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Levinger P, Fearn M, Dreher B, Bauman A, Brusco NK, Gilbert A, Soh SE, Burton E, James L, Hill KD. The ENJOY Seniors Exercise Park IMP-ACT project: IMProving older people's health through physical ACTivity: a hybrid II implementation design study protocol. Arch Public Health 2024; 82:43. [PMID: 38532524 DOI: 10.1186/s13690-024-01262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION The health benefits of physical activity are well established; however, most older people are not sufficiently physically active. Despite the availability of various physical activity interventions and programs, implementation of effective prevention strategies to reduce older people's physical inactivity are lacking. The ENJOY IMP-ACT project is an implementation research project, based on a previous evidence-based physical and social activity program utilising specialised outdoor exercise equipment (the Seniors Exercise Park) for older people. The ENJOY IMP-ACT aims to increase participation in physical activity to improve health outcomes for older people in Victoria, Australia. METHOD The ENJOY IMP-ACT is a hybrid II implementation-effectiveness pre-post mixed method study design. Five local governments (6 public sites/parks) will undergo a 3-month control period followed by 9-months implementation intervention (TERM framework intervention: Training, Engagement, Resources development, Marketing and promotion), and a maintenance phase (3 months). Various methodologies will be employed throughout the project at each site and will include direct observations of park users, intercept surveys with park users, online access monitor platform (using an online app), interviews with stakeholders and exercise program leaders, a process evaluation of physical activity programs, a social return-on-investment analysis, and other related activities. DISCUSSION Through the implementation framework design, the ENJOY IMP-ACT is uniquely placed to translate an evidenced-based physical and social activity program into real world settings and increase physical activity among older people. If successful, this program will inform scale up across Australia with the goal of improving the health and wellbeing of older people. TRIAL REGISTRATION This registration trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial number ACTRN12622001256763 . Date registered 20/09/2022.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
| | - Marcia Fearn
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Bronwyn Dreher
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Adrian Bauman
- School of Public Health, and the Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
| | - Andrew Gilbert
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
- Department of Social Inquiry, La Trobe University, Melbourne, Australia
| | - Sze-Ee Soh
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lisa James
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
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AlMarzooqi MA, Alsukait RF, Aljuraiban GS, Alothman SA, AlAhmed R, Rakic S, Herbst CH, Al-Hazzaa HM, Alqahtani SA. Comprehensive assessment of physical activity policies and initiatives in Saudi Arabia 2016-2022. Front Public Health 2023; 11:1236287. [PMID: 37614443 PMCID: PMC10443594 DOI: 10.3389/fpubh.2023.1236287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 08/25/2023] Open
Abstract
Objective This study aimed to review health-enhancing physical activity (HEPA) policies and initiatives introduced in Saudi Arabia (SA) since 2016 and identify the gaps in their design and implementation. Methods A combination of methods was used, including semi-structured interviews with key informants from relevant entities (such as those from the ministries of health, education, sports, tourism, and other regulatory bodies) and a review of policy/initiative documents provided by them. Stakeholder mapping led by local experts and snowball sampling supported the identification of key informants. Three existing frameworks-the World Health Organization's HEPA Policy Audit Tool, the Global Observatory for Physical Activity (PA) Policy Inventory, and the European Monitoring Framework for PA Indicators-were used to develop data collection instruments. Results The review identified 44 policies/initiatives from different sectors. The Saudi Sports for All Federation is the leader in PA promotion and community sports development. However, there is a lack of multisectoral agenda and governance structures for PA promotion. The overlap between initiatives by different key informants results in duplication of efforts, including initiatives to promote PA among the general public led by competitive professional sports and community-based sports. Conclusion The study findings indicate that several policies/initiatives have been implemented in SA since 2016. However, there is a need to focus on the challenges or barriers that affect the sustainability of policies/initiatives. A system-based approach can help build on sectoral synergies, thereby accelerating progress in engaging the Saudi population with PA.
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Affiliation(s)
- Mezna A. AlMarzooqi
- Leaders Development Institute, Ministry of Sport, Riyadh, Saudi Arabia
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Reem F. Alsukait
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- World Bank Group, Washington, DC, United States
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- World Bank Group, Washington, DC, United States
| | - Shaima A. Alothman
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reem AlAhmed
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Hazzaa M. Al-Hazzaa
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Saleh A. Alqahtani
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, United States
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The effects of metro interventions on physical activity and walking among older adults: A natural experiment in Hong Kong. Health Place 2022; 78:102939. [DOI: 10.1016/j.healthplace.2022.102939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
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Connell H, Logan G, Somers C, Baker G, Broadfield S, Bunn C, Harper LD, Kelly P, McIntosh E, Pell JP, Puttnam J, Robson S, Gill JMR, Gray CM. Development and optimisation of a multi-component workplace intervention to increase cycling for the Cycle Nation Project. Front Sports Act Living 2022; 4:857554. [PMID: 36385778 PMCID: PMC9643150 DOI: 10.3389/fspor.2022.857554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
The Cycle Nation Project (CNP) aimed to develop, test the feasibility of and optimize a multi-component individual-/social-level workplace-based intervention to increase cycling among office staff at a multinational bank (HSBC UK). To do this, we first explored barriers to cycling in a nationally-representative survey of UK adults, then undertook focus groups with bank employees to understand any context-specific barriers and ways in which these might be overcome. These activities led to identification of 10 individual-level, two social-level, and five organizational-level modifiable factors, which were mapped to candidate intervention components previously identified in a scoping review of cycling initiatives. Interviews with HSBC UK managers then explored the practicality of implementing the candidate intervention components in bank offices. The resultant pilot CNP intervention included 32 core components across six intervention functions (education, persuasion, incentivisation, training, environmental restructuring, enablement). Participants received a loan bike for 12-weeks (or their own bike serviced), and a 9-week cycle training course (condensed to 6 weeks for those already confident in basic cycling skills), including interactive information sharing activities, behavior change techniques (e.g., weekly goal setting), bike maintenance training, practical off-road cycling skill games and on-road group rides. Sessions were delivered by trained bank staff members who were experienced cyclists. The CNP pilot intervention was delivered across three sites with 68 participants. It was completed in two sites (the third site was stopped due to COVID-19) and was feasible and acceptable to both women and men and across different ethnicities. In addition, the CNP intervention was successful (at least in the short term) in increasing cycling by 3 rides/week on average, and improving perceptions of safety, vitality, confidence, and motivation to cycle. Following minor modifications, the long-term effectiveness and cost-effectiveness of the CNP intervention should be tested in a full-scale randomized controlled trial.
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Affiliation(s)
- Hayley Connell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Greig Logan
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Camilla Somers
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Graham Baker
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Christopher Bunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Emma McIntosh
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Jason M. R. Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- *Correspondence: Jason M. R. Gill
| | - Cindy M. Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Cindy M. Gray
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Jepson R, Baker G, Cleland C, Cope A, Craig N, Foster C, Hunter R, Kee F, Kelly MP, Kelly P, Milton K, Nightingale G, Turner K, Williams AJ, Woodcock J. Developing and implementing 20-mph speed limits in Edinburgh and Belfast: mixed-methods study. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/xazi9445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Transport initiatives such as 20-mph (≈30-km/h) speed limits are anticipated to result in fewer road casualties and improve perceptions of safety, leading to increases in active travel. Lower speeds may also lead to more pleasant environments in which to live, work and play.
Objectives
The main objective was to evaluate and understand the processes and effects of developing and implementing 20-mph speed limits in Edinburgh and Belfast. The focus was on health-related outcomes (casualties and active travel) that may lead to public health improvements. An additional objective was to investigate the political and policy factors (conditions) that led to the decision to introduce the new speed limits.
Design
This was a mixed-methods study that comprised an outcome, process, policy and economic evaluation of two natural experiments.
Setting
The study was set in Edinburgh, Scotland, and Belfast, Northern Ireland, from 2000 to 2018.
Participants
The whole population of each city were participants, as well as stakeholders involved in implementation and decision-making processes.
Intervention
The intervention was the implementation of 20-mph legislation, signage, enforcement, and education and awareness-raising in Edinburgh (citywide) and Belfast (city centre).
Main outcome measures
The main outcomes measured were speed; number, type and severity of road collisions; perceptions; and liveability.
Data sources
The following data sources were used – routinely and locally collected quantitative data for speed, volume of traffic, casualties and collisions, and costs; documents and print media; surveys; interviews and focus groups; and Google Street View (Google Inc., Mountain View, CA, USA).
Results
Collisions and casualties – the overall percentage reduction in casualty rates was 39% (the overall percentage reduction in collision rates was 40%) in Edinburgh. The percentage reduction for each level of severity was 23% for fatal casualties, 33% for serious casualties and 37% for minor casualties. In Belfast there was a 2% reduction in casualties, reflecting differences in the size, reach and implementation of the two schemes. Perceptions – in Edinburgh there was an increase in two factors (support for 20 mph and rule-following after implementation) supported by the qualitative data. Liveability – for both cities, there was a small statistical increase in liveability. Speed – mean and median speeds reduced by 1.34 mph and 0.47 mph, respectively, at 12 months in Edinburgh, with no statistically significant changes in Belfast. History, political context, local policy goals, local priorities and leadership influenced decision-making and implementation in the two cities.
Limitations
There was no analysis of active travel outcomes because the available data were not suitable.
Conclusions
The pre-implementation period is important. It helps frame public and political attitudes. The scale of implementation and additional activities in the two cities had a bearing on the impacts. The citywide approach adopted by Edinburgh was effective in reducing speeds and positively affected a range of public health outcomes. The city-centre approach in Belfast (where speeds were already low) was less effective. However, the main outcome of these schemes was a reduction in road casualties at all levels of severity.
Future work
Future work should develop a statistical approach to public health interventions that incorporates variables from multiple outcomes. In this study, each outcome was analysed independently of each other. Furthermore, population measures of active travel that can be administered simply, inexpensively and at scale should be developed.
Study registration
This study is registered as ISRCTN10200526.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Graham Baker
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Claire Cleland
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | | | | | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Ruth Hunter
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Frank Kee
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Glenna Nightingale
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Kieran Turner
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | | | - James Woodcock
- Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
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Christofoletti M, Streit IA, Garcia LMT, Mendonça G, Benedetti TRB, Papini CB, Borges LJ, Binotto MA, Silva-Júnior FLE. Barriers and facilitators for physical activity domains in Brazil: a systematic review. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022279.04902022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This study aimed to systematically review scientific evidence on the barriers and facilitators of physical activity (PA) among the Brazilian population, considering different domains (leisure, travel, work/study, and household). The search was conducted in the MEDLINE/PubMed, ISI Web of Science, SCOPUS, BIREME/LILACS, and APA PsycNET databases and was limited to papers published between 2010 and 2020. A manual search of the Brazilian Journal of Physical Activity & Health was also conducted. The selection process consisted of screening titles and abstracts, followed by the analysis of full texts. Each paper was assessed by two independent reviewers, and when discrepancies arose, a third reviewer was consulted. Leisure, environmental barriers and facilitators were the most investigated domains in the 78 included studies. There was consistency in the positive associations between six different intrapersonal and social facilitators for leisure PA and one environmental factor for travel. There have been a small number of investigations on the work/study and household domains, and future investigations on intrapersonal and social barriers and facilitators in the travel domain are important.
