The relationship between bicycle commuting and perceived stress: a cross-sectional study

Climate protection, health and other motives for active transport - results of a cross-sectional survey in Germany

BACKGROUND

Active transport- for example walking and bicycling to travel from place to place- may improve physical fitness and health and mitigate climate change if it replaces motorised transport. The aim of this study is to analyse the active transport behaviour of adults living in Germany, to investigate differences among population groups and to determine whether climate protection is a frequent motive for this behaviour.

METHODS

This study uses self-reported data of 4,971 adults who participated in a national health survey (German Health Update 2021), which was conducted as a telephone survey from July to December 2021. Associations between active transport behaviour and corresponding motives with sociodemographic and health-related variables were analysed using logistic regression models.

RESULTS

Of the adult population, 83% use active transport at least once a week. The frequency and duration of walking per week are significantly higher than those for bicycling (walking 214 min/week; bicycling 57 min/week). Those with a lower education level are less likely to practise active transport than those with a higher education level. Furthermore, women are less likely to use a bicycle for transport than men. Among those practising active transport, the most frequently mentioned motive is "is good for health" (84%) followed by "to be physically active" (74%) and "is good for the climate/environment" (68%). Women and frequent bicyclists (at least 4 days/week) mention climate protection as a motive more often than men and those bicycling occasionally.

CONCLUSIONS

The improvement of active transport, especially among people with lower education and women (for bicycling), may benefit from better insights into motives and barriers. Climate protection is an important motivator for practising active transport within the adult population living in Germany and should therefore have greater emphasis in behavioural change programmes.

Mobility Infrastructures and Health: Scoping Review of studies in Europe

Objectives

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

Method

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

Results

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

Conclusion

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

Cities and mental health: The role of the built environment, and environmental and lifestyle factors in Barcelona

Built environment characteristics and related environmental exposures and behaviors have been, separately, implicated in the development of poor mental health. However, it is unclear how these factors act together in relation to mental health. We studied these factors simultaneously to evaluate the impact of the built environment, and the mediating role of environmental exposures and physical activity, on mental health, while also studying moderation by sex, age, and length of residence. We used a cross-sectional population-based sample of 3145 individuals aged 15-97 years from Barcelona, Spain. Time spent walking and mental health status were assessed with validated questionnaires, administered through a face-to-face interview. We characterized the built environment (e.g., building, population and intersection density and green space), road traffic noise, and ambient air pollution at the residential level using land cover maps, remote sensing, noise maps and land use regression models. Adjusted regression models accounting for spatial clustering were analyzed to study associations between built environment attributes and mental health, and mediation and moderation effects. Density attributes were directly or indirectly, through air pollution and less consistently through walking, associated with poor mental health. Green space indicators were associated with lower prevalence of poor mental health, partly through lower air pollution exposure and more walking. In some cases, these associations differed by sex, age or length of residence. Non-linear associations of density indicators with environmental exposures, and of particulate matter with poor mental health indicated threshold effects. We conclude that living in dense areas with high air pollution concentrations was associated with poor mental health. On the other hand, green areas with lower air pollution concentrations were protective against poor mental health. Greater urban density might benefit health, but might only do so when air pollution concentrations are low.

Active mobility and mental health: A scoping review towards a healthier world

Research has proven that engaging in active mobility (AM), namely walking and cycling for transportation, significantly enhances physical activity levels, leading to better physical health. It is still unclear whether AM could also offer any mental health benefits. This scoping review aims to provide a comprehensive understanding of the current knowledge on the relationship between AM and mental health, given its crucial role in public health. The authors searched online databases to isolate primary studies written in English involving an adult sample (16 or over). AM was the exposure factor. Many mental health elements were included as outcomes (depression, anxiety, self-esteem, self-efficacy, stress, psychological and subjective well-being, resilience, loneliness and social support, quality of life, mood, life satisfaction and sleep). The results were organised in a narrative summary per each outcome selected, graphical syntheses and an overview of gaps to be further examined. The authors identified a total of 55 papers as relevant. The results show inconsistency in study designs, definition and operationalisation of the variables, approach and methodologies used. A cross-sectional design was the dominant choice, primarily examining data from national public health surveys. Nonetheless, there has been improvement in outcomes of interests, initially mainly the quality of life and affect. Lately, authors have focused on a broader range of mental health-related factors (such as travel satisfaction). The experimental studies showed promising mental health improvements in those who used active modes more than those who used motorised vehicles. It creates a rationale for further research towards implementing a unified theoretical and methodological framework to study the link between AM and mental health. The ultimate goal is to generate solid conclusions that could support building societies and cities through public health promotion and sustainable strategies, like walking and cycling as a means of transport.

Benefits, risks, barriers, and facilitators to cycling: a narrative review

There is large potential to increase cycling participation worldwide. Participation in cycling is associated with lower risk of mortality from any cause, and incidence of cardiovascular disease and type 2 diabetes, as well as positive mental health and well-being. The largest potential for health gains likely to come from increasing participation amongst those who do not currently cycle regularly, rather than encouraging those who already cycle regularly to cycle more. Replacing car journeys with cycling can lead to reductions in air pollution emissions and lower pollutant exposure to the general population. Important gaps and uncertainties in the existing evidence base include: the extent to which the health benefits associated with cycling participation are fully causal due to the observational nature of much of the existing evidence base; the real-world economic cost-benefits of pragmatic interventions to increase cycling participation; and the most effective (combination of) approaches to increase cycling participation. To address these uncertainties, large-scale, long-term randomised controlled trials are needed to: evaluate the effectiveness, and cost-effectiveness, of (combinations of) intervention approaches to induce sustained long-term increases in cycling participation in terms of increases in numbers of people cycling regularly and number of cycling journeys undertaken, across a range of population demographic groups; establish the effects of such interventions on relevant outcomes related to health and wellbeing, economic productivity and wider societal impacts; and provide more robust quantification of potential harms of increasing cycling participation, such as collision risks.

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships

BACKGROUND

According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately.

OBJECTIVE

Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships.

DESIGN, SETTING, AND PARTICIPANTS

An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'.

METHODS

The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling.

RESULTS

The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern.

CONCLUSIONS

Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate.

TRIAL REGISTRATION NUMBER

DRKS.de (DRKS00015241); August 9, 2018.

