Walking and cycling to health: a comparative analysis of city, state, and international data

Neighbourhood Influences on Children's Weight-related Behaviours and Body Mass Index

Introduction

Neighbourhood contextual factors such as accessibility of food shops and green spaces are associated with adult bodyweight but not necessarily weight-related behaviours. Whether these associations are replicated amongst children is unknown.

Aim

To understand which aspects of childrens' neighbourhoods are associated with unhealthy weight and weight-related behaviours.

Methods

Individual-level data for children from the 2006/7 New Zealand Health Survey (of Body Mass Index (BMI), dietary indicators and socioeconomic variables) were linked with geographic level data on neighbourhood deprivation, rural/urban status, percentage of community engaged in active travel, access to green space, food shops and sports/leisure facilities. Logistic regression models were fitted for measures of BMI and weight-related behaviours; sugar sweetened beverage (SSB) consumption; fast-food consumption; and television viewing.

Results

Increased community engagement in active transport was, counterintuitively, the only neighbourhood contextual factor associated with unhealthy weight amongst children. After adjustment for socioeconomic and environmental variables, greater access to green space appeared to have a protective effect on SSB consumption and neighbourhood deprivation was associated with all three unhealthy weight-related behaviours (SSB and fast-food consumption and television viewing).

Conclusions

Although further research is needed, evidence from the current study suggests that a repertoire of health promotion interventions and policies to change unhealthy weight-related behaviours in high deprivation neighbourhoods may be required to address childhood obesity.

Does the Effect of Micro-Environmental Factors on a Street's Appeal for Adults' Bicycle Transport Vary across Different Macro-Environments? An Experimental Study

BACKGROUND

Characteristics of the physical environment can be classified into two broad categories: macro- ("raw" urban planning features influenced on a regional level) and micro- (features specifically within a streetscape influenced on a neighborhood level) environmental factors. In urban planning applications, it is more feasible to modify conditions at the neighborhood level than at the regional level. Yet for the promotion of bicycle transport we need to know whether relationships between micro-environmental factors and bicycle transport depend on different types of macro-environments. This study aimed to identify whether the effect of three micro-environmental factors (i.e., evenness of the cycle path surface, speed limits and type of separation between cycle path and motorized traffic) on the street's appeal for adults' bicycle transport varied across three different macro-environments (i.e., low, medium and high residential density street).

METHODS

In total, 389 middle-aged adults completed a web-based questionnaire consisting of socio-demographic characteristics and a series of choice tasks with manipulated photographs, depicting two possible routes to cycle along. Conjoint analysis was used to analyze the data.

RESULTS

Although the magnitude of the overall effects differed, in each macro-environment (i.e., low, medium and high residential density), middle-aged adults preferred a speed limit of 30 km/h, an even cycle path surface and a hedge as separation between motorized traffic and the cycle path compared to a speed limit of 50 or 70 km/h, a slightly uneven or uneven cycle path surface and a curb as separation or no separation between motorized traffic and the cycle path.

CONCLUSIONS

Our results suggest that irrespective of the macro-environment, the same micro-environmental factors are preferred in middle-aged adults concerning the street's appeal for bicycle transport. The controlled environment simulations in the experimental choice task have the potential to inform real life environmental interventions and suggest that micro-environmental changes can have similar results in different macro-environments.

Interactions between psychological and environmental characteristics and their impacts on walking

Due to walking's benefits to physical and mental health as well as to environmental and economic sustainability, numerous studies have examined psychological and environmental characteristics on their impacts on walking. However, understanding of how the interactions between psychological and environmental characteristics influence walking remains limited. Recently, both competitive mechanism and synergetic mechanism have been proposed, and a number of empirical studies have examined the interactions between psychological and environmental characteristics, but the results were inconsistent. We reviewed 11 recent studies and discussed their difference in terms of studies population, outcomes, environmental characteristics, and psychological characteristics. We propose a framework that integrate both mechanisms and provides an explanation to the inconsistency. More important, the framework may stimulate further empirical researches and provide implications for policy intervention to promote walking.

Changes in mode of transportation to work or school from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study

Objective

To describe changes in mode of transportation to work or school from pre-pregnancy to early pregnancy, to describe levels of physical activity related to mode of transportation to work or school, and to examine associations between changes in mode of transportation to work or school and educational level, body mass index (BMI) and age.

Methods

Between September 2009 and February 2013, 575 healthy pregnant nulliparous women were included into the Norwegian Fit for Delivery (NFFD) trial. At inclusion they reported their current and their pre-pregnancy mode of transportation to work or school. Data were analysed by multilevel mixed models with dichotomized modes of transportation as dependent variables.

Results

There was a significant change towards less active transportation to work or school and a decrease in level of physical activity from pre-pregnancy to early pregnancy. Pre-pregnancy, 58% used private transportation to work or school, compared to 64% in early pregnancy (p = 0.001). The percentage of women who biked (11% v. 5%, p < 0.001) decreased significantly from pre-pregnancy to early pregnancy.

Conclusions

In this sample of Norwegian women there was a significant change towards less active transportation to work or school and lower levels of physical activity from pre-pregnancy to early pregnancy.

•

We examined mode of transportation to work/school among pregnant women.

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Private transport was the dominant mode of transportation.

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There was a change towards less active transportation and less physical activity in early pregnancy.

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Only 46% continued biking to work/school in early pregnancy.

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High education was associated with decreased public and increased private transportation.

Examining the link between public transit use and active commuting

BACKGROUND

An established relationship exists between public transportation (PT) use and physical activity. However, there is limited literature that examines the link between PT use and active commuting (AC) behavior. This study examines this link to determine if PT users commute more by active modes.

METHODS

A volunteer, convenience sample of adults (n = 748) completed an online survey about AC/PT patterns, demographic, psychosocial, community and environmental factors. t-test compared differences between PT riders and non-PT riders. Binary logistic regression analyses examined the effect of multiple factors on AC and a full logistic regression model was conducted to examine AC.

RESULTS

Non-PT riders (n = 596) reported less AC than PT riders. There were several significant relationships with AC for demographic, interpersonal, worksite, community and environmental factors when considering PT use. The logistic multivariate analysis for included age, number of children and perceived distance to work as negative predictors and PT use, feelings of bad weather and lack of on-street bike lanes as a barrier to AC, perceived behavioral control and spouse AC were positive predictors.

CONCLUSIONS

This study revealed the complex relationship between AC and PT use. Further research should investigate how AC and public transit use are related.

Incidental physical activity in Melbourne, Australia: health and economic impacts of mode of transport and suburban location

ISSUE ADDRESSED

Using the known health impacts of physical activity (PA), levels of incidental PA in Melbourne were analysed, and after determining key behavioural associations, economic modelling estimated potential long-term health and economic benefits of changes in active transport (AT) patterns.

METHODS

A cross-sectional survey (VISTA07-08) obtained daily travel data from 29840 individuals of all ages in Melbourne evenly spread over 364 days of the year. Correlates of adequate PA were analysed. The health and economic impact of changes in AT from postulated changes in (1) mode of transport, and (2) transport use by urban sub-region, were modelled.

RESULTS

15.1% of individuals had adequate incidental PA. Private vehicle users averaged 10.0min PA, public transport users 35.2min and walkers/cyclists 38.3min daily. Distance from city centre was strongly inversely correlated with adequate PA. Conservative modelling of postulated changes in AT patterns found annual savings of 34-272 deaths, 114-903 new cases of disease and 442-3511 DALYs. Lifetime savings accounted for 17300-70100 days of home-based/leisure time production, and savings of $1.5-12.2million in the health sector and $2.9-22.9million in production.

