Understanding the drive to escort: a cross-sectional analysis examining parental attitudes towards children's school travel and independent mobility

BACKGROUND

The declining prevalence of Active School Transportation (AST) has been accompanied by a decrease in independent mobility internationally. The objective of this study was to compare family demographics and AST related perceptions of parents who let their children walk unescorted to/from school to those parents who escort (walk and drive) their children to/from school. By comparing these groups, insight was gained into how we may encourage greater AST and independent mobility in youth living in the Greater Toronto and Hamilton Area, Canada.

METHODS

This study involved a cross-sectional design, using data from a self-reported questionnaire (n =1,016) that examined parental perceptions and attitudes regarding AST. A multinomial logistic regression analysis was used to explore the differences between households where children travelled independently to school or were escorted.

RESULTS

Findings revealed that unescorted children were: significantly older, the families spoke predominantly English at home, more likely to live within one kilometer from school, and their parents agreed to a greater extent that they chose to reside in the current neighborhood in order for their child to walk to/from school. The parents of the escorted children worried significantly more about strangers and bullies approaching their child as well as the traffic volume around school.

CONCLUSIONS

From both a policy and research perspective, this study highlights the value of distinguishing between mode (i.e., walking or driving) and travel independence. For policy, our findings highlight the need for planning decisions about the siting of elementary schools to include considerations of the impact of catchment size on how children get to/from school. Given the importance of age, distance, and safety issues as significant correlates of independent mobility, research and practice should focus on the development and sustainability of non-infrastructure programs that alleviate parental safety concerns.

The importance of Active Transportation to and from school for daily physical activity among children

OBJECTIVE

To investigate if students who use of Active Transportation (AT) to and from school among urban and rural Canadian children are more likely to meet physical activity recommendations.

METHODS

The Raising healthy Eating and Active Living in Alberta (REAL Kids Alberta) study is a population-based health survey among Grade 5 students. In 2009, physical activity levels were measured using time-stamped pedometers (number of steps/hour) among 688 children. Parents reported mode of transportation to and from school (AT/non-AT). Multilevel multiple linear regression analyses with corresponding β coefficients were conducted to quantify the relationship between mode of transportation to and from school with (1) overall step count, and (2) the likelihood of achieving at least 13,500 steps per day recommended for optimal growth and development.

RESULTS

Among urban children, those who used AT to and from school accumulated more steps [β=1124(95% CI=170,2077)] and although not significant, were more likely to achieve the recommended 13,500 steps/day compared to those not using AT to and from school [OR=1.61(95% CI=0.93,2.81)].

CONCLUSION

Using AT to and from school appears to be beneficial to children by supplementing their physical activity, particularly those living in urban regions. Strategies to promote physical activity are needed, particular for children residing in rural regions and smaller towns.

Pre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2)

BACKGROUND

Numerous studies have reported that bariatric surgery patients report more physical activity (PA) after surgery than before; however, the quality of the PA assessment has been questionable.

METHODS

The longitudinal assessment of bariatric surgery-2 is a 10-center longitudinal study of adults undergoing bariatric surgery. Of 2458 participants, 455 were given an activity monitor, which records the steps per minute, and an exercise diary before and 1 year after surgery. The mean number of steps/d, active min/d, and high-cadence min/wk were calculated for 310 participants who wore the monitor ≥10 hr/d for ≥3 days at both evaluations. Pre- and postoperative PA were compared for differences using the Wilcoxon signed-rank test. Generalized estimating equations were used to identify independent preoperative predictors of postoperative PA.

RESULTS

PA increased significantly (P < .0001) from before to after surgery for all PA measures. The median values before and after surgery were 7563 and 8788 steps/d, 309 and 340 active min/d, and 72 and 112 high-cadence min/wk, respectively. However, depending on the PA measure, 24-29% of participants were ≥5% less active postoperatively than preoperatively. Controlling for surgical procedure, gender, age, and body mass index, more PA preoperatively independently predicted for more PA postoperatively (P < .0001, for all PA measures). Less pain, not having asthma, and the self-report of increasing PA as a weight loss strategy preoperatively also independently predicted for more high-cadence min/wk postoperatively (P < .05).

CONCLUSIONS

The majority of adults increase their PA level after bariatric surgery. However, most remain insufficiently active, and some become less active. Increasing PA, addressing pain, and treating asthma before surgery might have a positive effect on postoperative PA.