TWEETABLE ABSTRACT

Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

Barriers and enablers to local active travel during COVID-19: A case study of Streetspace interventions in two London boroughs

Background: During the coronavirus disease 2019 (COVID-19) pandemic, UK local authorities increased emergency active travel interventions. This study aimed to understand what aspects of temporary Streetspace for London schemes represent barriers or enablers to walking and cycling for short local journeys. Methods: Focusing on two Inner London boroughs, we conducted 21 semi-structured stakeholder interviews and sampled 885 public comments about Streetspace schemes. We triangulated the data in a thematic analysis to identify barriers and enablers, which were categorised using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Results: Opportunity and motivation factors were reflected in the barriers (accessibility and integration of the schemes; controversy, dissatisfaction, and doubt) and enablers (new routes and spaces; sustainability and health beliefs) and mixed themes (changes to traffic and appeal of the area; feelings of safety). Capability was not reflected in the main themes. Conclusions: Although aspects of Streetspace schemes were seen to enable active travel, our findings suggest that additional processes to address the acceptability, fairness, and unintended consequences of emergency interventions will be important to their long-term success for health and sustainability.

The health benefits of bicycling to school among adolescents in China: A propensity score matching study

Background

A large number of high-income countries are now promoting active commuting to school as an opportunity for adolescents to increase physical activity (PA) and improve their health. Few studies have examined the multiple benefits of active travel to school among adolescents in developing countries, especially in China. Hence, this study aims to estimate the effects of bicycling to school on adolescents' subjective health, physical health, and sickness absence.

Methods

Self-reported and cross-sectional data from 6,353 school-aged children (12-19 years old) in the 2014-2015 China Education Panel Survey (CEPS2014-2015) were used. The independent variable was a binary, self-reported indicator of whether children bicycled to school. The dependent variables included subjective health (self-reported health, mental stress), physical health (BMI, kidney disease, lung disease, heart disease, brain disease, upper limb fracture, lower limb fracture, and sickness frequency), and sickness absence. Propensity score matching (PSM) was used to estimate the causal effects of bicycling to school on adolescents' health.

Results

Bicycling to school positively affects both subjective and physical health. Those students who biked to school were associated with a higher self-rated health status, a healthier weight, a lower level of mental stress, and a lower risk of developing brain diseases. No significant relation is found between bicycling and sickness frequency, and sickness absence. Moreover, we separately compared the bicycling group with the walking group and the non-active travel group. There is still evidence that cycling is beneficial for students. Compared with walking to school, cycling to school resulted in a higher self-rated health score and a lower mental stress score. Physically, students who bicycled to school were less likely to be absent from school and suffer from kidney and brain diseases than students who walked to school. However, we do not find a significant difference in health outcomes from cycling compared to non-active modes of transportation. Further, differentiation of the health effects of bicycling across living areas shows that health effects are more pronounced for those living in edge and rural areas.

Conclusion

These findings provide evidence of the value of promoting bicycling to school in improving various adolescents' health outcomes in transitional China.

Analyzing Person-Place Interactions During Walking Episodes: Innovative Ambulatory Assessment Approach of Walking-Triggered e-Diaries

BACKGROUND

Walking behavior is positively associated with physiological and mental health as much evidence has already shown. Walking is also becoming a critical issue for health promotion in urban environments as it is the most often used form of active mobility and helps to replace carbon dioxide emissions from motorized forms of transport. It therefore contributes to mitigate the negative effects of climate change and heat islands within cities. However, to promote walking among urban dwellers and to utilize its health-enhancing potential, we need to know more about the way in which physical and social environments shape individual experiences during walking episodes. Such person-place interactions could not adequately be analyzed in former studies owing to methodological constraints.

OBJECTIVE

This study introduces walking-triggered e-diaries as an innovative ambulatory assessment approach for time-varying associations, and investigates its accuracy with 2 different validation strategies.

METHODS

The walking trigger consists of a combination of movement acceleration via an accelerometer and mobile positioning of the cellphone via GPS and transmission towers to track walking activities. The trigger starts an e-diary whenever a movement acceleration exceeds a predetermined threshold and participants' locations are identified as nonstationary outside a predefined place of residence. Every 420 (±300) seconds, repeated e-diaries were prompted as long as the trigger conditions were met. Data were assessed on 10 consecutive days. First, to investigate accuracy, we reconstructed walking routes and calculated a percentage score for all triggered prompts in relation to all walking routes where a prompt could have been triggered. Then, to provide data about its specificity, we used momentary self-reports and objectively assessed movement behavior to describe activity levels before the trigger prompted an e-diary.

RESULTS

Data of 67 participants could be analyzed and the walking trigger led to 3283 e-diary prompts, from which 2258 (68.8%) were answered. Regarding accuracy, the walking trigger prompted an e-diary on 732 of 842 (86.9%) reconstructed walking routes. Further, in 838 of 1206 (69.5%) triggered e-diaries, participants self-reported that they were currently walking outdoors. Steps and acceleration movement was higher during these self-reported walking episodes than when participants denied walking outdoors (steps: 106 vs 32; acceleration>0.2 g in 58.4% vs 19% of these situations).

CONCLUSIONS

Accuracy analysis revealed that walking-triggered e-diaries are suitable to collect different data of individuals' current experiences in situations in which a person walks outdoors. Combined with environmental data, such an approach increases knowledge about person-place interactions and provides the possibility to gain knowledge about user preferences for health-enhancing urban environments. From a methodological viewpoint, however, specificity analysis showed how changes in trigger conditions (eg, increasing the threshold for movement acceleration) lead to changes in accuracy.

The impact of black carbon (BC) on mode-specific galvanic skin response (GSR) as a measure of stress in urban environments

Previous research has shown that walking and cycling could help alleviate stress in cities, however there is poor knowledge on how specific microenvironmental conditions encountered during daily journeys may lead to varying degrees of stress experienced at that moment. We use objectively measured data and a robust causal inference framework to address this gap. Using a Bayesian Doubly Robust (BDR) approach, we find that black carbon exposure statistically significantly increases stress, as measured by Galvanic Skin Response (GSR), while cycling and while walking. Augmented Outcome Regression (AOR) models indicate that greenspace exposure and the presence of walking or cycling infrastructure could reduce stress. None of these effects are statistically significant for people in motorized transport. These findings add to a growing evidence-base on health benefits of policies aimed at decreasing air pollution, improving active travel infrastructure and increasing greenspace in cities.

