Cycling and walking to work in New Zealand, 1991-2006: regional and individual differences, and pointers to effective interventions

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.

Changes in public bike usage after the COVID-19 outbreak: A survey of Seoul public bike sharing users

When the COVID-19 pandemic swept across the world, people tended to seek more individualized and viable transportation modes, such as a bicycle. In this study, we examined the factors influencing changes in public bike sharing (PBS) in Seoul, to assess this trend post-pandemic. We conducted an online survey of 1,590 Seoul PBS users between July 30 and August 7, 2020. Using a difference-in-differences analysis, we found that participants who were affected by the pandemic used PBS 44.6 h more than unaffected individuals throughout the year. In addition, we used a multinomial logistic regression analysis to identify the factors affecting changes in PBS usage. In this analysis, the discrete dependent variables of increased, unchanged, and decreased were considered, representing the changes in PBS usage after the COVID-19 outbreak. Results revealed that PBS usage increased among female participants during weekday trips such as commuting to work and when there were perceived health benefits of using PBS. Conversely, PBS usage tended to decrease when the weekday trip purpose was for leisure or working out. Our findings offer insight into PBS user behaviors within the context of the COVID-19 pandemic and present policy implications to revitalize PBS usage.

Public Policies to Promote Sustainable Transports: Lessons from Valencia

Bicycling appears in the literature on urban mobility as a more sustainable transportation mode for future transportation, based on empirical evidence of the potential benefits of bicycling on the environment, society, and health. In this context, public interventions to promote and maintain bicycling as a sustainable practice and its positive effects are salient. This article reviews different cycling policies with respect to cycling facilities present in the literature and compares them with a case study in Valencia (Spain). We collected information on the public policies implemented in Valencia and the traffic intensity in bike lanes over detecting loops distributed around the city. The results show a strong increase in bicycle use accompanying the implementation of public policies that promote bicycling. The effectiveness of public policies and their impact on bicycling and sustainability are discussed.

Non-vehicle commuting in Italy: need for ergonomic action for women's lower limbs?

INTRODUCTION

The aim of this paper is to examine gender differences in the occurrence of accidents among workers while walking to or from their workplace (non-vehicle commuting accidents). We have previously found that the lower limb is more often injured at work among women, compared to men, so the paper concentrates on lower limb injuries.

METHODS

Using the records of the National Institute for Insurance against Injuries at Work (INAIL), we focused on the non-vehicle commuting accidents of women and men recognized as work-related for the period 2013-2017. In particular, we examined the gender difference by work sector and type of trauma suffered with particular attention to lower limb injuries.

RESULTS

The rate of non-vehicle commuting accidents (n. 60,936) among women was significantly higher than for men (1.29‰ vs 0.40‰ men, p < 0.001) for the period studied. Lower limb injuries (50.5% for women and 43.7% for men, p < 0.001) constituted the large majority of these injuries. In particular, dislocation of the ankle (78% for women vs 65.5% for men, p < 0.001), bruise of the knee (71.2% for women vs 54.9% for men, p < 0.001) and fracture of the foot (41% for women vs 33.6% for men, p < 0.001) were all significantly higher among women. The work sectors with higher injury rates were: Transport and Warehouse, Public Administration, Health and care services and Wholesale and retail trade. This result may be due to wear and tear from conditions at work. The women injured were on the average, a decade older than men (50-59 vs 40-49 years old).

CONCLUSIONS

Non-vehicle commuting represents an important, albeight neglected, preventable risk for women workers, causing lower limb trauma particularly at the ankle, the foot and the knee. These areas may be particularly injure-prone among women in specific sectors, due to the work environment. Effective prevention of these injuries requires gender-oriented ergonomic actions at work and in the commuting environment.

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

BACKGROUND

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

METHOD

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

RESULTS

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

DISCUSSION

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

Employer schemes to encourage walking to work: feasibility study incorporating an exploratory randomised controlled trial

Background

Physical inactivity increases the risk of many chronic diseases, including coronary heart disease, type 2 diabetes, obesity and some cancers. Increasing physical activity levels, particularly among the most sedentary, is an important aim of current public health policy in the UK. An opportunity for working adults to increase physical activity levels may be through walking during the daily commute.

