Health research needs more comprehensive accessibility measures: integrating time and transport modes from open data

Accessibility, neighborhood socioeconomic disadvantage and expenditures on electronic gambling machines: a spatial analysis based on player account data

BACKGROUND

Gambling and its harmful effects on human health and well-being represent a significant public health concern in many countries, with electronic gambling machines (EGMs) recognized as one of the most detrimental forms of gambling. Previous research has established an association between EGM accessibility, expenditure, gambling harm, and the socioeconomic status (SES) of neighborhoods. However, there is limited understanding of the direct impact of SES and EGM accessibility on individual player expenditures. Prior estimations of expenditure often rely on self-reported data or venue-level revenue statistics. This study uses high spatial resolution socioeconomic data together with individual-level account-based location and expenditure (point of sales) data (71,669 players, 745 EGM venues) to explore the association between EGM accessibility and neighborhood SES and to examine whether the EGM expenditure of neighborhood residents is associated with EGM accessibility and neighborhood SES.

DATA AND METHODS

Player account data include information on the home location and expenditure of the entire EGM gambling population across every EGM venue located in the Helsinki region, Finland. High-resolution (250 × 250 m) grid-level data on socioeconomic variables were used to obtain the local socioeconomic conditions of the players. EGM accessibility was estimated for every grid cell using a calibrated gravity model derived from the player account data. Statistical analyses included correlation analysis, spatial autocorrelation analysis, and regression models.

RESULTS

First, significantly higher levels of EGM accessibility were found in areas with lower local SES. Second, regression analysis revealed that both higher EGM accessibility and lower local SES were associated with higher annual losses per adult. These results, in combination with visual and spatial autocorrelation analyses, revealed that accessibility to EGM gambling is highly concentrated, especially in lower socioeconomic neighborhoods with higher levels of EGM expenditure.

CONCLUSIONS

The results lay the groundwork for future spatial research on gambling harm, expenditure, accessibility, and SES utilizing detailed account data on the interaction between players and venues. The results underscore the importance of spatial restrictions when regulating EGM accessibility, particularly in areas with vulnerable populations, as a crucial measure for public health and harm prevention. The results also enable targeted gambling harm prevention actions at the local level.

Spatial accessibility and equity of community healthcare: unraveling the impact of varying time and transport mode

Background

Achieving a higher level of accessibility and equity to community healthcare services has become a major concern for health service delivery from the perspectives of health planners and policy makers in China.

Methods

In this study, we introduced a comprehensive door-to-door (D2D) model, integrating it with the open OD API results for precise computation of accessibility to community hospitals over different transport modes. For the D2D public transit mode, we computed the temporal variation and standard deviation of accessibility at different times of the day. Additionally, accessibility values for D2D riding mode, D2D driving mode, and simple driving mode were also computed for comparison. Moreover, we introduced Lorenz curve and Gini index to assess the differences in equity of community healthcare across different times and transport modes.

Results

The D2D public transit mode exhibits noticeable fluctuations in accessibility and equity based on the time of day. Accessibility and equity were notably influenced by traffic flow between 8 AM and 11 AM, while during the period from 12 PM to 10 PM, the open hours of community hospitals became a more significant determinant in Nanjing. The moments with the most equitable and inequitable overall spatial layouts were 10 AM and 10 PM, respectively. Among the four transport modes, the traditional simple driving mode exhibited the smallest equity index, with a Gini value of only 0.243. In contrast, the D2D riding mode, while widely preferred for accessing community healthcare services, had the highest Gini value, reaching 0.472.

Conclusion

The proposed method combined the D2D model with the open OD API results is effective for accessibility computation of real transport modes. Spatial accessibility and equity of community healthcare experience significant fluctuations influenced by time variations. The transportation mode is also a significant factor affecting accessibility and equity level. These results are helpful to both planners and scholars that aim to build comprehensive spatial accessibility and equity models and optimize the location of public service facilities from the perspective of different temporal scales and a multi-mode transport system.

