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.

Impacts of active mobility on individual health mediated by physical activities

Active mobility, encompassing walking and cycling for transportation, is a potential solution to health issues arising from inadequate physical activity in modern society. However, the extent of active mobility's impact on individual physical activity levels, and its association with health as mediated by physical activities, is not fully quantified. This study aims to clarify the direct relationship between active mobility usage and individual health, as well as the indirect relationship mediated by physical activity, with a focus on varying levels of physical activity intensity. Utilizing data from the 2017 U.S. National Household Travel Survey (NHTS), we employed Poisson regression to predict active mobility usage based on socio-demographic and household socio-economic characteristics. A Structural Equation Model (SEM) was then used to investigate the direct and indirect effects of active mobility on individual health, mediated by physical activity. We further segmented individuals according to their intensity of physical activity to examine how such effect differs between different levels of physical activity. The study demonstrates that active mobility usage positively correlates with both the amount and intensity of physical activity. The effect of active mobility on individual health includes a direct positive effect (29% for intensity, 67.7% for amount) and an indirect effect mediated by physical activity (71% for intensity, 32.3% for amount). Notably, the mediation effect of active mobility on health is more substantial in the context of vigorous physical activities compared to light or moderate activities. Our findings reveal a significant positive influence of active mobility on individual health, encompassing both direct and indirect effects mediated by physical activities. These results quantitatively underscore the health benefits of active mobility and suggest the importance of promoting active mobility as a strategy to improve public health.

Understanding cycling mobility: Bologna case study

Understanding human mobility in touristic and historical cities is of the utmost importance for managing traffic and deploying new resources and services. In recent years, the need to enhance mobility has been exacerbated due to rapid urbanisation and climate changes. The main objective of this work is to study cycling mobility within the city of Bologna, Italy. We used six months dataset that consists of 320,118 self-reported bike trips. First, we performed several descriptive analysis to understand the temporal and spatial patterns of bike users for understanding popular roads and most favourite points within the city. The findings show how bike users present regular daily and weekly temporal patterns and the characteristics of their trips (i.e. distance, time and speed) follow well-known distribution laws. We also identified several points of interest in the city that are particularly attractive for cycling. Moreover, using several other public datasets, we found that bike usage is more correlated to temperature and precipitation and has no correlation to wind speed and pollution. We also exploited machine learning approaches for predicting short-term trips in the near future (that is for the following 10, 30, and 60 minutes), which could help local governmental agencies with urban planning. The best model achieved an R square of 0.91 for the 30-minute time interval, and a Mean Absolute Error of 2.52 and a Root Mean Squared Error of 3.88 for the 10-minute time interval.

Walking and cycling for health: A multi-group analysis of path models between genders

AIMS

Walking and cycling are beneficial for urban adults' health. Transport and recreation are modifiable domains of major physical activity resources. The purposes of this study were to explore associations among psychological and environmental factors, walking and cycling behaviours and quality of life by developing a path model and comparing gender differences.

DESIGN

A cross-sectional study.

METHODS

Participants were community-dwelling healthy urban adults aged 20-65 years. Data were collected between September 2019 and June 2020 by self-reported questionnaires, including health beliefs, the neighbourhood environment, walking and cycling behaviours and the World Health Organization Quality-of-Life Scale. An ANCOVA, chi-squared tests, partial least squares-path model and a multi-group analysis were performed for statistical analyses.

RESULTS

In total, 1294 valid responses were received, which included 41.27% men and 58.73% women. Men had lower walking behaviours and better self-efficacy than women. The developed path model indicated an acceptable model fit. Significant path coefficients were found among psychological and environmental factors, walking and cycling behaviours and quality of life. The path model between men and women found no significant differences in any path coefficients. Significant path coefficients of environmental factors with cycling behaviour and of walking behaviour with quality of life were found in men but not in women.

CONCLUSION

Improving individuals' health beliefs, self-efficacy and perceived walkability and cyclability is a beneficial strategy for promoting physical activity. Walking and cycling behaviours are recommended to improve the quality of life of urban adult populations.