CONCLUSIONS

Public transport users, walkers, cyclists and those living closer to the city centre were more likely to gain travel-related PA sufficient for health benefits. Both transport mode and urban location were associated with levels of travel-related PA that have significant health and financial impacts. SO WHAT?: Improving population levels of incidental PA may improve health and economic outcomes. This may require changes in urban and transport infrastructure.

Contribution of exposure, risk of crash and fatality to explain age- and sex-related differences in traffic-related cyclist mortality rates

This study was designed to quantify the percent contribution of exposure, risk of collision and fatality rate to the association of age and sex with the mortality rates among cyclists in Spain, and to track the changes in these contributions with time. Data were analyzed for 50,042 cyclists involved in road crashes in Spain from 1993 to 2011, and also for a subset of 13,119 non-infractor cyclists involved in collisions with a vehicle whose driver committed an infraction (used as a proxy sample of all cyclists on the road). We used decomposition and quasi-induced exposure methods to obtain the percent contributions of these three components to the mortality rate ratios for each age and sex group compared to males aged 25-34 years. Death rates increased with age, and the main component of this increase was fatality (around 70%). Among younger cyclists, however, the main component of increased death rates was risk of a collision. Males had higher death rates than females in every age group: this rate increased from 6.4 in the 5-14 year old group to 18.8 in the 65-79 year old group. Exposure, the main component of this increase, ranged between 70% and 90% in all age categories, although the fatality component also contributed to this increase. The contributions of exposure, risk of crash and fatality to cyclist death rates were strongly associated with age and sex. Young male cyclists were a high-risk group because all three components tended to increase their mortality rate.

Bicycling policy indirectly associated with overweight/obesity

BACKGROUND

Policies to enhance bicycling are correlated with health outcomes. Research has yet to provide an adequate, empirically derived explanation for this finding.

PURPOSE

To examine a comprehensive model of a pathway potentially linking bicycle policies to overweight/obesity.

METHODS

Data representing multiple years between 2006 and 2012 from CDC, U.S. Census Bureau, U.S. Department of Transportation, and the Alliance for Biking and Walking were subjected to bivariate and multivariate analyses in 2013. A path model was created to explain the relationship between bicycle policies and overweight/obesity in the 48 largest U.S. cities.

RESULTS

Zero-order correlations were significant between the number of bicycle policies and the percentage of workers bicycling to work and rates of overweight/obesity. These relationships did not remain statistically significant in the multivariate analysis. However, more bicycle policies were associated with a greater number of bicycle infrastructure components (p<0.005). In turn, bicycling infrastructure components were positively related to the percentage of workers bicycling to work (p<0.001), which was inversely associated with overweight/obesity rates (p<0.05).

CONCLUSIONS

The results of this study suggest that large cities with more policies aimed at promoting bicycling have fewer overweight/obese residents, partially because the policies are related to supportive bicycling infrastructures that promote bicycling to work.

Factors associated with active commuting among parents-to-be in Karlskrona, Sweden

Aim: The purpose of the present study is to examine the prevalence of active commuting and factors associated with participation in active commuting in the municipality of Karlskrona, Sweden. Active commuting is defined here as walking or cycling to and from school/work for at least 15 minutes one-way. Method: A cross-sectional study was carried out, which included baseline data from parents-to-be. Pregnant females and their partners were invited to participate in the study when they contacted either of the municipality’s two antenatal clinics. Data collection ran from March 2008 to February 2009. When completing the questionnaire, the participants were asked to reflect on their situation one month before the female became pregnant. The final sample consisted of 432 participants (response rate 51.9% for females and 85.0% for males). Results: The main mode of commuting was motor vehicle (63.0%), with active commuters forming a minority (8.3%). The main facilitating factor for active commuting was living in an urban as opposed to a rural area. Regular participation in outdoor recreational physical activity was significantly positively associated with active commuting. Being Swedish and being surrounded by a green space environment were significantly negatively associated with active commuting. Conclusions: This study found that the number of people who are active commuters is modest and other modes of transportation are preferred. Several facilitating and impeding factors associated with active commuting were also found, indicating the importance of applying a broad health-promoting approach to encouraging active commuting.

Climate change: challenges and opportunities for global health

IMPORTANCE

Health is inextricably linked to climate change. It is important for clinicians to understand this relationship in order to discuss associated health risks with their patients and to inform public policy.

OBJECTIVES

To provide new US-based temperature projections from downscaled climate modeling and to review recent studies on health risks related to climate change and the cobenefits of efforts to mitigate greenhouse gas emissions.

DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS

We searched PubMed and Google Scholar from 2009 to 2014 for articles related to climate change and health, focused on governmental reports, predictive models, and empirical epidemiological studies. Of the more than 250 abstracts reviewed, 56 articles were selected. In addition, we analyzed climate data averaged over 13 climate models and based future projections on downscaled probability distributions of the daily maximum temperature for 2046-2065. We also compared maximum daily 8-hour average ozone with air temperature data taken from the National Oceanic and Atmospheric Administration, National Climate Data Center.

RESULTS

By 2050, many US cities may experience more frequent extreme heat days. For example, New York and Milwaukee may have 3 times their current average number of days hotter than 32°C (90°F). High temperatures are also strongly associated with ozone exceedance days, for example, in Chicago, Illinois. The adverse health aspects related to climate change may include heat-related disorders, such as heat stress and economic consequences of reduced work capacity; respiratory disorders, including those exacerbated by air pollution and aeroallergens, such as asthma; infectious diseases, including vectorborne diseases and waterborne diseases, such as childhood gastrointestinal diseases; food insecurity, including reduced crop yields and an increase in plant diseases; and mental health disorders, such as posttraumatic stress disorder and depression, that are associated with natural disasters. Substantial health and economic cobenefits could be associated with reductions in fossil fuel combustion. For example, greenhouse gas emission policies may yield net economic benefit, with health benefits from air quality improvements potentially offsetting the cost of US and international carbon policies.

CONCLUSIONS AND RELEVANCE

Evidence over the past 20 years indicates that climate change can be associated with adverse health outcomes. Health care professionals have an important role in understanding and communicating the related potential health concerns and the cobenefits from policies to reduce greenhouse gas emissions.

Characterizing active transportation behavior among college students using the theory of planned behavior

Physical inactivity poses concern for health risks among all groups in the United States. Active transportation (AT) (e.g., bicycling) is one way of being physically active and may be helpful in promoting physical activity. This study characterized active transportation behavior among college students using the Theory of Planned Behavior. This study sought to describe predictors, including Theory of Planned Behavior (TPB) constructs, of AT behavior among college students at a large Midwest university. Students were recruited through the university registrar's office and e-mailed an electronic survey. Differences among AT users were determined using t-tests, and predictors of AT were identified using regression analysis. Significant differences between AT users for all TPB constructs were observed. Regression analysis using only TPB constructs accounted for 11.58% explained variation in AT use. Other variables added to the model resulted in 44.44% explained variation in AT use. The final model included subjective norms, age, perceived behavioral control, and transportation type and destination. The results of this research are insightful in explaining AT behavior. Perceived norms and the level of control students had regarding their method of transportation were important contributions to AT use. These results may be applied to promoting physical activity in community health.

Incorporating consideration of health impacts into land use development approval processes: Development of a Health Background Study Framework

OBJECTIVES

This project involved development of a Health Background Study (HBS) Framework to support consideration of health impacts within municipalities' approval process for land use development.

PARTICIPANTS

Peel Public Health and Toronto Public Health led the project with the participation of planners, urban designers, engineers, public health staff and development industry representatives.

SETTING

Historical growth in the Region of Peel and suburban Toronto has resulted in extensive low-density development, creating car-dependent communities with disconnected streets and segregated land uses.

