage in AT to/from destinations such as parks, shops, friends' and family members' residence, and sport fields which may be located closer than their school. Parents who drive their kids to/from school could drop them within a "walkable" distance so that they can walk for the remainder of the trip. Partnerships could be developed between schools and other nearby institutions that would allow cars and buses to use their parking lot temporarily so that children could do a portion of the school trip on foot. Developing a well-connected network of sidewalks along low traffic streets can also facilitate AT. At the policy level, decisions regarding school location have a direct influence on distance. Finally, social marketing campaigns could raise awareness about strategies to incorporate AT into one's lifestyle, and encourage parents to reconsider what constitutes a "walkable" distance.

Walking or dancing: patterns of physical activity by cross-sectional age among U.S. women

OBJECTIVES

To identify age differences in physical activity (PA) participation for women.

METHODS

Data from 3,952 women 25+ from the 2003-2006 National Health and Nutrition Examination Surveys (NHANES) were used to analyze participation patterns for 17 PA types.

RESULTS

The top five leisure PAs by participation rate for all ages were walking (42%), dancing (20%), treadmill (15%), biking (11%), and yoga (10%). Participation in running, dancing, treadmill, and team sports declined around ages 35 to 44, and participation in household PA, walking, weightlifting, and hiking declined around ages 55 to 64. At age 75+ further substantial decline in most activities occurred. Nativity status was the most important moderator for age-related PA decline.

CONCLUSIONS

Total PA declines with age but significant decline does not occur until ages 55 to 64. Major decline in leisure PA participation starts earlier at ages 35 to 44. While age-related declining patterns differ for different activities, the top five most popular leisure activities are similar for all age groups.

Factors influencing safety in a sample of marked pedestrian crossings selected for safety inspections in the city of Oslo

This paper reports an analysis of factors influencing safety in a sample of marked pedestrian crossings in the city of Oslo, Norway. The sample consists of 159 marked pedestrian crossings where a total of 316 accidents were recorded during a period of five years. The crossings were selected for inspection because of they were, for various reasons, regarded as sub-standard. The sample of crossings is therefore not representative of all pedestrian crossings in Oslo. Factors influencing the number of accidents were studied by means of negative binomial regression. Factors that were studied included the volume of pedestrians and vehicles, the number of traffic lanes at the crossing, the location of the crossing (midblock or junction), the type of traffic control, the share of pedestrians using the crossing and the speed of approaching vehicles. The analysis confirmed the presence of a "safety-in-numbers" effect, meaning that an increase in the number of pedestrians is associated with a lower risk of accident for each pedestrian. Crossings located in four-leg junctions or roundabouts had more accidents than crossings located in three-leg junctions or on sections between junctions. A high share of pedestrians crossing the road outside the marked crossing was associated with a high number of accidents. Increased speed was associated with an increased number of accidents.

Do lower income areas have more pedestrian casualties?

Pedestrian and motor vehicle casualties are analyzed for the State of New Jersey with the objective of determining how the income of an area may be associated with casualties. We develop a maximum-likelihood negative binomial model to examine how various spatially defined variables, including road, income, and vehicle ownership, may be associated with casualties using census block-group level data. Due to suspected spatial correlation in the data we also employ a conditional autoregressive Bayesian model using Markov Chain Monte Carlo simulation, implemented with Crimestat software. Results suggest that spatial correlation is an issue as some variables are not statistically significant in the spatial model. We find that both pedestrian and motor vehicle casualties are greater in lower income block groups. Both are also associated with less household vehicle ownership, which is not surprising for pedestrian casualties, but is a surprising result for motor vehicle casualties. Controls for various road categories provide expected relationships. Individual level data is further examined to determine relationships between the location of a crash victim and their residence zip code, and this largely confirms a residual effect associated with both lower income individuals and lower income areas.