"Don't wait for them to come to you, you go to them". A qualitative study of recruitment approaches in community based walking programmes in the UK

BACKGROUND

This study aimed to examine the experiences of walking promotion professionals on the range and effectiveness of recruitment strategies used within community based walking programmes within the United Kingdom.

METHODS

Two researchers recruited and conducted semi-structured interviews with managers and project co-ordinators of community based walking programmes, across the UK, using a purposive sampling frame. Twenty eight interviews were conducted, with community projects targeting participants by age, physical activity status, socio-demographic characteristics (i.e. ethnic group) or by health status. Three case studies were also conducted with programmes aiming to recruit priority groups and also demonstrating innovative recruitment methods. Data analysis adopted an approach using analytic induction.

RESULTS

Two types of programmes were identified: those with explicit health aims and those without. Programme aims which required targeting of specific groups adopted more specific recruitment methods. The selection of recruitment method was dependent on the respondent's awareness of 'what works' and the resource capacity at their disposal. Word of mouth was perceived to be the most effective means of recruitment but using this approach took time and effort to build relationships with target groups, usually through a third party. Perceived effectiveness of recruitment was assessed by number of participants rather than numbers of the right participants. Some programmes, particularly those targeting younger adult participants, recruited using new social communication media. Where adopted, social marketing recruitment strategies tended to promote the 'social' rather than the 'health' benefits of walking.

CONCLUSIONS

Effective walking programme recruitment seems to require trained, strategic, labour intensive, word-of-mouth communication, often in partnerships, in order to understand needs and develop trust and motivation within disengaged sedentary communities. Walking promotion professionals require better training and resources to deliver appropriate recruitment strategies to reach priority groups.

Vital signs: walking among adults--United States, 2005 and 2010

BACKGROUND

Physical activity has numerous health benefits, including improving weight management. The 2008 Physical Activity Guidelines for Americans recommend ≥150 minutes/week of moderate-intensity aerobic physical activity (e.g., brisk walking) for substantial health benefits. Walking is the most commonly reported physical activity by U.S. adults.

METHODS

CDC used data from the 2005 and 2010 National Health Interview Surveys to assess changes in prevalence of walking (defined as walking for transportation or leisure in at least one bout of 10 minutes or more in the preceding 7 days) by sex, age group, race/ethnicity, education, body mass index category, walking assistance status, region, and physician-diagnosed chronic disease. CDC also assessed the association between walking and meeting the aerobic physical activity guideline.

RESULTS

Overall, walking prevalence increased significantly from 55.7% in 2005 to 62.0% in 2010. Significantly higher walking prevalence was observed in most demographic and health characteristic categories examined. In 2010, the adjusted odds ratio of meeting the aerobic physical activity guideline among walkers, compared with non-walkers, was 2.95 (95% confidence interval = 2.73-3.19). CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: To sustain increases in the prevalence of walking, communities can implement evidence-based strategies such as creating or enhancing access to places for physical activity, or using design and land use policies and practices that emphasize mixed-use communities and pedestrian-friendly streets. The impact of these strategies on both walking and physical activity should be monitored systematically at the national, state, and local levels. Public health efforts to promote walking as a way to meet physical activity guidelines can help improve the health of U.S. residents.

Associations of physical activity with neighborhood environments and transportation modes in older Japanese adults

OBJECTIVE

We investigated associations of walking and other leisure-time physical activity (LTPA) with environmental characteristics and transportation modes in older Japanese adults.

METHODS

This cross-sectional study in 2010-2011 used data from 421 community-dwelling older adults aged 65-85 years living in Kasama City, rural Japan. We used the Physical Activity Scale for the Elderly to assess walking and other LTPAs, and the International Physical Activity Questionnaire Environment Module for neighborhood environments.

RESULTS

After adjusting for confounders, we found that good traffic safety and aesthetics were positively associated with high levels of walking (ORs=1.64-2.12); whereas, good access to public transportation was negatively associated with walking (OR=0.64, 95% CI=0.42-0.98). Good access to recreational facilities, presence of sidewalks, absence of hills, seeing people exercise, and aesthetically pleasing surroundings were positively associated with high levels of LTPA except walking (ORs=1.61-2.13). Individuals who rode bicycles more than once per week were more likely to engage in a LTPA except walking (1-3 days: OR=1.72, 95% CI=1.03-2.87; ≥4 days: OR=2.90, 95% CI=1.71-4.93).

