Effectiveness and equity impacts of town-wide cycling initiatives in England: a longitudinal, controlled natural experimental study

The co-benefits of active travel interventions beyond physical activity: a systematic review

Active travel is a widely recognised strategy for promoting active living but its co-benefits beyond increasing physical activity, such as broader health, environmental, and social benefits, have rarely been synthesised. We conducted a systematic review to examine the co-benefits of active travel interventions. Following a preregistered protocol (PROSPERO CRD42022359059), we identified 80 studies for the search period from Jan 1, 2000, to Sept 13, 2022. Across studies, there was consistent evidence that active travel interventions offered co-benefits beyond physical activity. Particularly, 25 (71%) of 35 studies favoured improved safety outcomes, 20 (67%) of 30 showed improved health, 17 (85%) of 20 supported economic benefits, 16 (84%) of 19 highlighted improved transport quality, 12 (92%) of 13 showed environmental benefits, and four (80%) of five documented social benefits. Despite the overall low-certainty evidence, mostly limited by the quasi-experimental design and natural-experimental design of many of the studies, active travel interventions offer unique opportunities to engage stakeholders across sectors to jointly address major societal issues, such as physical inactivity, traffic safety, and carbon emissions. This evidence can inform the design, implementation, and evaluation of active travel interventions.

Mobility Infrastructures and Health: Scoping Review of studies in Europe

Objectives

Movement-friendly environments with infrastructure favouring active mobility are important for promoting physical activity. This scoping literature review aims at identifying the current evidence for links between mobility infrastructures and (a) behaviour regarding active mobility, (b) health outcomes and (c) co-benefits.

Method

This review was conducted in accordance with the PRISMA scoping review guidelines using PubMed and EMBASE databases. Studies included in this review were conducted in Europe, and published between 2000 and March 2023.

Results

146 scientific articles and grey literature reports were identified. Connectivity of sidewalks, walkability, and accessibility of shops, services and work are associated with walking. Cycling is positively associated with cycle-paths, separation of cycling from traffic and proximity to greenspaces, and negatively associated with traffic danger. Increased active transportation has a protective effect on cardiovascular and respiratory health, obesity, fitness, and quality of life. Co-benefits result from the reduction of individual motorized transportation including reduced environmental pollution and projected healthcare expenditure.

Conclusion

Mobility infrastructure combined with social and educational incentives are effective in promoting active travel and reducing future healthcare expenses. A shift to active transportation would increase both individual and community health and decrease greenhouse gas emissions.

Equity impacts of cycling investment in England: A natural experimental study using longitudinally linked individual-level Census data

Background

Cycling is beneficial for health and the environment but the evidence on the overall and differential impacts of interventions to promote cycling is limited. Here we assess the equity impacts of funding awarded to support cycling in 18 urban areas between 2005 and 2011.

Methods

We used longitudinally linked 2001 and 2011 census data from 25,747 individuals in the Office for National Statistics Longitudinal Study of England and Wales. Logistic regression was used to assess the impacts of funding on commute mode as the interaction between time and area (intervention/comparison) in individual-level difference-in-difference analyses, adjusting for a range of potential confounding factors. Differential impacts were examined by age, gender, education and area-level deprivation, and uptake and maintenance of cycling were examined separately.

Results

Difference-in-difference analyses showed no intervention impact on cycle commuting prevalence in the whole sample (AOR = 1.08; 95% CI 0.92, 1.26) or among men (AOR = 0.91; 95% CI 0.76, 1.10) but found an intervention effect among women (AOR = 1.56; 95% CI 1.16, 2.10). The intervention promoted uptake of cycling commuting in women (AOR = 2.13; 95% CI 1.56, 2.91) but not men (AOR = 1.19; 95% CI 0.93, 1.51). Differences in intervention effects by age, education and area-level deprivation were less consistent and more modest in magnitude.

Conclusions

Living in an intervention area was associated with greater uptake of cycle commuting among women but not men. Potential gender differences in the determinants of transport mode choice should be considered in the design and evaluation of future interventions to promote cycling.

A qualitative study of active travel amongst commuters and older adults living in market towns

BACKGROUND

Being physically active is associated with better health, but rates of physical inactivity are high amongst adults in England. Active travel, defined as making routine journeys in physically active ways, has been identified as a potential solution. There is a lack of research into how modal shift towards active travel can be encouraged in market towns. The aims of the current study are to understand how new cycling and walking infrastructure and community activation projects might support modal shift to active travel amongst commuters and older adults in market towns.

METHODS

This was a qualitative study using focus groups, 'go-along' interviews, and in-depth interviews as the main methods of data collection. Thirty-three participants (12 commuters and 21 older adults) took part across six focus groups. Eight of these also completed a go-along interview (4 walking, 4 cycling). Data were analysed using the Framework method of thematic analysis.

RESULTS

Market towns have existing advantages for active travel, being relatively compact with most routine destinations within easy reach. The barriers to active travel faced by older adults and commuters in market towns are similar to those in cities; poor infrastructure remains the key barrier. Poorly maintained paths are hazardous for older pedestrians, and low-or-no lighting and lack of well-connected, delineated cycle routes deter both commuters and older adults. One factor which does appear qualitatively different to cities is participants' perception that the social norms of cycling differ in market towns.

CONCLUSIONS

Policies to promote active travel in market towns are most likely to be effective when they include measures targeted at both individual behaviour change and population level measures like large-scale infrastructure improvements. Initiatives to change the social norms around cycling may be required to increase active travel rates.

Impact of environmental interventions based on social programs on physical activity levels: A systematic review

Background

The design of social programs at the environmental level such as in schools, parks, bicycle paths, or workspaces generates changes in the behavior of individuals and modifies lifestyles by increasing physical activity (PA) levels.

Objective

To determine the effectiveness of environmental interventions based on social programs by changing the population's level of PA.

Methodology

Natural experiment studies that involved environmental intervention programs at a social level were included. The primary outcome was PA levels with consideration of both objective and subjective measurements. An electronic search was carried out in Medline/Pubmed, SCIENCE DIRECT, WEB OF SCIENCE, and CINAHL databases up to January 2022 with two reviewers screening titles and abstracts and selecting studies for full-text reading. Two reviewers also acquired relevant data and evaluated study quality using the ROBINS I tool. A qualitative analysis was performed.

Results

Three thousand eight hundred and sixty-five articles were found in the 4 consulted databases. After eliminating duplication (200), two reviewers screened 3,665 titles and abstracts and excluded 3,566 that did not meet the inclusion criteria, leaving 99 articles to be read in full text. The 99 full texts were reviewed of which 24 papers met the eligibility criteria. All were natural experiments published between 2011 and 2020 and all evaluated environmental social programs revealing that social programs at the environmental level promoted PA in various populations at the community level worldwide.

Conclusion

The 24 reviewed studies suggest innovative proposals for social programs that seek to increase PA and promote healthy lifestyles related to public activity policies developed in the countries in which they were generated. Environmental social programs can positively impact PA levels among children and adults.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=229718, identifier: CRD42021229718.