INTERVENTION

The inclusion of an HBS in developers' applications to municipalities is one approach by which health-related expectations for the built environment can be established within the approval process. Development of the HBS Framework used the six core elements of the built environment with the strongest evidence for impact on health and was informed by analysis of the provincial and local policy contexts, practices of other municipalities and stakeholder interviews. The Framework's contents were refined according to feedback from multidisciplinary stakeholder workshops.

OUTCOMES

The HBS Framework identifies minimum standards for built environment core elements that developers need to address in their applications. The Framework was created to be simple and instructive with applicability to a range of development locations and scales, and to various stages of the development approval process. Peel Public Health is leading several initiatives to support the use of the HBS as a part of the development application process.

CONCLUSION

The HBS Framework is a tool that public health and planning can use to support the consideration of health impacts within municipalities' land use development processes.

Street connectivity and walking for transport: role of neighborhood destinations

OBJECTIVE

Built environment attributes may be important determinants of physical activity. Greater street connectivity has been shown in several studies to be associated with adults' walking for transport (WFT). We examined the extent to which this association can be explained by the availability of utilitarian destinations.

METHODS

Adults (n=2544) participating in the Physical Activity in Localities and Community Environments (PLACE) study in Adelaide, Australia during 2003-2004, reported their WFT and perceived distances to 16 utilitarian destinations. Connectivity was calculated as the ratio of the number of intersections to Census Collection District land area. Marginal models via generalized estimating equations were used and the product-of-coefficients test was used to test mediation effects.

RESULTS

Connectivity was significantly associated with destination availability and with WFT frequency. The connectivity-WFT relationship was attenuated after taking availability of destinations into account, but remained significant. Availability of destinations accounted for 16% of the total effect of connectivity on WFT.

CONCLUSIONS

Higher connectivity can be associated with more frequent WFT, partly because more utilitarian destinations are available in areas with well-connected street networks. Further clarification of these relationships and other pathways through which connectivity influences residents' walking can inform urban design initiatives to promote physical activity.

The effect of changing micro-scale physical environmental factors on an environment's invitingness for transportation cycling in adults: an exploratory study using manipulated photographs

Previous studies have shown convincing evidence for positive relationships between transportation cycling in adults and macro-scale physical environmental factors. In contrast, relationships are less consistent for more changeable, micro-scale environmental factors. The majority of existing studies used observational study designs, which cannot determine causality. The present mixed-methods study used manipulated photographs to determine causal relationships between micro-scale environmental factors and the environment’s invitingness for transportation cycling. Further, interactions among environmental factors and moderating effects of gender, age and educational level were investigated. For this study, panoramic photograph of a street was manipulated on eight environmental factors: traffic, speed bump, general upkeep, evenness of the cycle path, vegetation, separation of motorized traffic, separation with sidewalk and cycle path width. Sixty-six middle-aged adults participated in the study and sorted the manipulated panoramic photographs from least to most inviting to cycle for transportation. Participants also provided qualitative data on how they sorted the streets. Multilevel cross-classified modelling was used to analyse the relationships between the environmental manipulations and the invitingness-scores. The qualitative data were deductively categorized according to the environmental factors. All environmental factors, except for separation with sidewalk, proved to have a significant main effect on the invitingness-score for transportation cycling. Cycle path evenness appeared to have the strongest effect on the invitingness. This effect was even stronger in an environment with good compared to poorly overall upkeep. Another significant interaction effect showed that the invitingness decreased when both separations along the cycle path were present compared to only a separation with traffic. No moderating effects of the demographic factors on these relationships were found. Qualitative data confirmed the observed quantitative relationships and added depth and understanding. Current study shows that the use of manipulated photographs can be an effective way to examine environment-physical activity relationships. Our findings indicate that evenness of the cycle path may be a crucial environmental factor when aiming to increase a street’s invitingness for transportation cycling among middle-aged adults. The findings of our exploratory study could be used to develop an environmental intervention to determine if our findings are applicable to real changes in cycling behavior.

Associations between active commuting, body fat, and body mass index: population based, cross sectional study in the United Kingdom

OBJECTIVE

To determine if promotion of active modes of travel is an effective strategy for obesity prevention by assessing whether active commuting (walking or cycling for all or part of the journey to work) is independently associated with objectively assessed biological markers of obesity.

DESIGN

Cross sectional study of data from the wave 2 Health Assessment subsample of Understanding Society, the UK Household Longitudinal Study (UKHLS). The exposure of interest, commuting mode, was self reported and categorised as three categories: private transport, public transport, and active transport.

PARTICIPANTS

The analytic samples (7534 for body mass index (BMI) analysis, 7424 for percentage body fat analysis) were drawn from the representative subsample of wave 2 respondents of UKHLS who provided health assessment data (n = 15,777).

MAIN OUTCOME MEASURES

Body mass index (weight (kg)/height (m)(2)); percentage body fat (measured by electrical impedance).

RESULTS

Results from multivariate linear regression analyses suggest that, compared with using private transport, commuting by public or active transport modes was significantly and independently predictive of lower BMI for both men and women. In fully adjusted models, men who commuted via public or active modes had BMI scores 1.10 (95% CI 0.53 to 1.67) and 0.97 (0.40 to 1.55) points lower, respectively, than those who used private transport. Women who commuted via public or active modes had BMI scores 0.72 (0.06 to 1.37) and 0.87 (0.36 to 0.87) points lower, respectively, than those using private transport. Results for percentage body fat were similar in terms of magnitude, significance, and direction of effects.

CONCLUSIONS

Men and women who commuted to work by active and public modes of transport had significantly lower BMI and percentage body fat than their counterparts who used private transport. These associations were not attenuated by adjustment for a range of hypothesised confounding factors.

Active travel intervention and physical activity behaviour: an evaluation

A physically active lifestyle is an important contributor to individual health and well-being. The evidence linking higher physical activity levels with better levels of morbidity and mortality is well understood. Despite this, physical inactivity remains a major global risk factor for mortality and, consequently, encouraging individuals to pursue physically active lifestyles has been an integral part of public health policy in many countries. Physical activity promotion and interventions are now firmly on national health policy agendas, including policies that promote active travel such as walking and cycling. This study evaluates one such active travel initiative, the Smarter Choices, Smarter Places programme in Scotland, intended to encourage uptake of walking, cycling and the use of public transport as more active forms of travel. House to house surveys were conducted before and after the programme intervention, in May/June 2009 and 2012 (12,411 surveys in 2009 and 9542 in 2012), for the evaluation of the programme. This paper analyses the physical activity data collected, focussing on what can be inferred from the initiative with regards to adult uptake of physical activity participation and whether, for those who participated in physical activity, the initiative impacted on meeting recommended physical activity guidelines. The results suggest that the initiative impacted positively on the likelihood of physical activity participation and meeting the recommended physical activity guidelines. Individuals in the intervention areas were on average 6% more likely to meet the physical activity guidelines compared to individuals in the non intervention areas. However, the absolute prevalence of physical activity participation declined in both intervention and control areas over time. Our evaluation of this active transport initiative indicates that similar programmes may aid in contributing to achieving physical activity targets and adds to the international evidence base on the benefits of active travel interventions.

Cardiovascular health: a cross-national comparison between the Maine Syracuse Study (Central New York, USA) and ORISCAV-LUX (Luxembourg)

BACKGROUND

Cardiovascular disease is the number one cause of death in the United States and in most European countries. Cardiovascular health, as defined by the American Heart Association, is comprised of seven health metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose). No studies have compared US data with data collected elsewhere, using this index of cardiovascular health

METHODS

We performed comparative analyses of cardiovascular health status in participants from 2 study sites in 2 different countries: the Maine-Syracuse Study, conducted in Central New York, USA in 2001-2006 (n=673), and the Observation of Cardiovascular Risk Factors in Luxembourg, conducted in 2007-2009 (n=1145).