Dynamic measurements of geographical accessibility considering traffic congestion using open data: a cross-sectional assessment for haemodialysis services in Cali, Colombia

Background

Many cities with traffic congestion lack accessibility assessments accounting for traffic congestion and equity considerations but have disaggregated georeferenced municipal-level open data on health services, populations, and travel times big data. We convened a multistakeholder intersectoral collaborative group that developed a digital, web-based platform integrating open and big data to derive dynamic spatial-temporal accessibility measurements (DSTAM) for haemodialysis services. We worked with stakeholders and data scientists and considered people's places of residence, service locations, and travel time to the service with the shortest travel time. Additionally, we predicted the impacts of strategically introducing haemodialysis services where they optimise accessibility.

Methods

Cross-sectional analyses of DSTAM, accounting for traffic congestion, were conducted using a web-based platform. This platform integrated traffic analysis zones, public census and health services datasets, and Google Distance Matrix API travel-time data. Predictive and prescriptive analytics identified optimal locations for new haemodialysis services and estimated improvements. Primary outcomes included the percentage of residents within a 20-min car drive of a haemodialysis service during peak and free-flow traffic congestion. Secondary outcomes focused on optimal locations to maximise accessibility with new services and potential improvements. Findings were disaggregated by sociodemographic characteristics, providing an equity perspective. The study in Cali, Colombia, used geographic and disaggregated sociodemographic data from the adjusted 2018 Colombian census. Predicted travel times were obtained for two weeks in 2020.

Findings

There were substantial traffic variations. Congestion reduced accessibility, especially among marginalised groups. For 6-12 July, free-flow and peak-traffic accessibility rates were 95.2% and 45.0%, respectively. For 23-29 November, free-flow and peak traffic accessibility rates were 89.1% and 69.7%. The locations where new services would optimise accessibility had slight variation and would notably enhance accessibility and health equity.

Interpretation

Establishing haemodialysis services in targeted areas has significant potential benefits. By increasing accessibility, it would enhance urban health and equity.

Funding

No external or institutional funding was received.

Towards more realistic measures of accessibility to emergency departments in Sweden

BACKGROUND

Assuring that emergency health care (EHC) is accessible is a key objective for health care planners. Conventional accessibility analysis commonly relies on resident population data. However, the allocation of resources based on stationary population data may lead to erroneous assumptions of population accessibility to EHC.

METHOD

Therefore, in this paper, we calculate population accessibility to emergency departments in Sweden with a geographical information system based network analysis. Utilizing static population data and dynamic population data, we investigate spatiotemporal patterns of how static population data over- or underestimates population sizes derived from temporally dynamic population data.

RESULTS

Our findings show that conventional measures of population accessibility tend to underestimate population sizes particularly in rural areas and in smaller ED's catchment areas compared to urban, larger ED's-especially during vacation time in the summer.

CONCLUSIONS

Planning based on static population data may thus lead to inequitable distributions of resources. This study is motivated in light of the ongoing centralization of ED's in Sweden, which largely depends on population sizes in ED's catchment areas.

Current patterns of trauma center proliferation have not led to proportionate improvements in access to care or mortality after injury: An ecologic study

BACKGROUND

Timely access to high-level (I/II) trauma centers (HLTCs) is essential to minimize mortality after injury. Over the last 15 years, there has been a proliferation of HLTC nationally. The current study evaluates the impact of additional HLTC on population access and injury mortality.

METHODS

A geocoded list of HLTC, with year designated, was obtained from the American Trauma Society, and 60-minute travel time polygons were created using OpenStreetMap data. Census block group population centroids, county population centroids, and American Communities Survey data from 2005 and 2020 were integrated. Age-adjusted nonoverdose injury mortality was obtained from CDC Wide-ranging Online Data for Epidemiologic Research and the Robert Wood Johnson Foundation. Geographically weighted regression models were used to identify independent predictors of HLTC access and injury mortality.