Infrastructure, policy and regulatory interventions to increase physical activity to prevent cardiovascular diseases and diabetes: a systematic review

BACKGROUND

Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity at a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.

METHODS

We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.

RESULTS

We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).

CONCLUSIONS

Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.

TRIAL REGISTRATION

PROSPERO 2018 CRD42018093429.

The effects of COVID-19 on female and male bike sharing users: Insights from Lisbon's GIRA

Women are among the groups most affected by the pandemic as they are more likely to be dependent on public transport (PT), which was heavily restricted during COVID-19. Thus, there is a need to consider transport alternatives such as bike sharing that can ensure their mobility needs. By conducting a survey to the bike sharing system (BSS) of Lisbon, we explored differences in travel behaviour and attitudes between female and male users before and during COVID-19. We found men to have higher bike ownership rates, a higher modal share of personal bicycle regarding commuting, and more likely to use their own bikes if BSS was unavailable. Conversely, women more frequently combined BSS with PT and were more likely to use PT if BSS was unavailable. Moreover, while men were using BSS more frequently than women pre-pandemic, during COVID-19 women are using BSS as frequently as men. Our research provides evidence on the potential role of BSS as a transport alternative during pandemics, inducing women to take up cycling who otherwise would not cycle, therefore, potentially decreasing the current cycling gender gap. Findings suggest that introducing family/friend discounts and promoting BSS for exercising may increase the share of female cyclists.

Transport preferences and dilemmas in the post-lockdown (COVID-19) period: Findings from a qualitative study of young commuters in Dhaka, Bangladesh

At the start of the pandemic in early 2020, many cities went to complete or partial lockdown to minimize the mass transmission of COVID-19. Consequently, personal travel patterns have changed throughout the world. This study explores the transport mode preferences and associated dilemmas that commuters face in Dhaka, Bangladesh, in the post-lockdown period. We conducted in-depth semi-structured interviews of 20 young commuters residing in Dhaka. We followed a deductive reasoning approach, and the transcriptions were analyzed following thematic analysis. Findings suggest that despite the perceived high risk of COVID-19 transmission in certain modes, all commuters don't have the ease and flexibility to switch to their preferred safer mode, with commuters trading-off between health risk, affordability and availability of suitable modes, along with other challenges. However, the country's sustainable goals can still be achieved if proper actions, such as removing the challenges commuters face while switching to a sustainable and safe mode during COVID-19 are taken.

Determinants of bicycle commuting and the effect of bicycle infrastructure investment in London: Evidence from UK census microdata

Worldwide, concern about physical inactivity and excessive car dependence has encouraged ambitious targets and policies to promote cycling. But policy making is hindered by limited knowledge about why cycling prevalence and trends vary greatly between different geographic areas (e.g. in London (UK) <1% cycle to work in Harrow compared to>15 % in Hackney) and individuals (e.g. by age or gender). The role of cycle infrastructure investment in explaining part of these patterns and trends is also unknown. We linked individual-level data on 317,117 London commuters (including 11,199 cyclists) in the 2001 and 2011 UK census to relevant geographic data, including on area-level cycling infrastructure investment during the period. Whilst cycle commuting increased over time on average, concentration curves and indices demonstrated that in contrast with England as a whole, cycling in London shifted from being dominated by commuters with lower socioeconomic status to commuters with higher socioeconomic status. In our first set of regression analyses, we showed that observed differences and time trends in cycling prevalence were partially explained by area-level differences in topography, greenspace, footpaths and crime levels and by differences and changes in population structures. In the second, we conducted a cost-effectiveness analysis which showed that expenditure on cycling infrastructure was associated with increased cycling at a marginal rate of £4915 per additional commuter cyclist, with some variation between groups: ethnic minorities were more responsive, and females, older people and those with lower socioeconomic status appeared less responsive. If planned increases in expenditure in England for the period 2020-25 were as cost-effective, and were sustained for the whole decade, our study suggests that commuter cycling prevalence could increase in England by 0.5 to 1.1 percentage points (this equates to a 16% to 34% increase in commuter cycling prevalence if compared to 2011 levels). More research is necessary to assess the impact on broader measures of cycling, active travel and overall physical activity, and to determine whether such expenditure constitutes good or equitable value for money.

Did Safe Cycling Infrastructure Still Matter During a COVID-19 Lockdown?

The UK government introduced strict measures (including asking people to work from home and a lockdown) to slow the spread of COVID-19 by limiting people’s movement. This led to substantial reductions in traffic, making roads much safer for cyclists. This provides a unique opportunity to study the role played by safe cycling infrastructure. Many UK cities have provided cycling infrastructure to improve safety and encourage cycling. However, access to safe cycling infrastructure varies across neighbourhoods, potentially contributing to inequality. Since roads became safer due to the unprecedented reduction in traffic during the lockdown, safe cycling infrastructure may not play a significant role during this period. On the other hand, safe cycling lanes are often connected to amenities, potentially attracting cyclists even if they confer no additional safety benefit. That is, connectivity might matter more than safety. In this study, we utilised crowdsourced cycling data and regression models to examine the extent to which cycling intensity for non-commuting purposes changes with different types of cycling infrastructure in the city of Glasgow, Scotland, UK. In addition, we selected some areas with large increases in cycling intensity and examined the surrounding environments using Google Street View. Our results showed that non-commuting cycling activities increased significantly after the government interventions on both typical roads and safe cycling lanes while much higher increases were observed on safe cycling lanes than on other roads. A further analysis showed that there were large increases in cycling volumes on both typical roads and safe cycling lanes with good amenities and connectivity, highlighting the importance of these factors when building new cycling infrastructure. Since safe cycling lanes are not equally accessible to people, providing temporary cycling lanes during the pandemic considering these conditions could encourage people to cycle more, and thereby improve their health.

Do multiple community-based interventions on health promotion tackle health inequalities?

BACKGROUND

Previous systematic reviews of the impact of multi-component community-based health promotion interventions on reducing health inequalities by socio-economic status (SES) were restricted to physical activity and smoking behavior, and revealed limited and rather disillusioning evidence. Therefore, we conducted a comprehensive review worldwide to close this gap, including a wide range of health outcomes.

METHODS

The Pubmed and PsycINFO databases were screened for relevant articles published between January 1999 and August 2019, revealing 87 potentially eligible publications out of 2876 hits. In addition, three studies out of a prior review on the effectiveness of community-based interventions were reanalyzed under the new research question. After a systematic review process, 23 papers met the inclusion criteria and were included in the synthesis.

RESULTS

More than half (56.5%) of the studies reported improvements of socially disadvantaged communities overall (i.e. reduced inequalities at the area level) in at least one health behavior and/or health status outcome. Amongst the remaining studies we found some beneficial effects in the most deprived sub-groups of residents (8.2%) and studies with no differences between intervention and control areas (34.8%). There was no evidence that any program under review resulted in an increase in health disparity.