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Christofoletti M, Streit IA, Garcia LMT, Mendonça G, Benedetti TRB, Papini CB, Borges LJ, Binotto MA, Silva-Júnior FLE. Barriers and facilitators for physical activity domains in Brazil: a systematic review. CIENCIA & SAUDE COLETIVA 2022; 27:3487-3502. [PMID: 36000639 DOI: 10.1590/1413-81232022279.04902022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
This study aimed to systematically review scientific evidence on the barriers and facilitators of physical activity (PA) among the Brazilian population, considering different domains (leisure, travel, work/study, and household). The search was conducted in the MEDLINE/PubMed, ISI Web of Science, SCOPUS, BIREME/LILACS, and APA PsycNET databases and was limited to papers published between 2010 and 2020. A manual search of the Brazilian Journal of Physical Activity & Health was also conducted. The selection process consisted of screening titles and abstracts, followed by the analysis of full texts. Each paper was assessed by two independent reviewers, and when discrepancies arose, a third reviewer was consulted. Leisure, environmental barriers and facilitators were the most investigated domains in the 78 included studies. There was consistency in the positive associations between six different intrapersonal and social facilitators for leisure PA and one environmental factor for travel. There have been a small number of investigations on the work/study and household domains, and future investigations on intrapersonal and social barriers and facilitators in the travel domain are important.
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Affiliation(s)
- Marina Christofoletti
- Departamento de Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Inês Amanda Streit
- Faculdade de Educação Física e Fisioterapia. Universidade Federal do Amazonas. Manaus AM Brasil
| | | | - Gerfeson Mendonça
- Instituto de Educação Física e Esporte, Universidade Federal de Alagoas. Curso de Educação Física, Centro Universitário CESMAC. Maceió AL Brasil
| | - Tânia Rosane Bertoldo Benedetti
- Departamento de Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Camila Bosquiero Papini
- Departamento de Ciências do Esporte, Universidade Federal do Triângulo Mineiro. Uberaba MG Brasil
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Assessing the Impact of Park Renovations on Cultural Ecosystem Services. LAND 2022. [DOI: 10.3390/land11050610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Urban parks are essential in enhancing the quality of city life by providing diverse cultural ecosystem services (CES). Despite considerable investments in park renovations, there is very little evidence about whether park renovations can properly secure CES. This study provides a basis for the incorporation of CES evaluation into urban park practice to maximize CES. We specifically ask how CES are influenced by park renovations. We developed a participatory mapping approach by asking people to assess CES on a current map and on a historical map, representing the situations before and after the renovation, instead of doing a follow-up study, in order to be more time-efficient and enhance the comparative effects. The results show that the park renovations had different impacts on CES and not all the renovations had positive impacts. This study has a huge potential for supporting park practice. First, this study shows that specific park renovations can be used to guide park management to enhance CES. Second, this study provides a new insight for landscape architects to rethink their design proposals before construction. Third, the study encourages the method of combining participatory mapping and interviews to link CES to a specific location and specific renovations.
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"Getting Ireland Active"-Application of a Systems Approach to Increase Physical Activity in Ireland Using the GAPPA Framework. J Phys Act Health 2021; 18:1427-1436. [PMID: 34583322 DOI: 10.1123/jpah.2020-0864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/15/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022]
Abstract
Physical activity (PA) promotion is a complex challenge, with the Global Action Plan on Physical Activity (GAPPA) endorsing a systems approach and recommending countries assess existing areas of progress which can be strengthened. This paper reports a process facilitating a systems approach for identifying current good practice and gaps for promoting PA in Ireland. Elements of participatory action research were enabled through 3 stages: (1) aligning examples of actions from Irish policy documents (n = 3) to the GAPPA, (2) workshop with stakeholders across multiple sectors, and (3) review of outputs. Data collected through the workshop were analyzed using a deductive thematic analysis guided by the GAPPA. The policy context in Ireland aligns closely to the GAPPA with the creation of Active Systems the most common strategic objective across policy documents. Forty participants (50% male) took part in the systems approach workshop, which after revision resulted in 80 examples of good practice and 121 actions for greater impact. A pragmatic and replicable process facilitating a systems approach was adopted and showed current Irish policy and practices align with the GAPPA "good practices." The process provides existing areas of progress which can be strengthened, as well as the policy opportunities and practice gaps.
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Milton K, Kelly MP, Baker G, Cleland C, Cope A, Craig N, Foster C, Hunter R, Kee F, Kelly P, Nightingale G, Turner K, Williams AJ, Woodcock J, Jepson R. Use of natural experimental studies to evaluate 20mph speed limits in two major UK cities. JOURNAL OF TRANSPORT & HEALTH 2021; 22:101141. [PMID: 34603959 PMCID: PMC8463832 DOI: 10.1016/j.jth.2021.101141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Reductions in traffic speed can potentially offer multiple health and public health benefits. In 2016, implementation of 20mph (30kph) speed limit interventions began in Edinburgh (city-wide) and Belfast (city centre). The aims of this paper are to describe 1) the broad theoretical approach and design of two natural experimental studies to evaluate the 20mph speed limits in Edinburgh and Belfast and 2) how these studies allowed us to test and explore theoretical mechanisms of 20mph speed limit interventions. METHODS The evaluation consisted of several work packages, each with different research foci, including the political decision-making processes that led to the schemes, their implementation processes, outcomes (including traffic speed, perceptions of safety, and casualties) and cost effectiveness. We used a combination of routinely and locally collected quantitative data and primary quantitative and qualitative data. RESULTS The evaluation identified many contextual factors influencing the likelihood of 20mph speed limits reaching the political agenda. There were substantial differences between the two sites in several aspects related to implementation. Reductions in speed resulted in significant reductions in collisions and casualties, particularly in Edinburgh, which had higher average speed at baseline. The monetary value of collisions and casualties prevented are likely to exceed the costs of the intervention and thus the overall balance of costs and benefits is likely to be favourable. CONCLUSIONS Innovative study designs, including natural experiments, are important for assessing the impact of 'real world' public health interventions. Using multiple methods, this project enabled a deeper understanding of not only the effects of the intervention but the factors that explain how and why the intervention and the effects did or did not occur. Importantly it has shown that 20mph speed limits can lead to reductions in speed, collisions and casualties, and are therefore an effective public health intervention.
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Affiliation(s)
- Karen Milton
- Norwich Medical School, University of East Anglia, UK
| | - Michael P. Kelly
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK
| | - Graham Baker
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, UK
| | - Claire Cleland
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, UK
| | | | | | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, UK
| | - Ruth Hunter
- Centre for Public Health, Queen's University Belfast, UK
| | - Frank Kee
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, UK
| | - Glenna Nightingale
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, UK
| | - Kieran Turner
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, UK
| | - Andrew J. Williams
- Division of Population and Behavioural Science, School of Medicine, University of St Andrews, UK
| | - James Woodcock
- Centre for Diet and Activity Research, University of Cambridge, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, UK
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Le Gouais A, Foley L, Ogilvie D, Panter J, Guell C. Sharing believable stories: A qualitative study exploring the relevance of case studies for influencing the creation of healthy environments. Health Place 2021; 71:102615. [PMID: 34320460 PMCID: PMC8520914 DOI: 10.1016/j.healthplace.2021.102615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/10/2021] [Accepted: 06/19/2021] [Indexed: 02/02/2023]
Abstract
Case study examples can inform policy recommendations and action to create healthy environments. This qualitative study, using semi-structured interviews with nine cross-sectoral stakeholders in England, explored the role of context in case study examples. We found that case studies can not only be a 'practical example' but also used as a 'believable story' with the power to influence decision-making. Case studies may be deemed believable if similar and locally relevant, but judgements can be inherently political and politicised. Metrics used to measure case study outcomes can differ in believability. Storytellers who understand different audiences can be used to build support.
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Affiliation(s)
- Anna Le Gouais
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK,Corresponding author. Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - Louise Foley
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - David Ogilvie
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Jenna Panter
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), School of Clinical Medicine, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, TR1 3HD, UK
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Levinger P, Dunn J, Panisset M, Dow B, Batchelor F, Biddle SJH, Duque G, Hill KD. Challenges and lessons learnt from the ENJOY project: recommendations for future collaborative research implementation framework with local governments for improving the environment to promote physical activity for older people. BMC Public Health 2021; 21:1192. [PMID: 34157995 PMCID: PMC8218291 DOI: 10.1186/s12889-021-11224-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The physical environment has been shown to have a positive effect on the promotion of physical activity of older people. Outdoor environments that incorporate specialised exercise equipment suitable for older people are uniquely placed to promote physical activity and social connectedness amongst older people. The ENJOY project included the installation of specialised outdoor exercise equipment (the Seniors Exercise Park) and the delivery of a physical and social activity program for older people as part of a prospective pre-post research design. The installation of the specialised equipment in public sites and an aged care facility was also aimed at increasing usage of the equipment by older people from the wider community and to increase physical and social activities. METHOD A conceptual framework for implementation and several engagement methods were utilised to guide the research and to support the participating partners throughout the project. This paper is a reflective narrative describing the collaborative process and approach utilised to engage local governments and community, and reports the challenges and the lessons learnt to inform future strategies for implementation. RESULTS The conceptual framework for the implementation process that guided the conduct and delivery of the ENJOY project included the core elements of the Interactive Systems Framework and the ecologic framework. These models incorporate elements of research-to-practice and community-centred implementation to accommodate the unique perspectives of a range of stakeholders. CONCLUSION Partner characteristics such as local governments' structure and policy as well as community factors can impact on implementation. Partnership with local governments with effective communication, strategic planning and community and seniors engagement approaches are recommended for successful implementation. The lessons learnt can further assist public health research design around changes to the built environment to positively impact on older people's physical activity levels. TRIAL REGISTRATION Trial registration number ACTRN12618001727235. Date of registration 19th October 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375979.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia.
| | - Jeremy Dunn
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
| | - Maya Panisset
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
| | - Briony Dow
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Deakin University, Waurn Ponds, Australia
| | - Frances Batchelor
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
- School of Nursing and Midwifery, Deakin University, Waurn Ponds, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
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Feil K, Allion S, Weyland S, Jekauc D. A Systematic Review Examining the Relationship Between Habit and Physical Activity Behavior in Longitudinal Studies. Front Psychol 2021; 12:626750. [PMID: 33746848 PMCID: PMC7969808 DOI: 10.3389/fpsyg.2021.626750] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: To explain physical activity behavior, social-cognitive theories were most commonly used in the past. Besides conscious processes, the approach of dual processes additionally incorporates non-conscious regulatory processes into physical activity behavior theories. Habits are one of various non-conscious variables that can influence behavior and thus play an important role in terms of behavior change. The aim of this review was to examine the relationship between habit strength and physical activity behavior in longitudinal studies. Methods: According to the PRISMA guidelines, a systematic search was conducted in three databases. Only peer-reviewed articles using a longitudinal study design were included. Both, habit and physical activity were measured at least once, and habit was related to physical activity behavior. Study quality was evaluated by assessment tools of the NHLBI. Results: Of 3.382 identified publications between 2016 and 2019, fifteen studies with different study designs were included. Most studies supported that positive correlations between habit and physical activity exist. Some positive direct and indirect effects of habit on physical activity were detected and only a minority of studies showed the influence of physical activity on habit strength. Studies differentiating between instigation and execution habit found positive correlations and revealed instigation habit as a stronger predictor of physical activity. The quality of studies was rated as reasonable using assessment tools of the NHLBI. Conclusion: This review revealed a bidirectional relationship between habit and physical activity. Whether habit predicts physical activity or vice versa is still unclear. The observation of habit influencing physical activity may be most appropriate in studies fostering physical activity maintenance while the influence of physical activity on habit may be reasonable in experimental studies with physical activity as intervention content to form a habit. Future investigations should differentiate between habit formation and physical activity maintenance studies depending on the research objective. Long-term study designs addressing the complexity of habitual behavior would be beneficial for establishing cue-behavior associations for the formation of habits. Furthermore, studies should differentiate between instigation and execution habit in order to investigate the influence of both variables on physical activity behavior independently.