The "path" not taken: exploring structural differences in mapped- versus shortest-network-path school travel routes

OBJECTIVES

School route measurement often involves estimating the shortest network path. We challenged the relatively uncritical adoption of this method in school travel research and tested the route discordance hypothesis that several types of difference exist between shortest network paths and reported school routes.

METHODS

We constructed the mapped and shortest path through network routes for a sample of 759 children aged 9 to 13 years in grades 5 and 6 (boys = 45%, girls = 54%, unreported gender = 1%), in Toronto, Ontario, Canada. We used Wilcoxon signed-rank tests to compare reported with shortest-path route measures including distance, route directness, intersection crossings, and route overlap. Measurement difference was explored by mode and location.

RESULTS

We found statistical evidence of route discordance for walkers and children who were driven and detected it more often for inner suburban cases. Evidence of route discordance varied by mode and school location.

CONCLUSIONS

We found statistically significant differences for route structure and built environment variables measured along reported and geographic information systems-based shortest-path school routes. Uncertainty produced by the shortest-path approach challenges its conceptual and empirical validity in school travel research.

Associations of Tai Chi, walking, and jogging with mortality in Chinese men

Moderate-intensity exercise has attracted considerable attention because of its safety and many health benefits. Tai Chi, a form of mind-body exercise that originated in ancient China, has been gaining popularity. Practicing Tai Chi may improve overall health and well-being; however, to our knowledge, no study has evaluated its relationship with mortality. We assessed the associations of regular exercise and specifically participation in Tai Chi, walking, and jogging with total and cause-specific mortality among 61,477 Chinese men in the Shanghai Men's Health Study (2002-2009). Information on exercise habits was obtained at baseline using a validated physical activity questionnaire. Deaths were ascertained through biennial home visits and linkage with a vital statistics registry. During a mean follow-up of 5.48 years, 2,421 deaths were identified. After adjustment for potential confounders, men who exercised regularly had a hazard ratio for total mortality of 0.80 (95% confidence interval: 0.74, 0.87) compared with men who did not exercise. The corresponding hazard ratios were 0.80 (95% confidence interval: 0.72, 0.89) for practicing Tai Chi, 0.77 (95% confidence interval: 0.69, 0.86) for walking, and 0.73 (95% confidence interval: 0.59, 0.90) for jogging. Similar inverse associations were also found for cancer and cardiovascular mortality. The present study provides the first evidence that, like walking and jogging, practicing Tai Chi is associated with reduced mortality.

Different risk thresholds in pedestrian road crossing behaviour: a comparison of French and Japanese approaches

When crossing the road, pedestrians have to make a trade-off between saving time and avoiding any risk of injuries. Here, we studied how culture influences an individual's perception of risks when crossing a street, using survival analysis. This study is the first to use this analysis to assess cognitive mechanisms and optimality of decisions underlying road crossing behaviour. We observed pedestrian behaviour in two city centres: Inuyama (Japan) and Strasbourg (France). In each city, observations were made at a safe site consisting of a crosswalk and a street light and at an unsafe site (i.e. no crosswalk or street light). At the unsafe site, we measured the time needed by a pedestrian to take a decision (Tdec). During Tdec, a pedestrian estimates whether he can (Tsafe) or cannot (Trisk) cross the road. Using survival analysis, we studied the distributions of these three time variables and showed that French pedestrians took more risks than Japanese pedestrians, and that males took more risks than females, but only in Japan. More studies would considerably broaden our understanding on how culture may affect decision-making processes under risky circumstances.

Injury incidence rates of cyclists compared to pedestrians, car occupants and powered two-wheeler riders, using a medical registry and mobility data, Rhône County, France

PURPOSE

In France, the bicycle's modal share is stabilizing after a decline; in some of France's major cities, it has even increased since the 1990s. It is hence relevant to improve the knowledge of the injury risk associated with cycling, compared with other means of transport such as car, walking and powered two-wheeler (PTW) riding.