CONCLUSIONS

Our results confirm that community-based interventions may be reducing absolute health inequalities of deprived and disadvantaged populations, but their potential so far is not fully realized. For the future, greater attention should be paid to inequalities between sub-groups within communities when analyzing changes in health inequality over time.

Autonomous vehicles and cycling: Policy implications and management issues

Cycling as a form of active transport has great benefits for individuals and society, yet prevalence rates in many countries are low. The advent of autonomous vehicles (AVs) is likely to have substantial implications for cyclists, however little is known about the nature and magnitude of the likely impacts and the resulting implications for government planning and policy. The aim of this exploratory study was to consult with a range of stakeholder groups to identify relevant issues and stimulate debate about future efforts to maximize the benefits of vehicle autonomy for cycling outcomes. Interviews were conducted with key stakeholders representing government (local, state, and federal departments responsible for transport, health, and/or infrastructure), cycling organizations, technology firms, AV manufacturing/servicing companies, trade unions, the law, insurers (public and private), transport policy consortia, and academia. The results suggest that AVs have the potential to increase cycling prevalence while reducing cycling accidents, but that a range of issues will need to be addressed to optimize these outcomes. In particular, informed decisions need to be made about the infrastructure and equipment investments that could encourage larger numbers of commuters to select cycling as their primary form of transport.

A systematic review of empirical and simulation studies evaluating the health impact of transportation interventions

Urban transportation is an important determinant of health and environmental outcomes, and therefore essential to achieving the United Nation's Sustainable Development Goals. To better understand the health impacts of transportation initiatives, we conducted a systematic review of longitudinal health evaluations involving: a) bus rapid transit (BRT); b) bicycle lanes; c) Open Streets programs; and d) aerial trams/cable cars. We also synthesized systems-based simulation studies of the health-related consequences of walking, bicycling, aerial tram, bus and BRT use. Two reviewers screened 3302 unique titles and abstracts identified through a systematic search of MEDLINE (Ovid), Scopus, TRID and LILACS databases. We included 39 studies: 29 longitudinal evaluations and 10 simulation studies. Five studies focused on low- and middle-income contexts. Of the 29 evaluation studies, 19 focused on single component bicycle lane interventions; the rest evaluated multi-component interventions involving: bicycle lanes (n = 5), aerial trams (n = 1), and combined bicycle lane/BRT systems (n = 4). Bicycle lanes and BRT systems appeared effective at increasing bicycle and BRT mode share, active transport duration, and number of trips using these modes. Of the 10 simulation studies, there were 9 agent-based models and one system dynamics model. Five studies focused on bus/BRT expansions and incentives, three on interventions for active travel, and the rest investigated combinations of public transport and active travel policies. Synergistic effects were observed when multiple policies were implemented, with several studies showing that sizable interventions are required to significantly shift travel mode choices. Our review indicates that bicycle lanes and BRT systems represent promising initiatives for promoting population health. There is also evidence to suggest that synergistic effects might be achieved through the combined implementation of multiple transportation policies. However, more rigorous evaluation and simulation studies focusing on low- and middle-income countries, aerial trams and Open Streets programs, and a more diverse set of health and health equity outcomes is required.

The atmospheric impacts of initiatives advancing shifts towards low-emission mobility: A scoping review

In an urban environment, people's daily traffic choices are reflected in emissions and the resulting local air composition, or air quality. Traffic contributes to the emissions of both carbon dioxide (CO₂), affecting climate, and particulate matter (PM), affecting atmospheric chemistry and human health. While the development of city infrastructure is not in the hands of individuals, it is their transport mode choices that constitute traffic. In this scoping review we analyse 108 initiatives from around the world potentially influencing individual travel behaviour and producing changes in the shares of different transport modes (modal shifts). The targets, types and techniques of initiatives are identified. Examples of economic, regulative, structural and persuasive initiatives are included. Special focus is on whether the impacts on CO₂ emissions, PM emissions and/or PM concentrations have been quantitatively evaluated, and on the quality and results of the evaluations. We observe that a variety of targets can motivate actions that lead to modal shifts and emission reductions. The results indicate that the level of atmospheric evaluations is low: absolute or relative changes in emissions and/or concentrations had been evaluated for only 31% (N = 34) of the reviewed initiatives, with substantial heterogeneity in quality. Sanctions, such as congestion charge and restrictions, have more likely been evaluated in peer reviewed analyses than incentives. Scientific evaluations of impacts on ambient PM concentrations are especially scarce (N = 4), although Air Quality is the primary target of 13% of actions and secondary target for at least 12%. We discuss the determinants of success and failure, when it comes to different types of initiatives, emission reductions and evaluations. A high-quality evaluation of atmospheric impacts captures the following: correct data about the modal shift (rate and direction), exclusion of external factors affecting the shift and emissions, and possible indirect impacts of the shift.

The effect of moving to East Village, the former London 2012 Olympic and Paralympic Games Athletes' Village, on mode of travel (ENABLE London study, a natural experiment)

BACKGROUND

Interventions to encourage active modes of travel (walking, cycling) may improve physical activity levels, but longitudinal evidence is limited and major change in the built environment / travel infrastructure may be needed. East Village (the former London 2012 Olympic Games Athletes Village) has been repurposed on active design principles with improved walkability, open space and public transport and restrictions on residential car parking. We examined the effect of moving to East Village on adult travel patterns.

METHODS

One thousand two hundred seventy-eight adults (16+ years) seeking to move into social, intermediate, and market-rent East Village accommodation were recruited in 2013-2015, and followed up after 2 years. Individual objective measures of physical activity using accelerometry (ActiGraph GT3X+) and geographic location using GPS travel recorders (QStarz) were time-matched and a validated algorithm assigned four travel modes (walking, cycling, motorised vehicle, train). We examined change in time spent in different travel modes, using multilevel linear regresssion models adjusting for sex, age group, ethnicity, housing group (fixed effects) and household (random effect), comparing those who had moved to East Village at follow-up with those who did not.

RESULTS

Of 877 adults (69%) followed-up, 578 (66%) provided valid accelerometry and GPS data for at least 1 day (≥540 min) at both time points; half had moved to East Village. Despite no overall effects on physical activity levels, sizeable improvements in walkability and access to public transport in East Village resulted in decreased daily vehicle travel (8.3 mins, 95%CI 2.5,14.0), particularly in the intermediate housing group (9.6 mins, 95%CI 2.2,16.9), and increased underground travel (3.9 mins, 95%CI 1.2,6.5), more so in the market-rent group (11.5 mins, 95%CI 4.4,18.6). However, there were no effects on time spent walking or cycling.

CONCLUSION

Designing walkable neighbourhoods near high quality public transport and restrictions on car usage, may offer a community-wide strategy shift to sustainable transport modes by increasing public transport use, and reducing motor vehicle travel.

Built Environment Interventions to Increase Active Travel: a Critical Review and Discussion

PURPOSE OF REVIEW

To review the literature on built environment interventions to increase active travel, focusing on work since 2000 and on methodological choices and challenges affecting studies.