RESULTS

The Cardiovascular Health Score, the sum of the total number of metrics at ideal levels, was higher in the Luxembourg site than in the Central New York site. Ideal cardiovascular health levels for body mass index, smoking, physical activity, and diet were more prevalent in the Luxembourg site than the Central New York site. Ideal levels for blood pressure were more prevalent in Central New York. Differences between the two sites remained with control for age, gender and socioeconomic indicators.

CONCLUSIONS

Cardiovascular health, as indexed by seven health metrics, was higher in the European study site than in the US study site. The largest differences were for the four lifestyle/behavior metrics, namely body mass index, smoking, physical activity, and diet. Preventative and intervention strategies will continue to be important for both countries in order to improve cardiovascular health.

On the buses: a mixed-method evaluation of the impact of free bus travel for young people on the public health

Background

In September 2005 London introduced a policy granting young people aged < 17 years access to free bus and tram travel. A year later this policy was extended to people aged < 18 years in education, work or training. This intervention was part of a broader environmental strategy in London to reduce private car use, but its primary aim was to decrease ‘transport exclusion’, and ensure that access to goods, services, education and training opportunities were not denied to some young people because of transport poverty. However, there were also likely to be positive and negative health implications, which were difficult to assess in the absence of a robust evidence base on the impact of transport policies on health and well-being.

Objectives

To evaluate the impact of free bus travel for young people in London on the public health. Specifically, to provide empirical evidence for the impact of this ‘natural experiment’ on health outcomes and behaviours (e.g. injuries, active travel) for young people; explore the effects on the determinants of health; identify the effects on older citizens of increased access to bus travel for young people and to identify whether or not the intervention represented value for money.

Design

Quasi-experimental design, using secondary analysis of routine data, primary qualitative data and literature reviews.

Setting

London, UK.

Participants

Young people aged 12–17 years and older citizens aged ≥ 60 years.

Intervention

The introduction of free bus travel for those aged < 17 years living in London in 2005, extended to those aged < 18 years in 2006.

Main outcome measures

Quantitative: number of journeys to school or work; frequency and distance of active travel (i.e. walking and/or cycling), bus travel, car travel; incidence of road traffic injuries and assaults and socioeconomic gradients in travel patterns. Qualitative: how free bus travel affected young people and older citizens’ travel and well-being.

Methods

Quantitative component: change-on-change analysis comparing pre–post change in the target age group (12–17 years) against that seen in ‘non-exposed’ groups [for travel mode, road traffic injury (RTI) and assaults]. Qualitative component: interviews analysed using both deductive and inductive methods. Economic evaluation: cost–benefit analysis (CBA).

Data sources

London Area Transport Survey (LATS) and London Travel Demand Survey (LTDS) (travel mode); STATS19 Road Accident data set (RTI); Hospital Episode Statistics (HES) (assaults); interviews with young people and older citizens; and cost data from providers and literature reviews.

Results

The introduction of free bus travel for young people was associated with higher use of bus travel by adults and young people [31% increase, 95% confidence interval (CI) 19% to 42%; and 26% increase, 95% CI 13% to 41%, respectively], especially for short journeys, and lower car distances relative to adults (relative change 0.73, 95% CI 0.55 to 0.94); no significant overall reduction in ‘active travel’ [reduction in number of walking trips but no evidence of change in distance walked (relative change 0.99, 95% CI 0.92 to 1.07)]; significant reduction in cycling relative to adults (but from a very low base); a reduction in road traffic injuries for car occupants (relative change 0.89, 95% CI 0.84 to 0.95) and cyclists (relative change 0.60, 95% CI 0.55 to 0.66), but not pedestrians; an overall modest increase in journeys to work or school (relative change 1.09, 95% CI 1.06 to 1.14); equivocal evidence of impact on socioeconomic gradients in travel behaviour and no evidence of adverse impact on travel of older people aged > 60 years. An increase in assaults largely preceded the scheme. Qualitative data suggested that the scheme increased opportunities for independent travel, social inclusion, and a sense of belonging and that it ‘normalised’ bus travel. The monetised benefits of the scheme substantially outweighed the costs, providing what the Department for Transport (DfT) considers ‘high’ value for money.

Conclusion

The free bus travel scheme for young people appears to have encouraged their greater use of bus transport for short trips without significant impact on their overall active travel. There was qualitative evidence for benefits on social determinants of health, such as normalisation of bus travel, greater social inclusion and opportunities for independent travel. In the context of a good bus service, universal free bus travel for young people appears to be a cost-effective contributor to social inclusion and, potentially, to increasing sustainable transport in the long term. Further research is needed on the effects of both active and other travel modes on the determinants of health; the factors that influence maintenance of travel mode change; travel as ‘social practice’; the impact of driving license changes on injury rates for young adults and the value of a statistical life for young people.

Funding

The National Institute for Health Research Public Health Research programme.

Change in walking and body mass index following residential relocation: the multi-ethnic study of atherosclerosis

OBJECTIVES

We investigated whether moving to neighborhoods with closer proximity of destinations and greater street connectivity was associated with more walking, a greater probability of meeting the "Every Body Walk!" campaign goals (≥ 150 minutes/week of walking), and reductions in body mass index (BMI).

METHODS

We linked longitudinal data from 701 participants, who moved between 2 waves of the Multi-Ethnic Study of Atherosclerosis (2004-2012), to a neighborhood walkability measure (Street Smart Walk Score) for each residential location. We used fixed-effects models to estimate if changes in walkability resulting from relocation were associated with simultaneous changes in walking behaviors and BMI.

RESULTS

Moving to a location with a 10-point higher Walk Score was associated with a 16.04 minutes per week (95% confidence interval [CI] = 5.13, 29.96) increase in transport walking, 11% higher odds of meeting Every Body Walk! goals through transport walking (adjusted odds ratio = 1.11; 95% CI = 1.02, 1.21), and a 0.06 kilogram per meters squared (95% CI = -0.12, -0.01) reduction in BMI. Change in walkability was not associated with change in leisure walking.

CONCLUSIONS

Our findings illustrated the potential for neighborhood infrastructure to support health-enhancing behaviors and overall health of people in the United States.

Diffusion of Complete Streets policies Across US communities

CONTEXT

Complete Streets policies guide planning in communities by making the transportation system accommodating to all users including vehicle drivers, pedestrians, and bicyclists, as well as those using public transportation. While the number of Complete Streets policies has increased over the past decade, no research has explored the factors attributing to the widespread diffusion of these policies.

OBJECTIVE

The purpose of this study was to apply concepts of the Diffusion of Innovation Theory to data related to Complete Streets policies in order to identify potential patterns and correlates.

METHODS

The main outcome of this study was policy adoption. Using the Diffusion of Innovation Theory and results from previous literature, we identified several factors that had the potential to affect the rate of Complete Streets policy diffusion: rural/urban status, state obesity rate, state funding for transportation, state obesity prevention funding, percentage of people who walk or bike to work in the state, presence of a state Complete Streets policy, and the number of bordering communities with Complete Streets policy. We used event history analysis as the main analysis method.

RESULTS

Data from 49 community-level policies were analyzed, with a "community" defined as a city, a county, or a regional/Metropolitan Planning Organization. Three variables were significant predictors of Complete Streets policy adoption: state obesity rate (odds ratio [OR] = 1.465; confidence interval [CI] = 1.10-1.96) percentage of people who bike or walk to work in the state (OR = 1.726; CI = 1.069-2.79), and presence of a border community with a Complete Streets policy (OR = 3.859; CI = 1.084-13.742).

CONCLUSION

Communities with Complete Streets policies varied in geographic and sociodemographic factors. Information about communities that are more likely to adopt a policy can be a tool for advocates and policy makers interested in this topic. Because adoption does not imply implementation, further research is needed to study outcomes of Complete Streets policies.