Health and well-being benefits of e-bike commuting for inactive, overweight people living in regional Australia

INTRODUCTION

Pedal-assisted electric-bikes (e-bikes) are bicycles fitted with electric motors. Motorised functions on e-bikes only operate when the user pedals, allowing riders a moderate amount of physical activity. This study aimed to explore the mental and physical health and well-being impacts related to ebike usage for inactive overweight or obese individuals living in regional Australia.

METHODS

Twenty inactive, overweight/obese people who seldom cycled were provided with an ebike over a 12-week period. Individual semi-structured interviews conducted at the end of the trial generated data about participants' experiences of using ebikes. Inductive thematic analysis of interview data using Thomas (2006) data analysis framework and NVivo 12 software was undertaken.

RESULTS

Data analysis revealed that e-cycling improved participants' mental and physical well-being and that they felt happier when riding an e-bike.

CONCLUSIONS

Riding an e-bike can improve mental and physical health, happiness and overall sense of well-being. Greater uptake of e-bikes would have positive health implications for the wider community. Results from this study can be used to inform active transport policy. SO WHAT?: Our study demonstrated that encouraging active transport in the form of e-cycling can improve the overall health and well-being of overweight and obese Australians. More specifically, e-cycling demonstrated a positive impact on mental health well-being.

The Association between Active Mobility and Subjective Wellbeing during COVID-19 in MENA Countries

Objective: To augment the international scientific approach to raising public mental health through active lifestyle among adults, we added the evidence of the association between physical activity and subjective wellbeing in the Middle East and North Africa region by emphasizing the mediator—COVID-19. This study aimed to identify the correlations between active mobility and subjective wellbeing during the COVID-19 pandemic in a sample from Tabriz, Iran, which has not yet been tackled in previous study. Methods: We finalized an online survey (N = 603) from adults between 5 June and 15 July 2021. This group reported their individual and socio-economic characteristics and their perception features and location (e.g., home, work) during COVID-19. The paper developed three ordinal logistic regression (OLR) models to examine the association between active mobility types such as commute, non-commute, frequency of active travel to parks and services per week, and different subjective wellbeing including: 1- life satisfaction, 2- feeling energetic, and 3- peaceful mind while controlling for socio-economic variables (e.g., age, gender, education, job, and income) and objective commute distance. We also incorporated the most relevant objective (street length, land-use mix, number of intersections, and building and population density) and subjective (perceived distance to different services, perceived walking places, and perceived facilities attractiveness) factors. Results: Positive response relationships between four types of physical activity levels and subjective wellbeing scores were demonstrated in all of the three developed models (with significant levels of 0.05, and 0.1) with appropriate model fits, which confirmed the existing literature. However, these relationships showed different patterns (varied significant levels) for each type of subjective wellbeing. In addition, the factors including street length (p value: 0.004), perceived walkable places (p value: 0.021, 0.068, 0.017, and 0.025) (positively), population density, and perceived distance to shopping malls (p value: 0.076, <0.0001, and 0.059 (negatively) were associated with different indicators of subjective wellbeing. Conclusion: As for the implication of our study, special actions by urban authorities such as increasing mixed-use and creating attractive places will be required to enhance the walkability of the neighborhoods. Moreover, notifying the adults regarding the benefits of physical activity is much more needed.

Characteristics of Electric Scooter and Bicycle Injuries After Introduction of Electric Scooter Rentals in Oslo, Norway

IMPORTANCE

When society introduces and accepts new transportation modes, it is important to map risks and benefits.

OBJECTIVE

To compare electric scooter (e-scooter) and bicycle injuries.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study is based on prospectively collected data on Norwegian patients who sustained e-scooter or bicycle injuries and presented to an emergency department affiliated with Oslo University Hospital between January 1, 2019, and March 31, 2020.

MAIN OUTCOMES AND MEASURES

e-Scooter and bicycle injuries were evaluated for associations with sex, age, time of injury, helmet use, intoxication, body region, and injury severity. Descriptive statistics are presented as mean (SD) or number with percentage, with significance set at P < .05 (2-tailed).

RESULTS

During the study period, 3191 patients were included (850 e-scooter riders, 2341 bicyclists) with 3839 injuries recorded (997 e-scooter, 2842 bicycle). The mean (SD) age of those injured was 34 (17) years, 2026 riders (63.5%) were male, 1474 (46.2%) were helmeted at the time of injury, and 516 (16.2%) were intoxicated by alcohol or other drugs. The annual incidence of injuries was 120 per 100 000 inhabitants for e-scooters and 340 per 100 000 inhabitants for bicycles. Men were overrepresented in both groups (529 e-scooter riders [62.2%] and 1497 bicyclists [63.9%]). e-Scooter riders were younger than bicyclists (mean [SD] age, 31 [12] vs 35 [18] years). Most injured e-scooter riders were aged 20 to 40 years, whereas injured bicyclists had a broader age distribution. e-Scooter injuries commonly occurred on weekends (378 [46.6%]) and during evening (230 [32.3%]) or nighttime (242 [34.1%]) hours. Most bicycle injuries occurred during weekdays (1586 [69.7%]) and daytime (1762 [61.3%]). e-Scooter riders were more often intoxicated (336 [39.5%] vs 180 [7.7%]) and had a lower rate of helmet use (18 [2.1%] vs 1456 [62.2%]). During nighttime, 230 injured e-scooter riders (91.3%) and 86 bicyclists (69.4%) were intoxicated. e-Scooter riders had more head and neck (317 [31.7%] vs 636 [22.4%]) and lower-limb (285 [28.6%] vs 632 [22.2%]) injuries and fewer upper-limb (341 [34.2%] vs 1276 [44.9%]), thoracic (41 [4.1%] vs 195 [6.9%]), and abdominal, pelvic, and lumbar (13 [1.3%] vs 103 [3.6%]) injuries.

CONCLUSIONS AND RELEVANCE

In this cohort study, e-scooter riders were younger than bicyclists, did not use helmets, were more often intoxicated, and were more often injured during nighttime. The rate of intoxication among e-scooter riders injured at night was high. Preventive measures, including awareness campaigns, regulating e-scooter availability, improving infrastructure, and implementing stricter helmet and alcohol policies, may prove effective for reducing injuries.