Objectives

To build on existing knowledge and resources to develop an employer-led scheme to increase walking to work; to test the feasibility of implementing and evaluating the intervention; and to explore other requirements of a full-scale trial.

Design

Feasibility study incorporating phase 1 resource review, focus groups with employees and interviews with employers in three workplaces (one small, one medium and one large); and phase 2 exploratory cluster randomised controlled trial (RCT) including process and economic evaluations.

Setting

Workplaces (eight small, five medium and four large) in Bristol.

Participants

One hundred and eighty-seven employees (89 male and 98 female) at baseline.

Interventions

Walk to Work promoters were recruited and trained about the health, social, economic and environmental benefits of walking to work and how to identify and promote safe walking routes for employees. They were given resource packs based on nine key behaviour change techniques. The role of the Walk to Work promoter was to encourage participating employees in their workplace to walk to work; to help to identify walking routes; to encourage goal setting; and to provide additional encouragement through four contacts over the following 10 weeks (face to face, e-mail or telephone, as appropriate).

Main outcome measures

Recruitment and retention rates; sample size calculation and estimation of the intracluster correlation coefficient (ICC); acceptability of the intervention and evaluation methods; and estimation of costs.

Results

Workplace and employee recruitment appeared to be restricted by the initial requirement to identify employees living within 2 miles of the workplace. Once recruited, no workplace withdrew from the study between baseline and 1-year follow-up. It proved feasible to recruit and train workplace Walk to Work promoters. The response rate was 132 (71%) at 1-year follow-up. Although the study was not powered to measure effectiveness, accelerometer data suggest that overall physical activity and moderate to vigorous physical activity (MVPA) were higher in the intervention arm than in the control arm at 1-year follow-up. The ICC was estimated at 0.12 (95% confidence interval 0.00 to 0.30). Based on an average cluster size of eight, an ICC of 0.15 and attrition of 25%, a total sample size of 678 would have 80% power with 5% significance to detect a 15% increase in mean MVPA. The average cost of the intervention was estimated at £441 per workplace. Activity levels were similar in the intervention and control arms at baseline.

Conclusions

The intervention and evaluation were feasible, and acceptable to participants. There was sufficient evidence of promise to justify a full-scale trial incorporating lessons learned during the feasibility study. Future work: an application is being submitted for a follow-on full-scale cluster RCT.

Trial registration

Current Controlled Trials ISRCTN72882329.

Funding

This project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 3, No. 4. See the NIHR Journals Library website for further project information. The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

Increasing active travel: aims, methods and baseline measures of a quasi-experimental study

BACKGROUND

Policy advisers are seeking robust evidence on the effectiveness of measures, such as promoting walking and cycling, that potentially offer multiple benefits, including enhanced health through physical activity, alongside reductions in energy use, traffic congestion and carbon emissions. This paper outlines the 'ACTIVE' study, designed to test whether the Model Communities Programme in two New Zealand cities is increasing walking and cycling. The intervention consists of the introduction of cycle and walkway infrastructure, along with measures to encourage active travel. This paper focuses on the rationale for our chosen study design and methods.

METHOD

The study design is multi-level and quasi-experimental, with two intervention and two control cities. Baseline measures were taken in 2011 and follow-up measures in 2012 and 2013. Our face-to-face surveys measured walking and cycling, but also awareness, attitudes and habits. We measured explanatory and confounding factors for mode choice, including socio-demographic and well-being variables. Data collected from the same households on either two or three occasions will be analysed using multi-level models that take account of clustering at the household and individual levels. A cost-benefit analysis will also be undertaken, using our estimates of carbon savings from mode shifts. The matching of the intervention and control cities was quite close in terms of socio-demographic variables, including ethnicity, and baseline levels of walking and cycling.

DISCUSSION

This multidisciplinary study provides a strong design for evaluating an intervention to increase walking and cycling in a developed country with relatively low baseline levels of active travel. Its strengths include the use of data from control cities as well as intervention cities, an extended evaluation period with a reasonable response rate from a random community survey and the availability of instrumental variables for sensitivity analyses.