Environmental and demographic correlates of bicycling

OBJECTIVE

The present study examined correlates of bicycle ownership and bicycling frequency, and projected increases in cycling if perceived safety from cars was improved.

METHODS

Participants were 1780 adults aged 20-65 recruited from the Seattle, Washington and Baltimore, Maryland regions (48% female; 25% ethnic/racial minority) and studied in 2002-2005. Bicycling outcomes were assessed by survey. Multivariable models were conducted to examine demographic and built environment correlates of bicycling outcomes.

RESULTS

About 71% of the sample owned bicycles, but 60% of those did not report cycling. Among bicycle owners, frequency of riding was greater among young, male, White, educated, and lean subgroups. Neighborhood walkability measures within 1 km were not consistently related to bicycling. For the whole sample, bicycling at least once per week was projected to increase from 9% to 39% if bicycling was safe from cars. Ethnic-racial minority groups and those in the least safe neighborhoods for bicycling had greater projected increases in cycling if safety from traffic was improved.

CONCLUSION

Implementing measures to improve bicyclists' safety from cars would primarily benefit racial-ethnic groups who cycle less but have higher rates of chronic diseases, as well as those who currently feel least safe bicycling.

Health impact assessment of increasing public transport and cycling use in Barcelona: a morbidity and burden of disease approach

OBJECTIVE

Quantify the health impacts on morbidity of reduced car trips and increased public transport and cycling trips.

METHODS

A health impact assessment study of morbidity outcomes related to replacing car trips in Barcelona metropolitan (3,231,458 inhabitants). Through 8 different transport scenarios, the number of cases of disease or injuries related to physical activity, particulate matter air pollution <2.5 μm (PM2.5) and traffic incidents in travelers was estimated. We also estimate PM2.5 exposure and cases of disease in the general population.

RESULTS

A 40% reduction in long-duration car trips substituted by public transport and cycling trips resulted in annual reductions of 127 cases of diabetes, 44 of cardiovascular diseases, 30 of dementia, 16 minor injuries, 0.14 major injuries, 11 of breast cancer and 3 of colon-cancer, amounting to a total reduction of 302 Disability Adjusted Life Years per year in travelers. The reduction in PM2.5 exposure in the general population resulted in annual reductions of 7 cases of low birth weight, 6 of preterm birth, 1 of cardiovascular disease and 1 of lower respiratory tract infection.

CONCLUSIONS

Transport policies to reduce car trips could produce important health benefits in terms of reduced morbidity, particularly for those who take up active transportation.

Walking for well-being: are group walks in certain types of natural environments better for well-being than group walks in urban environments?

The benefits of walking in natural environments for well-being are increasingly understood. However, less well known are the impacts different types of natural environments have on psychological and emotional well-being. This cross-sectional study investigated whether group walks in specific types of natural environments were associated with greater psychological and emotional well-being compared to group walks in urban environments. Individuals who frequently attended a walking group once a week or more (n = 708) were surveyed on mental well-being (Warwick Edinburgh Mental Well-being Scale), depression (Major Depressive Inventory), perceived stress (Perceived Stress Scale) and emotional well-being (Positive and Negative Affect Schedule). Compared to group walks in urban environments, group walks in farmland were significantly associated with less perceived stress and negative affect, and greater mental well-being. Group walks in green corridors were significantly associated with less perceived stress and negative affect. There were no significant differences between the effect of any environment types on depression or positive affect. Outdoor walking group programs could be endorsed through “green prescriptions” to improve psychological and emotional well-being, as well as physical activity.

The structure of spatial networks and communities in bicycle sharing systems

Bicycle sharing systems exist in hundreds of cities around the world, with the aim of providing a form of public transport with the associated health and environmental benefits of cycling without the burden of private ownership and maintenance. Five cities have provided research data on the journeys (start and end time and location) taking place in their bicycle sharing system. In this paper, we employ visualization, descriptive statistics and spatial and network analysis tools to explore system usage in these cities, using techniques to investigate features specific to the unique geographies of each, and uncovering similarities between different systems. Journey displacement analysis demonstrates similar journey distances across the cities sampled, and the (out)strength rank curve for the top 50 stands in each city displays a similar scaling law for each. Community detection in the derived network can identify local pockets of use, and spatial network corrections provide the opportunity for insight above and beyond proximity/popularity correlations predicted by simple spatial interaction models.

Active travel to work in New South Wales 2005-2010, individual characteristics and association with body mass index

OBJECTIVE

This study describes the prevalence of walking and cycling to work in New South Wales (NSW) from 2005-2010. It examines the demographic characteristics of those people walking and cycling to work and the association of walking and cycling with body mass index (BMI).

METHODS

Data from the NSW Continuous Health Survey, a telephone survey of health indicators among a representative sample of residents aged 16 years or over, were used.

RESULTS

There were no changes in the proportions of employed respondents walking or cycling to work in NSW from 2005 to 2010, with estimates ranging from 5.1-7.3% usually walking, and 1.4-1.8% usually cycling. People who walked (adjusted odds ratio [AOR]=1.07, 95%CI 1.00-1.14) or cycled (AOR=1.22, 95%CI 1.14-1.32) to work had higher levels of education, after adjusting for age, sex, income and residence.

CONCLUSIONS

There has been no overall increase in active commuting in NSW (2005-2010). Better efforts to communicate the benefits of active travel and less sedentary travel are warranted, in particular among those with lower levels of education.

IMPLICATIONS

More interventions are needed to encourage walking and cycling to work, in order to gain significant benefits in terms of maintaining a healthy weight.

Active travel to work and cardiovascular risk factors in the United Kingdom

BACKGROUND

Increasing active travel (walking, cycling, public transport) is increasingly seen as integral to strategies to raise physical activity levels.

PURPOSE

This study examined (1) sociodemographic correlates of active travel to work and (2) associations between active travel and cardiovascular risk factors in the United Kingdom (UK).

METHODS

Data come from Understanding Society, a nationally representative survey of UK residents in 2009/2011, analyzed in 2012. Multinomial logistic regression assessed associations between sociodemographic factors and mode of transport to work. Linear and logistic regression was used to examine associations between mode of travel and overweight/obesity, and having hypertension or diabetes.

RESULTS

A total of 69% of participants traveled to work using private transport, with public transport, walking, and cycling used by 16%, 12%, and 3%, respectively. Use of any active travel was more likely in participants living in London. Black participants were more likely to walk (AOR=1.41, 95% CI=1.08, 1.84) or take public transport (AOR=2.34, 95% CI=1.88, 2.90) to work than whites. Using public transport, walking, or cycling to work was associated with a lower likelihood of being overweight (AOR=0.80, 95% CI=0.54, 0.88 for walking). Walking or cycling was associated with a lower likelihood of having diabetes, and walking was associated with a lower likelihood of having hypertension than private transport (AOR=0.83, 95% CI=0.71, 0.97).

CONCLUSIONS

There are wide variations in the mode of travel to work across regions and sociodemographic groups in the UK. The protective association between active travel and cardiovascular risk demonstrated in this nationally representative study adds to growing evidence that concerted policy focus in this area may benefit population health.

Bringing bike share to a low-income community: lessons learned through community engagement, Minneapolis, Minnesota, 2011

Background

High prevalence of physical inactivity contributes to adverse health outcomes. Active transportation (cycling or walking) is associated with better health outcomes, and bike-sharing programs can help communities increase use of active transportation.

Community Context

The Minneapolis Health Department funded the Nice Ride Minnesota bike share system to expand to the Near North community in Minneapolis, Minnesota. Near North is a diverse, low-income area of the city where residents experience health disparities, including disparities in physical activity levels.

Methods

The installation of new bike share kiosks in Near North resulted in an environmental change to support physical activity. Community engagement was conducted pre-intervention only and consisted of focus groups, community meetings, and interviews. Postintervention data on bike share trips and subscribers were collected to assess intervention effectiveness.