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Affiliation(s)
- Katharina Feil
- Department of Health Education and Sport Psychology, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Sarah Allion
- Department of Health Education and Sport Psychology, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Susanne Weyland
- Department of Health Education and Sport Psychology, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Darko Jekauc
- Department of Health Education and Sport Psychology, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Uttley J, Fotios S, Lovelace R. Road lighting density and brightness linked with increased cycling rates after-dark. PLoS One 2020; 15:e0233105. [PMID: 32413065 PMCID: PMC7228109 DOI: 10.1371/journal.pone.0233105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/28/2020] [Indexed: 11/19/2022] Open
Abstract
Cycling has a range of benefits as is recognised by national and international policies aiming to increase cycling rates. Darkness acts as a barrier to people cycling, with fewer people cycling after-dark when seasonal and time-of-day factors are accounted for. This paper explores whether road lighting can reduce the negative impact of darkness on cycling rates. Changes in cycling rates between daylight and after-dark were quantified for 48 locations in Birmingham, United Kingdom, by calculating an odds ratio. These odds ratios were compared against two measures of road lighting at each location: 1) Density of road lighting lanterns; 2) Relative brightness as estimated from night-time aerial images. Locations with no road lighting showed a significantly greater reduction in cycling after-dark compared with locations that had some lighting. A nonlinear relationship was found between relative brightness at a location at night and the reduction in cyclists after-dark. Small initial increases in brightness resulted in large reductions in the difference between cyclist numbers in daylight and after-dark, but this effect reached a plateau as brightness increased. These results suggest only a minimal amount of lighting can promote cycling after-dark, making it an attractive mode of transport year-round.
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Affiliation(s)
- Jim Uttley
- School of Architecture, Arts Tower, University of Sheffield, Sheffield, England, United Kingdom
- * E-mail:
| | - Steve Fotios
- School of Architecture, Arts Tower, University of Sheffield, Sheffield, England, United Kingdom
| | - Robin Lovelace
- Institute for Transport Studies, University of Leeds, Leeds, England, United Kingdom
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STREB AR, MATIAS TS, LEONEL LDS, TOZETTO WR, VIEIRA CG, DEL DUCA GF. Association between physical inactivity in leisure, work, commuting, and household domains and nutritional status in adults in the capital cities of Brazil. REV NUTR 2019. [DOI: 10.1590/1678-9865201932e180276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Objective To investigate the association between different domains (leisure, work, commuting, and household) of physical activity, independent and cumulative, and excess weight and obesity in Brazilian adults. Methods This is a cross-sectional survey, conducted in 2015, through telephone interviews with a representative sample of adults from the capitals of Brazil. Physical inactivity was defined as non-participation in predefined physical activities for each assessed domain. Excess weight (Body Mass Index?25kg/m2) and obesity (Body Mass Index?30kg/m2) were determined from self-reported measurements of weight and height. A binary logistic regression was conducted after adjusting for sociodemographic factors. Results Among 54,174 subjects, physical inactivity in commuting (ORexcess weight=1.27, 95%CI=1.13,1.42 and ORobesity=1.25, 95%CI=1.06,1.47) and leisure (ORexcess weight=1.12, 95%CI=1.04,1.22 and ORobesity=1.30, 95%CI=1.17,1.45) domains were associated with nutritional status. In addition, a linear trend was observed between increasing obesity and cumulative physical inactivity of all four domains (p<0.001). Conclusion Cumulative physical inactivity, especially in the commuting and leisure domains, was associated with excess weight and obesity in adults living in the capitals of Brazil. One possible explanation of these findings is that these domains involve particularly longer duration and greater intensity of physical inactivity. Public policies concerning physical activity should prioritize actions focused in promoting physical activity on commuting and leisure-time to help prevent overweight and obesity in the Brazilian adult population.
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16
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The effect of infrastructural changes in the built environment on physical activity, active transportation and sedentary behavior – A systematic review. Health Place 2018; 53:135-149. [DOI: 10.1016/j.healthplace.2018.08.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/24/2018] [Accepted: 08/03/2018] [Indexed: 11/21/2022]
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17
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Macmillan AK, Mackie H, Hosking JE, Witten K, Smith M, Field A, Woodward A, Hoskins R, Stewart J, van der Werf B, Baas P. Controlled before-after intervention study of suburb-wide street changes to increase walking and cycling: Te Ara Mua-Future Streets study design. BMC Public Health 2018; 18:850. [PMID: 29986679 PMCID: PMC6038249 DOI: 10.1186/s12889-018-5758-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- A. K. Macmillan
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick St, Dunedin, 9054 New Zealand
| | - H. Mackie
- Mackie Research, Ltd, Auckland, New Zealand
| | - J. E. Hosking
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - K. Witten
- SHORE Whariki, Massey University, Auckland, New Zealand
| | - M. Smith
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - A. Field
- Dovetail Research Ltd, Auckland, New Zealand
| | - A. Woodward
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - R. Hoskins
- DesignTribe Architects, Auckland, New Zealand
| | - J. Stewart
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - B. van der Werf
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - P. Baas
- TERNZ Transport Research, Auckland, New Zealand
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Abstract
PURPOSE OF REVIEW While many levels of government recognize that walking and cycling (active travel) are critical to healthy cities, a continued challenge is to identify and prioritize strategies that will increase walking and cycling for transportation. We review evidence on policies that can increase active travel. RECENT FINDINGS The reviews included here conclude that policies related to active travel may operate at various levels of the socio-ecological framework, including society, cities, routes or individuals. The provision of convenient, safe and connected walking and cycling infrastructure is at the core of promoting active travel, but policies may work best when implemented in comprehensive packages. There is strong evidence that active travel can result in substantial health benefits. However, there remains considerable uncertainty about the exact effects of specific policies on walking or cycling rates or safety. Further research is needed to quantify the impact of specific policies or packages of policies, especially across different settings or for different population segments.
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Roberts JD, Hu M, Saksvig BI, Brachman ML, Durand CP. Examining the Influence of a New Light Rail Line on the Health of a Demographically Diverse and Understudied Population within the Washington, D.C. Metropolitan Area: A Protocol for a Natural Experiment Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020333. [PMID: 30720773 PMCID: PMC5858402 DOI: 10.3390/ijerph15020333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 01/26/2018] [Accepted: 02/09/2018] [Indexed: 01/23/2023]
Abstract
Approximately two-thirds of adults and youth in Prince George's County, Maryland, a suburb of Washington, D.C. are overweight or obese and less than half are achieving daily physical activity recommendations. Active transportation (AT), such as walking, biking or using public transportation (PT), is a strategic pathway to improving physical activity levels and thus reducing excess weight. Utilizing an expansion of the Washington, D.C. area transportation system with a new light rail line, the Purple Line Outcomes on Transportation (PLOT) Study will exam pre- and post-Purple Line PT use, AT behaviors and attitudes and physical activity among Prince George's County adults and youth. The PLOT Study will take advantage of this natural experiment in an area enduring significant racial/ethnic and gender-based overweight or obesity and physical inactivity disparities. While similar natural experiments on AT have been conducted in other U.S. cities, those studies lacked diverse and representative samples. To effectively evaluate these physical activity outcomes among this population, efforts will be used to recruit African American and Latino populations, the first and second most common racial/ethnic groups in Prince George's County. Finally, the PLOT Study will also examine how contextual effects (e.g., neighborhood built environment) impact PT, AT and physical activity.
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Affiliation(s)
- Jennifer D Roberts
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD 20742, USA.
| | - Ming Hu
- School of Architecture, Planning & Preservation, University of Maryland, College Park, MD 20742, USA.
| | - Brit Irene Saksvig
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD 20742, USA.
| | - Micah L Brachman
- Center for Geospatial Information Science, Department of Geographical Sciences, University of Maryland, College Park, MD 20742, USA.
| | - Casey P Durand
- Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Sciences Center, Houston, TX 77030, USA.
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20
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MacMillan F, George ES, Feng X, Merom D, Bennie A, Cook A, Sanders T, Dwyer G, Pang B, Guagliano JM, Kolt GS, Astell-Burt T. Do Natural Experiments of Changes in Neighborhood Built Environment Impact Physical Activity and Diet? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E217. [PMID: 29373567 PMCID: PMC5858286 DOI: 10.3390/ijerph15020217] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Freya MacMillan
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Emma S George
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia.
| | - Dafna Merom
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Andrew Bennie
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Amelia Cook
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Taren Sanders
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW 2060, Australia.
| | - Genevieve Dwyer
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Bonnie Pang
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Justin M Guagliano
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Gregory S Kolt
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia.
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21
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Veitch J, Salmon J, Crawford D, Abbott G, Giles-Corti B, Carver A, Timperio A. The REVAMP natural experiment study: the impact of a play-scape installation on park visitation and park-based physical activity. Int J Behav Nutr Phys Act 2018; 15:10. [PMID: 29368610 PMCID: PMC5784649 DOI: 10.1186/s12966-017-0625-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 12/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Designing parks that optimise visitation and support visitors to be active is important for public health. Yet there is very little evidence about whether playground refurbishment achieves these objectives. This study examined the impact of the installation of a play-scape in a large metropolitan park in Melbourne, Australia. METHODS Natural experiment study (intervention vs control). At both parks, park visitation and physical activity were assessed before (T1, 2013) and after the intervention at 12 (T2, 2014) and 24 months (T3, 2015). At each time point, measures included: observations of park visitors using the System for Observing Play and Recreation in Communities on four weekdays and four weekend days, objective monitors to record usage of the walking paths and the number of cars entering the park; and intercept surveys with adult park visitors. Cross-sectional surveys were conducted with local residents at T1 and T3. RESULTS The observational data showed a 176% increase in park visitor counts from T1 to T2 (Incidence Rate Ratio (IRR) = 2.76, 95% CI = 1.04-7.33), at the intervention park relative to the control park. The intervention park had a 119% increase in counts of visitors observed engaging in MVPA from T1 to T2 (IRR = 2.19, 95% CI = 1.14-4.20), and a 128% increase from T1 to T3 (IRR = 2.28, 95% CI = 1.19-4.38), relative to the control park. The relative increases in visitation at the intervention park play-scape compared with the control park playground were highly statistically significant from both T1 to T2 (IRR = 18.12, 95% CI = 5.51-59.59) and T1 to T3 (IRR = 15.05, 95% CI = 4.61-49.16). Similarly, there was a significant interaction between time and park with regard to the number of visitors observed engaging in MVPA in the play-scape/playground areas. The intercept survey data showed an increased odds of children's regular visitation to the intervention park at T2 (OR = 2.67, 95% CI = 1.08, 6.64), compared with T1, relative to the control park. The remaining results from the intercept survey, objective monitors and resident surveys showed no significant differences in visitation between the two parks. CONCLUSIONS These findings confirm that a well-designed play-scape installation has the potential to increase park visitation and encourage visitors to be physically active. TRIAL REGISTRATION Current controlled trial ISRCTN50745547 .