IMPACTS

What problem did the study address? A large proportion of urban adult populations still have insufficient physical activity globally. It is essential that implications from an overall perspective of psychological and environmental factors and their interactions be integrated to develop efficient strategies for promoting physical activity and quality of life. What were the main findings? The developed path model with an acceptable model fit found that psychological and environmental factors were important in explaining urban adults' walking and cycling behaviours and quality of life. Differences were not found between men's and women's path models. Where and on whom will the research have impact? Improving urban adults' psychological and environmental factors might be an efficient strategy for promoting sufficient physical activity. Men's low engagement in walking behaviours should garner increased attention. Providing equal opportunities for both genders to engage in walking and cycling behaviours are recommended for health promotion in urban regions.

Skip the wait and take a walk home! The suitability of point-of-choice prompts to promote active transportation among undergraduate students

Objectives: The objectives were to: determine undergraduate students' awareness of active transportation-promoting point-of-choice prompts; explore perceptions of the impact of the prompts on students' transportation choices; and obtain feedback regarding the suitability of the prompts. Participants: This cross-sectional study included a convenience sample of 346 undergraduate students. Methods: Prompts were displayed in March 2018 on one Canadian university campus. Thereafter, students completed a 20-question and study-specific online questionnaire containing a mix of closed- and open-ended questions. Results: Approximately 41% of respondents were aware of the prompts, with awareness levels being associated with the distribution and the design of the displays. Although students assessed them as suitable, the prompts did not impact the transportation choices of the majority of respondents who saw them. Conclusions: Findings contribute to the understanding of students' awareness levels of tailored and strategically-placed prompts, and the impact of this intervention on decisions to engage in active transportation.

The motivations for using bike sharing during the COVID-19 pandemic: Insights from Lisbon

Urban mobility has been severely impacted by the coronavirus pandemic, with public transport (PT) particularly affected due to infection risks and fears. The promotion of alternative modes of transport such as bike sharing systems (BSS) has gained a new drive as a possible way of providing an alternative to PT and limit a potential surge in private car use. In this study, we provide insights on the motivations for using bike sharing during the COVID-19 pandemic through a survey to the BSS users of Lisbon (entitled GIRA). Before the coronavirus pandemic, the most influential motivations were those connected to the BSS' Service Coverage & Quality (such as the convenient location of BSS stations near the users' destinations or the availability of shared e-bikes) as well as to the Personal Interests & Well-being of BSS users (namely the pleasure of cycling as well as the perceived environmental and health benefits). With the emergence of the COVID-19 pandemic, although the motivations of Service Coverage & Quality continue to be the most valued by respondents, the motivations associated with using BSS to avoid PT and to maintain a social distance during the trip are now as important as the motivations linked to Personal Interests & Well-being. Furthermore, new users who have joined bike sharing during COVID-19 give more importance to the Social Influence (such as seeing other people using the system or the influence of their social circle) comparatively to those who were already users before the pandemic and continue to use BSS. This research provides evidence on the importance of bike sharing to the resilience of urban transport systems, particularly during disruptive public health crises. It supports that BSS should continue to operate during the coronavirus pandemic as such systems offer a transport alternative to PT that is perceived to be capable of preserving a physical distance.

Bikes for Life: Measuring the effects of a bicycle distribution program on 6 to 12-year-old children's BMI and health behaviors

