Associations between individual socioeconomic position, neighbourhood disadvantage and transport mode: baseline results from the HABITAT multilevel study

Disparities in Travel-Related Barriers to Accessing Health Care From the 2017 National Household Travel Survey

Importance

Geographic access, including mode of transportation, to health care facilities remains understudied.

Objective

To identify sociodemographic factors associated with public vs private transportation use to access health care and identify the respondent, trip, and community factors associated with longer distance and time traveled for health care visits.

Design, Setting, and Participants

This cross-sectional study used data from the 2017 National Household Travel Survey, including 16 760 trips or a nationally weighted estimate of 5 550 527 364 trips to seek care in the United States. Households that completed the recruitment and retrieval survey for all members aged 5 years and older were included. Data were analyzed between June and August 2022.

Exposures

Mode of transportation (private vs public transportation) used to seek care.

Main Outcomes and Measures

Survey-weighted multivariable logistic regression models were used to identify factors associated with public vs private transportation and self-reported distance and travel time. Then, for each income category, an interaction term of race and ethnicity with type of transportation was used to estimate the specific increase in travel burden associated with using public transportation compared a private vehicle for each race category.

Results

The sample included 12 092 households and 15 063 respondents (8500 respondents [56.4%] aged 51-75 years; 8930 [59.3%] females) who had trips for medical care, of whom 1028 respondents (6.9%) were Hispanic, 1164 respondents (7.8%) were non-Hispanic Black, and 11 957 respondents (79.7%) were non-Hispanic White. Factors associated with public transportation use included non-Hispanic Black race (compared with non-Hispanic White: adjusted odds ratio [aOR], 3.54 [95% CI, 1.90-6.61]; P < .001) and household income less than $25 000 (compared with ≥$100 000: aOR, 7.16 [95% CI, 3.50-14.68]; P < .001). The additional travel time associated with use of public transportation compared with private vehicle use varied by race and household income, with non-Hispanic Black respondents with income of $25 000 to $49 999 experiencing higher burden associated with public transportation (mean difference, 81.9 [95% CI, 48.5-115.3] minutes) than non-Hispanic White respondents with similar income (mean difference, 25.5 [95% CI, 17.5-33.5] minutes; P < .001).

Conclusions and Relevance

These findings suggest that certain racial, ethnic, and socioeconomically disadvantaged populations rely on public transportation to seek health care and that reducing delays associated with public transportation could improve care for these patients.

Incentivising public transport use for physical activity gain: process evaluation of the COVID-19 disrupted trips4health randomised controlled trial

BACKGROUND

Partnering with a public transport (PT) provider, state government, and local government, the single-blinded randomised controlled trial, trips4health, investigated the impact of PT use incentives on transport-related physical activity (PA) in Tasmania, Australia. The intervention involved 16-weeks of incentives (bus trip credits) for achieving weekly PT use targets, supported by weekly text messages. This study objective was to conduct a process evaluation of the COVID-19 disrupted trips4health study.

METHODS

The Medical Research Council UK's framework for complex public health interventions guided the process evaluation. Participant reach, acceptability, fidelity and feasibility were evaluated. Administrative and post-intervention survey data were analysed descriptively. Semi-structured interviews with intervention participants (n = 7) and PT provider staff (n = 4) were analysed thematically.

RESULTS

Due to COVID-19, trips4health was placed on hold (March 2020) then stopped (May 2020) as social restrictions impacted PT use. At study cessation, 116 participants (approximately one third of target sample) had completed baseline measures, 110 were randomised, and 64 (n = 29 in the intervention group; n = 35 in the control group) completed post-intervention measures. Participants were 18 - 80 years (average 44.5 years) with females (69%) and those with tertiary education (55%) over-represented. The intervention was delivered with high fidelity with 96% of bus trip credits and 99% of behavioural text messages sent as intended. Interviewed PT staff said implementation was highly feasible. Intervention participant acceptability was high with 90% reporting bus trip incentives were helpful and 59% reporting the incentives motivated them to use PT more. From a total of 666 possible bus trip targets, 56% were met with 38% of intervention participants agreeing and 41% disagreeing that 'Meeting the bus trip targets was easy'. Interviews and open-ended survey responses from intervention participants revealed incentives motivated bus use but social (e.g., household member commitments) and systemic (e.g., bus availability) factors made meeting bus trip targets challenging.