Physical Activity Behavior, Motivation and Active Commuting: Relationships with the Use of Green Spaces in Italy

Many benefits of physical activity (PA) are observed with weekly average volumes of 150–300 min at moderate intensity. Public parks may be an attraction for many people living in the city and could help to achieve the recommended dose of PA. The present study aims to understand the motivation that drives people to a park and evaluate the amount of PA practiced by park-goers. A questionnaire was anonymously administered to 383 voluntary visitors to the Arcoveggio park (Bologna), aged 18–70 years. Sixty-one percent of participants practiced outdoor PA. Differences in park use between sexes and age groups were found. PA was higher in men than in women and in the 18–30 age group than in other age groups. Most participants travelled to the park in an active way (86.4%), resulting in easier attainment of the recommended amount of PA (64.5%). The main motivations for using the park were related to relaxation, performing PA, or both. According to a multiple regression model, the time per week spent at the park, the method of getting there, and the kind of PA were significant explanatory variables of the amount of PA practiced. In particular, the highest number of minutes of PA was achieved by those who travelled to the park by running, while those using vehicles presented the lowest number. All initiatives to promote active commuting and activities in the urban park represent an important strategy to improve health, supporting adults to lead an active lifestyle.

Estimating the Health Effects of Adding Bicycle & Pedestrian Paths: Modeling At The Census Tract-Level (Preprint)

Background

Adding additional bicycle and pedestrian paths to an area can lead to improved health outcomes for residents over time. However, quantitatively determining which areas benefit more from bicycle and pedestrian paths, how many miles of bicycle and pedestrian paths are needed, and the health outcomes that may be most improved remain open questions.

Objective

Our work provides and evaluates a methodology that offers actionable insight for city-level planners, public health officials, and decision makers tasked with the question “To what extent will adding specified bicycle and pedestrian path mileage to a census tract improve residents’ health outcomes over time?”

Methods

We conducted a factor analysis of data from the American Community Survey, Center for Disease Control 500 Cities project, Strava, and bicycle and pedestrian path location and use data from two different cities (Norfolk, Virginia, and San Francisco, California). We constructed 2 city-specific factor models and used an algorithm to predict the expected mean improvement that a specified number of bicycle and pedestrian path miles contributes to the identified health outcomes.

Results

We show that given a factor model constructed from data from 2011 to 2015, the number of additional bicycle and pedestrian path miles in 2016, and a specific census tract, our models forecast health outcome improvements in 2020 more accurately than 2 alternative approaches for both Norfolk, Virginia, and San Francisco, California. Furthermore, for each city, we show that the additional accuracy is a statistically significant improvement (P<.001 in every case) when compared with the alternate approaches. For Norfolk, Virginia (n=31 census tracts), our approach estimated, on average, the percentage of individuals with high blood pressure in the census tract within 1.49% (SD 0.85%), the percentage of individuals with diabetes in the census tract within 1.63% (SD 0.59%), and the percentage of individuals who had >2 weeks of poor physical health days in the census tract within 1.83% (SD 0.57%). For San Francisco (n=49 census tracts), our approach estimates, on average, that the percentage of individuals who had a stroke in the census tract is within 1.81% (SD 0.52%), and the percentage of individuals with diabetes in the census tract is within 1.26% (SD 0.91%).

Conclusions

We propose and evaluate a methodology to enable decision makers to weigh the extent to which 2 bicycle and pedestrian paths of equal cost, which were proposed in different census tracts, improve residents’ health outcomes; identify areas where bicycle and pedestrian paths are unlikely to be effective interventions and other strategies should be used; and quantify the minimum amount of additional bicycle path miles needed to maximize health outcome improvements. Our methodology shows statistically significant improvements, compared with alternative approaches, in historical accuracy for 2 large cities (for 2016) within different geographic areas and with different demographics.

Perceived stress in Chinese patients with coronary heart disease: a cross-sectional study

OBJECTIVE

Studies have shown that chronic stress is closely linked to the occurrence and development of cardiovascular disease. To date, few studies have focused on perceived stress in coronary heart diseases (CHD) patients and the possible factors influencing the stress. This study aims to investigate the perceived stress of patients with CHD and determine the individual attributes closely associated with it.

DESIGN

A cross-sectional study.

PARTICIPATES

A total of 2215 patients with CHD were enrolled and perceived stress was assessed with the Chinese version Perceived Stress Scale (CPSS). Participants were divided into two groups due to CPSS score and binary logistic regression was applied to analyse the factors that affected perceived stress level.

RESULTS

The mean CPSS score of Chinese patients with CHD was 27.16±6.35 Compared with participants who received senior middle school education or below, those with a university degree had a higher probability of high perceived stress (OR 1.453, 95% CI 1.206 to 1.750); this difference was more evident in participants with a master or doctoral degree (OR 1.928, 95% CI 1.290 to 2.882). Also engaging in mental labour (OR 1.389, 95% CI 1.144 to 1.686), having children (OR 2.226, 95% CI 1.098 to 4.515) and having a habit of risky alcohol consumption (OR 1.492, 95% CI 1.146 to 1.944) were associated with perceived stress.

CONCLUSION

Patients who had higher educational attainment, engaged in mental labour, had children, and had a habit of risky alcohol consumption were much easier to perceive the stress.

Chronic stress, behavioral tendencies, and determinants of health behaviors in nurses: a mixed-methods approach

BACKGROUND

Nurses experience high, and often chronic, levels of occupational stress. As high-quality care requires a healthy workforce, individualized stress-alleviating interventions for nurses are needed. This study explored barriers and resources associated with health behaviors in nurses with different stress levels and work-related behavioral tendencies and identified health behavior determinants based on the Health Action Process Approach (HAPA) model.

METHODS

Applying a mixed methods transformative triangulation design, n = 43 nurses filled out chronic stress (SSCS) and work-related behavior and experience patterns (German acronym AVEM) questionnaires, and participated in semi-structured interviews. With content analysis, categories of health behavior-related barriers and resources emerged. Behavior determinants (self-efficacy, outcome expectancies), health behavior, and barriers and resources were quantified via frequency and magnitude coding and interrelated with SSCS and AVEM scores to link level of health behavior with potential influencing factors. Nonparametric tests explored differences in quantified variables for SSCS and AVEM scores and 4-step-hierarchical regression analysis identified predictors for health behavior.

RESULTS

Eighty-four percent of the nurses were chronically stressed while 49% exhibited unhealthy behavioral tendencies at the workplace. 16 personal and organizational themes (six resources, ten barriers) influenced health behaviors. Stress was associated with resource frequency (p = .027) and current health behaviors (p = .07). Self-efficacy significantly explained variance in health behaviors (p = .003).

CONCLUSION

Health promotion related barriers and resources should be considered in designing nurse health promotion campaigns. Practitioners need to individualize and tailor interventions toward stress and behavioral experiences for sustainable effects on adherence and health.