METHODS

The injury incidence rates were estimated by the ratio between accident data and mobility (exposure) data. Two accident data sources were used: police data and hospital-based data (outpatients and inpatients) from the Rhône road trauma Registry. This provides four injury categories: all-injury, hospitalization, serious-injury and fatal-injury. Exposure data were estimated from a regional household travel survey (RTS), using three measures of mobility: number of trips, distance traveled and time spent traveling. The survey was carried out from November 2005 to April 2006, on weekdays, outside school and public holidays; this seasonality was corrected using the 2007-2008 national household travel survey (NTS) that covered an entire year. Only information involving accidents and trips in, and residents of, the Rhône County (1.6 million inhabitants, including the city Lyon) were included in our study. Trends of injury rates were also evaluated in Greater Lyon, using previous travel surveys.

RESULTS

The PTW riders had the highest all-injury, hospitalization, serious-injury and fatal-injury rates, followed by cyclists, and lastly by pedestrians and car occupants. The rates between men and women seemed similar among pedestrians and among car occupants. For car occupants, pedestrians and cyclists, the age group 18-25 years had higher all-injury rate compared with the age group 25-65 years. On the contrary, the age group≥65 years seemed to have higher hospitalization and serious-injury rates, compared with the age group 25-65 years. For cyclists, the injury rates seemed higher in non-dense areas than in dense areas. Between 1996-1997 and 2005-2006 and with regards to time spent traveling, the all-injury, serious-injury and fatal-injury rates seemed to have decreased for car occupants and cyclists.

CONCLUSION

The higher risk for PTW riders is confirmed and quantified; it is very high. Decrease in injury rates seems more marked for cyclists; this may indicate the "safety in numbers" effect. Countermeasures for improving road safety could be implemented, especially for vulnerable road user types. However, they will not be sufficient to fill in the gap between the much higher risk for PTW riders and that of car occupants. Exposure-based injury rates can be a tool for monitoring and evaluating the effectiveness of policies and programs, and for comparisons between countries.

Walking, cycling and driving to work in the English and Welsh 2011 census: trends, socio-economic patterning and relevance to travel behaviour in general

OBJECTIVES

Increasing walking and cycling, and reducing motorised transport, are health and environmental priorities. This paper examines levels and trends in the use of different commute modes in England and Wales, both overall and with respect to small-area deprivation. It also investigates whether commute modal share can serve as a proxy for travel behaviour more generally.

METHODS

23.7 million adult commuters reported their usual main mode of travelling to work in the 2011 census in England and Wales; similar data were available for 1971-2001. Indices of Multiple Deprivation were used to characterise socio-economic patterning. The National Travel Survey (2002-2010) was used to examine correlations between commute modal share and modal share of total travel time. These correlations were calculated across 150 non-overlapping populations defined by region, year band and income.

RESULTS

Among commuters in 2011, 67.1% used private motorised transport as their usual main commute mode (-1.8 percentage-point change since 2001); 17.8% used public transport (+1.8% change); 10.9% walked (-0.1% change); and 3.1% cycled (+0.1% change). Walking and, to a marginal extent, cycling were more common among those from deprived areas, but these gradients had flattened over the previous decade to the point of having essentially disappeared for cycling. In the National Travel Survey, commute modal share and total modal share were reasonably highly correlated for private motorised transport (r = 0.94), public transport (r = 0.96), walking (r = 0.88 excluding London) and cycling (r = 0.77).

CONCLUSIONS

England and Wales remain car-dependent, but the trends are slightly more encouraging. Unlike many health behaviours, it is more common for socio-economically disadvantaged groups to commute using physically active modes. This association is, however, weakening and may soon reverse for cycling. At a population level, commute modal share provides a reasonable proxy for broader travel patterns, enhancing the value of the census in characterising background trends and evaluating interventions.