Outcome

Focus group participants offered insights on facilitators and barriers to bike share and suggested system improvements. Community engagement efforts showed that Near North residents were positive about Nice Ride and wanted to use the system; however, the numbers of trips and subscriptions in Near North were low.

Interpretation

Results show that the first season of the expansion was moderately successful in improving outreach efforts and adapting bike share to meet the needs of low-income populations. However, environmental change without adequate, ongoing community engagement may not be sufficient to result in behavior change.

What are the health benefits of active travel? A systematic review of trials and cohort studies

Background

Increasing active travel (primarily walking and cycling) has been widely advocated for reducing obesity levels and achieving other population health benefits. However, the strength of evidence underpinning this strategy is unclear. This study aimed to assess the evidence that active travel has significant health benefits.

Methods

The study design was a systematic review of (i) non-randomised and randomised controlled trials, and (ii) prospective observational studies examining either (a) the effects of interventions to promote active travel or (b) the association between active travel and health outcomes. Reports of studies were identified by searching 11 electronic databases, websites, reference lists and papers identified by experts in the field. Prospective observational and intervention studies measuring any health outcome of active travel in the general population were included. Studies of patient groups were excluded.

Results

Twenty-four studies from 12 countries were included, of which six were studies conducted with children. Five studies evaluated active travel interventions. Nineteen were prospective cohort studies which did not evaluate the impact of a specific intervention. No studies were identified with obesity as an outcome in adults; one of five prospective cohort studies in children found an association between obesity and active travel. Small positive effects on other health outcomes were found in five intervention studies, but these were all at risk of selection bias. Modest benefits for other health outcomes were identified in five prospective studies. There is suggestive evidence that active travel may have a positive effect on diabetes prevention, which may be an important area for future research.

Conclusions

Active travel may have positive effects on health outcomes, but there is little robust evidence to date of the effectiveness of active transport interventions for reducing obesity. Future evaluations of such interventions should include an assessment of their impacts on obesity and other health outcomes.

Neighborhood walkability and active travel (walking and cycling) in New York City

Urban planners have suggested that built environment characteristics can support active travel (walking and cycling) and reduce sedentary behavior. This study assessed whether engagement in active travel is associated with neighborhood walkability measured for zip codes in New York City. Data were analyzed on engagement in active travel and the frequency of walking or biking ten blocks or more in the past month, from 8,064 respondents to the New York City 2003 Community Health Survey (CHS). A neighborhood walkability scale that measures: residential, intersection, and subway stop density; land use mix; and the ratio of retail building floor area to retail land area was calculated for each zip code. Data were analyzed using zero-inflated negative binomial regression incorporating survey sample weights and adjusting for respondents' sociodemographic characteristics. Overall, 44 % of respondents reported no episodes of active travel and among those who reported any episode, the mean number was 43.2 episodes per month. Comparing the 75th to the 25th percentile of zip code walkability, the odds ratio for reporting zero episodes of active travel was 0.71 (95 % CI 0.61, 0.83) and the exponentiated beta coefficient for the count of episodes of active travel was 1.13 (95 % CI 1.06, 1.21). Associations between lower walkability and reporting zero episodes of active travel were significantly stronger for non-Hispanic Whites as compared to non-Hispanic Blacks and to Hispanics and for those living in higher income zip codes. The results suggest that neighborhood walkability is associated with higher engagement in active travel.

Bicycle guidelines and crash rates on cycle tracks in the United States

OBJECTIVES

We studied state-adopted bicycle guidelines to determine whether cycle tracks (physically separated, bicycle-exclusive paths adjacent to sidewalks) were recommended, whether they were built, and their crash rate.

METHODS

We analyzed and compared US bicycle facility guidelines published between 1972 and 1999. We identified 19 cycle tracks in the United States and collected extensive data on cycle track design, usage, and crash history from local communities. We used bicycle counts and crash data to estimate crash rates.

RESULTS

A bicycle facility guideline written in 1972 endorsed cycle tracks but American Association of State Highway and Transportation Officials (AASHTO) guidelines (1974-1999) discouraged or did not include cycle tracks and did not cite research about crash rates on cycle tracks. For the 19 US cycle tracks we examined, the overall crash rate was 2.3 (95% confidence interval = 1.7, 3.0) per 1 million bicycle kilometers.

CONCLUSIONS

AASHTO bicycle guidelines are not explicitly based on rigorous or up-to-date research. Our results show that the risk of bicycle-vehicle crashes is lower on US cycle tracks than published crashes rates on roadways. This study and previous investigations support building cycle tracks.

Health-related factors associated with mode of travel to work

Active commuting (AC) to the workplace is a potential strategy for incorporating physical activity into daily life and is associated with health benefits. This study examined the association between health-related factors and mode of travel to the workplace. Methods. A volunteer convenience sample of employed adults completed an online survey regarding demographics, health-related factors, and the number of times/week walking, biking, driving, and using public transit to work (dichotomized as no walk/bike/drive/PT and walk/bike/drive/PT 1 + x/week). Logistic regression was used to predict the likelihood of each mode of transport and meeting PA recommendations from AC according to demographics and health-related factors. Results. The sample (n = 1175) was aged 43.5 ± 11.4 years and was primarily White (92.7%) and female (67.9%). Respondents reported walking (7.3%), biking (14.4%), taking public transit (20.3%), and driving (78.3%) to work at least one time/week. Among those reporting AC, 9.6% met PA recommendations from AC alone. Mode of travel to work was associated with several demographic and health-related factors, including age, number of chronic diseases, weight status, and AC beliefs. Discussion. Mode of transportation to the workplace and health-related factors such as disease or weight status should be considered in future interventions targeting AC.

Effect of bike lane infrastructure improvements on ridership in one New Orleans neighborhood

BACKGROUND

Incorporating cycling into daily life is one way to increase physical activity.

PURPOSE

This study examined the impact of building new bike lanes in New Orleans to determine whether more people were cycling on the street and with the flow of traffic after bike lanes were built.

METHODS

Through direct observation of one intervention and two adjacent streets, observers counted cyclists riding on the street and sidewalk, with and against traffic, before and after installation of the lanes. Data were tallied separately for adults, children, males, females, and by race for each location.

RESULTS

There was an increase in cyclists on all three streets after the installation of the bike lanes, with the largest increase on the street with the new lane. Additionally, the proportion of riders cycling with traffic increased after the lanes were striped.

CONCLUSIONS

Bike lanes can have a positive impact in creating a healthy neighborhood.

Predictors of cycling in college students

OBJECTIVES

To (1) assess cycling-related questions that have been added to the electronic version of the American College Health Association National College Health Assessment II (ACHA-NCHA), (2) examine cycling prevalence, and (3) identify predictors of cycling in college students.

PARTICIPANTS

Predominately female (69%), undergraduate (89%), and white (85%) students (N = 949) from a large, urban, northwestern, bicycle-friendly university completed the electronic version of the ACHA-NCHA II.

METHODS

Thirty cycling-related questions were added to the ACHA-NCHA II and a subsample of questions was analyzed.

RESULTS

Cycling questions added to the ACHA-NCHA II scale were reliable and valid, based on the psychometric data analysis. More than half (59%) of this sample cycled; of those, 58% cycled for transportation and 44% for recreation. Facilitators and barriers to cycling were different for cycling in general and cycling for transportation.

CONCLUSIONS

Cycling questions added to the ACHA-NCHA II can be utilized to enhance knowledge relative to cycling on college campuses.

What moves them? Active transport among inhabitants of Dutch deprived districts

BACKGROUND

Active modes of transport like walking and cycling have been shown to be valuable contributions to daily physical activity. The current study investigates associations between personal and neighbourhood environmental characteristics and active transport among inhabitants of Dutch deprived districts.