The role of multilevel factors in geographic differences in bicycle crash risk: a prospective cohort study

BACKGROUND

Regular cycling plays an important role in increasing physical activity levels but raises safety concerns for many people. While cyclists bear a higher risk of injury than most other types of road users, the risk differs geographically. Auckland, New Zealand's largest urban region, has a higher injury risk than the rest of the country. This paper identified underlying factors at individual, neighbourhood and environmental levels and assessed their relative contribution to this risk differential.

METHODS

The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 and followed over a median period of 4.6 years through linkage to four national databases. The Auckland participants were compared with others in terms of baseline characteristics, crash outcomes and perceptions about environmental determinants of cycling. Cox regression modelling for repeated events was performed with multivariate adjustments.

RESULTS

Of the 2554 participants whose addresses could be mapped, 919 (36%) resided in Auckland. The Auckland participants were less likely to be Māori but more likely to be socioeconomically advantaged and reside in an urban area. They were less likely to cycle for commuting and off-road but more likely to cycle in the dark and in a bunch, use a road bike and use lights in the dark. They had a higher risk of on-road crashes (hazard ratio: 1.47; 95% CI: 1.22, 1.76), of which 53% (95% CI: 20%, 72%) was explained by baseline differences, particularly related to cycling off-road, in the dark and in a bunch and residing in urban areas. They were more concerned about traffic volume, speed and drivers' behaviour.

CONCLUSIONS

The excess crash risk in Auckland was explained by cycling patterns, urban residence and factors associated with the region's car-dominated transport environment.

Incidence, risk, and protective factors of bicycle crashes: findings from a prospective cohort study in New Zealand

OBJECTIVE

To estimate the incidence and risk of medically or police attended bicycle crashes in a prospective cohort study in New Zealand.

METHOD

The Taupo Bicycle Study involved 2590 adult cyclists recruited from the country's largest cycling event in 2006 and followed over a median period of 4.6 years through linkage to four administrative databases. Incidence rates with Poisson distribution confidence intervals were computed and Cox regression modelling for repeated events was performed.

RESULTS

The 66 on-road crashes and 10 collisions per 1000 person-years corresponded to 240 crashes and 38 collisions per million hours spent road cycling. The risk increased by 6% and 8% respectively for an extra cycling hour each week. There were 50 off-road crashes per 1000 person-years. Residing in urban areas and in Auckland (region with the lowest level of cycling), riding in a bunch, using a road bike and experiencing a previous crash predicted a higher risk. Habitual use of conspicuity aids appeared to lower the risk.

CONCLUSION

The risk is higher in urban areas and where cycling is less common, and increased by bunch riding and previous crashes. These findings alongside the possible protective effect of conspicuity aids suggest promising approaches to improving cycle safety.

Completeness and accuracy of crash outcome data in a cohort of cyclists: a validation study

Background

Bicycling, despite its health and other benefits, raises safety concerns for many people. However, reliable information on bicycle crash injury is scarce as current statistics rely on a single official database of limited quality. This paper evaluated the completeness and accuracy of crash data collected from multiple sources in a prospective cohort study involving cyclists.

Methods

The study recruited 2438 adult cyclists from New Zealand’s largest mass cycling event in November 2006 and another 190 in 2008, and obtained data regarding bicycle crashes that were attended by medical personnel or the police and occurred between the date of recruitment and 30 June 2011, through linkage to insurance claims, hospital discharges, mortality records and police reports. The quality of the linked data was assessed by capture-recapture methods and by comparison with self-reported injury data collected in a follow-up survey.

Results

Of the 2590 cyclists who were resident in New Zealand at recruitment, 855 experienced 1336 crashes, of which 755 occurred on public roads and 120 involved a collision with a motor vehicle, during a median follow-up of 4.6 years. Log-linear models estimated that the linked data were 73.7% (95% CI: 68.0%-78.7%) complete with negligible differences between on- and off-road crashes. The data were 83.3% (95% CI: 78.9%-87.6%) complete for collisions. Agreement with the self-reported data was moderate (kappa: 0.55) and varied by personal factors, cycling exposure and confidence in recalling crash events. If self-reports were considered as the gold standard, the linked data had 63.1% sensitivity and 93.5% specificity for all crashes and 40.0% sensitivity and 99.9% specificity for collisions.