Treating pediatric obesity is challenging. The objective was to evaluate effect of receiving a bicycle on (a) physical activity, (b) sedentary activity, (c) Body Mass Index (BMI), and (d) eating habits. A stepped-wedge randomized controlled trial of 6- to 12-year-old patients with overweight/obesity was conducted April 2012-2018. Participants were randomized to wait 0, 2, 4, or 6 months for a bicycle. Outcomes on activity, BMI and eating were collected at 3, 6, 9- and 12-months after children received a bicycle. A total of 525 participants with 387 (74%) completed 3-month follow-up questionnaire, and 346 (66%) completed 12-month follow-up visit. Participants were mostly Latino/a (71%) and low income (58%), and 31% had never ridden a bicycle. Median baseline BMI was 98th percentile. At 3 months, 62% reported bicycle use last week, on average 3.6 days. Time spent on sedentary activities decreased by 48 min/day (p = 0.04), and time spent playing sports increased by 1.7 h/week (p < 0.01). No reduction in BMI was seen. Consumption of sugary drinks decreased (by 0.59 servings/week, p < 0.01), and consumption of vegetables increased (0.71 servings/week, p = 0.04). At 12 months, sedentary time, sugary drink and vegetable consumption remained significantly more favorable than at enrollment (p < 0.01, p < 0.01, p = 0.04 respectively), but not significantly different (p = 0.47 for sedentary, p = 0.73 for sugary drink) and significantly less favorable (p < 0.01 for vegetables) than at the time of intervention. Participants reported riding bicycle, improved activity and dietary habits, though reversion towards baseline behavior was seen by one year and no change in BMI from enrollment.

Evaluation of a New Urban Cycling Infrastructure in Caceres (Spain)

The purpose of the research is the evaluation of the impact of a new bike lane network built in Cáceres (Spain) in October 2019, a city with a weak tradition in the use of bicycles. Prior to the new project, the percentage of displacement by bicycle was under 0.2% (by contrast, private cars was 56%). The project has introduced a real network in 33 new streets and avenues, and 250 new parking places for bicycles. The impact has been evaluated by two online surveys, one conducted in November–December 2019 just after the inauguration, and the other conducted in January–February 2020. For that, the impact evolution after the first 3 months has also been evaluated. The result allows to analyze the citizens’ response to the new infrastructure; the main conclusion is that the effect of the built infrastructure is clearly positive in terms of new users, new potential users, and bike general image for the citizens. Moreover, this positive effect has grown after the first 3 months.

Identifying factors associated with obesity traits in undergraduate students: a scoping review

OBJECTIVES

This scoping review identifies factors associated with obesity traits including body mass index, weight, and body fat percentage in undergraduate students.

METHODS

We searched CINAHL, EMBASE, MEDLINE, and PsycINFO for original studies of undergraduate students where an obesity trait was associated with a risk factor.

RESULTS

Two-hundred sixty-eight articles were included comprising of 251 studies: 186 cross-sectional, 50 cohort, 11 interventional, and 4 qualitative. We extracted data on risk/protective factors, obesity traits, and the direction of effect between them. We identified a variety of factors including age, sex, ethnicity, socioeconomic status, religion, diet, eating habits, physical activity, sedentary activity, sleep, stress, university campus life, alcohol use, smoking, psychiatric disorders, body image, eating attitude, eating regulation, personality, sociocultural influences, and genetics. The majority of associations were cross-sectional. For longitudinal findings, usually only one study investigated each trait.

CONCLUSIONS

This review identifies a need for higher quality evidence to support results from cross-sectional studies and replication of findings of longitudinal studies. This review identifies gaps in the literature, generates hypotheses, guides researchers to plan future studies, and helps decision-makers design obesity-prevention programs in universities.

Effect of a Service-Learning Program on the Active Lifestyle of Children with Autism Spectrum Disorder: A Pilot Study

Background: active lifestyles and Physical Activity (PA) are closely related to health. Healthy habits such as being physically active should be consolidated during childhood. Children with Autism Spectrum Disorders (ASD) present fewer opportunities to be involved in PA. For this reason, we conducted a Service-Learning (SL) program to enhance the possibility of participating ASD children enjoying PA sessions. The aim of this study was to analyze and describe the evolution in terms of the frequency and intensity of PA performed by ASD children who participated in the SL program. Methods: we used a quasi-experimental design. The sample was formed by 26 children with ASD (Experimental group: n = 16; 4 girls, 12 boys) (Control group: n = 10; 1 girl, 9 boys) with ASD level 1. Results: after the intervention program, moderate PA during the week increased significantly (Pre-Median: 92.04, Range: 35.71–126.47 min; Post-Median: 212.67, Range: 99.75, 271.04 min) (p ≤ 0.001). When comparing both groups, the tendency to do PA in the Experimental group remained more stable. Also, the improvements in moderate intensities were higher in the Experimental group after the intervention. Conclusion: a six-month SL program improved the moderate PA routines of ASD children. However, longer programs and longitudinal studies are required.