METHOD

Questionnaires about health, neighbourhoods, and physical activity behaviour were completed by 742 adults. Data was analysed by means of multivariate linear regression analyses.

RESULTS

Being younger, female, and migrant and having a normal weight were associated with more walking for active transport. Being younger, male, and native Dutch and having a normal weight were associated with more cycling for active transport. Neighbourhood characteristics were generally not correlated with active transport. Stratified analyses, based on significant person-environment interactions, showed that migrants and women walked more when cars did not exceed maximum speed in nearby streets and that younger people walked more when speed of traffic in nearby streets was perceived as low. Among migrants, more cycling was associated with the perceived attractiveness of the neighbourhood surroundings.

DISCUSSION AND CONCLUSION

Results indicated that among inhabitants of Dutch deprived districts, personal characteristics were associated with active transport, whereas neighbourhood environmental characteristics were generally not associated with active transport. Nevertheless, interaction effects showed differences among subgroups that should be considered in intervention development.

Global obesity: trends, risk factors and policy implications

The worldwide increase in obesity and related chronic diseases has largely been driven by global trade liberalization, economic growth and rapid urbanization. These factors continue to fuel dramatic changes in living environments, diets and lifestyles in ways that promote positive energy balance. Nutritional transitions in low-income and middle-income countries are typically characterized by increases in the consumption of animal fat and protein, refined grains, and added sugar. This change is coupled with reductions in physical activity owing to more mechanized and technologically driven lifestyles. Given the high costs of obesity and comorbidities in terms of health-care expenditure and quality of life, prevention strategies are paramount, particularly in low-income and middle-income countries that must manage coexisting infectious diseases and undernutrition in addition to the obesity epidemic. As countries become increasingly urbanized, undernutrition and obesity can exist side by side within the same country, community or household, which is a particular challenge for health systems with limited resources. Owing to the scope and complexity of the obesity epidemic, prevention strategies and policies across multiple levels are needed in order to have a measurable effect. Changes should include high-level global policies from the international community and coordinated efforts by governments, organizations, communities and individuals to positively influence behavioural change.

Active transportation and cardiovascular disease risk factors in U.S. adults

BACKGROUND

Evidence of associations between active transportation (walking and bicycling for transportation) and health outcomes is limited. Better understanding of this relationship would inform efforts to increase physical activity by promoting active transportation.

PURPOSE

This study examined associations between active transportation and cardiovascular disease risk factors in U.S. adults.

METHODS

Using the 2007-2008 and 2009-2010 cycles of the National Health and Nutrition Examination Survey (NHANES), adults (N=9933) were classified by level of active transportation. Multivariable linear and logistic regression analyses controlled for sociodemographic characteristics, smoking status, and minutes/week of non-active transportation physical activity. Analyses were conducted in 2011.

RESULTS

Overall, 76% reported no active transportation. Compared with no active transportation, mean BMI was lower among individuals with low (-0.9, 95% CI= -1.4, -0.5) and high (-1.2, 95% CI= -1.7, -0.8) levels of active transportation. Mean waist circumference was lower in the low (-2.2 cm, 95% CI= -3.2, -1.2) and high (-3.1 cm, 95% CI= -4.3, -1.9) active transportation groups. The odds of hypertension were 24% lower (AOR=0.76, 95% CI=0.61, 0.94) and 31% lower (AOR=0.69, 95% CI=0.58, 0.83) among individuals with low and high levels of active transportation, respectively, compared with no active transportation. High active transportation was associated with 31% lower odds of diabetes (AOR=0.69, 95% CI=0.54, 0.88). Active transportation was not associated with high-density lipoprotein level.

CONCLUSIONS

Active transportation was associated with more-favorable cardiovascular risk factor profiles, providing additional justification for infrastructure and policies that permit and encourage active transportation.

Can the built environment reduce health inequalities? A study of neighbourhood socioeconomic disadvantage and walking for transport

Residents of socioeconomically disadvantaged neighbourhoods are more likely to walk for transport than their counterparts in advantaged neighbourhoods; however, the reasons for higher rates of transport walking in poorer neighbourhoods remain unclear. We investigated this issue using data from the HABITAT study of physical activity among 11,037 mid-aged residents of 200 neighbourhoods in Brisbane, Australia. Using a five-step mediation analysis and multilevel regression, we found that higher levels of walking for transport in disadvantaged neighbourhoods was associated with living in a built environment more conducive to walking (i.e. greater street connectivity and land use mix) and residents of these neighbourhoods having more limited access to a motor vehicle. The health benefits that accrue to residents of disadvantaged neighbourhoods as a result of their higher levels of walking for transport might help offset the negative effects of less healthy behaviours (e.g. smoking, poor diet), thus serving to contain or reduce neighbourhood inequalities in chronic disease.

Gender differences in recreational and transport cycling: a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints

BACKGROUND

Gender differences in cycling are well-documented. However, most analyses of gender differences make broad comparisons, with few studies modeling male and female cycling patterns separately for recreational and transport cycling. This modeling is important, in order to improve our efforts to promote cycling to women and men in countries like Australia with low rates of transport cycling. The main aim of this study was to examine gender differences in cycling patterns and in motivators and constraints to cycling, separately for recreational and transport cycling.

METHODS

Adult members of a Queensland, Australia, community bicycling organization completed an online survey about their cycling patterns; cycling purposes; and personal, social and perceived environmental motivators and constraints (47% response rate). Closed and open-end questions were completed. Using the quantitative data, multivariable linear, logistic and ordinal regression models were used to examine associations between gender and cycling patterns, motivators and constraints. The qualitative data were thematically analyzed to expand upon the quantitative findings.

RESULTS

In this sample of 1862 bicyclists, men were more likely than women to cycle for recreation and for transport, and they cycled for longer. Most transport cycling was for commuting, with men more likely than women to commute by bicycle. Men were more likely to cycle on-road, and women off-road. However, most men and women did not prefer to cycle on-road without designed bicycle lanes, and qualitative data indicated a strong preference by men and women for bicycle-only off-road paths. Both genders reported personal factors (health and enjoyment related) as motivators for cycling, although women were more likely to agree that other personal, social and environmental factors were also motivating. The main constraints for both genders and both cycling purposes were perceived environmental factors related to traffic conditions, motorist aggression and safety. Women, however, reported more constraints, and were more likely to report as constraints other environmental factors and personal factors.

CONCLUSION

Differences found in men's and women's cycling patterns, motivators and constraints should be considered in efforts to promote cycling, particularly in efforts to increase cycling for transport.

Time use and physical activity: a shift away from movement across the globe

Technology linked with reduced physical activity (PA) in occupational work, home/domestic work, and travel and increased sedentary activities, especially television viewing, dominates the globe. Using detailed historical data on time allocation, occupational distributions, energy expenditures data by activity, and time-varying measures of metabolic equivalents of task (MET) for activities when available, we measure historical and current MET by four major PA domains (occupation, home production, travel and active leisure) and sedentary time among adults (>18 years). Trends by domain for the United States (1965-2009), the United Kingdom (1961-2005), Brazil (2002-2007), China (1991-2009) and India (2000-2005) are presented. We also project changes in energy expenditure by domain and sedentary time (excluding sleep and personal care) to 2020 and 2030 for each of these countries. The use of previously unexplored detailed time allocation and energy expenditures and other datasets represents a useful addition to our ability to document activity and inactivity globally, but highlights the need for concerted efforts to monitor PA in a consistent manner globally, increase global PA and decrease sedentary behavior. Given the potential impact on weight gain and other cardiometabolic health risks, the differential declines in MET of activity and increases in sedentary time across the globe represent a major threat to global health.