Conclusions

Routinely collected databases substantially underestimate the frequency of bicycle crashes. Self-reported crash data are also incomplete and inconsistent. It is necessary to improve the quality of individual data sources as well as record linkage techniques so that all available data sources can be used reliably.

Global physical activity levels: surveillance progress, pitfalls, and prospects

To implement effective non-communicable disease prevention programmes, policy makers need data for physical activity levels and trends. In this report, we describe physical activity levels worldwide with data for adults (15 years or older) from 122 countries and for adolescents (13-15-years-old) from 105 countries. Worldwide, 31·1% (95% CI 30·9-31·2) of adults are physically inactive, with proportions ranging from 17·0% (16·8-17·2) in southeast Asia to about 43% in the Americas and the eastern Mediterranean. Inactivity rises with age, is higher in women than in men, and is increased in high-income countries. The proportion of 13-15-year-olds doing fewer than 60 min of physical activity of moderate to vigorous intensity per day is 80·3% (80·1-80·5); boys are more active than are girls. Continued improvement in monitoring of physical activity would help to guide development of policies and programmes to increase activity levels and to reduce the burden of non-communicable diseases.

Temporal, seasonal and weather effects on cycle volume: an ecological study

BACKGROUND

Cycling has the potential to provide health, environmental and economic benefits but the level of cycling is very low in New Zealand and many other countries. Adverse weather is often cited as a reason why people do not cycle. This study investigated temporal and seasonal variability in cycle volume and its association with weather in Auckland, New Zealand's largest city.

METHODS

Two datasets were used: automated cycle count data collected on Tamaki Drive in Auckland by using ZELT Inductive Loop Eco-counters and weather data (gust speed, rain, temperature, sunshine duration) available online from the National Climate Database. Analyses were undertaken using data collected over one year (1 January to 31 December 2009). Normalised cycle volumes were used in correlation and regression analyses to accommodate differences by hour of the day and day of the week and holiday.

RESULTS

In 2009, 220,043 bicycles were recorded at the site. There were significant differences in mean hourly cycle volumes by hour of the day, day type and month of the year (p < 0.0001). All weather variables significantly influenced hourly and daily cycle volumes (p < 0.0001). The cycle volume increased by 3.2% (hourly) and 2.6% (daily) for 1°C increase in temperature but decreased by 10.6% (hourly) and 1.5% (daily) for 1 mm increase in rainfall and by 1.4% (hourly) and 0.9% (daily) for 1 km/h increase in gust speed. The volume was 26.2% higher in an hour with sunshine compared with no sunshine, and increased by 2.5% for one hour increase in sunshine each day.

CONCLUSIONS

There are temporal and seasonal variations in cycle volume in Auckland and weather significantly influences hour-to-hour and day-to-day variations in cycle volume. Our findings will help inform future cycling promotion activities in Auckland.

Regional variations in pedal cyclist injuries in New Zealand: safety in numbers or risk in scarcity?

OBJECTIVE

To assess regional variations in rates of traffic injuries to pedal cyclists resulting in death or hospital inpatient treatment, in relation to time spent cycling and time spent travelling in a car.

METHODS

Cycling injuries were identified from the Mortality Collection and the National Minimum Dataset. Time spent cycling and time spent travelling as a driver or passenger in a car/van/ute/SUV were computed from National Household Travel Surveys. There are 16 census regions in New Zealand, some of which were combined for this analysis to ensure an adequate sample size, resulting in eight regional groups. Analyses were undertaken for 1996-99 and 2003-07.

RESULTS

Injury rates, per million hours spent cycling, varied widely across regions (11 to 33 injuries during 1996-99 and 12 to 78 injuries during 2003-07). The injury rate increased with decreasing per capita time spent cycling. The rate also increased with increasing per capita time spent travelling in a car. There was an inverse association between the injury rate and the ratio of time spent cycling to time spent travelling in a car. The expected number of cycling injuries increased with increasing total time spent cycling but at a decreasing rate particularly after adjusting for total time spent travelling in a car.

CONCLUSIONS

The findings indicate a 'risk in scarcity' effect for New Zealand cyclists such that risk profiles of cyclists are likely to deteriorate if fewer people use a bicycle and more use a car.