Healthy Behavior and Environmental Behavior Correlate with Bicycle Commuting

Previous studies have identified that environmental awareness correlates with the choice of bicycle travel. However, few studies have considered the relationships with different types of healthy behaviors and environmental behaviors. This study examined the relationships between several healthy and environmental behaviors and the choice of bicycle commute using survey data. A total of 803 residents participated in this questionnaire survey. Using factor analysis, we constructed latent factors of healthy behaviors and environmental behaviors. Using a binary logistic regression model, we examined the relationship between latent factors and cycling usage, controlling for demographic characteristics. Factor analysis revealed three latent factors of healthy behaviors: “healthy diet”, “avoiding tobacco or overdrinking”, and “physical activity”. The latent factors of environmental behaviors were as follows: “household behavior” and “purchasing behavior”. The results showed that “avoiding tobacco or overdrinking”, “physical activity” and “purchasing behavior” correlated positively with bicycle commuting. Differences were also observed in relation to demographic characteristics.

Active mobility versus motorized transport? User choices and benefits for the society

Measures promoting active mobility - walking or cycling - are often seen as an effective strategy to meet multiple urban objectives. The advantages of such behavioural changes cover multiple dimensions at public and individual level, including positive impacts on health, safety, climate, economy, environment and air quality. However, there is still a considerable potential for increasing the uptake of active mobility in urban areas. This paper explores the determinants of active mobility choice and compares the demographic, socio-economic and cultural factors that influence it. The methodology combines extensive survey data, an EU-wide transport model and detailed indicators of external costs of transport with a Gradient Boosting Machine Learning approach. The model based scenarios quantify the benefit in terms of external costs savings from increasing active mobility shares. Such savings - at EU level, can reach the amount of 15 billion euro per year for a shift of 10% of trips to active mobility modes.

The effects of traveling in different transport modes on galvanic skin response (GSR) as a measure of stress: An observational study

BACKGROUND

Stress is one of many ailments associated with urban living, with daily travel a potential major source. Active travel, nevertheless, has been associated with lower levels of stress compared to other modes. Earlier work has relied on self-reported measures of stress, and on study designs that limit our ability to establish causation.

OBJECTIVES

To evaluate effects of daily travel in different modes on an objective proxy measure of stress, the galvanic skin response (GSR).

METHODS

We collected data from 122 participants across 3 European cities as part of the Physical Activity through Sustainable Transport Approaches (PASTA) study, including: GSR measured every minute alongside confounders (physical activity, near-body temperature) during three separate weeks covering 3 seasons; sociodemographic and travel information through questionnaires. Causal relationships between travel in different modes (the "treatment") and stress were established by using a propensity score matching (PSM) approach to adjust for potential confounding and estimating linear mixed models (LMM) with individuals as random effects to account for repeated measurements. In three separate analyses, we compared GSR while cycling to not cycling, then walking to not walking then motorized (public or private) travel to any activity other than motorized travel.

RESULTS

Depending on LMM formulations used, cycling reduces 1-minute GSR by 5.7% [95% CI: 2.0-16.9%] to 11.1% [95% CI: 5.0-24.4%] compared to any other activity. Repeating the analysis for other modes we find that: walking is also beneficial, reducing GSR by 3.9% [95% CI: 1.4-10.7%] to 5.7% [95% CI: 2.6-12.3%] compared to any other activity; motorized mode (private or public) in reverse increases GSR by up to 1.1% [95% CI: 0.5-2.9%].

DISCUSSION

Active travel offers a welcome way to reduce stress in urban dwellers' daily lives. Stress can be added to the growing number of evidence-based reasons for promoting active travel in cities.

App-Tailoring Requirements to Increase Stress Management Competencies Within Families: Cross-sectional Survey Study

Background

Families experiencing high levels of psychological distress are considered a particularly vulnerable population for adverse effects on mental and physical health. Moreover, highly stressed individuals engage less in mental health promoting activities and show low stress management competencies. App-based stress interventions seem promising for the treatment and prevention of stress outcomes and might be a low-threshold solution.

Objective

The aim of this study was to identify the requirements for a tailored app to reduce stress in a cohort of highly stressed families that have low stress management skills.

Methods

Parents (n=1008; age: mean 47.7 years, SD 6.1; female: 599/1008, 59.7%) completed an extensive web-based survey and were subdivided into a target (stressed individuals with low stress competency) and nontarget group according to their reported stress level and stress management competencies. Group differences were analyzed using analysis of variance. In principal component analysis with Kaiser varimax rotation, personally defined stress management goals were grouped into components. Linear regression models were also calculated.

Results

A 3-factor solution cumulatively explained 56% of the variance in personally defined goals of interest for stress management with (1) active strategies (25.61% explained variance), (2) general competency (17.95% explained variance) and (3) passive strategies (12.45% explained variance). The groups differed in age (F_1,978=27.67, P<.001), health index (F_1,958=246.14, P<.001), personally defined general-competency goal (F_1,958=94.16 P<.001), as well as “information acquisition” (F_1,971=14.75, P<.001) and “need for stimulation” (F_1,981=54.49, P<.001) personality traits. A regression model showed that for the active strategies goals of interest, only app feature information or instructional videos had a significant effect (P=.02). The general competency factor showed none, and the passive strategies factor showed significant effects for 2 app features—suggestions for planning possible activities with the family (P=.01) and diaries for documentation and development of strategies (P=.03).

Conclusions

The results of this survey study highlight the need to develop an app to increase stress management competencies that takes into consideration perceived stress level, stress management skills, personality, and personally defined goals of the user. The content of the app should be tailored to previously detected personality traits, especially selective information acquisition and low need for stimulation. Furthermore, personally defined stress management goals seem to affect interest in some features.