CONCLUSIONS

trips4health demonstrated good acceptability and strong fidelity and feasibility. Future intervention studies incentivising PT use will need to ensure a broader demographic is reached and include more supports to meet PT targets.

TRIAL REGISTRATION

ACTRN12619001136190 .

Associations between socioeconomic status and physical activity among older adults: cross-sectional results from the OUTDOOR ACTIVE study

BACKGROUND

Regular physical activity (PA) is an important strategy for healthy ageing. Socioeconomic status was found to be a key determinant of PA, however, evidence on associations between socioeconomic status and PA among older adults is limited. The aim of this study was to contribute to research on the associations of socioeconomic status and PA among older adults by including self-reported and objectively measured PA data. Furthermore, we examined the self-reported PA data more closely by looking at the activities separately.

METHODS

Cross-sectional data of 1507 participants (52.5% female) of the OUTDOOR ACTIVE study between 65 and 75 years, residing in Bremen, Germany, were included in the analyses. Self-reported PA was assessed via questionnaire and comprised all organised and non-organised activities. For analyses, mean hours per week of total and moderate to vigorous PA, and mean metabolic equivalents per week were used. Objectively measured PA was assessed using accelerometers over seven consecutive days. Socioeconomic status was included as an additive social class index containing education, income, and occupation. To test for associations between PA and socioeconomic status, linear regressions were carried out.

RESULTS

Self-reported PA showed significant negative associations with socioeconomic status for both men and women. Objectively measured PA was positively associated with socioeconomic status, which was significant in men but not in women. When examining physical activities separately, time spent on housework, gardening, biking, and walking decreased with increasing socioeconomic status. Women in the second SES quintile and men in the third quintile reported the most, and women in the first quintile and men in the fifth quintile the least hours per week spent on exercise.

CONCLUSIONS

The results of this study contributed to the existing research gap on the associations of socioeconomic status and PA among older adults. Moreover, we provided information on both self-reported and objectively measured PA, and showed the discrepancies in the two methods' results. These findings can help to develop PA promotion interventions targeting specific socioeconomic status groups and to develop accurate, valid, and reliable self-reported and objective measurements of PA for older adults.

Individual socioeconomic position, neighbourhood disadvantage and mental well-being: a cross-sectional multilevel analysis of mid-age adults

Background

Socioeconomic disadvantage is associated with mental illness, yet its relationship with mental well-being is unclear. Mental well-being is defined as feeling good and functioning well. Benefits of mental well-being include reduced mortality, improved immune functioning and pain tolerance, and increased physical function, pro-social behaviour, and academic and job performance. This study aims to explore the relationship between individual socioeconomic position (SEP), neighbourhood disadvantage and mental well-being in mid-age adults.

Methods

Multilevel modelling was used to analyse data collected from 7866 participants from the second (2009) wave of HABITAT (How Areas in Brisbane Influence healTh and activiTy), a longitudinal study (2007–2018) of adults aged 40–65 years living in Brisbane, Australia. Mental well-being was measured using the Warwick Edinburgh Mental Well-Being Scale (WEMWBS). Exposure measures were education, occupation, household income, and neighbourhood socioeconomic disadvantage.

Results

The lowest MWB scores were observed for the least educated (β = − 1.22, 95%CI = − 1.74, − 0.71), those permanently unable to work (β = − 5.50, 95%CI = − 6.90, − 4.10), the unemployed (β = − 2.62, 95%CI = − 4.12, − 1.13), and members of low-income households (β = − 3.77, 95%CI = − 4.59, − 2.94). Residents of the most disadvantaged neighbourhoods had lower MWB scores than those living in the least disadvantaged neighbourhoods, after adjustment for individual-level SEP (β = − 0.96, 95%CI = − 1.66, − 0.28).