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Affiliation(s)
- Jenny Veitch
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - David Crawford
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | | | - Alison Carver
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Götschi T, de Nazelle A, Brand C, Gerike R. Towards a Comprehensive Conceptual Framework of Active Travel Behavior: a Review and Synthesis of Published Frameworks. Curr Environ Health Rep 2017; 4:286-295. [PMID: 28707281 PMCID: PMC5591356 DOI: 10.1007/s40572-017-0149-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW This paper reviews the use of conceptual frameworks in research on active travel, such as walking and cycling. Generic framework features and a wide range of contents are identified and synthesized into a comprehensive framework of active travel behavior, as part of the Physical Activity through Sustainable Transport Approaches project (PASTA). PASTA is a European multinational, interdisciplinary research project on active travel and health. RECENT FINDINGS Along with an exponential growth in active travel research, a growing number of conceptual frameworks has been published since the early 2000s. Earlier frameworks are simpler and emphasize the distinction of environmental vs. individual factors, while more recently several studies have integrated travel behavior theories more thoroughly. Based on the reviewed frameworks and various behavioral theories, we propose the comprehensive PASTA conceptual framework of active travel behavior. We discuss how it can guide future research, such as data collection, data analysis, and modeling of active travel behavior, and present some examples from the PASTA project.
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Affiliation(s)
- Thomas Götschi
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Audrey de Nazelle
- Centre for Environmental Policy, Imperial College London, London, UK
| | | | - Regine Gerike
- Institute of Transport Planning and Road Traffic, Technische Universität Dresden, Dresden, Germany
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Panter J, Ogilvie D. Can environmental improvement change the population distribution of walking? J Epidemiol Community Health 2017; 71:528-535. [PMID: 28270502 PMCID: PMC5484036 DOI: 10.1136/jech-2016-208417] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have explored the impact of environmental change on walking using controlled comparisons. Even fewer have examined whose behaviour changes and how. In a natural experimental study of new walking and cycling infrastructure, we explored changes in walking, identified groups who changed in similar ways and assessed whether exposure to the infrastructure was associated with trajectories of walking. METHODS 1257 adults completed annual surveys assessing walking, sociodemographic and health characteristics and use of the infrastructure (2010-2012). Residential proximity to the new routes was assessed objectively. We used latent growth curve models to assess change in total walking, walking for recreation and for transport, used simple descriptive analysis and latent class analysis (LCA) to identify groups who changed in similar ways and examined factors associated with group membership using multinomial regression. RESULTS LCA identified five trajectories, characterised by consistently low levels; consistently high levels; decreases; short-lived increases; and sustained increases. Those with lower levels of education and lower incomes were more likely to show both short-lived and sustained increases in walking for transport. However, those with lower levels of education were less likely to take up walking. Proximity to the intervention was associated with both uptake of and short-lived increases in walking for transport. CONCLUSIONS Environmental improvement encouraged the less active to take up walking for transport, as well as encouraging those who were already active to walk more. Further research should disentangle the role of socioeconomic characteristics in determining use of new environments and changes in walking.
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Affiliation(s)
- Jenna Panter
- Department of Medicine, MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical, University of Cambridge, Cambridge, UK
| | - David Ogilvie
- Department of Medicine, MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), School of Clinical, University of Cambridge, Cambridge, UK
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Veitch J, Salmon J, Giles-Corti B, Crawford D, Dullaghan K, Carver A, Timperio A. Challenges in conducting natural experiments in parks-lessons from the REVAMP study. Int J Behav Nutr Phys Act 2017; 14:5. [PMID: 28095861 PMCID: PMC5240380 DOI: 10.1186/s12966-016-0460-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022] Open
Abstract
Experimental evidence on the role of the built environment for promoting physical activity is important for informing how to create cities that promote active living. Parks provide opportunities for physical activity; however, there is little robust evidence on the impact of park refurbishment. Government agencies often modify parks, providing opportunities for natural experiment studies of these interventions. Such an opportunity was provided by the modification of a large park in Victoria, Australia in 2013 when the Recording and EValuating Activity in a Modified Park (REVAMP) study was established. Based on insights from the REVAMP study, this paper discusses challenges involved in conducting natural experiments in park settings, focussing on issues that may help design more effective future evaluations of the impact of park refurbishment. Natural experiments offer unique opportunities to evaluate the impact of large-scale changes to the built environment. They provide valuable data that might not otherwise be possible to gather, because of the costs associated with modification of the environment. However, factors beyond the control of the study team contribute to the complexity of both organising and conducting natural experiments, with potential flow-on effects to the quality of data. Therefore many extraneous factors need to be considered when designing, costing and conducting natural experiments; studies should identify opportunities to include key partners from the inception of the project, be flexible yet robust, and allow sufficient funding to accommodate unexpected changes in the research protocol. TRIAL REGISTRATION Current controlled trial ISRCTN50745547 , registration date 11.1.2014.
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Affiliation(s)
- Jenny Veitch
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia.
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Billie Giles-Corti
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - David Crawford
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Kate Dullaghan
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Alison Carver
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
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Hess F, Salze P, Weber C, Feuillet T, Charreire H, Menai M, Perchoux C, Nazare JA, Simon C, Oppert JM, Enaux C. Active Mobility and Environment: A Pilot Qualitative Study for the Design of a New Questionnaire. PLoS One 2017; 12:e0168986. [PMID: 28052086 PMCID: PMC5215579 DOI: 10.1371/journal.pone.0168986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 12/09/2016] [Indexed: 11/18/2022] Open
Abstract
It is generally accepted that active mobility, mainly walking and cycling, contributes to people's physical and mental health. One of the current challenges is to improve our understanding of this type of behaviour. This study aims to identify factors from the daily-life environment that may be related to active mobility behaviours, in order to design a new questionnaire for a quantitative study of a large adult population. The new questionnaire obtained through this pilot study combines information from interviews with existing questionnaires materials in order to introduce new factors while retaining the factors already assessed. This approach comprises three stages. The first was a content analysis (Reinert method) of interviews with a sample of participants about daily living activities as well as mobility. This stage led to a typology of factors suggested by interviews. The second was a scoping review of the literature in order to identify the active mobility questionnaires currently used in international literature. The last stage was a cross-tabulation of the factors resulting from the written interviews and the questionnaires. A table of the inter-relationships between the interview-based typology and the questionnaires shows discrepancies between factors considered by the existing questionnaires, and factors coming from individual interviews. Independent factors which were ignored in or absent from the questionnaires are the housing situation within the urban structure, overall consideration of the activity space beyond the limits of the residential neighbourhood, the perception of all the transportation modes, and the time scheduling impacting the modes actually used. Our new questionnaire integrates both the usual factors and the new factors that may be related to active mobility behaviours.
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Affiliation(s)
- Franck Hess
- Laboratoire Image, Ville, Environnement, Department of Geography, Strasbourg University, Strasbourg, France
- * E-mail:
| | - Paul Salze
- Laboratoire Image, Ville, Environnement, Department of Geography, Strasbourg University, Strasbourg, France
| | - Christiane Weber
- Laboratoire Image, Ville, Environnement, CNRS, Strasbourg, France
| | - Thierry Feuillet
- Paris 13 University, Sorbonne Paris Cité—Equipe de Recherche en Epidémiologie Nutritionnelle, U1153 Inserm, Inra, Cnam, Centre de Recherche en Epidémiologie et Biostatistiques; CRNH IdF, Bobigny, France
| | - Hélène Charreire
- Lab-Urba, Urbanism Institute of Paris, Department of Geography, Paris-Est Créteil University, Paris, France
| | - Mehdi Menai
- Paris 13 University, Sorbonne Paris Cité—Equipe de Recherche en Epidémiologie Nutritionnelle, U1153 Inserm, Inra, Cnam, Centre de Recherche en Epidémiologie et Biostatistiques; CRNH IdF, Bobigny, France
| | | | | | - Chantal Simon
- CARMEN, INSERM U1060/Lyon 1University/INRA U1235, Lyon, France
| | - Jean-Michel Oppert
- Paris 13 University, Sorbonne Paris Cité—Equipe de Recherche en Epidémiologie Nutritionnelle, U1153 Inserm, Inra, Cnam, Centre de Recherche en Epidémiologie et Biostatistiques; CRNH IdF, Bobigny, France
- Department of Nutrition, Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière Hospital (AP-HP), Pierre et Marie Curie University—Paris 6, Paris, France
| | - Christophe Enaux
- Laboratoire Image, Ville, Environnement, Department of Geography, Strasbourg University, Strasbourg, France
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Song Y, Preston J, Ogilvie D. New walking and cycling infrastructure and modal shift in the UK: A quasi-experimental panel study. TRANSPORTATION RESEARCH. PART A, POLICY AND PRACTICE 2017; 95:320-333. [PMID: 28163399 PMCID: PMC5270770 DOI: 10.1016/j.tra.2016.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Heavy dependency on car use leads to traffic congestion, pollution, and physical inactivity, which impose high direct and indirect costs on society. Promoting walking and cycling has been recognised as one of the means of mitigating such negative effects. Various approaches have been taken to enhance walking and cycling levels and to reduce the use of automobiles. This paper examines the effectiveness of infrastructure interventions in promoting walking and cycling for transport. Two related sets of panel data, covering elapsed time periods of one and two years, were analysed to track changes in travel behaviour following provision of new walking and cycling infrastructure so that modal shift from private car use to walking and cycling can be investigated. Two types of exposure measures were tested: distance from the infrastructure (a measure of potential usage), and actual usage of the infrastructure. Only the latter measure was statistically significantly associated with modal shift. This in turn suggested that infrastructure provision was not a sufficient condition for modal shift, but may have been a necessary condition. Along with the use of new infrastructure, the loss of employment, higher education, being male and being part of the ethnic majority were consistently found to be significantly and positively associated with modal shift towards walking and cycling. The findings of this study support the construction of walking and cycling routes, but also suggest that such infrastructure alone may not be enough to promote active travel.