Is the built-environment at origin, on route, and at destination associated with bicycle commuting? A gender-informed approach

There is limited evidence on the gender differences and location-specific built-environment factors associated with bicycling in Latin American cities. This study aimed to assess commuting in Bogotá by (1) analyzing the gender-specific trend of the standardized number of bicycle commuters during 2005-2017; and (2) assessing the socio-demographic, community, built-environment and natural factors associated with bicycle commuting stratified by gender. This secondary-data analysis included data from the Household Travel Surveys and Multipurpose Surveys to calculate the number of bicycle commuters per habitant from 2005 to 2017 by gender. We assessed the socio-demographic and built-environment factors fitting generalized additive models stratified by gender using the 2015 Household Travel Survey. Although both women and men increased the standardized number of bicycle commuters, male commuters show a steeper trend than women, evidencing the widening gender gap in bicycle commuting over time. Bicycle commuting was negatively associated with household motor vehicle ownership, steeper terrain slope, longer commute distance, and scarce low-stress roads at trip origin and route. Among women, the availability of bike paths at the trip destination was positively associated with bicycling, while age and being a student were negatively associated with bicycling. Among men, living in areas with the lowest socio-economic status was positively associated with bicycling, while having a driver's license and living close to bus rapid transit stations were negatively associated with bicycling. In conclusion, bicycle and transport infrastructure play different roles in commuting by bicycle by gender and trip stages (origin - route - destination).

Are Latin American cycling commuters "at risk"? A comparative study on cycling patterns, behaviors, and crashes with non-commuter cyclists

INTRODUCTION

As part of the transformation of urban transportation dynamics, commuter cycling has acquired a high relevance as an alternative mode of transport in different countries, and Latin America seems to be one of the main focus of this worldwide "revolution". However, the high rates of crashes and injuries suffered by commuters have become a relevant issue in the field of road safety, especially in emerging regions with low cycling tradition, where social and infrastructural gaps may endanger the cyclists' safety.

OBJECTIVES

This study had two objectives. First, to compare key safe cycling-related variables between cycling commuters and non-commuters; and second, to differentially asses the effect of individual and cycling-related variables on their self-reported crash rates.

METHOD

For this cross-sectional research, the data provided by 577 Latin American urban cyclists from three countries (Argentina, Colombia and Mexico) with a mean age of 32.7 years was used. They answered a questionnaire on cycling habits, risk perception, rule knowledge, cycling behaviors and riding crashes.

RESULTS

The outcomes of this study showed that, despite having a higher risk perception, cycling commuters perform deliberate risky cycling behaviors (traffic violations) more frequently, and they suffer more crashes; cycling commuters report higher rates of psychological distress, and a lower degree of rule knowledge and protective behaviors than non-commuters. Furthermore, structural similarities and differences in the explanation of cycling crashes were found across commuters and non-commuters.

CONCLUSION

The results of this study suggest that non-commuters, whose purposes for cycling are more aimed at leisure and occasional trips, perform less risky behaviors but suffer more cycling distractions, whereas commuters are comparatively more exposed to behavioral-based safety risks, and suffer more frequent crashes. Since recent evidence forecasts that urban cycling will keep growing in Latin American cities, it is necessary to implement policies and educational/training improvements that may enhance the safety and health of cyclists in these countries.

Does Environmental Walkability Matter? The Role of Walkable Environment in Active Commuting

Since walkability plays an important role in active commuting, several cities are actively promoting its integration into urban and environmental planning policies. This study examined the association between walkability and active commuting in Seoul, Korea. A multilevel logistic regression model was used to examine the correlation between Walkability Score and the probability of active commuting after controlling for individual variables. The analysis used 129,044 individual samples nested within 424 administrative districts (dongs). In this study, three models were tested: Model 1 contained only individual variables, Model 2 contained individual variables and Walkability Score, and Model 3 included neighborhood-level variables in addition to the variables of Model 2. The results showed that the Walkability Score was significantly correlated with the odds of active commuting. Specifically, every additional one-point increase in Walkability Score was associated with 0.3% higher odds of active commuting (Model 2: odds ratio (OR) = 1.003, 95% confidence interval (CI) = 1.001-1.005; Model 3: OR = 1.003, 95% CI = 1.001-1.006). Additionally, public transportation density was also positively correlated with the odds of active commuting. The odds of active commuting were positively correlated with younger age, female, lower-income, and having no car. Based on the findings, policy recommendations in urban planning and design, transport engineering, and environmental planning are provided.

Commute patterns and depression: Evidence from eleven Latin American cities

INTRODUCTION

Although travel behavior is expected to influence personal health, few studies have examined associations with mental health. This study examines associations between commute patterns and mental health using survey data in 11 Latin American cities.

METHODS

Using a survey conducted by the Development Bank of Latin America in 2016, we measured the presence of depressive symptoms using the 10-item Center for Epidemiologic Studies Depression (CESD-10) screening scale. We used multilevel non-linear models to estimate the magnitude of the associations between commute patterns and depression risk, adjusting for socio-demographic and neighborhood characteristics.

RESULTS

We found that, on average, every 10 more minutes of commuting time is associated with 0.5% (p = 0.011) higher probability of screening positively for depression. Furthermore, when decomposing commuting time into free-flow time and delay time, we found that delay and not free-flow time, were associated with depression. Specifically, every 10 additional minutes of traffic delay is associated with 0.8% (p = 0.037) higher probability of screening positively for depression. When examining differences by travel mode, we find that users of formal transit (e.g. subway or bus rapid transit) are 4.8% (p = 0.040) less likely to be screened positively for depression than drivers. In addition, not having transit stops within a 10-min walk from home is associated with higher probability of screening positively for depression.

CONCLUSIONS

Our findings provide preliminary evidence that better access to mass transit systems and less congestion may be linked to better mental health among urban residents.

Well-being, behavioral patterns and cycling crashes of different age groups in Latin America: Are aging adults the safest cyclists?

Objectives

This study aimed at analyzing the cycling safety-related factors and the mental health indicators of elderly cyclists in comparison with other age groups.

Methods

For this cross-sectional study, we analyzed the data of 911 bicyclists from two Latin American countries that have been experiencing a substantial growth of urban cycling during the last few years: Colombia and Argentina. Participants responded to an e-questionnaire on bicycling behaviors, mental health and cycling safety.

Results

Aging adults reported lower rates of risky behaviors and traffic crashes (around .38 in five years), and, on the other hand, more cycling protective behaviors, a higher risk perception and a better knowledge of traffic norms than both other adults (26–50 years old) and young cyclists (<26). Cycling behaviors and crashes were found to be significantly related to mental health indicators, the latter being higher in aging cyclists. However, this population remains more prone to distractions experienced while cycling than other age groups.

Conclusions

Although the behavioral features of aging adults were comparatively “safer” than the ones displayed by other age groups, factors such as cycling distractions and this population’s over-representation in traffic crashes suggest the need of enforcing policymaking for a better integration of this age segment in alternative transportation dynamics.