RECENT FINDINGS

Increasingly, there is evidence that built environment interventions can lead to more walking or cycling. Evidence is stronger for cycling than for walking interventions, and there is a relative lack of evidence around differential impacts of interventions. Some of the evidence remains methodologically weak, with much work in the 'grey' literature. While evidence in the area continues to grow, data gaps remain. Greater use of quasi-experimental techniques, improvements in routine monitoring of smaller schemes, and the use of new big data sources are promising. More qualitative research could help develop a more sophisticated understanding of behaviour change.

A systematic review of the effect of infrastructural interventions to promote cycling: strengthening causal inference from observational data

Background

Previous reviews have suggested that infrastructural interventions can be effective in promoting cycling. Given inherent methodological complexities in the evaluation of such changes, it is important to understand whether study results obtained depend on the study design and methods used, and to describe the implications of the methods used for causality. The aims of this systematic review were to summarize the effects obtained in studies that used a wide range of study designs to assess the effects of infrastructural interventions on cycling and physical activity, and whether the effects varied by study design, data collection methods, or statistical approaches.

Methods

Six databases were searched for studies that evaluated infrastructural interventions to promote cycling in adult populations, such as the opening of cycling lanes, or the expansion of a city-wide cycling network. Controlled and uncontrolled studies that presented data before and after the intervention were included. No language or date restrictions were applied. Data was extracted for any outcome presented (e.g. bikes counted on the new infrastructure, making a bike trip, cycling frequency, cycling duration), and for any purpose of cycling (e.g. total cycling, recreational cycling, cycling for commuting). Data for physical activity outcomes and equity effects was extracted, and quality assessment was conducted following previous methodologies and the UK Medical Research Council guidance on natural experiments. The PROGRESS-Plus framework was used to describe the impact on subgroups of the population.

Studies were categorized by outcome, i.e. changes in cycling behavior, or usage of the cycling infrastructure. The relative change was calculated to derive a common outcome across various metrics and cycling purposes. The median relative change was presented to evaluate whether effects differed by methodological aspects.

Results

The review included 31 studies and all were conducted within urban areas in high-income countries. Most of the evaluations found changes in favor of the intervention, showing that the number of cyclists using the facilities increased (median relative change compared to baseline: 62%; range: 4 to 438%), and to a lesser extent that cycling behavior increased (median relative change compared to baseline: 22%; range: − 21 to 262%). Studies that tested for statistical significance and studies that used subjective measurement methods (such as surveys and direct observations of cyclists) found larger changes than those that did not perform statistical tests, and those that used objective measurement methods (such as GPS and accelerometers, and automatic counting stations). Seven studies provided information on changes of physical activity behaviors, and findings were mixed. Three studies tested for equity effects following the opening of cycling infrastructure.

Conclusions

Study findings of natural experiments evaluating infrastructural interventions to promote cycling depended on the methods used and the approach to analysis. Studies measuring cycling behavior were more likely to assess actual behavioral change that is most relevant for population health, as compared to studies that measured the use of cycling infrastructure. Triangulation of methods is warranted to overcome potential issues that one may encounter when evaluating environmental changes within the built environment.

Trial registration

The protocol of this study was registered at PROSPERO (CRD42018091079).

A systematic review of the effect of infrastructural interventions to promote cycling: strengthening causal inference from observational data

BACKGROUND

Previous reviews have suggested that infrastructural interventions can be effective in promoting cycling. Given inherent methodological complexities in the evaluation of such changes, it is important to understand whether study results obtained depend on the study design and methods used, and to describe the implications of the methods used for causality. The aims of this systematic review were to summarize the effects obtained in studies that used a wide range of study designs to assess the effects of infrastructural interventions on cycling and physical activity, and whether the effects varied by study design, data collection methods, or statistical approaches.

METHODS

Six databases were searched for studies that evaluated infrastructural interventions to promote cycling in adult populations, such as the opening of cycling lanes, or the expansion of a city-wide cycling network. Controlled and uncontrolled studies that presented data before and after the intervention were included. No language or date restrictions were applied. Data was extracted for any outcome presented (e.g. bikes counted on the new infrastructure, making a bike trip, cycling frequency, cycling duration), and for any purpose of cycling (e.g. total cycling, recreational cycling, cycling for commuting). Data for physical activity outcomes and equity effects was extracted, and quality assessment was conducted following previous methodologies and the UK Medical Research Council guidance on natural experiments. The PROGRESS-Plus framework was used to describe the impact on subgroups of the population. Studies were categorized by outcome, i.e. changes in cycling behavior, or usage of the cycling infrastructure. The relative change was calculated to derive a common outcome across various metrics and cycling purposes. The median relative change was presented to evaluate whether effects differed by methodological aspects.

RESULTS

The review included 31 studies and all were conducted within urban areas in high-income countries. Most of the evaluations found changes in favor of the intervention, showing that the number of cyclists using the facilities increased (median relative change compared to baseline: 62%; range: 4 to 438%), and to a lesser extent that cycling behavior increased (median relative change compared to baseline: 22%; range: - 21 to 262%). Studies that tested for statistical significance and studies that used subjective measurement methods (such as surveys and direct observations of cyclists) found larger changes than those that did not perform statistical tests, and those that used objective measurement methods (such as GPS and accelerometers, and automatic counting stations). Seven studies provided information on changes of physical activity behaviors, and findings were mixed. Three studies tested for equity effects following the opening of cycling infrastructure.

CONCLUSIONS

Study findings of natural experiments evaluating infrastructural interventions to promote cycling depended on the methods used and the approach to analysis. Studies measuring cycling behavior were more likely to assess actual behavioral change that is most relevant for population health, as compared to studies that measured the use of cycling infrastructure. Triangulation of methods is warranted to overcome potential issues that one may encounter when evaluating environmental changes within the built environment.

TRIAL REGISTRATION

The protocol of this study was registered at PROSPERO (CRD42018091079).

Searching for health equity: validation of a search filter for ethnic and socioeconomic inequalities in transport

BACKGROUND

Efforts to improve health equity should be informed by the best available evidence. However, equity-related research is inconsistently indexed, and uses a variety of terms to describe key concepts, making it difficult to reliably identify all relevant studies. We report the development and validation of a search strategy for studies investigating whether the effects of interventions differ by ethnicity or socio-economic status, using the field of transport and health as an example.

METHODS

Adapting previously described methods, we followed four steps: generation of a test set of eligible studies, search strategy development, search strategy validation, and documentation.

RESULTS

Drawing from 12 systematic reviews, supplemented by additional studies identified by experts and colleagues, we identified a test set of 11 studies that met our eligibility criteria. We assigned five studies to a development set, which we used to develop and refine our search strategy. We assigned the remaining six studies to a validation set, against which we tested our final search strategy. The final search strategy identified all studies in both validation and development sets.

CONCLUSIONS

The validated search strategy derived in this study facilitates the conduct of systematic reviews and other literature searches investigating whether the effects of interventions differ by ethnicity or socio-economic status and may be further developed in future for other equity-focused searches and reviews.