Conclusions

Both individual-level SEP and neighbourhood disadvantage are associated with mental well-being although the association is stronger for individual-level SEP. This research highlights the need to address individual and neighbourhood-level socioeconomic determinants of mental well-being.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12905-7.

Socioeconomic correlates of sedentary time during pregnancy among women at risk of gestational diabetes in the UK

Little is known about the relationship between socioeconomic position (SEP) and duration and patterning of objectively measured sedentary time (ST) among adults, especially adults at high risk of diabetes. The aim of this study was to examine cross-sectional associations of SEP with ST (total, prolonged ST, breaks in ST) and self-reported TV time among pregnant women at risk of gestational diabetes in the UK. At 20 weeks' gestation, pregnant women (n=174) wore an activPAL accelerometer and reported their usual TV time. Generalized linear mixed models were used to test associations of education, household income and area-level deprivation (separately and with mutual adjustment) with total ST, prolonged ST and breaks in ST. Logistic regression models were used to test associations between SEP indicators and high (≥2h/day) TV time. Those with the lowest education, lowest household income and highest area-level deprivation had the lowest ST and lowest prolonged ST. After mutual adjustment, area-level deprivation remained associated with total ST (β=0.10 [0.01, 0.20]). There was an inverse association between area-level deprivation and breaks in sedentary time (exp(b)=1.11 [1.01, 1.22]). Education was the only SEP correlate of high TV time, with more of those with least education reporting high TV time; this association persisted after adjustment for household income and area-level deprivation. The association between SEP and total and prolonged ST (positive) was the opposite of the association between education and high TV time (negative) in this sample of high-risk pregnant women. These findings should inform interventions to reduce sedentary time.

The prevalence of alcohol and other drugs in fatal road crashes in Victoria, Australia

BACKGROUND

Driving under the influence of drugs, including alcohol, is a globally recognised risk factor for road traffic crashes. While the prevalence of alcohol and other drugs in fatal road crashes has been examined in other countries, recent data investigating drug driving in fatal Australian crashes are limited. This study aimed to examine how the presence of alcohol and other drugs in fatal road trauma in Victoria has changed over time in different road users.

METHODS

A population-based review of road trauma deaths was performed over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System (NCIS) and the Victorian State Trauma Registry (VSTR). Drugs were grouped according to type and analysed accordingly. Poisson regression models were used to determine change in incidence rates over the study period.

RESULTS

There were 2287 road traffic fatalities with complete toxicology data (97% of all road traffic fatalities). Alcohol (blood alcohol concentration, BAC) was the most commonly detected drug (>0.001 g/100 mL: 21.1%; >0.05 g/100 mL: 18.4%), followed by opioids (17.3%), THC (13.1%), antidepressants (9.7%), benzodiazepines (8.8%), amphetamine-type stimulants (7.1%), ketamine (3.4%), antipsychotics (0.9%) and cocaine (0.2%). Trends demonstrated changing use over time with specific drugs. Alcohol positive road fatalities declined 9% per year in passenger car/4WD drivers (IRR = 0.91, 95% CI: 0.88-0.95). The incidence of strong opioids (oxycodone, fentanyl, morphine, and methadone) increased 6% per year (IRR = 1.06; 95% CI: 1.02-1.10). Methylamphetamine was detected in 6.6% of cases and showed a yearly increase of 7% (IRR = 1.07; 95% CI: 1.01-1.13). The incidence of THC remained unchanged over the period, observed in 13.1% of cases. Stronger opioids were more commonly detected among pedal cyclists (19.0%) and pedestrians (20.9%) while THC was more commonly detected among motorcyclists (19.8%) and other light vehicle drivers (17.6%).