Global physical activity levels: surveillance progress, pitfalls, and prospects

To implement effective non-communicable disease prevention programmes, policy makers need data for physical activity levels and trends. In this report, we describe physical activity levels worldwide with data for adults (15 years or older) from 122 countries and for adolescents (13-15-years-old) from 105 countries. Worldwide, 31·1% (95% CI 30·9-31·2) of adults are physically inactive, with proportions ranging from 17·0% (16·8-17·2) in southeast Asia to about 43% in the Americas and the eastern Mediterranean. Inactivity rises with age, is higher in women than in men, and is increased in high-income countries. The proportion of 13-15-year-olds doing fewer than 60 min of physical activity of moderate to vigorous intensity per day is 80·3% (80·1-80·5); boys are more active than are girls. Continued improvement in monitoring of physical activity would help to guide development of policies and programmes to increase activity levels and to reduce the burden of non-communicable diseases.

Motorized transportation, social status, and adiposity: the China Health and Nutrition Survey

BACKGROUND

Increased dependence on motorized transportation may contribute to obesity. Countries in rapid socioeconomic transitions, such as China, provide an opportunity to investigate such an association.

PURPOSE

The aim of the study was to examine the hypotheses that increased dependence on motorized transportation is related to adiposity and that this effect will be more pronounced in adults with high SES or those who live in urban regions.

METHODS

Data from the longitudinal China Health and Nutrition Survey conducted from 1997 to 2006 (n=3853, aged 18-55 years at baseline, 52% women, ~7.8 years' follow-up) were used to examine the association between motorized transportation (none, 1-5 years, >5 years) and changes in body weight and waist circumference (WC) by using multivariate regression. SES factors were obtained from questionnaires. Data were analyzed in 2010.

RESULTS

Use of motorized transportation for >5 years was related to ~1.2 kg greater weight gain (p=0.006) and ~1.0 cm larger WC gain (p=0.017) in men, when compared with the nonmotorized transportation group and adjusted for baseline age, anthropometry, dietary intake, and follow-up time. These changes were slightly more pronounced in men with higher income or from rural areas, but the difference was not significant. In women, the tendency to have motorized transportation with weight gain was less pronounced (+1.1 kg, p=0.008). Low education and high income were the most predominant factors. In 2006, motorized transportation was associated with a 1.3-fold higher OR for obesity (p(trend)=0.054) and abdominal obesity (p(trend)=0.047) in men, and a 2-fold higher OR of obesity in women (p(trend) <0.001).

CONCLUSIONS

Motorized transportation was related to an increase in adiposity in the Chinese population, particularly in men.

Inequalities in usage of a public bicycle sharing scheme: socio-demographic predictors of uptake and usage of the London (UK) cycle hire scheme

OBJECTIVE

Cycling confers individual and population-level health benefits, but uptake is not always equitable across socio-demographic groups. We sought to examine inequalities in uptake and usage of London's Barclays Cycle Hire (BCH) scheme.

METHOD

We obtained complete BCH registration data, and compared users with the general population. We examined usage levels by explanatory variables including gender, small-area income-deprivation and local cycling prevalence.

RESULTS

100,801 registered individuals made 2.5 million trips between July 2010 and March 2011. Compared with residents and workers in the central London area served by the scheme, registered individuals were more likely to be male and to live in areas of low deprivation and high cycling prevalence. Among those registered, females made 1.63 (95%CI 1.53, 1.74) fewer trips per month than males, and made under a fifth of all trips. Adjusting for the fact that deprived areas were less likely to be close to BCH docking stations, users in the most deprived areas made 0.85 (95%CI 0.63,1.07) more trips per month than those in the least deprived areas.

CONCLUSION

Females and residents in deprived areas are underrepresented among users of London's public bicycle sharing scheme. The scheme's planned expansion into more deprived areas has, however, the potential to create a more equitable uptake of cycling.

Perceived neighborhood environmental attributes associated with adults' transport-related walking and cycling: Findings from the USA, Australia and Belgium

Background

Active transportation has the potential to contribute considerably to overall physical activity levels in adults and is likely to be influenced by neighborhood-related built environment characteristics. Previous studies that examined the associations between built environment attributes and active transportation, focused mainly on transport-related walking and were conducted within single countries, limiting environmental variability. We investigated the direction and shape of relationships of perceived neighborhood attributes with transport-related cycling and walking in three countries; and examined whether these associations differed by country and gender.

Methods

Data from the USA (Baltimore and Seattle), Australia (Adelaide) and Belgium (Ghent) were pooled. In total, 6,014 adults (20–65 years, 55.7% women) were recruited in high-/low-walkable and high-/low-income neighborhoods. All participants completed the Neighborhood Environmental Walkability Scale and the International Physical Activity Questionnaire. Generalized additive mixed models were used to estimate the strength and shape of the associations.

Results

Proximity to destinations, good walking and cycling facilities, perceiving difficulties in parking near local shopping areas, and perceived aesthetics were included in a ‘cyclability’ index. This index was linearly positively related to transport-related cycling and no gender- or country-differences were observed. The ‘walkability’ index consisted of perceived residential density, land use mix access, proximity of destinations and aesthetics. A non-linear positive relationship with transport-related walking was found. This association was stronger in women than in men, and country-specific associations were identified: the strongest association was observed in Seattle, the weakest in Adelaide. In Ghent, the association weakened at higher levels of walkability.

Conclusions

For cycling, consistent correlates were found in the three countries, but associations were less straightforward for transport-related walking. Moreover, the identified neighborhood environmental correlates were different for walking compared to cycling. In order to further clarify the shape of these associations and reach more specific international guidelines for developing walkable and bikeable neighborhoods, future studies should include even more countries to maximize environmental variability.

Active transport, physical activity, and body weight in adults: a systematic review

CONTEXT

Physical activity has various health benefits. Active transport can contribute to total physical activity and thus affect body weight because of increased energy expenditure. This review summarizes published evidence on associations of active transport, general physical activity, and body weight in adults.

EVIDENCE ACQUISITION

A systematic review of the literature was conducted in October 2010 using eight databases. A total of 14,216 references were screened; full texts were retrieved for 95 articles. Forty-six articles (36 unique studies) were included: 20 (17) from Europe; 18 (13) from North America, Australia, and New Zealand; and eight (six) from other countries. Analyses of the retrieved papers were carried out between November 2010 and March 2011.

EVIDENCE SYNTHESIS

Of 15 studies assessing active transport and physical activity, five found associations in the expected direction (more active transport associated with more physical activity) for all or most variables studied, nine found some associations, and one reported no associations. Of 30 studies assessing active transport and body weight, 13 reported associations in the expected direction (more active transport associated with lower body weight) for all or most variables studied, 12 found some associations, two presented some associations in the expected and some in the opposite direction, and three reported no associations.

CONCLUSIONS

There is limited evidence that active transport is associated with more physical activity as well as lower body weight in adults. However, study heterogeneity, predominantly cross-sectional designs, and crude measures for active transport and physical activity impede quantitative conclusions.

Integration of health and environment through health impact assessment: cases from three continents

Despite the strong linkage between environment and health, institutions responsible for these fields operate in largely fragmented ways with limited interaction. As illustrated in the recent engagement between health and urban planning institutions, inter-institutional cooperation could support more effective and politically acceptable solutions for both local and global problems. Analysis of three case-studies, from three different continents, shows that HIA might serve to promote synergies among health and environmental disciplines in different local contexts, and could lead to institutional and procedural changes that promote health. Case examples provided supportive evidence for these effects, despite differences in approaches to HIA and governance levels. Obstacles to the use of HIA for inter-institutional integration also differed between countries. Lessons learned could support cooperation in other common interests of health and environment disciplines such as research, training and preparedness, and mitigation of public health emergencies related to the environment.