Restructuring the built environment to change adult health behaviors: a scoping review integrated with behavior change frameworks

Built environment restructuring can improve public health through increased opportunity for healthy behaviors. Behavioral science targets individual health behaviors within place, suggesting the potential to integrate these approaches. This scoping review was one of the first to summarise the impact built environment restructuring has on health outcomes and behaviors and integrate these findings with the Capability-Opportunity-Motivation-Behavior model and Theoretical Domains Framework of behavior change. Potential studies were identified from 12 academic databases in urban design, psychology and public health. Search parameters involved 50 environment types, for example green space or healthy cities, combined with both an intervention (e.g. green infrastructure, active transport) and a measurable health outcome (e.g. exercise, wellbeing). Searches were limited to North America, Europe, or Australia/New Zealand. Of 536 potential studies reviewed against defined inclusion/exclusion criteria, 23 contributed to the findings. Evidence supported the positive influence of restructuring on varied health outcomes, many of which were drivers and domains of health behavior. Most studies indicated a clear contribution to increased physical activity. Recommendations include the need for explicit communication of theories guiding restructuring project design, consideration of health outcomes beyond physical activity, and better investigation of unanticipated barriers to health behaviors arising from built environment restructuring projects.

Quantifying the contribution of utility cycling to population levels of physical activity: an analysis of the Active People Survey

Background

Methods

Results

Conclusion

Controlled before-after intervention study of suburb-wide street changes to increase walking and cycling: Te Ara Mua-Future Streets study design

BACKGROUND

Achieving a shift from car use to walking, cycling and public transport in cities is a crucial part of healthier, more environmentally sustainable human habitats. Creating supportive active travel environments is an important precursor to this shift. The longevity of urban infrastructure necessitates retrofitting existing suburban neighbourhoods. Previous studies of the effects of street changes have generally relied on natural experiments, have included few outcomes, and have seldom attempted to understand the equity impacts of such interventions.

METHODS

In this paper we describe the design of Te Ara Mua - Future Streets, a mixed-methods, controlled before-after intervention study to assess the effect of retrofitting street changes at the suburb scale on multiple health, social and environmental outcomes. The study has a particular focus on identifying factors that improve walking and cycling to local destinations in low-income neighbourhoods and on reducing social and health inequities experienced by Māori (Indigenous New Zealanders) and Pacific people. Qualitative system dynamics modelling was used to develop a causal theory for the relationships between active travel, and walking and cycling infrastructure. On this basis we selected outcomes of interest. Together with the transport funder, we triangulated best evidence from the literature, transport policy makers, urban design professionals and community knowledge to develop interventions that were contextually and culturally appropriate. Using a combination of direct observation and random sample face to face surveys, we are measuring outcomes in these domains of wellbeing: road-user behaviour, changes to travel mode for short trips, physical activity, air quality, road traffic injuries, greenhouse gas emissions, and perceptions of neighbourhood social connection, safety, and walking and cycling infrastructure .

DISCUSSION

While building on previous natural experiments, Te Ara Mua - Future Streets is unique in testing an intervention designed by the research team, community and transport investors together; including a wide range of objective outcome measures; and having an equity focus. When undertaking integrated intervention studies of this kind, a careful balance is needed between epidemiological imperatives, the constraints of transport funding and implementation and community priorities, while retaining the ability to contribute new evidence for healthy, equitable transport policy. The study was retrospectively registered as a clinical trial on 21 June 2018 in the ISCRTN registry: ISRCTN89845334 http://www.isrctn.com/ISRCTN89845334.

Tram system related cycling injuries

INTRODUCTION

Understanding of tram-system related cycling injuries (TSRCI) is poor. The aim of this study was to report the spectrum of injuries, demographics and social deprivation status of patients. Secondary aims included assessment of accident circumstances, effects of TSRCI on patients' confidence cycling, together with time off work and cycling.

METHODS

A retrospective review of patients presenting to emergency services across all hospitals in Edinburgh and West Lothian with tram related injuries between May 2009 and April 2016 was undertaken. Medical records and imagining were analysed and patients were contacted by telephone.

RESULTS

191 cyclists (119 males, 72 females) were identified. 63 patients sustained one or more fractures or dislocations. Upper limb fractures/dislocations occurred in 55, lower limb fractures in 8 and facial fractures in 2. Most patients demonstrated low levels of socioeconomic deprivation. In 142 cases, the wheel was caught in tram-tracks, while in 32 it slid on tracks. The latter occurred more commonly in wet conditions (p = 0.028). 151 patients answered detailed questionnaires. Ninety-eight were commuting. 112 patients intended to cross tramlines and 65 accidents occurred at a junction. Eighty patients reported traffic pressures contributed to their accident. 120 stated that their confidence was affected and 24 did not resume cycling. Female gender (p < 0.001) and presence of a fracture/dislocation (p = 0.012) were independent predictors of negative effects on confidence. Patients sustaining a fracture/dislocation spent more time off work (median 5 days vs 1, p < 0.001) and cycling (median 57 days vs 21, p < 0.001).

CONCLUSIONS

TSRCI occur predominantly in young to middle-aged adults with low levels of socioeconomic deprivation, most commonly when bicycle wheels get caught in tram-tracks. They result in various injuries, frequently affecting the upper limb. Traffic pressures are commonly implicated. Most patients report negative effects on confidence and a sizeable minority do not resume cycling. TSRCI can result in significant loss of working and cycling days.

Do Natural Experiments of Changes in Neighborhood Built Environment Impact Physical Activity and Diet? A Systematic Review

Physical activity and diet are major modifiable risk factors for chronic disease and have been shown to be associated with neighborhood built environment. Systematic review evidence from longitudinal studies on the impact of changing the built environment on physical activity and diet is currently lacking. A systematic review of natural experiments of neighborhood built environment was conducted. The aims of this systematic review were to summarize study characteristics, study quality, and impact of changes in neighborhood built environment on physical activity and diet outcomes among residents. Natural experiments of neighborhood built environment change, exploring longitudinal impacts on physical activity and/or diet in residents, were included. From five electronic databases, 2084 references were identified. A narrative synthesis was conducted, considering results in relation to study quality. Nineteen papers, reporting on 15 different exposures met inclusion criteria. Four studies included a comparison group and 11 were pre-post/longitudinal studies without a comparison group. Studies reported on the impact of redeveloping or introducing cycle and/or walking trails (n = 5), rail stops/lines (n = 4), supermarkets and farmers' markets (n = 4) and park and green space (n = 2). Eight/15 studies reported at least one beneficial change in physical activity, diet or another associated health outcome. Due to limitations in study design and reporting, as well as the wide array of outcome measures reported, drawing conclusions to inform policy was challenging. Future research should consider a consistent approach to measure the same outcomes (e.g., using measurement methods that collect comparable physical activity and diet outcome data), to allow for pooled analyses. Additionally, including comparison groups wherever possible and ensuring high quality reporting is essential.