RESULTS

Over the 15-year (2005-2020) study period, the number of HLTC increased by 31.0% (445 to 583), while population access to HLTC increased by 6.9% (77.5-84.4%). Despite this increase, access was unchanged in 83.1% of counties, with a median change in access of 0.0% (interquartile range, 0.0-1.1%). Population-level age-adjusted injury mortality rates increased by 5.39 per 100,000 population during this time (60.72 to 66.11 per 100,000). Geographically weighted regression controlling for population demography and health indicators found higher median income and higher population density to be positively associated with majority (≥50%) HLTC population coverage and negatively associated with county-level nonoverdose mortality.

CONCLUSION

Over the past 15 years, the number of HLTC increased 31%, while population access to HLTC increased only 6.9%. High-level (I/II) trauma center designation is likely driven by factors other than population need. To optimize efficiency and decrease potential oversupply, the designation process should include population level metrics. Geographic information system methodology can be an effective tool to assess optimal placement.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

Analyzing Spatial Location Preference of Urban Activities with Mode-Dependent Accessibility Using Integrated Land Use–Transport Models

Accessibility is the ease of reaching opportunities (goods, services, activities, and destinations). Accessibility of desirable locations such as households and commercial locations, is typically scaffolded by land use patterns and transportation infrastructure. It can reflect people’s travel convenience, cities’ viability, sustainability, and mitigate the negative effects on the environment and public safety. Consequently, it is recognized as a fundamental principle in urban sustainable development policies worldwide. In the literature, most of the studies have used a static or partially dynamic approach with a single mode such as a car or public transportation by using conventional models. These “static” models assume that household locations are static and that transportation supply and opportunities for social practice activities are fixed in time and space, which can lead to biased or even misleading assumptions in accessibility models. Therefore, the aim of this study is to evaluate the impact of dynamic spatial accessibility through Mode-Dependent Accessibility (MDA) on the location choice behaviors of urban activities such as households and commercialin the City of Wuhan, China. This study employed the Mode-Dependent Travel Demand Model (M-TDM) to measure the impact of short-term MDA on household and commercial activities for the years 2012 and 2015. Additionally, an integrated spatial economic (ISE) model such as PECAS (Production, Exchange, Consumption, Allocation, System) in order to investigate location preferences of urban activities over space and time. Regarding household and commercial location choice, the ISE modeling results revealed that households and commercial activities are sensitive to MDA, especially using transit. The ISE method predicted that the R2 for household and commercial location choice models was 0.84 to 0.90 for transit-based accessibility, whereas the R2 for logsum-based static models was 0.48 to 0.72. In addition, their findings suggest that highly accessible locations that are well served by auto are more appealing for household and commercial activities. The findings of this study will help urban planners, transportation planners, and policymakers take into account the dynamic nature of short-term MDA when zoning and allocating urban activities and public amenities, instead of using static accessibility.

Influence of geographic access and socioeconomic characteristics on breast cancer outcomes: A systematic review

Socio-economic and geographical inequalities in breast cancer mortality have been widely described in European countries and the United States. To investigate the combined effects of geographic access and socio-economic characteristics on breast cancer outcomes, a systematic review was conducted exploring the relationships between: (i) geographic access to healthcare facilities (oncology services, mammography screening), defined as travel time and/or travel distance; (ii) breast cancer-related outcomes (mammography screening, stage of cancer at diagnosis, type of treatment and rate of mortality); (iii) socioeconomic status (SES) at individuals and residential context levels. In total, n = 25 studies (29 relationships tested) were included in our systematic review. The four main results are: The statistical significance of the relationship between geographic access and breast cancer-related outcomes is heterogeneous: 15 were identified as significant and 14 as non-significant. Women with better geographic access to healthcare facilities had a statistically significant fewer mastectomy (n = 4/6) than women with poorer geographic access. The relationship with the stage of the cancer is more balanced (n = 8/17) and the relationship with cancer screening rate is not observed (n = 1/4). The type of measures of geographic access (distance, time or geographical capacity) does not seem to have any influence on the results. For example, studies which compared two different measures (travel distance and travel time) of geographic access obtained similar results. The relationship between SES characteristics and breast cancer-related outcomes is significant for several variables: at individual level, age and health insurance status; at contextual level, poverty rate and deprivation index. Of the 25 papers included in the review, the large majority (n = 24) tested the independent effect of geographic access. Only one study explored the combined effect of geographic access to breast cancer facilities and SES characteristics by developing stratified models.