CONCLUSIONS

A decline in the prevalence of alcohol in fatalities suggests that law enforcement and public health strategies in Australia to address road fatalities and drink-driving may have had a positive effect. However, increases were observed in the incidence of other potentially impairing drugs including opioids and amphetamines, specifically methylamphetamine, indicating a concerning trend in road safety in Victoria that warrants further monitoring.

Active commuting to work among teachers of public basic education of the state of Minas Gerais

Abstract - The aim of the study was to verify the prevalence and factors associated with active transport to work among public basic education teachers in the state of Minas Gerais. An epidemiological survey of the websurvey type was carried out with teachers from the state public system of basic education in Minas Gerais. The collection took place from August to September 2020 via digital form. The dependent variable was active transport to work and the crude; and adjusted Poisson Regression was used. 15,641 teachers participated in the study, of which, 26.1% were actively commuting to work. There was a higher prevalence among women (PR=1.08; 95%CI 1.01; 1.17), aged 41 to 59 years (PR=1.20; 95%CI 1.12;1.28), from the urban area (PR=1.51; 95%CI 1.37;1.66), with lower family income (PR=1.75; 95%CI 1.48;1.93), those with working time higher than 20 years (PR=1.27; 95%CI 1.19;1.35), who work as teachers for up to 39 hours per week (PR=1.15; 95%CI 1.06;1.25), with eutrophic weight (PR=1.09; 95%CI 1.02;1.17) and those who practiced physical activity 5 times or more a week (PR=1.25; 95%CI 1.15;1.36). The results showed that there is a significant prevalence of teachers who do not carry out active transport to work. The highest prevalence of active transport to work was significantly associated with several variables, among which the census area and family income. Incentives are needed to promote active transportation among teachers.

Exploring the Impact of Remoteness and Socio-Economic Status on Child and Adolescent Injury-Related Mortality in Australia

Injuries are a leading cause of harm for children. This study explores the impact of determinants of health on children (0-19 years) injury-related mortality (namely remoteness and socio-economic disadvantage, calculated using the index of relative socio-economic advantage and disadvantage (IRSAD)). Cause of death data from the Australian Bureau of Statistics were sourced for children in Australia between 1 July 2007 to 30 June 2017. Fifteen injury categories (ICD-10-AM external cause codes) were used. Burden and trends by injury mechanism were explored. A total of 5153 children died; with road traffic incidents (3.39 per 100,000 population), intentional self-harm (2.46) and drowning (0.72) being the leading mechanisms. Female fatality rates in very remote areas (8.73) were nine times higher than in major cities (Relative Risk [RR] = 8.73; 95% Confidence Interval [95% CI]: 4.23-18.00). Fatality rates increased with remoteness; very remote areas recording an injury-related fatality rated six times (RR = 5.84; 95% CI: 3.76-9.12) that of major city residents. Accidental poisoning and intentional self-harm fatalities were more likely in high IRSAD areas, while road traffic fatalities were more likely in low and mid socio-economic areas (X2 = 69.1; p < 0.001). People residing in regional and remote areas and from low socio-economic backgrounds already face significant health and lifestyle challenges associated with disadvantage. It is time to invest in injury prevention interventions for these populations, as well as upstream policy strategies to minimize any further preventable loss of life.

Individual and Environmental Factors Associated with Participation in Physical Activity as Adolescents Transition to Secondary School: A Qualitative Inquiry

The transition from elementary to secondary school is an emotionally and socially complex time when adverse behaviors appear, such as decreased levels of physical activity (PA). Behavioral and environmental factors that influence PA during this time are poorly understood. Therefore, we aimed to identify factors that influence PA as adolescents transition to secondary school. Qualitative interviews were conducted with a sample of 27 ethnically diverse child–parent dyads within the public-school system in British Columbia, Canada (50% boys, 68% mothers, 25% White). The interviews probed for environmental and behavioral factors in school, family, and social contexts that potentially initiated changes in PA, specifically related to the adolescents’ transitions. Interviews were recorded and transcribed verbatim. Thematic analyses identified factors at the individual, social, familial, and school levels that may trigger adolescents to change their participation in PA as they transition from elementary to secondary school. Twenty-two factors emerged from the qualitative analysis including school factors (8), household factors (3), social factors (4), and intrapersonal factors (7). These findings contribute to a better understanding of adolescents’ PA behaviors and highlight the influence of changing environments as they transition from elementary school to secondary school.