CONCLUSION

This study adds information on correlates of physical activity among older Japanese adults; the positive association between LTPA except walking and the frequency of bicycle travel is an especially new and intriguing finding.

Is baseline physical activity a determinant of participation in worksite walking clubs? Data from the HealthWorks Trial

BACKGROUND

Some evidence suggests that physical activity programs mainly attract employees who are already active. This study examined the degree to which baseline physical activity was associated with enrollment in worksite walking clubs.

METHODS

All variables were measured at baseline. Walking club participation was measured over 2 years. There were 642 individuals from 3 worksites with complete data available for logistic regression analyses.

RESULTS

Baseline physical activity [OR (95% CI)=1.00 (0.99, 1.01)] was not a significant predictor of walking club participation. Participants who were older [OR=1.03 (1.01, 1.04)] or indicated more social support for physical activity [OR=1.13 (1.02, 1.25)] had significantly higher odds of participation relative to those who were younger or indicated less social support, respectively. In addition, men [OR=-0.25 (0.18, 0.36)] and employees from the second worksite [OR=-0.41 (0.25, 0.67)] had significantly lower odds of participation relative to women and employees from the first or third worksites, respectively. Sensitivity analyses arrived at similar conclusions.

CONCLUSIONS

Worksite walking clubs were appealing across varying levels of physical activity. Future research should improve marketing and program design to engage harder-to-reach segments of the workforce, particularly young men and those with limited social support.

Examining aspects of the built environment: an evaluation of a community walking map project

OBJECTIVE

Interventions that address the built environment present an opportunity to affect behaviours such as physical activity. The purpose of this study was to evaluate a community walking map developed for eight neighbourhoods in the City of Edmonton (COE).

METHOD

A walking map developed in partnership with the COE's Walkable Initiative was distributed to 11,994 households across eight neighbourhoods in July 2010. In total, 149 respondents completed an online follow-up survey that assessed the effectiveness of the walking maps in influencing physical activity.

RESULTS

Of the 149 respondents, 89 (59.7%) reported that they had received a copy of the map, and 60 (40.2%) reported that they had not. Of those who had a copy, 76.4% (n=68) indicated that the routes and destinations on the map encouraged them to walk more in the community, 64.0% (n=57) stated they would walk more often to get to destinations, and 55.1% (n=49) indicated they would walk more often for physical activity or exercise as a result of having a copy of the map. Finally, 91.0% (n=81) stated that they found the map to be useful, as it provided walking routes (60/81, 74.1%,) and places to go in the community (57/81, 70.4%). Of those who did not receive a copy, 95.0% (n=57) indicated that they would use a community walking map.

CONCLUSION

This evaluation demonstrated that a community walking map was a valuable tool for not only encouraging walking for physical activity but also motivating individuals to explore their communities and visit local community destinations.

Physical activity associated with public transport use--a review and modelling of potential benefits

Active travel, particularly walking and cycling, has been recommended because of the health benefits associated with increased physical activity. Use of public transport generally involves some walking to bus stops or train stations. This paper is a systematic review of how much time is spent in physical activity among adults using public transport. It also explores the potential effect on the population level of physical activity if inactive adults in NSW, Australia, increased their walking through increased use of public transport. Of 1,733 articles, 27 met the search criteria, and nine reported on absolute measures of physical activity associated with public transport. A further 18 papers reported on factors associated with physical activity as part of public transport use. A range of 8–33 additional minutes of walking was identified from this systematic search as being attributable to public transport use. Using “bootstrapping” statistical modelling, if 20% of all inactive adults increased their walking by only 16 minutes a day for five days a week, we predict there would be a substantial 6.97% increase in the proportion of the adult population considered “sufficiently active”. More minutes walked per day, or a greater uptake of public transport by inactive adults would likely lead to significantly greater increases in the adult population considered sufficiently active.

Walking distance by trip purpose and population subgroups

BACKGROUND

Walking distance is an important concept in the fields of transportation and public health. A distance of 0.25 miles is often used as an acceptable walking distance in U.S. research studies. Overall, research on the distance and duration of walking trips for different purposes and across different population groups remains limited.

PURPOSE

This study examines the prevalence of walking and distances and durations of walking trips for different purposes among U.S. residents.

METHODS

The distances and durations of walking trips for different purposes across population groups were compared using nationally representative data from the 2009 National Household Travel Survey (NHTS). Distance decay functions were used to summarize the distribution of walking distances and durations for different purposes and population subgroups. Data were analyzed in 2011.