IMPLICATIONS

Cooperative efforts to promote cycling and its safety and to restrict car use may reverse the risk in scarcity effect.

Environmental and psychological correlates of older adult's active commuting

PURPOSE

This study explored the environmental and psychological correlates of active commuting in a sample of adults from the European Prospective Investigation into Cancer Norfolk cohort.

METHODS

Members of the cohort who were in employment, lived within 10 km of work, and did not report a limitation that precluded walking were included in this analysis. Psychological factors, perceptions of the neighborhood environment and travel mode to work were reported using questionnaires. Neighborhood and route environmental characteristics were estimated objectively using a geographical information system. The mediating effects of psychological factors were assessed using a series of regression models.

RESULTS

A total of 1279 adults (mean age=60.4 yr, SD=5.4 yr) were included in this analysis, of whom 25% actively commuted to work. In multivariable regression analyses, those who reported strong habits for walking or cycling were more likely to actively commute, whereas those living 4-10 km from work were less likely to actively commute. In addition, living in a rural area was associated with a decreased likelihood of men's active commuting, and in women, living in a neighborhood with high road density and having a route to work that was not on a main or secondary road was associated with an increased likelihood of active commuting. There was weak evidence that habit acted to partly mediate the associations between environmental correlates and active commuting in both sexes.

CONCLUSIONS

The findings suggest that interventions designed to encourage the development of habitual behaviors for active commuting may be effective, especially among those living close to work.

Walking: the first steps in cardiovascular disease prevention

PURPOSE OF REVIEW

Health professionals are presented with the challenge of prescribing physical activity that is likely to be sustained by the sedentary majority. Walking is eminently suited to physical activity prescription for inactive individuals as it is accessible to men and women of all ages and social groups and poses little risk of injury. This paper reviews recent evidence of the health benefits of walking and promotion of walking behavior.

RECENT FINDINGS

Large observational studies consistently show associations between walking and cardiovascular disease endpoints over long periods of follow-up. Intervention studies further support the health benefits of walking, showing improvements in clinical biomarkers and measures after shorter periods of follow-up. Walking appears to have cardiovascular disease-related health benefits in younger, middle-aged, and older men and women, in both healthy and patient populations. Pedometer-based, mobile phone-based, and computer-based programs are effective in increasing walking levels. Neighborhood and workplace amenities and programs may be important supports for walking behaviors.

SUMMARY

Walking has the potential to play a key role in the primary and secondary prevention of cardiovascular disease. Clinicians can prescribe walking to assist patients meet physical activity recommendations and help identify supports available to the patient.

Injuries to pedal cyclists on New Zealand roads, 1988-2007

BACKGROUND

The risk of injury is one of the major barriers to engaging in cycling. We investigated exposure-based rates and profiles of traffic injuries sustained by pedal cyclists that resulted in death or hospital inpatient treatment in New Zealand, one of the most car dependent countries.

METHODS

Pedal cyclist traffic injuries were identified from the Mortality Collection and the National Minimum Dataset. Total time spent cycling was used as the measure of exposure and computed from National Household Travel Surveys. Analyses were undertaken for the periods 1988-91, 1996-99 and 2003-07 in relation to other major road users and by age, gender and body region affected. A modified Barell matrix was used to characterise the profiles of pedal cyclist injuries by body region affected and nature of injury.

RESULTS

Cyclists had the second highest rate of traffic injuries compared to other major road user categories and the rate increased from 1996-99 to 2003-07. During 2003-07, 31 injuries occurred per million hours spent cycling. Non-collision crashes (40%) and collisions with a car, pick-up truck or van (26%) accounted for two thirds of the cycling injuries. Children and adolescents aged under 15 years were at the highest risk, particularly of non-collision crashes. The rate of traumatic brain injuries fell from 1988-91 to 1996-99; however, injuries to other body parts increased steadily. Traumatic brain injuries were most common in collision cases whereas upper extremity fractures were most common in other crashes.

CONCLUSIONS

The burden of fatal and hospitalised injuries among pedal cyclists is considerable and has been increasing over the last decade. This underscores the development of road safety and injury prevention programmes for cyclists alongside the cycling promotion strategies.