Employing virtual advisors in preventive care for underserved communities: results from the COMPASS study

Electronically delivered health promotion programs that are aimed primarily at educated, health-literate individuals have proliferated, raising concerns that such trends could exacerbate health disparities in the United States and elsewhere. The efficacy of a culturally and linguistically adapted virtual advisor that provides tailored physical activity advice and support was tested in low-income older adults. Forty inactive adults (92.5% Latino) 55 years of age and older were randomized to a 4-month virtual advisor walking intervention or a waitlist control. Four-month increases in reported minutes of walking/week were greater in the virtual advisor arm (mean increase = 253.5 ± 248.7 minutes/week) relative to the control (mean increase = 26.8 ± 67.0 minutes/week; p = .0008). Walking increases in the virtual advisor arm were substantiated via objectively measured daily steps (slope analysis p = .002). All but one intervention participant continued some interaction with the virtual advisor in the 20-week poststudy period (mean number of poststudy sessions = 14.0 ± 20.5). The results indicate that a virtual advisor delivering culturally and linguistically adapted physical activity advice led to meaningful 4-month increases in walking relative to control among underserved older adults. This interactive technology, which requires minimal language and computer literacy, may help reduce health disparities by ensuring that all groups benefit from e-health opportunities.

Travel mode and physical activity at Sydney University

How staff and students travel to university can impact their physical activity level. An online survey of physical activity and travel behaviour was conducted in early November 2012 to inform planning of physical activity and active travel promotion programs at the University of Sydney, Australia as part of the "Sit Less, Move More" sub-committee of the Healthy University Initiative, and as baseline data for evaluation. There were 3,737 useable responses, 60% of which were from students. Four out of five respondents travelled to the University on the day of interest (Tuesday, November 30, 2012). The most frequently used travel modes were train (32%), car as driver (22%), bus (17%), walking (17%) and cycling (6%). Staff were twice as likely to drive as students, and also slightly more likely to use active transport, defined as walking and cycling (26% versus 22%). Overall, 41% of respondents were sufficiently active (defined by meeting physical activity recommendations of 150 min per week). Participants were more likely to meet physical activity recommendations if they travelled actively to the University. With a high proportion of respondents using active travel modes or public transport already, increasing the physical activity levels and increasing the use of sustainable travel modes would mean a mode shift from public transport to walking and cycling for students is needed and a mode shift from driving to public transport or active travel for University staff. Strategies to achieve this are discussed.

Impact of social and technological distraction on pedestrian crossing behaviour: an observational study

OBJECTIVES

The objective of the present work was to study the impact of technological and social distraction on cautionary behaviours and crossing times in pedestrians.

METHODS

Pedestrians were observed at 20 high-risk intersections during 1 of 3 randomly assigned time windows in 2012. Observers recorded demographic and behavioural information, including use of a mobile device (talking on the phone, text messaging, or listening to music). We examined the association between distraction and crossing behaviours, adjusting for age and gender. All multivariate analyses were conducted with random effect logistic regression (binary outcomes) and random effect linear regression (continuous outcomes), accounting for clustering by site.

RESULTS

Observers recorded crossing behaviours for 1102 pedestrians. Nearly one-third (29.8%) of all pedestrians performed a distracting activity while crossing. Distractions included listening to music (11.2%), text messaging (7.3%) and using a handheld phone (6.2%). Text messaging, mobile phone use and talking with a companion increased crossing time. Texting pedestrians took 1.87 additional seconds (18.0%) to cross the average intersection (3.4 lanes), compared to undistracted pedestrians. Texting pedestrians were 3.9 times more likely than undistracted pedestrians to display at least 1 unsafe crossing behaviour (disobeying the lights, crossing mid-intersection, or failing to look both ways). Pedestrians listening to music walked more than half a second (0.54) faster across the average intersection than undistracted pedestrians.

CONCLUSIONS

Distracting activity is common among pedestrians, even while crossing intersections. Technological and social distractions increase crossing times, with text messaging associated with the highest risk. Our findings suggest the need for intervention studies to reduce risk of pedestrian injury.