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Affiliation(s)
- Yena Song
- Department of Geography, Chonnam National University, Gwangju 61186, South Korea
- Corresponding author.
| | - John Preston
- Transportation Research Group, Faculty of Engineering and the Environment, University of Southampton, Building 176, Bodlrewood, Southampton SO16 7QF, UK
| | - David Ogilvie
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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The effect of changing the built environment on physical activity: a quantitative review of the risk of bias in natural experiments. Int J Behav Nutr Phys Act 2016; 13:107. [PMID: 27717360 PMCID: PMC5055702 DOI: 10.1186/s12966-016-0433-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Evidence regarding the association of the built environment with physical activity is influencing policy recommendations that advocate changing the built environment to increase population-level physical activity. However, to date there has been no rigorous appraisal of the quality of the evidence on the effects of changing the built environment. The aim of this review was to conduct a thorough quantitative appraisal of the risk of bias present in those natural experiments with the strongest experimental designs for assessing the causal effects of the built environment on physical activity. Methods Eligible studies had to evaluate the effects of changing the built environment on physical activity, include at least one measurement before and one measurement of physical activity after changes in the environment, and have at least one intervention site and non-intervention comparison site. Given the large number of systematic reviews in this area, studies were identified from three exemplar systematic reviews; these were published in the past five years and were selected to provide a range of different built environment interventions. The risk of bias in these studies was analysed using the Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI). Results Twelve eligible natural experiments were identified. Risk of bias assessments were conducted for each physical activity outcome from all studies, resulting in a total of fifteen outcomes being analysed. Intervention sites included parks, urban greenways/trails, bicycle lanes, paths, vacant lots, and a senior citizen’s centre. All outcomes had an overall critical (n = 12) or serious (n = 3) risk of bias. Domains with the highest risk of bias were confounding (due to inadequate control sites and poor control of confounding variables), measurement of outcomes, and selection of the reported result. Conclusions The present review focused on the strongest natural experiments conducted to date. Given this, the failure of existing studies to adequately control for potential sources of bias highlights the need for more rigorous research to underpin policy recommendations for changing the built environment to increase physical activity. Suggestions are proposed for how future natural experiments in this area can be improved. Electronic supplementary material The online version of this article (doi:10.1186/s12966-016-0433-3) contains supplementary material, which is available to authorized users.
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Pilkington P, Powell J, Davis A. Evidence-Based Decision Making When Designing Environments for Physical Activity: The Role of Public Health. Sports Med 2016; 46:997-1002. [PMID: 26842016 PMCID: PMC4920850 DOI: 10.1007/s40279-015-0469-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The important role that the environment plays in health and well-being is widely accepted, as is the impact that the built and natural environment can have on levels of physical activity. As levels of physical activity are a key determinant of health, promoting physical activity through actions to improve the environment is a priority for public health action. The challenge for public health is to ensure that the way the environment is shaped and transformed by a range of professionals, organisations and agencies, maximises health gain in relation to health, including physical activity. This article discusses how the public health profession can and should contribute to generating and disseminating evidence to inform decision-making processes for designing environments to promote physical activity. There are significant challenges to building and applying the evidence base in this area. These include the complex environments in which interventions operate, disciplinary differences in approaches to evidence generation and use, and the fact that public health has little responsibility for environmental change. However, case studies of best practice, presented in the article, offer a snapshot of how challenges can be overcome, to build an accessible evidence base and help to improve the environment for the promotion of physical activity.
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Affiliation(s)
- Paul Pilkington
- Faculty of Health and Applied Sciences, Department of Health and Social Sciences, The University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK.
| | - Jane Powell
- Faculty of Health and Applied Sciences, Department of Health and Social Sciences, The University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Adrian Davis
- Strategic Transport Division, Bristol City Council, Brunel House, Bristol, BS1 5UY, UK
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Humphreys DK, Panter J, Sahlqvist S, Goodman A, Ogilvie D. Changing the environment to improve population health: a framework for considering exposure in natural experimental studies. J Epidemiol Community Health 2016; 70:941-6. [PMID: 27056683 PMCID: PMC5390281 DOI: 10.1136/jech-2015-206381] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 03/18/2016] [Indexed: 11/30/2022]
Abstract
There is renewed optimism regarding the use of natural experimental studies to generate evidence as to the effectiveness of population health interventions. Natural experimental studies capitalise on environmental and policy events that alter exposure to certain social, economic or environmental factors that influence health. Natural experimental studies can be useful for examining the impact of changes to ‘upstream’ determinants, which may not be amenable to controlled experiments. However, while natural experiments provide opportunities to generate evidence, they often present certain conceptual and methodological obstacles. Population health interventions that alter the physical or social environment are usually administered broadly across populations and communities. The breadth of these interventions means that variation in exposure, uptake and impact may be complex. Yet many evaluations of natural experiments focus narrowly on identifying suitable ‘exposed’ and ‘unexposed’ populations for comparison. In this paper, we discuss conceptual and analytical issues relating to defining and measuring exposure to interventions in this context, including how recent advances in technology may enable researchers to better understand the nature of population exposure to changes in the built environment. We argue that when it is unclear whether populations are exposed to an intervention, it may be advantageous to supplement traditional impact assessments with observational approaches that investigate differing levels of exposure. We suggest that an improved understanding of changes in exposure will assist the investigation of the impact of complex natural experiments in population health.
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Affiliation(s)
- David K Humphreys
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Jenna Panter
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Shannon Sahlqvist
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, University of Cambridge, Cambridge, UK Centre for Physical Activity and Nutrition Research (C-PAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Anna Goodman
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, University of Cambridge, Cambridge, UK Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - David Ogilvie
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, University of Cambridge, Cambridge, UK
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30
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Gerike R, de Nazelle A, Nieuwenhuijsen M, Panis LI, Anaya E, Avila-Palencia I, Boschetti F, Brand C, Cole-Hunter T, Dons E, Eriksson U, Gaupp-Berghausen M, Kahlmeier S, Laeremans M, Mueller N, Orjuela JP, Racioppi F, Raser E, Rojas-Rueda D, Schweizer C, Standaert A, Uhlmann T, Wegener S, Götschi T. Physical Activity through Sustainable Transport Approaches (PASTA): a study protocol for a multicentre project. BMJ Open 2016; 6:e009924. [PMID: 26743706 PMCID: PMC4716182 DOI: 10.1136/bmjopen-2015-009924] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Only one-third of the European population meets the minimum recommended levels of physical activity (PA). Physical inactivity is a major risk factor for non-communicable diseases. Walking and cycling for transport (active mobility, AM) are well suited to provide regular PA. The European research project Physical Activity through Sustainable Transport Approaches (PASTA) pursues the following aims: (1) to investigate correlates and interrelations of AM, PA, air pollution and crash risk; (2) to evaluate the effectiveness of selected interventions to promote AM; (3) to improve health impact assessment (HIA) of AM; (4) to foster the exchange between the disciplines of public health and transport planning, and between research and practice. METHODS AND ANALYSIS PASTA pursues a mixed-method and multilevel approach that is consistently applied in seven case study cities. Determinants of AM and the evaluation of measures to increase AM are investigated through a large scale longitudinal survey, with overall 14,000 respondents participating in Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich. Contextual factors are systematically gathered in each city. PASTA generates empirical findings to improve HIA for AM, for example, with estimates of crash risks, factors on AM-PA substitution and carbon emissions savings from mode shifts. Findings from PASTA will inform WHO's online Health Economic Assessment Tool on the health benefits from cycling and/or walking. The study's wide scope, the combination of qualitative and quantitative methods and health and transport methods, the innovative survey design, the general and city-specific analyses, and the transdisciplinary composition of the consortium and the wider network of partners promise highly relevant insights for research and practice. ETHICS AND DISSEMINATION Ethics approval has been obtained by the local ethics committees in the countries where the work is being conducted, and sent to the European Commission before the start of the survey. The PASTA website (http://www.pastaproject.eu) is at the core of all communication and dissemination activities.
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Affiliation(s)
- Regine Gerike
- University of Natural Resources and Life Sciences Vienna, Institute for Transport Studies, Vienna, Austria
- Dresden University of Technology, Chair of Integrated Transport Planning and Traffic Engineering, Dresden, Germany
| | - Audrey de Nazelle
- Centre for Environmental Policy, Imperial College London, London, UK
| | - Mark Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luc Int Panis
- Flemish Institute for Technological Research (VITO), Mol, Belgium
- Transportation Research Institute (IMOB), Hasselt University, Diepenbeek, Belgium
| | - Esther Anaya
- Centre for Environmental Policy, Imperial College London, London, UK
| | - Ione Avila-Palencia
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Christian Brand
- Transport Studies Unit, University of Oxford (UOXF), Oxford, UK
| | - Tom Cole-Hunter
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Evi Dons
- Flemish Institute for Technological Research (VITO), Mol, Belgium
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Mailin Gaupp-Berghausen
- University of Natural Resources and Life Sciences Vienna, Institute for Transport Studies, Vienna, Austria
| | - Sonja Kahlmeier
- Physical Activity and Health Unit, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Michelle Laeremans
- Flemish Institute for Technological Research (VITO), Mol, Belgium
- Transportation Research Institute (IMOB), Hasselt University, Diepenbeek, Belgium
| | - Natalie Mueller
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Francesca Racioppi
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Elisabeth Raser
- University of Natural Resources and Life Sciences Vienna, Institute for Transport Studies, Vienna, Austria
| | - David Rojas-Rueda
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Christian Schweizer
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Arnout Standaert
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Tina Uhlmann
- University of Natural Resources and Life Sciences Vienna, Institute for Transport Studies, Vienna, Austria
| | - Sandra Wegener
- University of Natural Resources and Life Sciences Vienna, Institute for Transport Studies, Vienna, Austria
| | - Thomas Götschi
- Physical Activity and Health Unit, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Audrey S, Batista-Ferrer H. Healthy urban environments for children and young people: A systematic review of intervention studies. Health Place 2015; 36:97-117. [PMID: 26457624 PMCID: PMC4676191 DOI: 10.1016/j.healthplace.2015.09.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 12/04/2022]
Abstract
This systematic review collates, and presents as a narrative synthesis, evidence from interventions which included changes to the urban environment and reported at least one health behaviour or outcome for children and young people. Following a comprehensive search of six databases, 33 primary studies relating to 27 urban environment interventions were included. The majority of interventions related to active travel. Others included park and playground renovations, road traffic safety, and multi-component community-based initiatives. Public health evidence for effectiveness of such interventions is often weak because study designs tend to be opportunistic, non-randomised, use subjective outcome measures, and do not incorporate follow-up of study participants. However, there is some evidence of potential health benefits to children and young people from urban environment interventions relating to road safety and active travel, with evidence of promise for a multi-component obesity prevention initiative. Future research requires more robust study designs incorporating objective outcome measures.
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Affiliation(s)
- Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
| | - Harriet Batista-Ferrer
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
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Rissel C, Greaves S, Wen LM, Crane M, Standen C. Use of and short-term impacts of new cycling infrastructure in inner-Sydney, Australia: a quasi-experimental design. Int J Behav Nutr Phys Act 2015; 12:129. [PMID: 26444001 PMCID: PMC4596499 DOI: 10.1186/s12966-015-0294-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/26/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Chris Rissel
- Sydney School of Public Health, University of Sydney, Sydney, Australia.
| | - Stephen Greaves
- Institute of Transport and Logistics Studies, University of Sydney, Sydney, Australia.
| | - Li Ming Wen
- Sydney School of Public Health, University of Sydney and Sydney Local Health District, Sydney, Australia.
| | - Melanie Crane
- Sydney School of Public Health, University of Sydney and Sydney Local Health District, Sydney, Australia.
| | - Chris Standen
- Institute of Transport and Logistics Studies, University of Sydney, Sydney, Australia.