Evidence of Green Areas, Cycle Infrastructure and Attractive Destinations Working Together in Development on Urban Cycling

The built environment influences and promotes cycling that has now become a challenge for sustainable urban mobility in many cities where this mode of transport carries little weight. This is the case for Granada (Spain), a medium-sized city in southern Europe, which as a university city and with lots of green areas, could find potential supportive factors to promote cycling. Website-apps with a Global Positioning System (GPS), such as Ciclogreen that encourage active accessibility try to promote cycling and are supported by the University of Granada. The aim of this work is to assess the capacity of green areas and some influential factors of their built environment to attract cycling routes. To this end, a spatial analysis was made and interpreted by a statistical model to check the correlation between these factors and a high number of cycling routes through or near the green areas. The results show a high number of cycling routes within urban surroundings that include green areas, cycle lanes, university facilities, and public car parks in proximity relationships. Identifying synergies among these urban factors and the information and incentive coming from a digital catalyst in shape on an app could be useful in urban planning for cycling.

Longer, More Active Commute, but Still not Very Active: Five-Year Physical Activity and Travel Behavior Change in a University Population

Active travel can support the achievement of recommended levels of physical activity. Monitoring travel behavior of university students and staff provides a useful insight into patterns of regional travel and population level changes in physical activity. This study sought to evaluate current travel and physical activity behaviors in a university population and to determine whether these changed over time. An online survey of travel behavior and physical activity was conducted at the University of Sydney, Australia. The survey was actively promoted for three weeks prior to the release of the survey among staff and students, which asked about travel behavior on a specific day in September 2017. The survey questions were the same as those used in a similar online survey conducted across the University in 2012. In total, 4359 People completed the survey, representing 10.8% of staff and 4.1% of students. Approximately two thirds of survey respondents were students, in both the 2012 and 2017 surveys. Compared with 2012, there was an increase in active travel to the University in 2017 from increased walking and train travel. Compared to 2012, in 2017 there was an increase in average minutes walked by about nine minutes, and less time spent sitting. Trip lengths increased, with 68% of trips taking longer than 30 min in 2017. The amount of time spent in low-moderate levels physical activity increased between 2012 and 2017, potentially related to active travel behavior. Citywide changes towards a system-wide transport fare structure was the biggest change in the transport environment between the two surveys and may have contributed to increased train travel.

Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant Program

Introduction

Public health focuses on a range of evidence-based approaches for addressing chronic conditions, from individual-level clinical interventions to broader changes in policies and environments that protect people’s health and make healthy living easier. This study examined the potential long-term impact of clinical and community interventions as they were implemented by Community Transformation Grant (CTG) program awardees.

Methods

We used the Prevention Impacts Simulation Model, a system dynamics model of cardiovascular disease prevention, to simulate the potential 10-year and 25-year impact of clinical and community interventions implemented by 32 communities receiving a CTG program award, assuming that program interventions were sustained during these periods.

Results

Sustained clinical interventions implemented by CTG awardees could potentially avert more than 36,000 premature deaths and $3.2 billion in discounted direct medical costs (2017 US dollars) over 10 years and 109,000 premature deaths and $8.1 billion in discounted medical costs over 25 years. Sustained community interventions could avert more than 24,000 premature deaths and $3.4 billion in discounted direct medical costs over 10 years and 88,000 premature deaths and $9.1 billion in discounted direct medical costs over 25 years. CTG clinical activities had cost-effectiveness of $302,000 per death averted at the 10-year mark and $188,000 per death averted at the 25-year mark. Community interventions had cost-effectiveness of $169,000 and $57,000 per death averted at the 10- and 25-year marks, respectively.