Understanding bicycling in cities using system dynamics modelling

BACKGROUND

Increasing urban bicycling has established net benefits for human and environmental health. Questions remain about which policies are needed and in what order, to achieve an increase in cycling while avoiding negative consequences. Novel ways of considering cycling policy are needed, bringing together expertise across policy, community and research to develop a shared understanding of the dynamically complex cycling system. In this paper we use a collaborative learning process to develop a dynamic causal model of urban cycling to develop consensus about the nature and order of policies needed in different cycling contexts to optimise outcomes.

METHODS

We used participatory system dynamics modelling to develop causal loop diagrams (CLDs) of cycling in three contrasting contexts: Auckland, London and Nijmegen. We combined qualitative interviews and workshops to develop the CLDs. We used the three CLDs to compare and contrast influences on cycling at different points on a "cycling trajectory" and drew out policy insights.

RESULTS

The three CLDs consisted of feedback loops dynamically influencing cycling, with significant overlap between the three diagrams. Common reinforcing patterns emerged: growing numbers of people cycling lifts political will to improve the environment; cycling safety in numbers drives further growth; and more cycling can lead to normalisation across the population. By contrast, limits to growth varied as cycling increases. In Auckland and London, real and perceived danger was considered the main limit, with added barriers to normalisation in London. Cycling congestion and "market saturation" were important in the Netherlands.

CONCLUSIONS

A generalisable, dynamic causal theory for urban cycling enables a more ordered set of policy recommendations for different cities on a cycling trajectory. Participation meant the collective knowledge of cycling stakeholders was represented and triangulated with research evidence. Extending this research to further cities, especially in low-middle income countries, would enhance generalizability of the CLDs.

Residential area and physical activity: A multi-level study of 68,000 adults in Stockholm County

Aim: To determine whether there are systematic differences in physical activity between residential areas after extensive control for sociodemographic factors at the individual level. Methods: Multi-level regressions of walking/bicycling, sedentary activities, household work and exercise were carried out in a representative sample of 68,303 adults in 39 residential areas in Stockholm County, first adjusting at the individual level for country of birth, sex, age, education, occupational class and income. The type of housing was then considered at the individual level or, for walking/bicycling and exercise, at both the individual and area levels (as a measure of area density). Results: After adjustment for sociodemographic factors, differences between residential areas remained in walking/bicycling, corresponding to 0.27 SD, or 50 min/week between the most and least active areas. Forty per cent of this difference could be explained by the type of housing at the area level. For sedentary activities and household work, respectively, much of the variation that remained after adjustment for sociodemographic factors was, in turn, explained by the type of housing at the individual level, leaving a difference of 0.16 SD (80 min/week) and 0.13 SD (60 min/week), respectively. For exercise, the corresponding difference was 0.11 SD (11 min/week, not sensitive to housing). Conclusions: Area level factors may influence walking/bicycling. High area density was associated with more activity. However, high density also comes with a type of housing (apartments) that is associated with less household work and, surprisingly, more sedentary activities, introducing a challenging trade-off. The differences in exercise were smaller than for all other types of activities.

Changes in bicycling over time associated with a new bike lane: relations with kilocalories energy expenditure and body mass index

Although bicycling has been related to positive health indicators, few studies examine health-related measures associated with non-competitive community cycling before and after cycling infrastructure improvements. This study examined cycling changes in a neighborhood receiving a bike lane, light rail, and other "complete street" improvements. Participants wore accelerometers and global positioning system (GPS) data loggers for one week in both 2012 and 2013, pre- and post- construction completion. Participants sampled within 2 km of the complete street improvements had the following patterns of cycling: never cyclists (n=434), continuing cyclists (n= 29), former cyclists (n=33, who bicycled in 2012 but not 2013), and new cyclists (n=40, who bicycled in 2013 but not 2012). Results show that all three cycling groups, as identified by GPS/accelerometry data, expended more estimated kilocalories (kcal) of energy per minute during the monitoring week than those who were never detected cycling, net of control variables. Similar but attenuated results emerged when cycling self-report measures were used. BMI was not related to cycling group but those who cycled longer on the new path had lower BMI. Although cyclists burn more calories than non-cyclists across the week, among cyclists, their cycling days involved more calories expended than their non-cycling days. The new cyclists account for 39% of the cyclists identified in this study and former cyclists account for 32% of cyclists. These results suggest that cycling is healthy, but that sustaining rates of cycling will be an important goal for future policy and research.

A Complete Street Intervention for Walking to Transit, Nontransit Walking, and Bicycling: A Quasi-Experimental Demonstration of Increased Use

BACKGROUND

Complete streets require evaluation to determine if they encourage active transportation.

METHODS

Data were collected before and after a street intervention provided new light rail, bike lanes, and better sidewalks in Salt Lake City, Utah. Residents living near (<800 m) and far (≥801 to 2000 m) from the street were compared, with sensitivity tests for alternative definitions of near (<600 and <1000 m). Dependent variables were accelerometer/global positioning system (GPS) measures of transit trips, nontransit walking trips, and biking trips that included the complete street corridor.

RESULTS

Active travel trips for Near-Time 2 residents, the group hypothesized to be the most active, were compared with the other 3 groups (Near-Time 1, Far-Time 1, and Far-Time 2), net of control variables. Near-Time 2 residents were more likely to engage in complete street transit walking trips (35%, adjusted) and nontransit walking trips (50%) than the other 3 groups (24% to 25% and 13% to 36%, respectively). Bicycling was less prevalent, with only 1 of 3 contrasts significant (10% of Near-Time 2 residents had complete street bicycle trips compared with 5% of Far-Time 1 residents).

CONCLUSIONS

Living near the complete street intervention supported more pedestrian use and possibly bicycling, suggesting complete streets are also public health interventions.

Impact of offering cycle training in schools upon cycling behaviour: a natural experimental study

BACKGROUND

England's national cycle training scheme, 'Bikeability', aims to give children in England the confidence to cycle more. There is, however, little evidence on the effectiveness of cycle training in achieving this. We therefore examined whether delivering Bikeability was associated with cycling frequency or with independent cycling.

METHODS

We conducted a natural experimental study using information on children aged 10-11 years participating in the nationally-representative Millennium Cohort Study. We identified Cohort participants whose schools had offered Bikeability in 2011-2012 using operational Bikeability delivery data (children in London excluded, as delivery data not available). Our natural experimental design capitalised on the fact that Cohort participants were surveyed at different times during 2012 and were also offered Bikeability at different times during 2012. This allowed us to compare cycling levels between children whose schools delivered Bikeability before their survey interview ('intervention group', N = 2563) and an otherwise comparable group of children whose schools delivered Bikeability later in the year ('control group', N = 773). Parents reported whether their child had completed formal cycle training; their child's cycling frequency; whether their child ever made local cycling trips without an adult; and other child and family factors. We used Poisson regression with robust standard errors to examine whether cycling behaviour differed between the intervention and control groups.

RESULTS

Children whose school had offered Bikeability were much more likely to have completed cycle training than the control group (68% vs. 28%, p < 0.001). There was, however, no evidence that delivering Bikeability in school was associated with cycling more often (49.0% cycling at least once per week in the intervention group vs. 49.6% in the control group; adjusted risk ratio 0.99, 95% CI 0.89, 1.10). There was likewise no evidence of an association with cycling independently (51.5% in the intervention group vs. 50.1% in the control group; adjusted risk ratio 0.97, 95% CI 0.89, 1.06).