Cross-sectional associations of neighbourhood socioeconomic disadvantage and greenness with accelerometer-measured leisure-time physical activity in a cohort of ageing workers

OBJECTIVE

Neighbourhood characteristics may affect the level of physical activity (PA) of the residents. Few studies have examined the combined effects of distinctive neighbourhood characteristics on PA using objective data or differentiated between activity during working or non-working days. We examined the associations of socioeconomic disadvantage and greenness with accelerometer-measured leisure-time PA during working and non-working days.

DESIGN

Cross-sectional study.

SETTING

Finnish Retirement and Aging (FIREA) study.

PARTICIPANTS

708 workers (604 women, mean age 62.4 ranging from 58 to 64 years,) participating in the FIREA study who provided PA measurement data for at least 1 working and non-working day.

PRIMARY AND SECONDARY OUTCOMES

PA was measured with wrist-worn accelerometer on average of 4 working and 2 non-working days. Outcomes were total PA, light PA (LPA) and moderate-to-vigorous PA (MVPA). These measurements were linked to data on neighbourhood socioeconomic disadvantage and greenness within the home neighbourhood (750×750 m). Generalised linear models were adjusted for possible confounders.

RESULTS

On non-working days, higher neighbourhood disadvantage associated with lower levels of total PA (p value=0.07) and higher level of neighbourhood greenness associated with higher level of total PA (p value=0.04). Neighbourhood disadvantage and greenness had an interaction (p value=0.02); in areas of low disadvantage higher greenness did not associate with the level of total PA. However, in areas of high disadvantage, 2 SD higher greenness associated with 46 min/day (95% CI 8.4 to 85) higher total PA. Slightly stronger interaction was observed for LPA (p=0.03) than for the MVPA (p=0.09). During working days, there were no associations between neighbourhood characteristics and leisure-time total PA.

CONCLUSIONS

Of the disadvantaged neighbourhoods, those characterised by high levels of greenness seem to associate with higher levels of leisure-time PA during non-working days. These findings suggest that efforts to add greenness to socioeconomically disadvantaged neighbourhoods might reduce inequalities in PA.

Poverty and Covid-19: Rates of Incidence and Deaths in the United States During the First 10 Weeks of the Pandemic

The Covid-19 pandemic in the winter and spring of 2020 represents a major challenge to the world health care system that has not been seen perhaps since the influenza pandemic in 1918. The virus has spread across the world, claiming lives on all continents with the exception of Antarctica. Since its arrival in the United States, attention has been paid to how Covid-19 cases and deaths have been distributed across varying socioeconomic and ethnic groups. The goal of this study was to examine this issue during the early weeks of the pandemic, with the hope of shedding some light on how the number of cases and the number of deaths were, or were not related to poverty. Results of this study revealed that during the early weeks of the pandemic more disadvantaged counties in the United States had a larger number of confirmed Covid-19 cases, but that over time this trend changed so that by the beginning of April, 2020 more affluent counties had more confirmed cases of the virus. The number of deaths due to Covid-19 were associated with poorer and more urban counties. Discussion of these results focuses on the possibility that testing for the virus was less available in more disadvantaged counties later in the pandemic than was the case earlier, as the result of an overall lack of adequate testing resources across the nation.

Perceived Social and Built Environment Correlates of Transportation and Recreation-Only Bicycling Among Adults

Introduction

Research on perceptions of environmental factors in relation to transportation and recreation bicycling is limited in the United States. We explored the association between perceived social and built environment factors with total, transportation, and recreation bicycling in a sample of adult bicyclists in Austin, Texas, and Birmingham, Alabama. The objective of this study was to examine the relationship between perceived social and built environment factors and domain-specific bicycling in a sample of adult bicyclists.