Conclusion

Clinical interventions have the potential to avert more premature deaths than community interventions. However, community interventions, if sustained over the long term, have better cost-effectiveness.

Biking to School: The Role of Bicycle-Sharing Programs in Adolescents

BACKGROUND

The purpose of this study was to: (1) describe modes of transport to school, with a specific focus on the use of public bicycle share programs (PBSP); and (2) assess sociodemographic, psychosocial, and environmental correlates of bike and PBSP use to go to school.

METHODS

A group of 465 adolescents from the International Physical Activity and the Environment Network (IPEN) Adolescent Study (Valencia, Spain) participated in the research. Mixed regression analyses were conducted on the data obtained.

RESULTS

Not having bicycle access, a PBSP card, or a public bike lane close to the school is negatively associated with bicycle use. PBSP is positively associated with physical self-efficacy and bicycle availability and negatively associated with the number of vehicles per drivers at home and not having PBSP stations close to the school.

CONCLUSIONS

The strongest predictive factor, as regards cycling as an active mode of transport to school among adolescents is having a PBSP card. Schools have a crucial role in promoting bicycle use through collaboration when designing public policies that consider access to bike lane networks and PBSP stations and therefore should encourage local government implementation policies and/or increase PBSP stations within 250 m of the school.

Bikeshare Use in Urban Communities: Individual and Neighborhood Factors

Objective

Bicycling is an affordable way to increase access to employment, schooling, and services and an effective measure against obesity. Bikeshare programs can make bicycling accessible to diverse populations, but little evidence exists on their adoption in low-resource neighborhoods. Our study examined factors associated with bikeshare use in a metropolitan area in the southern United States.

Methods

We performed a retrospective cross-sectional analysis of a database of clients (N=815) who rented a bicycle from Zyp Bikeshare in Birmingham, Alabama between October 2015 and November 2016. Individual-level variables included bike use frequency, average speed, total miles traveled, total minutes ridden, bike type (traditional vs electricity-assisted pedelec), membership type, sex, and age. Area-level data aggregated to Census tracts, proxies for neighborhoods, were obtained from the 2010 US Census after geocoding clients' billing addresses. Using exploratory factor analysis, a neighborhood socioeconomic disadvantage index (SDI) was constructed. Bikeshare station presence in a tract was included as a covariate. Multivariate linear regression models, adjusted for clustering on Census tracts, were estimated to determine predictors of bikeshare use.

Results

In a multivariate regression model of individual and neighborhood characteristics adjusted for clustering, each decile increase in the SDI was associated with a 9% increase in bikeshare use (P<.001). Bikeshare use was also positively associated with speed (.1, P<.001), total miles (.008, P<.001), and pedelec use (1.02, P<.01).

Conclusion

Higher neighborhood socioeconomic disadvantage is associated with higher bikeshare use. Bikeshare is a viable transportation option in low-resource neighborhoods and may be an effective tool to improve the connectivity, livability, and health of urban communities.

Transtheoretical Model of Change during Travel Behavior Interventions: An Integrative Review

This study aims to identify the relevant empirical work, to synthesize its findings, and to thus attain a general understanding of the application of the Transtheoretical Model (TTM) in transport behavior research. An integrative literature review was used to determine whether or not the implemented interventions impact the stages and processes of travel behavior change. Data was collected from different databases. English language articles published between 2002 and 2017 were included. After sequentially narrowing the search and removing duplicates, 53 relevant papers remained, 13 of which fulfilled the stated criteria of constituting a transport intervention study using the TTM as a reference frame. The final 13 studies were classified and categorized according to stages and processes in the TTM. Findings showed that none of the interventions met the method requirements for a proper evaluation of design and outcome measurement. Reporting did not follow a standardized structure desirable when enabling comparative analyses. Allowing for these shortcomings, it is inferred that positive travel behavior changes have been obtained during some interventions. Importantly, although it was stated that the empirical studies were based on the TTM, the included interventions were implemented irrespective of the individual’s stage of change. For future research, it will be necessary to conduct evaluations of higher quality.