CONCLUSIONS

Offering high-quality cycle training free at the point of delivery in English schools encourages children to do cycle training, but we found no evidence of short-term effects on cycling frequency or independent cycling. Future evaluation should investigate longer-term effects on these and other stated Bikeability objectives such as increasing cycling safety.

Health impacts of the Cambridgeshire Guided Busway: a natural experimental study

Background

Improving transport infrastructure to support walking and cycling on the journey to and from work – active commuting – could help to promote physical activity and improve population health.

Aims

To assess whether or not investment in new high-quality transport infrastructure was associated with an increase in active commuting; wider health impacts of changes in travel behaviour; determinants of the use and uptake of active commuting; and how changes in travel behaviour were distributed in the population and related to the wider social context.

Design

The Commuting and Health in Cambridge study, comprising a quasi-experimental cohort study combined with both nested and supplementary in-depth quantitative and qualitative studies.

Setting

Cambridgeshire, UK.

Participants

A cohort of 1143 adults living within 30 km of Cambridge, working in the city and recruited in 2009; and a separate sample of 1710 users intercepted on the Cambridgeshire Guided Busway in 2012.

Intervention

The Cambridgeshire Guided Busway, comprising a new bus network using 22 km of guideway (segregated bus track) accompanied by a traffic-free path for pedestrians and cyclists, opened in 2011.

Main outcome measure

Change in time spent in active commuting from 2009 to 2012, using a self-reported measure validated using georeferenced combined heart rate and movement sensor data.

Methods

A delay from 2009 to 2011 in completing the intervention entailed some changes to the original design and attrition of the cohort. A period of methodological and observational research on active commuting preceded the evaluation, which was based on a quasi-experimental cohort analysis together with the intercept and qualitative data. A graded measure of each participant’s exposure to the intervention, based on the proximity of the busway to his or her home, served as the basis for controlled comparisons.

Results

Commuting practices were complex and shaped by various changeable social and environmental factors. Walking and cycling were often incorporated into longer commuting journeys made predominantly by car or public transport. In multivariable multinomial regression analyses, exposure to the intervention was associated with a greater likelihood of a large increase in the proportion of commuting trips involving any active travel [adjusted relative risk ratio (RRR) 1.80, 95% confidence interval (CI) 1.27 to 2.55], of a large decrease in the proportion of trips made entirely by car (RRR 2.09, 95% CI 1.35 to 3.21), and of an increase in weekly cycle commuting time (RRR 1.34, 95% CI 1.03 to 1.76). There was a mixed pattern of effects at the individual level, with the intervention providing a more supportive environment for active commuting for some and not for others. There was some evidence that the effect was most pronounced among those who reported no active commuting at baseline, and observational evidence suggesting a relationship between active commuting, greater overall physical activity, and improved well-being and weight status.

Conclusions

These findings provide new empirical support and direction for reconfiguring transport systems to improve population health and reduce health inequalities. They should be combined with evidence from research evaluating related environmental changes in other settings, preferably using longer periods of observation and controlled comparisons, to support more generalisable causal inference.

Funding

The National Institute for Health Research Public Health Research programme.

Cycle training for children: Which schools offer it and who takes part?

PURPOSE

The 'Bikeability' cycle training scheme, a flagship policy of the government in England, aims to give children the skills and confidence to cycle more safely and more often. Little, however, is known about the scheme׳s reach. This paper examined which schools offer Bikeability, and which children participate in cycle training.

METHODS

We used operational delivery data to examine which primary schools in England offered Bikeability. Predictors included the deprivation level of the student body and the local prevalence of cycling. We then examined cycle training participation using data from 6986 participants (age 10-11) in the nationally-representative Millennium Cohort Study. Parents reported whether their child had completed formal cycle training, along with other child and family factors. We used operational data to identify children whose school had previously delivered Bikeability.

RESULTS

55% of schools offered Bikeability to the cohort of children leaving primary school in 2012; this fell to 48% in schools in the top tenth for student deprivation. Among Millennium Cohort participants, 47% of children had completed cycle training; this proportion rose to 68% among children whose schools had offered Bikeability. In adjusted robust Poisson regression models, participation rates were lower among minority ethnic children, particularly South Asians; among children who played sport less often; and among children whose parents were poorer or less educated. The magnitude of these differences was largest among children whose schools had not offered Bikeability (all p≤0.02 for interaction, except for income where p=0.09), although trends in the same direction were observed in schools that had offered Bikeability.

CONCLUSIONS

Offering high-quality cycle training free of charge in English schools reduced but did not eliminate inequalities in cycle training participation. Further promoting the scheme to parents and schools, particularly in deprived areas, would be expected to increase uptake and help reduce current inequalities in participation.

Use of and short-term impacts of new cycling infrastructure in inner-Sydney, Australia: a quasi-experimental design

Background

Given increasing investment in new cycling infrastructure, it is important to understand its impacts. The Sydney Transport and Health Study evaluates a new 2.4 km bi-directional separated bicycle path in inner-Sydney. This paper describes the users of the new bicycle path, and examines its short-term impacts upon cycling behaviour and perceptions of the local environment.

Methods

Data were collected from two bike counts at two intersections on the new bicycle path in the intervention area in 2013 and 2014. On-line surveys collected individual participant data in the intervention area and a similar comparison area before the bicycle path was built (2013), and 12 months later (four months after completion) (n = 512). The data included self-reported cycling behaviour, use of the new bicycle path and perceptions of changes in the local environment.

Results

Bike counts at two sites on the new bicycle path reported an increase of 23 % and 97 % respectively at 12 months. However, among the participants in the cohort, there was no change in the self-reported weekly frequency of cycling. One in six (approximately 15 %) participants reported using the new bicycle path, with most users (76 %) living in the intervention area. Bicycle path users were most likely to be frequent riders (at least weekly) [adjusted odds ratio (AOR) = 7.50, 95 % CI 3.93–14.31], be a high intensity recreational rider (AOR = 4.38, 95 % CI 1.53–12.54) or a low intensity transport rider (AOR = 2.42, 95 % CI 1.17–5.04) and live closer to the bicycle path (AOR = 1.24, 1.13–1.37). Perceptions that the neighbourhood was more pleasant, that there were more people walking and cycling were significantly higher in the intervention area at 12 months (both P values <0.05).

Conclusions

Existing cycling behaviour and proximity to the bicycle path were associated with the use of the new bicycle path. Increased use of the new bicycle path as reported by the participants in the intervention area and increased cycling recorded by the bike counts may be due to existing cyclists changing routes to use the new path, and more cyclists from outside the study area using the new path, as study participants did not increase their frequency of cycling. Increases in cycling frequency in the intervention neighbourhood may require a longer lead time, additional promotional activities and further maturation of the Sydney bicycle path network.