Methods

Adults aged 18 to 65 who rode a bicycle at least once in the past year completed an internet-based survey that was developed for this study to specifically assess correlates of bicycling; the study was conducted from October 2016 through January 2017. Perceived environmental factors assessed were residential density, traffic safety, destination, connectivity, safety from crime, aesthetics, and bicycle infrastructure. Multivariable logistic regression models were used to estimate the association of each perceived environmental factor (tertile 1, lowest; tertile 3, highest) with recreation-only and transportation bicycling. Effect modification of the relation between environmental factors and bicycling outcomes by sex was also examined.

Results

The final analytic sample size was 801 participants. All environmental factors examined, including residential density, traffic safety, destinations, connectivity, aesthetics, bicycle infrastructure, and safety from crime showed significantly direct associations with transportation bicycling. Traffic safety, destinations, aesthetics, and bicycle infrastructure showed significant direct and inverse associations with recreation-only bicycling. Effect modification by sex was identified with residential density; a significant direct association with recreation-only bicycling was seen among women.

Conclusion

These findings illustrate that bicycling for transportation is associated with different perceived environmental factors than is recreation-only bicycling, with some significant modification by sex. Comprehensive tools that assess the perceived environment for bikeability in the United States are warranted.

Neighborhood Disadvantage and Body Mass Index: A Study of Residential Relocation

Natural experiments, such as longitudinal observational studies that follow-up residents as they relocate, provide a strong basis to infer causation between the neighborhood environment and health. In this study, we examined whether changes in the level of neighborhood disadvantage were associated with changes in body mass index (BMI) after residential relocation. This analysis included data from 928 residents who relocated between 2007 and 2013, across 4 waves of the How Areas in Brisbane Influence Health and Activity (HABITAT) study in Brisbane, Australia. Neighborhood disadvantage was measured using a census-derived composite index. For individual-level data, participants self-reported their height, weight, education, occupation, and household income. Data were analyzed using multilevel, hybrid linear models. Women residing in less disadvantaged neighborhoods had a lower BMI, but there was no association among men. Neighborhood disadvantage was not associated with within-individual changes in BMI among men or women when moving to a new neighborhood. Despite a growing body of literature suggesting an association between neighborhood disadvantage and BMI, we found this association may not be causal among middle-aged and older adults. Observing associations between neighborhood socioeconomic disadvantage and BMI over the life course, including the impact of residential relocation at younger ages, remains a priority for future research.

Cycling for Transportation in Sao Paulo City: Associations with Bike Paths, Train and Subway Stations

Cities that support cycling for transportation reap many public health benefits. However, the prevalence of this mode of transportation is low in Latin American countries and the association with facilities such as bike paths and train/subway stations have not been clarified. We conducted a cross-sectional analysis of the relationship between bike paths, train/subway stations and cycling for transportation in adults from the city of Sao Paulo. We used data from the Sao Paulo Health Survey (n = 3145). Cycling for transportation was evaluated by a questionnaire and bike paths and train/subway stations were geocoded using the geographic coordinates of the adults' residential addresses in 1500-m buffers. We used multilevel logistic regression, taking account of clustering by census tract and households. The prevalence of cycling for transportation was low (5.1%), and was more prevalent in males, singles, those active in leisure time, and in people with bicycle ownership in their family. Cycling for transportation was associated with bike paths up to a distance of 500 m from residences (OR (Odds Ratio) = 2.54, 95% CI (Confidence interval) 1.16-5.54) and with the presence of train/subway stations for distances >500 m from residences (OR = 2.07, 95% CI 1.10-3.86). These results are important to support policies to improve cycling for transportation in megacities such as Sao Paulo.