RESULTS

Sixteen percent of respondents had at least one daily walking trip. The mean and median values for walking distance were 0.7 and 0.5 miles, respectively. For walking duration, the mean and median values were 14.9 and 10 minutes. About 65% of walking trips were more than 0.25 miles in distance, and about 18% of walking trips were more than 1 mile. Large variations were found among various purposes for both distance and duration. The distances and durations of walking for recreation were substantially longer than those for other purposes. People with lower versus higher household income walked longer distances for work but shorter distances for recreation.

CONCLUSIONS

Only a small fraction of respondents walk, but trips longer than 0.25 miles are common. There is substantial variability in the distance and duration of walking trips by purpose and population subgroups. These differences have implications for developing strategies to increase physical activity through walking.

Promoting walking among office employees - evaluation of a randomized controlled intervention with pedometers and e-mail messages

BACKGROUND

The purpose of the study was to evaluate a 6-month intervention to promote office-employees' walking with pedometers and e-mail messages.

METHODS

Participants were recruited by 10 occupational health care units (OHC) from 20 worksites with 2,230 employees. Voluntary and insufficiently physically active employees (N = 241) were randomized to a pedometer (STEP, N = 123) and a comparison group (COMP, N = 118). STEP included one group meeting, log-monitored pedometer-use and six e-mail messages from OHC. COMP participated in data collection. Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) and costs were assessed with questionnaires (0, 2, 6, 12 months), process evaluation and interviews (12 months).

RESULTS

The intervention reached 29% (N = 646) of employees in terms of participation willingness. Logistic regression showed that the proportion of walkers tended to increase more in STEP than in COMP at 2 months in "walking for transportation" (Odds ratio 2.12, 95%CI 0.94 to 4.81) and at 6 months in "walking for leisure" (1.86, 95%CI 0.94 to 3.69). Linear model revealed a modest increase in the mean duration of "walking stairs" at 2 and 6 months (Geometric mean ratio 1.26, 95%CI 0.98 to 1.61; 1.27, 0.98 to 1.64). Adoption and implementation succeeded as intended. At 12 months, some traces of the intervention were sustained in 15 worksites, and a slightly higher number of walkers in STEP in comparison with COMP was observed in "walking stairs" (OR 2.24, 95%CI 0.94 to 5.31) and in "walking for leisure" (2.07, 95%CI 0.99 to 4.34). The direct costs of the intervention were 43 Euros per participant.

CONCLUSIONS

The findings indicate only modest impact on some indicators of walking. Future studies should invest in reaching the employees, minimizing attrition rate and using objective walking assessment. TRIAL REGISTERATION: ISRCTN79432107.

Scenario simulation-based assessment of trip difficulty for urban residents under rainstorm waterlogging

In this study, an experiment was performed to assess the trip difficulty for urban residents of different age groups walking in various depths of water, and the data were corroborated with the real urban rainstorm waterlogging scenarios in downtown (Daoli district) Ha-Erbin (China). Mathematical models of urban rainstorm waterlogging were constructed using scenario simulation methods, aided by the GIS spatial analysis technology and hydrodynamic analysis of the waterway systems in the study area. Then these models were used to evaluate the impact of waterlogging on the safety of residents walking in the affected area. Results are summarized as: (1) for an urban rainstorm waterlogging scenario reoccurring once every 10 years, three grid regions would have waterlogging above 0.5 m moving at a velocity of 1.5 m/s. Under this scenario, waterlogging would accumulate on traffic roads only in small areas, affecting the safety and mobility of residents walking in the neighborhood; (2) for an urban rainstorm waterlogging scenario reoccurring once every 20 years, 13 grids experienced the same waterlogging situation affecting a larger area of the city; (3) for an urban rainstorm waterlogging scenario reoccurring once every 50 years, 86 grid regions were affected (waterlogging above 0.5 m moving at 1.5 m/s), and those areas would become impassable for residents.

Pilot study of a dog walking randomized intervention: effects of a focus on canine exercise

OBJECTIVE

The promotion of dog walking among owners who do not walk their dogs regularly may be a viable physical activity intervention aperture, yet research is very limited and no intervention studies have employed control groups. Therefore, the purpose of this pilot study was to examine the viability of dog walking for physical activity intervention using messages targeting canine exercise.