Key message

Understanding how new cycling infrastructure impacts communities can influence the promotion of such infrastructure.

What interventions increase commuter cycling? A systematic review

OBJECTIVE

To identify interventions that will increase commuter cycling.

SETTING

All settings where commuter cycling might take place.

PARTICIPANTS

Adults (aged 18+) in any country.

INTERVENTIONS

Individual, group or environmental interventions including policies and infrastructure.

PRIMARY AND SECONDARY OUTCOME MEASURES

A wide range of 'changes in commuter cycling' indicators, including frequency of cycling, change in workforce commuting mode, change in commuting population transport mode, use of infrastructure by defined populations and population modal shift.

RESULTS

12 studies from 6 countries (6 from the UK, 2 from Australia, 1 each from Sweden, Ireland, New Zealand and the USA) met the inclusion criteria. Of those, 2 studies were randomised control trials and the remainder preintervention and postintervention studies. The majority of studies (n=7) evaluated individual-based or group-based interventions and the rest environmental interventions. Individual-based or group-based interventions in 6/7 studies were found to increase commuter cycling of which the effect was significant in only 3/6 studies. Environmental interventions, however, had small but positive effects in much larger but more difficult to define populations. Almost all studies had substantial loss to follow-up.

CONCLUSIONS

Despite commuter cycling prevalence varying widely between countries, robust evidence of what interventions will increase commuter cycling in low cycling prevalence nations is sparse. Wider environmental interventions that make cycling conducive appear to reach out to hard to define but larger populations. This could mean that environmental interventions, despite their small positive effects, have greater public health significance than individual-based or group-based measures because those interventions encourage a larger number of people to integrate physical activity into their everyday lives.

Increasing active travel: results of a quasi-experimental study of an intervention to encourage walking and cycling

BACKGROUND

There is increased interest in the effectiveness and co-benefits of measures to promote walking and cycling, including health gains from increased physical activity and reductions in fossil fuel use and vehicle emissions. This paper analyses the changes in walking and cycling in two New Zealand cities that accompanied public investment in infrastructure married with programmes to encourage active travel.

METHOD

Using a quasi-experimental two-group pre-post study design, we estimated changes in travel behaviour from baseline in 2011 to mid-programme in 2012, and postprogramme in 2013. The intervention and control cities were matched in terms of sociodemographic variables and baseline levels of walking and cycling. A face-to-face survey obtained information on walking and cycling. We also drew from the New Zealand Travel Survey, a national ongoing survey of travel behaviour, which was conducted in the study areas. Estimates from the two surveys were combined using meta-analysis techniques.

RESULTS

The trips and physical activity were evaluated. Relative to the control cities, the odds of trips being by active modes (walking or cycling) increased by 37% (95% CI 8% to 73%) in the intervention cities between baseline and postintervention. The net proportion of trips made by active modes increased by about 30%. In terms of physical activity levels, there was little evidence of an overall change.

DISCUSSION

Comparing the intervention cities with the matched controls, we found substantial changes in walking and cycling, and conclude that the improvements in infrastructure and associated programmes appear to have successfully arrested the general decline in active mode use evident in recent years.

Contrasts in active transport behaviour across four countries: how do they translate into public health benefits?

OBJECTIVE

Countries and regions vary substantially in transport related physical activity that people gain from walking and cycling and in how this varies by age and gender. This study aims to quantify the population health impacts of differences between four settings.

METHOD

The Integrated Transport and Health Model (ITHIM) was used to estimate health impacts from changes to physical activity that would arise if adults in urban areas in England and Wales adopted travel patterns of Switzerland, the Netherlands, and California. The model was parameterised with data from travel surveys from each setting and estimated using Monte Carlo simulation. Two types of scenarios were created, one in which the total travel time budget was assumed to be fixed and one where total travel times varied.

RESULTS

Substantial population health benefits would accrue if people in England and Wales gained as much transport related physical activity as people in Switzerland or the Netherlands, whilst smaller but still considerable harms would occur if active travel fell to the level seen in California. The benefits from achieving the travel patterns of the high cycling Netherlands or high walking Switzerland were similar.

CONCLUSION

Differences between high income countries in how people travel have important implications for population health.

Cycling promotion and non-communicable disease prevention: health impact assessment and economic evaluation of cycling to work or school in Florence

OBJECTIVE

To estimate the effects of cycling promotion on major non-communicable diseases (NCDs) and costs from the public healthcare payer's perspective.

DESIGN

Health impact assessment and economic evaluation using a dynamic model over a ten-year period and according to two cycling promotion scenarios.

SETTING

Cycling to work or school in Florence, Italy.

POPULATION

All individuals aged 15 and older commuting to work or school in Florence.

MAIN OUTCOME MEASURES

The primary outcome measures were changes in NCD incidence and healthcare direct costs for the Tuscany Regional Health Service (SST) due to increased cycling. The secondary outcome was change in road traffic accidents.

RESULTS

Increasing cycling modal share in Florence from 7.5% to about 17% (Scenario 1) or 27% (Scenario 2) could decrease the incidence of type 2 diabetes by 1.2% or 2.5%, and the incidence of acute myocardial infarction (AMI) and stroke by 0.6% or 1.2%. Within 10 years, the number of cases that can be prevented is 280 or 549 for type 2 diabetes, 51 or 100 for AMI, and 51 or 99 for stroke in Scenario 1 or Scenario 2, respectively. Average annual discounted savings for the SST are estimated to amount to €400,804 or €771,201 in Scenario 1 or Scenario 2, respectively. In Florence, due to the high use of vulnerable motorized vehicles (such as scooters, mopeds, and motorcycles), road traffic accidents are expected to decline in both our scenarios. Sensitivity analyses showed that health benefits and savings for the SST are substantial, the most sensitive parameters being the relative risk estimates of NCDs and active commuting.

CONCLUSIONS

Effective policies and programs to promote a modal shift towards cycling among students and workers in Florence will contribute to reducing the NCD burden and helping long-term economic sustainability of the SST.

New walking and cycling routes and increased physical activity: one- and 2-year findings from the UK iConnect Study

OBJECTIVES

We evaluated the effects of providing new high-quality, traffic-free routes for walking and cycling on overall levels of walking, cycling, and physical activity.

METHODS

1796 adult residents in 3 UK municipalities completed postal questionnaires at baseline (2010) and 1-year follow-up (2011), after the construction of the new infrastructure. 1465 adults completed questionnaires at baseline and 2-year follow-up (2012). Transport network distance from home to infrastructure defined intervention exposure and provided a basis for controlled comparisons.

RESULTS

Living nearer the infrastructure did not predict changes in activity levels at 1-year follow-up but did predict increases in activity at 2 years relative to those living farther away (15.3 additional minutes/week walking and cycling per km nearer; 12.5 additional minutes/week of total physical activity). The effects were larger among participants with no car.

CONCLUSIONS

These new local routes may mainly have displaced walking or cycling trips in the short term but generated new trips in the longer term, particularly among those unable to access more distant destinations by car. These findings support the potential for walking and cycling infrastructure to promote physical activity.