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Panter J, Ogilvie D. Theorising and testing environmental pathways to behaviour change: natural experimental study of the perception and use of new infrastructure to promote walking and cycling in local communities. BMJ Open 2015; 5:e007593. [PMID: 26338837 PMCID: PMC4563264 DOI: 10.1136/bmjopen-2015-007593] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/05/2015] [Accepted: 05/22/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Some studies have assessed the effectiveness of environmental interventions to promote physical activity, but few have examined how such interventions work. We investigated the environmental mechanisms linking an infrastructural intervention with behaviour change. DESIGN Natural experimental study. SETTING Three UK municipalities (Southampton, Cardiff and Kenilworth). PARTICIPANTS Adults living within 5 km of new walking and cycling infrastructure. INTERVENTION Construction or improvement of walking and cycling routes. Exposure to the intervention was defined in terms of residential proximity. OUTCOME MEASURES Questionnaires at baseline and 2-year follow-up assessed perceptions of the supportiveness of the environment, use of the new infrastructure, and walking and cycling behaviours. Analysis proceeded via factor analysis of perceptions of the physical environment (step 1) and regression analysis to identify plausible pathways involving physical and social environmental mediators and refine the intervention theory (step 2) to a final path analysis to test the model (step 3). RESULTS Participants who lived near and used the new routes reported improvements in their perceptions of provision and safety. However, path analysis (step 3, n=967) showed that the effects of the intervention on changes in time spent walking and cycling were largely (90%) explained by a simple causal pathway involving use of the new routes, and other pathways involving changes in environmental cognitions explained only a small proportion of the effect. CONCLUSIONS Physical improvement of the environment itself was the key to the effectiveness of the intervention, and seeking to change people's perceptions may be of limited value. Studies of how interventions lead to population behaviour change should complement those concerned with estimating their effects in supporting valid causal inference.
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Affiliation(s)
- Jenna Panter
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - David Ogilvie
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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Are income-related differences in active travel associated with physical environmental characteristics? A multi-level ecological approach. Int J Behav Nutr Phys Act 2015; 12:73. [PMID: 26044262 PMCID: PMC4461897 DOI: 10.1186/s12966-015-0217-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 04/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Rates of active travel vary by socio-economic position, with higher rates generally observed among less affluent populations. Aspects of both social and built environments have been shown to affect active travel, but little research has explored the influence of physical environmental characteristics, and less has examined whether physical environment affects socio-economic inequality in active travel. This study explored income-related differences in active travel in relation to multiple physical environmental characteristics including air pollution, climate and levels of green space, in urban areas across England. We hypothesised that any gradient in the relationship between income and active travel would be least pronounced in the least physically environmentally-deprived areas where higher income populations may be more likely to choose active transport as a means of travel. Methods Adults aged 16+ living in urban areas (n = 20,146) were selected from the 2002 and 2003 waves of the UK National Travel Survey. The mode of all short non-recreational trips undertaken by the sample was identified (n = 205,673). Three-level binary logistic regression models were used to explore how associations between the trip being active (by bike/walking) and three income groups, varied by level of multiple physical environmental deprivation. Results Likelihood of making an active trip among the lowest income group appeared unaffected by physical environmental deprivation; 15.4% of their non-recreational trips were active in both the least and most environmentally-deprived areas. The income-related gradient in making active trips remained steep in the least environmentally-deprived areas because those in the highest income groups were markedly less likely to choose active travel when physical environment was ‘good’, compared to those on the lowest incomes (OR = 0.44, 95% CI = 0.22 to 0.89). Conclusions The socio-economic gradient in active travel seems independent of physical environmental characteristics. Whilst more affluent populations enjoy advantages on some health outcomes, they will still benefit from increasing their levels of physical activity through active travel. Benefits of active travel to the whole community would include reduced vehicle emissions, reduced carbon consumption, the preservation or enhancement of infrastructure and the presentation of a ‘normalised’ behaviour.
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Sahlqvist S, Goodman A, Jones T, Powell J, Song Y, Ogilvie D. Mechanisms underpinning use of new walking and cycling infrastructure in different contexts: mixed-method analysis. Int J Behav Nutr Phys Act 2015; 12:24. [PMID: 25889383 PMCID: PMC4340230 DOI: 10.1186/s12966-015-0185-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 02/05/2015] [Indexed: 12/03/2022] Open
Abstract
Background Few studies have evaluated the effects of infrastructural improvements to promote walking and cycling. Even fewer have explored how the context and mechanisms of such interventions may interact to produce their outcomes. Methods This mixed-method analysis forms part of the UK iConnect study, which aims to evaluate new walking and cycling routes at three sites — Cardiff, Kenilworth and Southampton. Applying a complementary follow-up approach, we first identified differences in awareness and patterns of use of the infrastructure in survey data from a cohort of adult residents at baseline in spring 2010 (n = 3516) and again one (n = 1849) and two (n = 1510) years later following completion of the infrastructural projects (Analysis 1). We subsequently analysed data from 17 semi-structured interviews with key informants to understand how the new schemes might influence walking and cycling (Analysis 2a). In parallel, we analysed cohort survey data on environmental perceptions (Analysis 2b). We integrated these two datasets to interpret differences across the sites consistent with a theoretical framework that hypothesised that the schemes would improve connectivity and the social environment. Results After two years, 52% of Cardiff respondents reported using the infrastructure compared with 37% in Kenilworth and 22% in Southampton. Patterns of use did not vary substantially between sites. 17% reported using the new infrastructure for transport, compared with 39% for recreation. Environmental perceptions at baseline were generally unfavourable, with the greatest improvements in Cardiff. Qualitative data revealed that all schemes had a recreational focus to varying extents, that the visibility of schemes to local people might be an important mechanism driving use and that the scale and design of the schemes and the contrast they presented with existing infrastructure may have influenced their use. Conclusions The dominance of recreational uses may have reflected the specific local goals of some of the projects and the discontinuity of the new infrastructure from a satisfactory network of feeder routes. Greater use in Cardiff may have been driven by the mechanisms of greater visibility and superior design features within the context of an existing environment that was conducive neither to walking or cycling nor to car travel. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0185-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shannon Sahlqvist
- Centre for Physical Activity and Nutrition Research (C-PAN), School of Exercise and Nutrition Sciences, Deakin University, 75 Pigdons Rd, Geelong, Australia. .,Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
| | - Anna Goodman
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK. .,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Tim Jones
- Department of Planning, Oxford Brookes University, Oxford, UK.
| | - Jane Powell
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK.
| | - Yena Song
- School of Civil Engineering and the Environment, University of Southampton, Southampton, UK.
| | - David Ogilvie
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK.
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Translating active living research into policy and practice: one important pathway to chronic disease prevention. J Public Health Policy 2015; 36:231-43. [PMID: 25611892 DOI: 10.1057/jphp.2014.53] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Global concerns about rising levels of chronic disease make timely translation of research into policy and practice a priority. There is a need to tackle common risk factors: tobacco use, unhealthy diets, physical inactivity, and harmful alcohol use. Using evidence to inform policy and practice is challenging, often hampered by a poor fit between academic research and the needs of policymakers and practitioners--notably for active living researchers whose objective is to increase population physical activity by changing the ways cities are designed and built. We propose 10 strategies that may facilitate translation of research into health-enhancing urban planning policy. Strategies include interdisciplinary research teams of policymakers and practitioners; undertaking explicitly policy-relevant research; adopting appropriate study designs and methodologies (evaluation of policy initiatives as 'natural experiments'); and adopting dissemination strategies that include knowledge brokers, advocates, and lobbyists. Conducting more policy-relevant research will require training for researchers as well as different rewards in academia.
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Adams EJ, Goad M, Sahlqvist S, Bull FC, Cooper AR, Ogilvie D. Reliability and validity of the transport and physical activity questionnaire (TPAQ) for assessing physical activity behaviour. PLoS One 2014; 9:e107039. [PMID: 25215510 PMCID: PMC4162566 DOI: 10.1371/journal.pone.0107039] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 08/11/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND No current validated survey instrument allows a comprehensive assessment of both physical activity and travel behaviours for use in interdisciplinary research on walking and cycling. This study reports on the test-retest reliability and validity of physical activity measures in the transport and physical activity questionnaire (TPAQ). METHODS The TPAQ assesses time spent in different domains of physical activity and using different modes of transport for five journey purposes. Test-retest reliability of eight physical activity summary variables was assessed using intra-class correlation coefficients (ICC) and Kappa scores for continuous and categorical variables respectively. In a separate study, the validity of three survey-reported physical activity summary variables was assessed by computing Spearman correlation coefficients using accelerometer-derived reference measures. The Bland-Altman technique was used to determine the absolute validity of survey-reported time spent in moderate-to-vigorous physical activity (MVPA). RESULTS In the reliability study, ICC for time spent in different domains of physical activity ranged from fair to substantial for walking for transport (ICC = 0.59), cycling for transport (ICC = 0.61), walking for recreation (ICC = 0.48), cycling for recreation (ICC = 0.35), moderate leisure-time physical activity (ICC = 0.47), vigorous leisure-time physical activity (ICC = 0.63), and total physical activity (ICC = 0.56). The proportion of participants estimated to meet physical activity guidelines showed acceptable reliability (k = 0.60). In the validity study, comparison of survey-reported and accelerometer-derived time spent in physical activity showed strong agreement for vigorous physical activity (r = 0.72, p<0.001), fair but non-significant agreement for moderate physical activity (r = 0.24, p = 0.09) and fair agreement for MVPA (r = 0.27, p = 0.05). Bland-Altman analysis showed a mean overestimation of MVPA of 87.6 min/week (p = 0.02) (95% limits of agreement -447.1 to +622.3 min/week). CONCLUSION The TPAQ provides a more comprehensive assessment of physical activity and travel behaviours and may be suitable for wider use. Its physical activity summary measures have comparable reliability and validity to those of similar existing questionnaires.