Combining Temporal and Multi-Modal Approaches to Better Measure Accessibility to Banking Services

The UK, as elsewhere, has seen an accelerating trend of bank branch closures and reduced opening hours since the early 2000s. The reasons given by the banks are well rehearsed, but the impact assessments they provide to justify such programs and signpost alternatives have been widely criticized as being inadequate. This is particularly so for vulnerable customers dependent on financial services who may face difficulties in accessing remaining branches. There is a need whilst analyzing spatial patterns of access to also include temporal availability in relation to transport opportunities. Drawing on a case study of potential multi-modal accessibility to banks in Wales, we demonstrate how open-source tools can be used to examine patterns of access whilst considering the business operating hours of branches in relation to public transport schedules. The inclusion of public and private travel modes provides insights into access that are often overlooked by a consideration of service-side measures alone. Furthermore, findings from the types of tools developed in this study are illustrative of the additional information that could be included in holistic impact assessments, allowing the consequences of decisions being taken to close or reduce the operating hours of bank branches to be more clearly communicated to customers.

Assessing physical access to healthy food across United Kingdom: A systematic review of measures and findings

Background

Existing research suggests that physical access to food can affect diet quality and thus obesity rates. When defining retail food environment (RFE) quantitatively, there is a little agreement on how to measure "lack of healthy food" and what parameters to use, resulting in a heterogeneity of study designs and outcome measures. In turn, this leads to a conflicting evidence base being one of the many barriers to using evidence in policy-making.

Aims

This systematic review aimed to identify and describe methods used to assess food accessibility in the United Kingdom (UK) to overcome heterogeneity by providing a classification of measures.

Materials & Methods

The literature search included electronic and manual searches of peer-reviewed literature and was restricted to studies published in English between January 2010 and March 2021. A total of 9365 articles were assessed for eligibility, of which 44 articles were included in the review. All included studies were analysed with regards to their main characteristics (e.g., associations between variables of interest, setting, sample, design, etc.) and definition of RFE and its metrics. When defining these metrics, the present review distinguishes between a point of origin (centroid, address) from which distance was calculated, summary statistic of accessibility (proximity, buffer, Kernel), and definition of distance (Euclidean, network distance). Trends, gaps and limitations are identified and recommendations made for food accessibility research in UK.

Results

Multiple theoretical and methodological constructs are currently used, mostly quantifying distance by means of Euclidean and ring-buffer distance, using both proximity- and density-based approaches, and ranging from absolute to relative measures. The association between RFE and diet and health in rural areas, as well as a spatiotemporal domain of food access, remains largely unaccounted.

Discussion

Evidence suggests that the duration of exposure may bear a greater importance than the level of exposure and that density-based measures may better capture RFE when compared with proximity-based measures, however, using more complex measures not necessarily produce better results. To move the field forward, studies have called for a greater focus on causality, individual access and the use of various measures, neighbourhood definitions and potential confounders to capture different aspects and dimensions of the RFE, which requires using univariate measures of accessibility and considering the overall context in terms of varying types of neighbourhoods.

Conclusion

In order to render ongoing heterogeneity in measuring RFE, researchers should prioritise measures that may provide a more accurate and realistic account of people's lives and follow an intuitive approach based on convergence of results until consensus could be reached on using some useful standards.