METHOD

Inactive dog owners (n=58) were randomized to either a standard control condition or the intervention (persuasive material about canine health from walking and a calendar to mark walks) after completing a baseline questionnaire package and wearing a pedometer for one week. Participants (standard condition n=28; intervention condition n=30) completed the six and 12 week follow-up questionnaire packages.

RESULTS

Intention to treat analyses showed that both groups increased physical activity significantly across the 12 weeks (η(2)=0.09 to 0.21). The intervention group resulted in significantly higher step-counts compared to the control group (Δ 1823 steps) and showed significantly higher trajectories from baseline to 12 weeks in the self-reported physical activity measures (η(2)=0.11 to 0.27).

CONCLUSION

The results are promising for the viability of increasing dog walking as a means for physical activity promotion and suggest that theoretical fidelity targeting canine exercise may be a helpful approach.

The effect of a school-based active commuting intervention on children's commuting physical activity and daily physical activity

OBJECTIVE

To investigate the effect of a school-based intervention called Travelling Green (TG) on children's walking to and from school and total daily physical activity.

METHOD

A quasi-experiment with 166 Scottish children (8-9 years) was conducted in 2009. One group (n=79) received TG and another group (n=87) acted as a comparison. The intervention lasted 6 weeks and consisted of educational lessons and goal-setting tasks. Steps and MVPA (daily, a.m. commute, p.m. commute, and total commute) were measured for 5 days pre- and post-intervention using accelerometers.

RESULTS

Mean steps (daily, a.m., p.m., and total commute) decreased from pre- to post-intervention in both groups (TG by 901, 49, 222, and 271 steps/day and comparison by 2528, 205, 120, and 325 steps/day, respectively). No significant group by time interactions were found for a.m., p.m., and total commuting steps. A medium (partial eta squared=0.09) and significant (p<0.05) group by time interaction was found for total daily steps. MVPA results were similar to step results.

CONCLUSIONS

TG has a little effect on walking to and from school. However, for total daily steps and daily MVPA, TG results in a smaller seasonal decrease than for children who do not receive the intervention.

Physical activity among Amish and non-Amish adults living in Ohio Appalachia

To understand the behavioral lifestyle factors that may contribute to lower cancer incidence rates among the Amish population, this study evaluated differences in physical activity (PA) levels between Amish and non-Amish adults living in Ohio Appalachia. Amish (n = 134) and non-Amish (n = 154) adults completed face-to-face interviews as part of a cancer-related lifestyle study. Self-report of PA level was measured by the International Physical Activity Questionnaire (IPAQ) and by a diary of steps/day (pedometer: Digi-Walker SW-200). Total metabolic equivalent tasks (MET) minutes was calculated from the IPAQ and average number of steps/day from a pedometer diary. Amish males walked more steps/day (mean ± standard error (SE): 11,447 ± 611 vs. 7,605 ± 643; P < 0.001) and had a higher IPAQ score (MET min/week) (mean ± SE: 8,354 ± 701 vs. 5,547 ± 690; P < 0.01) than non-Amish males. In addition, Amish farmers walked significantly more steps/day than Amish non-farmers (mean ± SE: 15,278 ± 1,297 vs. 10,742 ± 671; P < 0.01). There was a trend for Amish females to walk more steps/day (mean ± SE: 7,750 ± 477 vs. 6,547 ± 437; P = 0.06) and to have higher IPAQ scores (mean ± SE: 4,966 ± 503 vs. 3,702 ± 450; P = 0.06) compared to non-Amish females. Two measures of PA demonstrated a higher PA level among Amish males, especially farmers, and a trend for higher PA level among Amish females. Higher levels of PA warrants further investigation as one factor potentially contributing to lower cancer incidence rates documented among the Amish.

Macroscopic spatial analysis of pedestrian and bicycle crashes

This study investigates the effect of spatial correlation using a Bayesian spatial framework to model pedestrian and bicycle crashes in Traffic Analysis Zones (TAZs). Aggregate models for pedestrian and bicycle crashes were estimated as a function of variables related to roadway characteristics, and various demographic and socio-economic factors. It was found that significant differences were present between the predictor sets for pedestrian and bicycle crashes. The Bayesian Poisson-lognormal model accounting for spatial correlation for pedestrian crashes in the TAZs of the study counties retained nine variables significantly different from zero at 95% Bayesian credible interval. These variables were - total roadway length with 35 mph posted speed limit, total number of intersections per TAZ, median household income, total number of dwelling units, log of population per square mile of a TAZ, percentage of households with non-retired workers but zero auto, percentage of households with non-retired workers and one auto, long term parking cost, and log of total number of employment in a TAZ. A separate distinct set of predictors were found for the bicycle crash model. In all cases the Bayesian models with spatial correlation performed better than the models that did not account for spatial correlation among TAZs. This finding implies that spatial correlation should be considered while modeling pedestrian and bicycle crashes at the aggregate or macro-level.