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Affiliation(s)
- Emma J. Adams
- British Heart Foundation National Centre for Physical Activity and Health, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Mary Goad
- British Heart Foundation National Centre for Physical Activity and Health, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Shannon Sahlqvist
- Centre for Physical Activity and Nutrition Research (C-PAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Fiona C. Bull
- Centre for the Built Environment and Health, School of Population Health, University of Western Australia, Perth, Australia
| | - Ashley R. Cooper
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - David Ogilvie
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, United Kingdom
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Brand C, Goodman A, Ogilvie D. Evaluating the impacts of new walking and cycling infrastructure on carbon dioxide emissions from motorized travel: a controlled longitudinal study. APPLIED ENERGY 2014; 128:284-295. [PMID: 26435570 PMCID: PMC4591464 DOI: 10.1016/j.apenergy.2014.04.072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Walking and cycling is widely assumed to substitute for at least some motorized travel and thereby reduce energy use and carbon dioxide (CO2) emissions. While the evidence suggests that a supportive built environment may be needed to promote walking and cycling, it is unclear whether and how interventions in the built environment that attract walkers and cyclists may reduce transport CO2 emissions. Our aim was therefore to evaluate the effects of providing new infrastructure for walking and cycling on CO2 emissions from motorised travel. A cohort of 1849 adults completed questionnaires at baseline (2010) and one-year follow-up (2011), before and after the construction of new high-quality routes provided as part of the Sustrans Connect2 programme in three UK municipalities. A second cohort of 1510 adults completed questionnaires at baseline and two-year follow-up (2012). The participants reported their past-week travel behaviour and car characteristics from which CO2 emissions by mode and purpose were derived using methods described previously. A set of exposure measures of proximity to and use of the new routes were derived. Overall transport CO2 emissions decreased slightly over the study period, consistent with a secular trend in the case study regions. As found previously the new infrastructure was well used at one- and two-year follow-up, and was associated with population-level increases in walking, cycling and physical activity at two-year follow-up. However, these effects did not translate into sizeable CO2 effects as neither living near the infrastructure nor using it predicted changes in CO2 emissions from motorised travel, either overall or disaggregated by journey purpose. This lack of a discernible effect on travel CO2 emissions are consistent with an interpretation that some of those living nearer the infrastructure may simply have changed where they walked or cycled, while others may have walked or cycled more but few, if any, may have substituted active for motorised modes of travel as a result of the interventions. While the findings to date cannot exclude the possibility of small effects of the new routes on CO2 emissions, a more comprehensive approach of a higher 'dosage' of active travel promotion linked with policies targeted at mode shift away from private motorized transport (such as urban car restraint and parking pricing, car sharing/pooling for travel to work, integrating bike sharing into public transport system) may be needed to achieve the substantial CO2 savings needed to meet climate change mitigation and energy security goals.
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Affiliation(s)
- Christian Brand
- Environmental Change Institute, University of Oxford, Oxford, United Kingdom
| | - Anna Goodman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK ()
| | - David Ogilvie
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK ()
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Goodman A, Sahlqvist S, Ogilvie D. New walking and cycling routes and increased physical activity: one- and 2-year findings from the UK iConnect Study. Am J Public Health 2014; 104:e38-46. [PMID: 25033133 PMCID: PMC4151955 DOI: 10.2105/ajph.2014.302059] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Anna Goodman
- Anna Goodman, Shannon Sahlqvist, and David Ogilvie are with the Medical Research Council Epidemiology Unit and the UK Clinical Research Collaboration Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK. Anna Goodman is also with the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. Shannon Sahlqvist is also with the Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Lowe M, Boulange C, Giles-Corti B. Urban design and health: progress to date and future challenges. Health Promot J Austr 2014; 25:14-8. [PMID: 24739774 DOI: 10.1071/he13072] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/21/2013] [Indexed: 11/23/2022] Open
Abstract
Over the last 15 years, a growing body of Australian and international evidence has demonstrated that urban design attributes are associated with a range of health outcomes. For example, the location of employment, shops and services, provision of public and active transport infrastructure and access to open space and recreational opportunities are associated with chronic disease risk factors such as physical activity levels, access to healthy food, social connectedness, and air quality. Despite the growing knowledge base, this evidence is not being consistently translated into urban planning policy and practice in Australia. Low-density neighbourhoods with poor access to public transport, shops and services continue to be developed at a rapid rate in the sprawling outer suburbs of Australian cities. This paper provides an overview of the evidence of the association between the built environment and chronic diseases, highlighting progress and future challenges for health promotion. It argues that health promotion practitioners and researchers need to more closely engage with urban planning practitioners, policymakers and researchers to encourage the creation of healthy urban environments through integrated transport, land use and infrastructure planning. There is also a need for innovative research to evaluate the effectiveness of policy options. This would help evidence to be more effectively translated into policy and practice, making Australia a leader in planning healthy communities.
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Affiliation(s)
- Melanie Lowe
- McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, University of Melbourne, Level 5, 207 Bouverie Street, Carlton, Vic. 3010, Australia
| | - Claire Boulange
- McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, University of Melbourne, Level 5, 207 Bouverie Street, Carlton, Vic. 3010, Australia
| | - Billie Giles-Corti
- McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, University of Melbourne, Level 5, 207 Bouverie Street, Carlton, Vic. 3010, Australia
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Veitch J, Salmon J, Carver A, Timperio A, Crawford D, Fletcher E, Giles-Corti B. A natural experiment to examine the impact of park renewal on park-use and park-based physical activity in a disadvantaged neighbourhood: the REVAMP study methods. BMC Public Health 2014; 14:600. [PMID: 24924919 PMCID: PMC4073813 DOI: 10.1186/1471-2458-14-600] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modifying the built environment by improving parks is potentially a sustainable way to increase population level physical activity. Despite considerable investment in parks and park renovations, few natural experiments on the impact of improving amenities on park use and park-based physical activity have been conducted. REVAMP is a natural experiment that aims to examine whether park improvement increases overall park usage, park-based physical activity and active travel to and from the park in the intervention compared with the control park over a two-year period; and to identify which specific aspects of the park refurbishment attracts park visitors and encourages park users to be more active. This paper describes the methods of the REVAMP study. METHODS The intervention park is a large regional park (329 hectares) located in a low socio-economic status (SES) area in the north-eastern suburbs of Melbourne, Australia. The control park is a regional park (120 hectares) located in a high SES area in the eastern suburbs of Melbourne. Multiple methodologies to evaluate the impact of the park renovation are being employed including: cross-sectional surveys of local residents living near the two parks, direct observations of park users, intercept surveys with park users, and electronic monitoring of path usage and car traffic within the parks. Baseline measures were conducted in April-May 2013 (T1), and an innovative play space suitable for children of all ages and abilities was installed at the intervention park between September 2013 and February 2014. Follow-up measures will be repeated in April-May 2014 (T2) and April-May 2015 (T3). All methodologies will be completed at both the intervention and control parks at all three time-points, with the exception of the cross-sectional survey of local residents which will only be conducted at T1 and T3. CONCLUSION This research will inform future park developments, and will contribute to creating an evidence base of the impact of park refurbishment, and the development of natural experiment methodology. TRIAL REGISTRATION Current controlled trial ISRCTN50745547, registration date 11.1.2014.
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Affiliation(s)
- Jenny Veitch
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Jo Salmon
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Alison Carver
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Anna Timperio
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - David Crawford
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Elly Fletcher
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Billie Giles-Corti
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Goodman A, Sahlqvist S, Ogilvie D. Who uses new walking and cycling infrastructure and how? Longitudinal results from the UK iConnect study. Prev Med 2013; 57:518-24. [PMID: 23859933 PMCID: PMC3807875 DOI: 10.1016/j.ypmed.2013.07.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/02/2013] [Accepted: 07/04/2013] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To examine how adults use new local walking and cycling routes, and what characteristics predict use. METHODS 1849 adults completed questionnaires in 2010 and 2011, before and after the construction of walking and cycling infrastructure in three UK municipalities. 1510 adults completed questionnaires in 2010 and 2012. The 2010 questionnaire measured baseline characteristics; the follow-up questionnaires captured infrastructure use. RESULTS 32% of participants reported using the new infrastructure in 2011, and 38% in 2012. Walking for recreation was by far the most common use. In both follow-up waves, use was independently predicted by higher baseline walking and cycling (e.g. 2012 adjusted rate ratio 2.09 (95% CI 1.55, 2.81) for >450 min/week vs. none). Moreover, there was strong specificity by mode and purpose, e.g. baseline walking for recreation specifically predicted walking for recreation on the infrastructure. Other independent predictors included living near the infrastructure, better general health and higher education or income. CONCLUSIONS The new infrastructure was well-used by local adults, and this was sustained over two years. Thus far, however, the infrastructure may primarily have attracted existing walkers and cyclists, and may have catered more to the socio-economically advantaged. This may limit its impacts on population health and health equity.
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Affiliation(s)
- Anna Goodman
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Box 296, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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Adams EJ, Goodman A, Sahlqvist S, Bull FC, Ogilvie D. Correlates of walking and cycling for transport and recreation: factor structure, reliability and behavioural associations of the perceptions of the environment in the neighbourhood scale (PENS). Int J Behav Nutr Phys Act 2013; 10:87. [PMID: 23815872 PMCID: PMC3702387 DOI: 10.1186/1479-5868-10-87] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 06/21/2013] [Indexed: 11/29/2022] Open
Abstract
Background Emerging evidence suggests that walking and cycling for different purposes such as transport or recreation may be associated with different attributes of the physical environment. Few studies to date have examined these behaviour-specific associations, particularly in the UK. This paper reports on the development, factor structure and test-retest reliability of a new scale assessing perceptions of the environment in the neighbourhood (PENS) and the associations between perceptions of the environment and walking and cycling for transport and recreation. Methods A new 13-item scale was developed for assessing adults’ perceptions of the environment in the neighbourhood (PENS). Three sets of analyses were conducted using data from two sources. Exploratory and confirmatory factor analyses were used to identify a set of summary environmental variables using data from the iConnect baseline survey (n = 3494); test-retest reliability of the individual and summary environmental items was established using data collected in a separate reliability study (n = 166); and multivariable logistic regression was used to determine the associations of the environmental variables with walking for transport, walking for recreation, cycling for transport and cycling for recreation, using iConnect baseline survey data (n = 2937). Results Four summary environmental variables (traffic safety, supportive infrastructure, availability of local amenities and social order), one individual environmental item (street connectivity) and a variable encapsulating general environment quality were identified for use in further analyses. Intraclass correlations of these environmental variables ranged from 0.44 to 0.77 and were comparable to those seen in other similar scales. After adjustment for demographic and other environmental factors, walking for transport was associated with supportive infrastructure, availability of local amenities and general environment quality; walking for recreation was associated with supportive infrastructure; and cycling for transport was associated only with street connectivity. There was limited evidence of any associations between environmental attributes and cycling for recreation. Conclusion PENS is acceptable as a short instrument for assessing perceptions of the urban environment. Previous findings that different attributes of the environment may be associated with different behaviours are confirmed. Policy action to create supportive environments may require a combination of environmental improvements to promote walking and cycling for different purposes.
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Affiliation(s)
- Emma J Adams
- British Heart Foundation National Centre for Physical Activity and Health, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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Christian H, Knuiman M, Bull F, Timperio A, Foster S, Divitini M, Middleton N, Giles-Corti B. A new urban planning code's impact on walking: the residential environments project. Am J Public Health 2013; 103:1219-28. [PMID: 23678917 PMCID: PMC3682616 DOI: 10.2105/ajph.2013.301230] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether people moving into a housing development designed according to a state government livable neighborhoods subdivision code engage in more walking than do people who move to other types of developments. METHODS In a natural experiment of 1813 people building homes in 73 new housing developments in Perth, Western Australia, we surveyed participants before and then 12 and 36 months after moving. We measured self-reported walking using the Neighborhood Physical Activity Questionnaire and collected perceptions of the environment and self-selection factors. We calculated objective measures of the built environment using a Geographic Information System. RESULTS After relocation, participants in livable versus conventional developments had greater street connectivity, residential density, land use mix, and access to destinations and more positive perceptions of their neighborhood (all P < .05). However, there were no significant differences in walking over time by type of development (P > .05). CONCLUSIONS Implementation of the Livable Neighborhoods Guidelines produced more supportive environments; however, the level of intervention was insufficient to encourage more walking. Evaluations of new urban planning policies need to incorporate longer term follow-up to allow time for new neighborhoods to develop.