Neighborhood socioeconomic disadvantage and body mass index among residentially stable mid-older aged adults: Findings from the HABITAT multilevel longitudinal study

Despite a body of evidence on the relationship between neighborhood socioeconomic disadvantage and body mass index (BMI), few studies have examined this relationship over time among ageing populations. This study examined associations between level of neighborhood socioeconomic disadvantage and the rate of change in BMI over time. The sample included 11,035 participants aged between 40 and 65years at baseline from the HABITAT study, residing in 200 neighborhoods in Brisbane, Australia. Data were collected biennially over four waves from 2007 to 2013. Self-reported height and weight were used to calculate BMI, while neighborhood disadvantage was measured using a census-based composite index. All models were adjusted for age, education, occupation, and household income. Analyses were conducted using multilevel linear regression models. BMI increased over time at a rate of 0.08kg/m² (95% CI 0.02, 0.13) and 0.17kg/m² (95% CI 0.11, 0.29) per wave for men and women respectively. Both men and women residing in the most disadvantaged neighborhoods had a higher average BMI than their counterparts living in the least disadvantaged neighborhoods. There were no evident differences in the rate of BMI change over time by level of neighborhood disadvantage. The findings suggest that by mid-older age, the influence of neighborhood socioeconomic conditions over time on BMI may have already played out. Future research should endeavor to identify the genesis of neighborhood socioeconomic inequalities in BMI, the determinants of these inequalities, and then suitable approaches to intervening.

Population levels of, and inequalities in, active travel: A national, cross-sectional study of adults in Scotland

This study aimed to describe active travel (walking or cycling) in Scotland and explore potential demographic, geographic, and socio-economic inequalities in active travel. We extracted data for the period 2012-13 (39,585 journey stages) from the Scottish Household Survey. Survey travel diaries recorded all journeys made on the previous day by sampled individuals aged 16 + living within Scotland, and the stages within each journey. Descriptive statistics were calculated for journey stages, mode, purpose and distance. Logistic regression models were fitted to examine the relationship between the likelihood of a journey stage being active, age, sex, area deprivation and urban/rural classification. A quarter of all journey stages were walked or cycled (26%, n: 10,280/39,585); 96% of these were walked. Those living in the least deprived areas travelled a greater average distance per active journey stage than those in the most deprived. The likelihood of an active journey stage was higher for those living in the most deprived areas than for those in the least deprived (Odds Ratio (OR) 1.21, 95% CI 1.04-1.41) and for those in younger compared to older age groups (OR 0.44, 95% CI 0.34-0.58). In conclusion, socio-economic inequalities in active travel were identified, but - contrary to the trends for many health-beneficial behaviours - with a greater likelihood of active travel in more deprived areas. This indicates a potential contribution to protecting and improving health for those whose health status tends to be worse. Walking was the most common mode of active travel, and should be promoted as much as cycling.

Psychosocial and environmental correlates of active and passive transport behaviors in college educated and non-college educated working young adults

Background

This study aimed to examine potential differences in walking, cycling, public transport and passive transport (car/moped/motorcycle) to work and to other destinations between college and non-college educated working young adults. Secondly, we aimed to investigate which psychosocial and environmental factors are associated with the four transport modes and whether these associations differ between college and non-college educated working young adults.

Methods

In this cross-sectional study, 224 working young adults completed an online questionnaire assessing socio-demographic variables (8 items), psychosocial variables (6 items), environmental variables (10 items) and transport mode (4 types) and duration to work/other destinations. Zero-inflated negative binomial regression models were performed in R.

Results

A trend (p<0.10) indicated that more college educated compared to non-college educated young adults participated in cycling and public transport. However, another trend indicated that cycle time and public transport trips were longer and passive transport trips were shorter in non-college compared to college educated working young adults. In all working young adults, high self-efficacy towards active transport, and high perceived benefits and low perceived barriers towards active and public transport were related to more active and public transport. High social support/norm/modeling towards active, public and passive transport was related to more active, public and passive transport. High neighborhood walkability was related to more walking and less passive transport. Only in non-college educated working young adults, feeling safe from traffic and crime in their neighborhood was related to more active and public transport and less passive transport.