Modulation of cortical and subcortical brain areas at low and high exercise intensities

INTRODUCTION

The brain plays a key role in the perceptual regulation of exercise, yet neuroimaging techniques have only demonstrated superficial brain areas responses during exercise, and little is known about the modulation of the deeper brain areas at different intensities.

OBJECTIVES/METHODS

Using a specially designed functional MRI (fMRI) cycling ergometer, we have determined the sequence in which the cortical and subcortical brain regions are modulated at low and high ratings perceived exertion (RPE) during an incremental exercise protocol.

RESULTS

Additional to the activation of the classical motor control regions (motor, somatosensory, premotor and supplementary motor cortices and cerebellum), we found the activation of the regions associated with autonomic regulation (ie, insular cortex) (ie, positive blood-oxygen-level-dependent (BOLD) signal) during exercise. Also, we showed reduced activation (negative BOLD signal) of cognitive-related areas (prefrontal cortex), an effect that increased during exercise at a higher perceived intensity (RPE 13-17 on Borg Scale). The motor cortex remained active throughout the exercise protocol whereas the cerebellum was activated only at low intensity (RPE 6-12), not at high intensity (RPE 13-17).

CONCLUSIONS

These findings describe the sequence in which different brain areas become activated or deactivated during exercise of increasing intensity, including subcortical areas measured with fMRI analysis.

Association of commuting mode with dyslipidemia and its components after accounting for air pollution in the working population of Beijing, China

Background

Evidence of the association between dyslipidemia and its components with commuting mode after adjusting for air pollution is limited. This study aimed to explore the association of dyslipidemia and its components with the modes used to commute to and from work after accounting for air pollution and other potential confounding factors.

Methods

This cross–sectional study was based on data collected from a working population of 69 functional communities in Beijing in 2016. A final sample of 8090 adults aged 18–65 years (mean age: 38.36 ± 9.75 years) was enrolled in the study. Risk estimates and their corresponding 95% confidence intervals (CIs) for the associations of dyslipidemia and its components with commuting mode were determined using multivariate logistic regression models.

Results

Of the 8090 subjects, 2419 (29.90%) met the criteria for dyslipidemia. Compared with car or taxi commuters, walking (OR 0.79, 95% CI 0.64 to 0.97), cycling (OR 0.71, 95% CI 0.58 to 0.86) and bus-riding commuters (OR 0.78, 95% CI 0.66 to 0.91) had a lower risk for dyslipidemia. Compared with car or taxi commuting, walking, cycling and bus-riding commuting were also associated with a lower risk for some components of dyslipidemia. Among the walking, cycling and bus-riding commuters, a dose-response trend of the association between dyslipidemia, some of its components and commuting mode by commuting time was also observed.

Conclusions

Walking, cycling and bus-riding commuting can reduce the risk for dyslipidemia and some of its components. Education on the prevention of dyslipidemia should be emphasized among higher-risk people who usually commute by car or taxi. Population-wide health may be improved by policies that encourage active commuting, particularly cycling and walking.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6887-x) contains supplementary material, which is available to authorized users.

Visit Duration Does Not Correlate with Perceived Physician Empathy

BACKGROUND

Perceived physician empathy is a strong driver of patient satisfaction. We assessed the influence of wait time, time spent with the surgeon, and surgeon stress level on the way patients rated surgeon empathy.

METHODS

One hundred and fourteen patients visiting 1 of 6 participating surgeons were prospectively enrolled in the study. We recorded patient demographics and assessed the patient rating of perceived physician empathy. Time waiting for the surgeon and time spent with the surgeon were measured with use of ambulatory tracking systems and by research assistants with stopwatches outside the patient rooms. Patient ratings of surgeon empathy were assessed with use of the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE), and surgeon stress level was assessed with use of the Perceived Stress Score short form. The mean wait time was 30 ± 18 minutes, and the mean time spent with the surgeon was 8.7 ± 5.3 minutes. Two separate multilevel linear regression models were used to compare factors associated with the JSPPPE and time spent with the surgeon.

RESULTS

Neither time spent with the surgeon nor wait time was independently associated with perceived physician empathy; being male, having at least a post-college graduate degree, and higher self-reported surgeon stress levels were independently associated with less perceived empathy. More time spent with the surgeon was independently associated with lower self-reported surgeon stress levels; follow-up visits and visits for a traumatic condition were independently associated with less time spent with the surgeon.

CONCLUSIONS

The results of the present study show that improved communication strategies, rather than shorter wait time or increased time spent with the patient, may increase patient satisfaction. This should be a focus of future research.

Bicycle Sharing: Sustainable Value Creation and Institutionalisation Strategies in Barcelona

A highly debatable issue is whether or not a paradigm shift toward the sharing economy could help to address the economic, social and environmental challenges of our time. This article contributes to the academic discussion by exploring the types of value created by sharing organisations and the strategies they use to institutionalise themselves in relation to powerful institutions. The study applies two analytical frameworks, based on value creation and institutional strategies, to three empirical case studies of bicycle sharing systems (BSS) in Barcelona. Rich data was collected from a variety of primary and secondary sources, including a field visit to Barcelona, interviews with representatives of the three bicycle sharing systems, observations and literature analysis. We found that the environmental value these organisations create is closely interlinked with the social value they produce and that these values outweigh negative impacts of their operations. All case organisations employ regulative, normative and cultural-cognitive strategies for their institutionalisation but are also subject to powerful institutions beyond their individual control. We recommend that entrepreneurs, city officials, the public and other stakeholders engage in collaborative and open development processes to shape the emerging sharing economy alongside the institutional work of sharing organisations.

Active Commuting Behaviours from High School to University in Chile: A Retrospective Study

Objective: To compare the differences in the modes and distance of the displacements in high school and university stage in the same sample. Methods: A total of 1288 volunteer university students (614 males and 674 females) participated, with an average age of 22.7 ± 5.8 years, belonging to four private and public universities in Chile where a validated self-report questionnaire was applied to the study, which included the modes, travel time, and distance at school and university. Results: The active commuting decreases from school to university when leaving home (males: 39.6% to 34.0%; p = 0.033 and females: 32.9% to 18.5%, p < 0.001), as well as when returning (males: 44.1% to 33.7%; p < 0.001 and females: 38.6% to 17.6%, p < 0.001). Conversely, non-active modes of transport increase, especially in females (go: 67.1% to 81.4%, return: 61.5% to 82.6%), affected by the increase in the use of public transportation in university. It was also defined that at both school and at university, the active commuting decreases the greater the distance travelled. Conclusion: The active modes of commuting decreased between high school and university and the non-active mode of commuting was the most frequent form of mobility to high school and university, observing that the active trips decreased when the distance from the home to high school or university increased. Public and private intervention policies and strategies are required to maintain or increase the modes of active commuting in the university stage for an active life in adulthood.