Physical environmental factors related to walking and cycling in older adults: the Belgian aging studies

BACKGROUND

Socio-ecological models emphasize the relationship between the physical environment and physical activity (PA). However, knowledge about this relationship in older adults is limited. Therefore, the present study aims to investigate the relationship between area of residence (urban, semi-urban or rural) and older adults' walking and cycling for transportation and recreation. Additionally, relationships between several physical environmental factors and walking and cycling and possible moderating effects of area of residence, age and gender were studied.

METHODS

Data from 48,879 Flemish older adults collected in 2004-2010 through peer research were analyzed. Walking, cycling and environmental perceptions were assessed using self-administered questionnaires. The Study Service of the Flemish Government provided objective data on municipal characteristics. Multilevel logistic regression analyses were applied.

RESULTS

Urban participants were more likely to walk daily for transportation compared to rural (OR = 1.43; 95% CI = 1.22, 1.67) and semi-urban participants (OR = 1.32; 95% CI = 1.13, 1.54). Urban participants were less likely to cycle daily for transportation compared to semi-urban participants (OR = 0.72; 95% CI = 0.56, 0.92). Area of residence was unrelated to weekly recreational walking/cycling. Perceived short distances to services (ORs ranging from 1.04 to 1.19) and satisfaction with public transport (ORs ranging from 1.07 to 1.13) were significantly positively related to all walking/cycling behaviors. Feelings of unsafety was negatively related to walking for transportation (OR = 0.93, 95% CI = 0.91, 0.95) and recreational walking/cycling (OR = 0.95, 95% CI = 0.92, 0.97). In females, it was also negatively related to cycling for transportation (OR = 0.94, 95% CI = 0.90, 0.98).

CONCLUSIONS

Urban residents were more likely to walk for transportation daily compared to semi-urban and rural residents. Daily cycling for transportation was less prevalent among urban compared to semi-urban residents. Access to destinations appeared to be important for promoting both walking and cycling for transportation and recreation across all demographic subgroups. Additionaly, feelings of unsafety were associated with lower rates of walking for transportation and walking/cycling for recreation in all subgroups and cycling for transportation in females. No clear patterns emerged for other environmental factors.

Freshwater availability and water fetching distance affect child health in sub-Saharan Africa

Currently, more than two-thirds of the population in Africa must leave their home to fetch water for drinking and domestic use. The time burden of water fetching has been suggested to influence the volume of water collected by households as well as time spent on income generating activities and child care. However, little is known about the potential health benefits of reducing water fetching distances. Data from almost 200, 000 Demographic and Health Surveys carried out in 26 countries were used to assess the relationship between household walk time to water source and child health outcomes. To estimate the causal effect of decreased water fetching time on health, geographic variation in freshwater availability was employed as an instrumental variable for one-way walk time to water source in a two-stage regression model. Time spent walking to a household's main water source was found to be a significant determinant of under-five child health. A 15-min decrease in one-way walk time to water source is associated with a 41% average relative reduction in diarrhea prevalence, improved anthropometric indicators of child nutritional status, and a 11% relative reduction in under-five child mortality. These results suggest that reducing the time cost of fetching water should be a priority for water infrastructure investments in Africa.

Active commuting to school among adolescents in Ho Chi Minh City, Vietnam: change and predictors in a longitudinal study, 2004 to 2009

BACKGROUND

Active commuting (walking or cycling) to/from school is an important part of the overall physical activity levels of children but is on the decline in many countries. Data for adolescents on mode of transportation to and from school are limited for low- and middle-income countries, including Vietnam.

PURPOSE

This paper aims to describe the changes in the prevalence of active commuting to and from school, and to examine prospectively the predictors of active commuting, among adolescents from Ho Chi Minh City (HCMC).