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Affiliation(s)
- Hayley Christian
- Centre for Built Environment and Health, School of Population Health, The University of Western Australia, Crawley, Australia.
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Brand C, Goodman A, Rutter H, Song Y, Ogilvie D. Associations of individual, household and environmental characteristics with carbon dioxide emissions from motorised passenger travel. APPLIED ENERGY 2013; 104:158-169. [PMID: 24882922 PMCID: PMC4032180 DOI: 10.1016/j.apenergy.2012.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/29/2012] [Accepted: 11/02/2012] [Indexed: 05/07/2023]
Abstract
Carbon dioxide (CO2) emissions from motorised travel are hypothesised to be associated with individual, household, spatial and other environmental factors. Little robust evidence exists on who contributes most (and least) to travel CO2 and, in particular, the factors influencing commuting, business, shopping and social travel CO2. This paper examines whether and how demographic, socio-economic and other personal and environmental characteristics are associated with land-based passenger transport and associated CO2 emissions. Primary data were collected from 3474 adults using a newly developed survey instrument in the iConnect study in the UK. The participants reported their past-week travel activity and vehicle characteristics from which CO2 emissions were derived using an adapted travel emissions profiling method. Multivariable linear and logistic regression analyses were used to examine what characteristics predicted higher CO2 emissions. CO2 emissions from motorised travel were distributed highly unequally, with the top fifth of participants producing more than two fifth of emissions. Car travel dominated overall CO2 emissions, making up 90% of the total. The strongest independent predictors of CO2 emissions were owning at least one car, being in full-time employment and having a home-work distance of more than 10 km. Income, education and tenure were also strong univariable predictors of CO2 emissions, but seemed to be further back on the causal pathway than having a car. Male gender, late-middle age, living in a rural area and having access to a bicycle also showed significant but weaker associations with emissions production. The findings may help inform the development of climate change mitigation policies for the transport sector. Targeting individuals and households with high car ownership, focussing on providing viable alternatives to commuting by car, and supporting planning and other policies that reduce commuting distances may provide an equitable and efficient approach to meeting carbon mitigation targets.
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Affiliation(s)
- Christian Brand
- Environmental Change Institute, School of Geography and the Environment, University of Oxford, United Kingdom
| | - Anna Goodman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Harry Rutter
- National Obesity Observatory, Oxford, United Kingdom
| | - Yena Song
- Faculty of Engineering and the Environment, University of Southampton, United Kingdom
| | - David Ogilvie
- Medical Research Council Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, United Kingdom
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Sahlqvist S, Goodman A, Cooper AR, Ogilvie D. Change in active travel and changes in recreational and total physical activity in adults: longitudinal findings from the iConnect study. Int J Behav Nutr Phys Act 2013; 10:28. [PMID: 23445724 PMCID: PMC3598920 DOI: 10.1186/1479-5868-10-28] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To better understand the health benefits of promoting active travel, it is important to understand the relationship between a change in active travel and changes in recreational and total physical activity. METHODS These analyses, carried out in April 2012, use longitudinal data from 1628 adult respondents (mean age 54 years; 47% male) in the UK-based iConnect study. Travel and recreational physical activity were measured using detailed seven-day recall instruments. Adjusted linear regression models were fitted with change in active travel defined as 'decreased' (<-15 min/week), 'maintained' (± 15 min/week) or 'increased' (>15 min/week) as the primary exposure variable and changes in (a) recreational and (b) total physical activity (min/week) as the primary outcome variables. RESULTS Active travel increased in 32% (n=529), was maintained in 33% (n=534) and decreased in 35% (n=565) of respondents. Recreational physical activity decreased in all groups but this decrease was not greater in those whose active travel increased. Conversely, changes in active travel were associated with commensurate changes in total physical activity. Compared with those whose active travel remained unchanged, total physical activity decreased by 176.9 min/week in those whose active travel had decreased (adjusted regression coefficient -154.9, 95% CI -195.3 to -114.5) and was 112.2 min/week greater among those whose active travel had increased (adjusted regression coefficient 135.1, 95% CI 94.3 to 175.9). CONCLUSION An increase in active travel was associated with a commensurate increase in total physical activity and not a decrease in recreational physical activity.
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Affiliation(s)
- Shannon Sahlqvist
- Centre for Physical Activity and Nutrition Research (C-PAN) School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Medical Research Council Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, UK
| | - Anna Goodman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ashley R Cooper
- Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, Bristol, UK
| | - David Ogilvie
- Medical Research Council Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, UK
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Yang L, Griffin S, Chapman C, Ogilvie D. The feasibility of rapid baseline objective physical activity measurement in a natural experimental study of a commuting population. BMC Public Health 2012; 12:841. [PMID: 23036074 PMCID: PMC3524024 DOI: 10.1186/1471-2458-12-841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 09/27/2012] [Indexed: 11/17/2022] Open
Abstract
Background Studies of the effects of environmental interventions on physical activity should include valid measures of physical activity before and after the intervention. Baseline data collection can be difficult when the timetable for introduction of an intervention is outside researchers’ control. This paper reports and reflects on the practical issues, challenges and results of rapid baseline objective physical activity measurement using accelerometers distributed by post in a natural experimental study. Methods A sample of working adults enrolling for the Commuting and Health in Cambridge study and expressing willingness to wear an activity monitor was selected to undertake baseline accelerometer assessment. Each selected participant received a study pack by post containing the core study questionnaire and an accelerometer to wear for seven consecutive days, and was asked to return their accelerometer and completed questionnaire in person or by post using the prepaid special delivery envelope provided. If a pack was not returned within two weeks of issue, a reminder was sent to the participant. Each participant received up to five reminders by various methods including letter, email, telephone and letter sent by recorded delivery. Results 95% of participants registering for the study were willing in principle to undertake accelerometer assessment. Using a pool of 221 accelerometers, we achieved a total of 714 issues of accelerometers to participants during a six month period. 116 (16%) participants declined to use the accelerometer after receiving it. Three accelerometers failed, 45 (6% of 714) were lost and many were returned with insufficient data recorded, resulted in 109 (15%) participants re-wearing their accelerometer for a second week of measurement. 550 (77%) participants completed data collection, 478 (87% of 550) to the required standard. A total of 694 reminders were issued to retrieve unreturned accelerometers. More than 90% of accelerometers were retrieved after a maximum of two reminders. Conclusions It is feasible to use accelerometers to collect baseline objective physical activity data by post from a large number of participants in a limited time period. However, a substantial pool of devices is required and researchers need to be prepared to make significant efforts to recover some of the devices.
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Affiliation(s)
- Lin Yang
- MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
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Sahlqvist S, Song Y, Ogilvie D. Is active travel associated with greater physical activity? The contribution of commuting and non-commuting active travel to total physical activity in adults. Prev Med 2012; 55:206-11. [PMID: 22796629 PMCID: PMC3824070 DOI: 10.1016/j.ypmed.2012.06.028] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 06/28/2012] [Accepted: 06/29/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND To complement findings that active travel reduces the risk of morbidity and mortality from chronic diseases, an understanding of the mechanisms through which active travel may lead to improved health is required. PURPOSE The aim of this study is to examine the descriptive epidemiology of all active travel and its associations with recreational and total physical activity in a sample of adults in the UK. METHODS In April 2010, data were collected from 3516 adults as part of the baseline survey for the iConnect study in the UK. Travel and recreational physical activity were assessed using detailed seven-day recall instruments. Linear regression analyses, controlling for demographic characteristics, examined associations between active travel, defined as any walking and cycling for transport, and recreational and total physical activity. RESULTS 65% of respondents (mean age 50.5 years) reported some form of active travel, accumulating an average of 195 min/week (standard deviation=188.6). There were no differences in the recreational physical activity levels of respondents by travel mode category. Adults who used active travel did however report significantly higher total physical activity than those who did not. CONCLUSIONS Substantial physical activity can be accumulated through active travel which also contributes to greater total physical activity.
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Affiliation(s)
- Shannon Sahlqvist
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, United Kingdom.
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Goodman A, Brand C, Ogilvie D. Associations of health, physical activity and weight status with motorised travel and transport carbon dioxide emissions: a cross-sectional, observational study. Environ Health 2012; 11:52. [PMID: 22862811 PMCID: PMC3536622 DOI: 10.1186/1476-069x-11-52] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/24/2012] [Indexed: 05/23/2023]
Abstract
BACKGROUND Motorised travel and associated carbon dioxide (CO₂) emissions generate substantial health costs; in the case of motorised travel, this may include contributing to rising obesity levels. Obesity has in turn been hypothesised to increase motorised travel and/or CO₂ emissions, both because heavier people may use motorised travel more and because heavier people may choose larger and less fuel-efficient cars. These hypothesised associations have not been examined empirically, however, nor has previous research examined associations with other health characteristics. Our aim was therefore to examine how and why weight status, health, and physical activity are associated with transport CO₂ emissions. METHODS 3463 adults completed questionnaires in the baseline iConnect survey at three study sites in the UK, reporting their health, weight, height and past-week physical activity. Seven-day recall instruments were used to assess travel behaviour and, together with data on car characteristics, were used to estimate CO2 emissions. We used path analysis to examine the extent to which active travel, motorised travel and car engine size explained associations between health characteristics and CO₂ emissions. RESULTS CO₂ emissions were higher in overweight or obese participants (multivariable standardized probit coefficients 0.16, 95% CI 0.08 to 0.25 for overweight vs. normal weight; 0.16, 95% CI 0.04 to 0.28 for obese vs. normal weight). Lower active travel and, particularly for obesity, larger car engine size explained 19-31% of this effect, but most of the effect was directly explained by greater distance travelled by motor vehicles. Walking for recreation and leisure-time physical activity were associated with higher motorised travel distance and therefore higher CO₂ emissions, while active travel was associated with lower CO₂ emissions. Poor health and illness were not independently associated with CO₂ emissions. CONCLUSIONS Establishing the direction of causality between weight status and travel behaviour requires longitudinal data, but the association with engine size suggests that there may be at least some causal effect of obesity on CO₂ emissions. More generally, transport CO₂ emissions are associated in different ways with different health-related characteristics. These include associations between health goods and environmental harms (recreational physical activity and high emissions), indicating that environment-health 'co-benefits' cannot be assumed. Instead, attention should also be paid to identifying and mitigating potential areas of tension, for example by promoting low-carbon recreational physical activity.
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Affiliation(s)
- Anna Goodman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Christian Brand
- Environmental Change Institute and Transport Studies Unit, Oxford University Centre for the Environment, Oxford University, South Parks Road, Oxford OX1 3QY, UK
| | - David Ogilvie
- Medical Research Council Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Box 296, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
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