Active transport and obesity prevention - A transportation sector obesity impact scoping review and assessment for Melbourne, Australia

Given the alarming prevalence of obesity worldwide and the need for interventions to halt the growing epidemic, more evidence on the role and impact of transport interventions for obesity prevention is required. This study conducts a scoping review of the current evidence of association between modes of transport (motor vehicle, walking, cycling and public transport) and obesity-related outcomes. Eleven reviews and thirty-three primary studies exploring associations between transport behaviours and obesity were identified. Cohort simulation Markov modelling was used to estimate the effects of body mass index (BMI) change on health outcomes and health care costs of diseases causally related to obesity in the Melbourne, Australia population. Results suggest that evidence for an obesity effect of transport behaviours is inconclusive (29% of published studies reported expected associations, 33% mixed associations), and any potential BMI effect is likely to be relatively small. Hypothetical scenario analyses suggest that active transport interventions may contribute small but significant obesity-related health benefits across populations (approximately 65 health adjusted life years gained per year). Therefore active transport interventions that are low cost and targeted to those most amenable to modal switch are the most likely to be effective and cost-effective from an obesity prevention perspective. The uncertain but potentially significant opportunity for health benefits warrants the collection of more and better quality evidence to fully understand the potential relationships between transport behaviours and obesity. Such evidence would contribute to the obesity prevention dialogue and inform policy across the transportation, health and environmental sectors.

[Perceived barriers to active commuting to school: reliability and validity of a scale]

OBJECTIVE

To examine the reliability and validity of a scale to measure perceived barriers to active commuting to school among Spanish young people.

METHOD

The validity of the scale was assessed in a sample of 465 adolescents (14-18 years) using a confirmatory factor analysis and studying its association with self-reported active commuting to school. The reliability of the instrument was evaluated in a sub-sample that completed the scale twice separated by a one-week interval.

RESULTS

The results showed that the barriers scale had satisfactory fit indices, and two factors were determined. The first included environment- and safety-related items (α=0.72), while the other concerned planning and psychosocial items (α=0.64). Active commuting to school showed significant correlations with the total score of the barriers scale (rho=-0.27; p <0.001), with the environmental/safety barriers (rho=-0.22; p <0.001), as well as with the planning/psychosocial barriers (rho=-0.29; p <0.001). Test-retest ICCs for the barriers ranged from 0.68 to 0.77.

CONCLUSION

The developed scale has acceptable validity and good reliability to assess barriers to active commuting to school among Spanish young people.

Association of Sociodemographic and Perceived Environmental Factors with Public Bicycle Use among Taiwanese Urban Adults

Background: This study examined the sociodemographic and perceived environmental factors associated with public bicycle use among Taiwanese urban adults. Methods: A random-digit-dialing telephone-based cross-sectional survey was administered to Taiwanese urban adults aged 20–64 years in 2015. Data on sociodemographic variables, perceived environmental factors (for attributes identified in the International Physical Activity Questionnaire-Environmental Module), and public bicycle use were obtained from 1002 adults in three cities. Adjusted logistic regression was used. Results: After adjustment for potential confounders, the results showed that adults aged 20–29 years (odds ratio (OR) = 4.42) with a university degree or higher (OR = 2.03) were more likely to use public bicycles. In addition, adults living in Kaohsiung City were less likely to use public bicycles (OR = 0.24). Adults who saw people being active (OR = 1.76; 95% CI: 1.05–2.86) and had positive aesthetic experiences of their environment (OR = 1.69) were more likely to use public bicycles. Conclusions: Our findings suggest that seeing physically active people and positive aesthetic perceptions of the environment are key factors for developing transportation policies and intervention strategies for promoting public bicycle use among Taiwanese urban adults.