METHODS

The data are from a 5-year cohort study from 2004 of a representative sample of 759 adolescents from 18 schools in HCMC. Data were obtained at five annual assessments using validated questionnaires to capture commuting behaviors, socioeconomic and demographic factors, individual and family characteristics, and physical and social environmental factors. Height and weight were measured by trained staff using standardized guidelines. Generalized linear latent and mixed models with a hierarchic approach were used to analyze the data in 2011.

RESULTS

The results show a remarkable decrease in the prevalence of active commuting in adolescents from 27.8% in 2004 to 19.6% in 2009. Male students, from the least-wealthy families, living in suburban areas, close to school, studying at schools in less-wealthy districts, were more likely to actively commute.

CONCLUSIONS

In the context of an epidemic of childhood and adolescent obesity in urban Vietnam, the decline in active commuting over the 5 years of this study highlights the need for development of urban physical environments favorable for active commuting and education campaigns to promote active commuting in adolescents.

Measuring combined exposure to environmental pressures in urban areas: an air quality and noise pollution assessment approach

This study presents a methodological scheme developed to provide a combined air and noise pollution exposure assessment based on measurements from personal portable monitors. Provided that air and noise pollution are considered in a co-exposure approach, they represent a significant environmental hazard to public health. The methodology is demonstrated for the city of Thessaloniki, Greece. The results of an extensive field campaign are presented and the variations in personal exposure between modes of transport, routes, streets and transport microenvironments are evaluated. Air pollution and noise measurements were performed simultaneously along several commuting routes, during the morning and evening rush hours. Combined exposure to environmental pollutants is highlighted based on the Combined Exposure Factor (CEF) and Combined Dose and Exposure Factor (CDEF). The CDEF takes into account the potential relative uptake of each pollutant by considering the physical activities of each citizen. Rather than viewing environmental pollutants separately for planning and environmental sustainability considerations, the possibility of an easy-to-comprehend co-exposure approach based on these two indices is demonstrated. Furthermore, they provide for the first time a combined exposure assessment to these environmental pollutants for Thessaloniki and in this sense they could be of importance for local public authorities and decision makers. A considerable environmental burden for the citizens of Thessaloniki, especially for VOCs and noise pollution levels is observed. The material herein points out the importance of measuring public health stressors and the necessity of considering urban environmental pollution in a holistic way.

Exploring walking differences by socioeconomic status using a spatial agent-based model

We use an exploratory agent-based model of adults' walking behavior within a city to examine the possible impact of interventions on socioeconomic differences in walking. Simulated results show that for persons of low socioeconomic status, increases in walking resulting from increases in their positive attitude towards walking may diminish over time if other features of the environment are not conducive to walking. Similarly, improving the safety level for the lower SES neighborhoods may be effective in increasing walking, however, the magnitude of its effectiveness varies by levels of land use mix, such that effects of safety are greatest when persons live in areas with a large mix of uses.

The CHOICE study: a "taste-test" of utilitarian vs. leisure walking among older adults

OBJECTIVE

Utilitarian walking (e.g., walking for transport) and leisure walking (e.g., walking for health/recreation) are encouraged to promote health, yet few studies have explored specific preferences for these two forms of physical activity or factors that impact such preferences. A quasi-experimental crossover design was used to evaluate how training underactive midlife and older adults in each type of walking impacted total steps taken and how it was linked to their subsequent choice of walking types.

METHODS

Participants (N = 16) were midlife and older adults (M age = 64 ± 8 years) who were mostly women (81%) and white (75%). To control for order effects, participants were randomized to instruction in either utilitarian or leisure walking for 2 weeks and then the other type for 2 weeks. Participants then entered a 2-week "free choice" phase in which they chose any mixture of the walking types. Outcome variables included walking via OMRON pedometer and the ratio of utilitarian versus leisure walking during the free-choice phase. Participants completed surveys about their neighborhood (NEWS) and daily travel to multiple locations.

RESULTS

Instruction in leisure-only, utilitarian-only, and a freely chosen mixture of the two each resulted in significant increases in steps taken relative to baseline (ps < 0.05). Having to go to multiple locations daily and traveling greater distances to locations were associated with engagement in more utilitarian walking. In contrast, good walking paths, neighborhood aesthetics, easy access to exercise facilities, and perceiving easier access to neighborhood services were associated with more leisure walking.

CONCLUSIONS

Results from this pilot study suggest that midlife and older adults may most easily meet guidelines through either leisure only or a mixture of leisure and utilitarian walking, and tailored suggestions based on the person's neighborhood may be useful.