Conclusions

Educational levels should be taken into account when promoting healthy transport behaviors in working young adults. Among non-college educated working young adults, focus should be on increasing active and public transport participation and on increasing neighborhood safety to increase active and public transport use. Among college educated working young adults, more minutes of active transport should be encouraged.

Pedestrian-oriented zoning is associated with reduced income and poverty disparities in adult active travel to work, United States

Active travel to work can provide additional minutes of daily physical activity. While the literature points to the relationship between zoning, equity and socioeconomic status, and physical activity, no study has quantitatively explored these connections. This study examined whether zoning may help to moderate any income and poverty inequities in active travel and taking public transit to work. Research was conducted between May 2012 and June 2015. Zoning data were compiled for 3914 jurisdictions covering 45.45% of the U.S. population located in 471 of the most populous U.S. counties and 2 consolidated cities located in 48 states and the District of Columbia. (Sensitivity analyses also captured unincorporated areas which, with the municipalities, collectively covered ~72% of the U.S.

POPULATION

) Zoning codes were obtained and evaluated to assess the pedestrian-orientation of the zoning codes. Public transit use, active travel to work, median household income, and poverty data were obtained for all study jurisdictions from the 2010-2014 American Community Survey estimates. Associations were examined through multivariate regression models, controlling for community sociodemographics, clustered on county, with robust standard errors. We found that certain pedestrian-oriented zoning provisions (e.g., crosswalks, bike-pedestrian connectivity, street connectivity, bike lanes, bike parking, and more zoning provisions) were associated with reduced income and/or poverty disparities in rates of public transit use and active travel to work. Findings from this study can help to inform cross-sectoral collaborations between the public health, planning, and transportation fields regarding zoning for pedestrian-orientation and active travel.

Car free cities: Pathway to healthy urban living

BACKGROUND

Many cities across the world are beginning to shift their mobility solution away from the private cars and towards more environmentally friendly and citizen-focused means. Hamburg, Oslo, Helsinki, and Madrid have recently announced their plans to become (partly) private car free cities. Other cities like Paris, Milan, Chengdu, Masdar, Dublin, Brussels, Copenhagen, Bogota, and Hyderabad have measures that aim at reducing motorized traffic including implementing car free days, investing in cycling infrastructure and pedestrianization, restricting parking spaces and considerable increases in public transport provision. Such plans and measures are particularly implemented with the declared aim of reducing greenhouse gas emissions. These reductions are also likely to benefit public health.

AIMS

We aimed to describe the plans for private car free cities and its likely effects on public health.

METHODS

We reviewed the grey and scientific literature on plans for private car free cities, restricted car use, related exposures and health.

RESULTS

An increasing number of cities are planning to become (partly) private car free. They mainly focus on the reduction of private car use in city centers. The likely effects of such policies are significant reductions in traffic-related air pollution, noise, and temperature in city centers. For example, up to a 40% reduction in NO2 levels has been reported on car free days. These reductions are likely to lead to a reduction in premature mortality and morbidity. Furthermore the reduction in the number of cars, and therefore a reduction in the need for parking places and road space, provides opportunities to increase green space and green networks in cities, which in turn can lead to many beneficial health effects. All these measures are likely to lead to higher levels of active mobility and physical activity which may improve public health the most and also provide more opportunities for people to interact with each other in public space. Furthermore, such initiatives, if undertaken at a sufficiently large scale can result in positive distal effects and climate change mitigation through CO2 reductions. The potential negative effects which may arise due to motorized traffic detouring around car free zone into their destinations also need further evaluation and the areas in which car free zones are introduced need to be given sufficient attention so as not to become an additional way to exacerbate socioeconomic divides. The extent and magnitude of all the above effects is still unclear and needs further research, including full chain health impact assessment modeling to quantify the potential health benefits of such schemes, and exposure and epidemiological studies to measure any changes when such interventions take place.

CONCLUSIONS

The introduction of private car free cities is likely to have direct and indirect health benefits, but the exact magnitude and potential conflicting effects are as yet unclear. This paper has overviewed the expected health impacts, which can be useful to underpin policies to reduce car use in cities.