Influence of the Natural and Built Environment on Personal Exposure to Fine Particulate Matter (PM2.5) in Cyclists Using City Designated Bicycle Routes

Urban cyclists are exposed to many traffic-related air pollutants including particulate matter (PM) that may increase vulnerability to health effects. This study investigates second-by-second personal exposure to PM2.5 (fine particulate matter that is 2.5 microns in diameter and less) along bicycle commuting paths, and assesses elements of the natural and built environment for the relative importance of these factors in understanding the variability in PM2.5 personal exposure. Urban cyclists were carrying high resolution PM2.5 monitors (placed in a backpack) in combination with portable GPS trackers to provide a spatial identity to each one-second pollutant measurement. The results of this study indicate that daily averages of PM2.5 concentrations from all bicycle routes were weakly correlated with meteorological variables, however, a strong influence of regional levels of PM2.5 was observed. Geospatial analysis of PM2.5 personal exposure concentrations showed a considerable variation within routes, correlated with land use (with lower concentrations in parks and higher in industrial areas) and clustered at four areas: busiest bridge, heavily trafficked road segments, the downtown urban core, and two construction sites. This study has found many incidences of personal exposure to PM2.5 exceeding the provincial guidelines for healthy activity (e.g., very poor (PM2.5 > 91 μg/m3) pollution concentrations are clustered in three regions: approaching the bridge in the west part of the city; the downtown urban core; and two under construction spots), which suggests behavioural and infrastructure modifications in balancing the health benefits of cycling with the environmental exposure to air pollutants.

Active commuting through natural environments is associated with better mental health: Results from the PHENOTYPE project

BACKGROUND

Commuting routes with natural features could promote walking or cycling for commuting. Commuting through natural environments (NE) could have mental health benefits as exposure to NE can reduce stress and improve mental health, but there is little evidence. This study evaluates the association between NE and commuting, whether active or not, and the association between commuting (through NE), whether active or not, and mental health. We also evaluate the moderating effect of NE quality on the association between NE commuting and mental health.

METHODS

This cross-sectional study was based on adult respondents (n = 3599) of the Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe (PHENOTYPE) project. Data were collected in four European cities in Spain, the Netherlands, Lithuania and the United Kingdom. Data on commuting behavior (active commuting at least one day/week, daily NE commuting) and mental health were collected with questionnaires. Associations were estimated with multilevel analyses including random intercepts at city- and neighborhood level.

RESULTS

Adjusted multilevel analyses showed that daily NE commuters were more often active commuters (OR 1.42; 95% CI 1.19, 1.70). There was no association between active commuting and mental health, but daily NE commuters had on average a 2.74 (95% CI 1.66, 3.82) point higher mental health score than those not commuting through NE. The association with mental health was stronger among active commuters (4.03, 95% CI 2.13, 5.94) compared to non-active commuters (2.21; 95% CI 0.90, 3.51) when daily commuting through NE, but NE quality did not have a moderating effect.

CONCLUSIONS

Daily NE commuting was associated with better mental health, especially for active commuters. Daily NE commuters were likely to be active commuters. Active commuting itself was not associated with mental health. These findings suggest that cities should invest in commuting routes with nature for cycling and walking.

The effects of transport mode use on self-perceived health, mental health, and social contact measures: A cross-sectional and longitudinal study

BACKGROUND

Transport mode choice has been associated with different health risks and benefits depending on which transport mode is used. We aimed to evaluate the association between different transport modes use and several health and social contact measures.

METHODS

We based our analyses on the Physical Activity through Sustainable Transport Approaches (PASTA) longitudinal study, conducted over a period of two years in seven European cities. 8802 participants finished the baseline questionnaire, and 3567 answered the final questionnaire. Participants were 18 years of age or older (16 years of age or older in Zurich) and lived, worked and/or studied in one of the case-study cities. Associations between transport mode use and health/social contact measures were estimated using mixed-effects logistic regression models, linear regression models, and logistic regression models according to the data available. All the associations were assessed with single and multiple transport mode models. All models were adjusted for potential confounders.

RESULTS

In multiple transport mode models, bicycle use was associated with good self-perceived health [OR (CI 95%) = 1.07 (1.05, 1.08)], all the mental health measures [perceived stress: coef (CI 95%) = -0.016 (-0.028, -0.004); mental health: coef (CI 95%) = 0.11 (0.05, 0.18); vitality: coef (CI 95%) = 0.14 (0.07, 0.22)], and with fewer feelings of loneliness [coef (CI 95%) = -0.03 (-0.05, -0.01)]. Walking was associated with good self-perceived health [OR (CI 95%) = 1.02 (1.00, 1.03)], higher vitality [coef (CI 95%) = 0.14 (0.05, 0.23)], and more frequent contact with friends/family [OR (CI 95%) = 1.03 (1.00, 1.05)]. Car use was associated with fewer feelings of loneliness [coef (CI 95%) = -0.04 (-0.06, -0.02)]. The results for e-bike and public transport use were non-significant, and the results for motorbike use were inconclusive.

CONCLUSIONS

Similarity of findings across cities suggested that active transport, especially bicycle use, should be encouraged to improve population health and social outcomes.

Neighbourhood Built Environment Influences on Physical Activity among Adults: A Systematized Review of Qualitative Evidence

Qualitative studies can provide important information about how and why the built environment impacts physical activity decision-making—information that is important for informing local urban policies. We undertook a systematized literature review to synthesize findings from qualitative studies exploring how the built environment influences physical activity in adults. Our review included 36 peer-reviewed qualitative studies published from 1998 onwards. Our findings complemented existing quantitative evidence and provided additional insight into how functional, aesthetic, destination, and safety built characteristics influence physical activity decision-making. Sociodemographic characteristics (age, sex, ethnicity, and socioeconomic status) also impacted the BE’s influence on physical activity. Our review findings reinforce the need for synergy between transportation planning, urban design, landscape architecture, road engineering, parks and recreation, bylaw enforcement, and public health to be involved in creating neighbourhood environments that support physical activity. Our findings support a need for local neighbourhood citizens and associations with representation from individuals and groups with different sociodemographic backgrounds to have input into neighbourhood environment planning process.