Characterization of pedestrian accidents and an examination of infrastructure measures to improve pedestrian safety in Israel

The high share of pedestrian fatalities in Israel provided the impetus for this study which looked for infrastructure solutions to improve pedestrian safety. First, a detailed analysis of pedestrian accidents in 2006-2007, with an emphasis on the infrastructure characteristics involved, was performed; it found that 75% of the fatalities and 95% of the injuries occurred in urban areas, the majority of cases occurring on road sections (not at junctions). About 80% of the accidents took place when a pedestrian crossed the road, the majority of them at non-crosswalk locations or at non-signalized crosswalks. International comparisons showed that the characteristics of fatal pedestrian accidents in Israel were similar to the average pedestrian accident in Europe in terms of accident location, time, and the demographic characteristics of the victims. A typology of pedestrian fatalities in Israel was built for the years 2003-2006; it demonstrated a high share of accidents at these locations: in Jewish or mixed-population towns-not at pedestrian crossings on urban street sections, and both at pedestrian crossings and not at pedestrian crossings at urban junctions; in Arab towns; and on dual-carriageway rural roads. Second, based on a literature study, a summary of about 60 pedestrian-safety-related measures was developed. Third, to diagnose the infrastructure characteristics and deficiencies associated with pedestrian accidents, detailed field studies were carried out at 95 urban locations. A major finding revealed that more than 80% of the sites with a high concentration of pedestrian-vehicle accidents in Israel were situated on arterial multi-lane streets belonging to city centers, where on a micro-level there were no indications of major deficiencies in the basic design elements of most sites. Finally, cross-checking of the safety problems identified and the infrastructure solutions available provided lists of measures recommended for application at various types of sites. It was concluded that in order to generate a significant change in the state of pedestrian injury in Israel, a move from spot treatment to a systemic treatment of the problem is required. A systemic inquiry and the transformation of the urban road network should be performed in order to diminish the areas of vehicle-pedestrian conflicts and to significantly reduce vehicle speeds in areas of pedestrian presence and activity.

Pedestrian crash trends and potential countermeasures from around the world

As automobile transportation continues to increase around the world, bicyclists, pedestrians, and motorcyclists, also known as vulnerable road users (VRUs), will become more susceptible to traffic crashes, especially in countries where traffic laws are poorly enforced. Many countries, however, are employing innovative strategies to ensure that road users can more safely navigate the urban landscape. While bicyclists and motorcyclists are important road users, this paper will focus on pedestrian crash problems and solutions. Pedestrians are most at risk in urban areas due in part to the large amount of pedestrian and vehicle activity in urban areas. With this in mind, designing safe, accessible, and comprehensive facilities for pedestrians is vital to reducing pedestrian crashes. This paper will provide some insight into the magnitude of the pedestrian crash problem around the world, and will offer some lessons learned from several countries, particularly in Europe and the U.S., for improving pedestrian safety. Beginning with pedestrian safety statistics at the global, regional, and national levels, this paper will address potential countermeasures and strategies for improving pedestrian safety from an international perspective.

Behavioral change during weight loss program and one-year follow-up: Saku Control Obesity Program (SCOP) in Japan

This study evaluated effects of a behavioral approach which placed emphasis on tailored behavior counseling, diet, weight loss and weight maintenance. A one-year randomized controlled trial was conducted among 235 overweight/obese adults in Japan. The intervention group (n=119) received individual-based counseling using a behavioral approach and the changes made in the diet and physical activity were dependent on each participant as much as possible. One year later, the intervention group lost significantly more weight than the control group (-5.0 kg vs. 0.1 kg for men and -3.9 kg vs. -0.2 kg for women). Compared to the control group, the male intervention group reduced overall energy, cereals and dairy products consumption significantly, while increasing green and yellow vegetable intake, and the female intervention group significantly reduced intake of dairy products. Regarding behaviors, both male and female intervention groups increased the number of walking steps and women improved their irregular eating habits compared to those in the control groups. Behavior changes were related to weight loss; participants who maintained the action/maintenance stage or moved to later stages lost significantly more weight than participants who remained in the pre-contemplation/contemplation/preparation stages or regressed to earlier stages. After one-year follow-up, the intervention group maintained significantly lower weights, lower energy intakes and improvements in irregular eating habits. Our behavioral approach led to diet and behavior modification, weight loss and maintenance. Because modified variables differed between men and women, gender-specific approaches may be necessary.