Measuring the Differences of Public Health Service Facilities and Their Influencing Factors

The equitable distribution of public health facilities is a major concern of urban planners. Previous studies have explored the balance and fairness of various medical resource distributions using the accessibility of in-demand public medical service facilities while ignoring the differences in the supply of public medical service facilities. First aid data with location information and patient preference information can reflect the ability of each hospital and the health inequities in cities. Determining which factors affect the measured differences in public medical service facilities and how to alter these factors will help researchers formulate targeted policies to solve the current resource-balance situation of the Ministry of Public Health. In this study, we propose a method to measure the differences in influence among hospitals based on actual medical behavior and use geographically weighted regression (GWR) to analyze the spatial correlations among the location, medical equipment, medical ability, and influencing factors of each hospital. The results show that Wuhan presents obvious health inequality, with the high-grade hospitals having spatial agglomeration in the city-center area, while the number and quality of hospitals in the peripheral areas are lower than those in the central area; thus, the hospitals in these peripheral areas need to be further improved. The method used in this study can measure differences in the influence of public medical service facilities, and the results are consistent with the measured differences at hospital level. Hospital influence is not only related to the equipment and medical ability of each hospital but is also affected by location factors. This method illustrates the necessity of conducting more empirical research on the public medical service supply to provide a scientific basis for formulating targeted policies from a new perspective.

Disparities in Geographical Access to Hospitals in Portugal

Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for implementing policies to improve the access to those services. The aim of this paper is to assess whether inequalities in terms of access to a hospital in Portugal have improved over the last 20 years. A population-weighted driving time was applied using the census tract population, the roads network, the reference hospitals’ catchment area and the municipality boundaries. The results show that municipalities are 25 min away from the hospital—3 min less than in 1991—and that there is an association with premature mortality, elderly population and population density. However, disparities between municipalities are still huge. Municipalities with higher rates of older populations, isolated communities or those located closer to the border with Spain face harder challenges and require greater attention from local administration. Since municipalities now have responsibilities for health, it is important they implement interventions at the local level to tackle disparities impacting access to healthcare.

Measuring Accessibility of Healthcare Facilities for Populations with Multiple Transportation Modes Considering Residential Transportation Mode Choice

Accessibility research of healthcare facilities is developing towards multiple transportation modes (MTM), which are influenced by residential transportation choices and preferences. Due to differences in travel impact factors such as traffic conditions, origin location, distance to the destination, and economic cost, residents’ daily travel presents different residential transportation mode choices (RTMC). The purpose of our study was to measure the spatial accessibility of healthcare facilities based on MTM considering RTMC (MTM-RTMC). We selected the gravity two-step floating catchment area method (G2SFCA) as a fundamental model. Through the single transportation mode (STM), MTM, and MTM-RTMC, three aspects used to illustrate and redesign the G2SFCA, we obtained the MTM-RTMC G2SFCA model that integrates RTMC probabilities and the travel friction coefficient. We selected Nanjing as the experimental area, used route planning data of four modes (including driving, walking, public transportation, and bicycling) from a web mapping platform, and applied the three models to pediatric clinic services to measure accessibility. The results show that the MTM-RTMC mechanism is to make up for the traditional estimation of accessibility, which loses sight of the influence of residential transportation choices. The MTM-RTMC mechanism that provides a more realistic and reliable way can generalize to major accessibility models and offers preferable guidance for policymakers.

Disparities in travel times between car and transit: Spatiotemporal patterns in cities

Cities worldwide are pursuing policies to reduce car use and prioritise public transit (PT) as a means to tackle congestion, air pollution, and greenhouse gas emissions. The increase of PT ridership is constrained by many aspects; among them, travel time and the built environment are considered the most critical factors in the choice of travel mode. We propose a data fusion framework including real-time traffic data, transit data, and travel demand estimated using Twitter data to compare the travel time by car and PT in four cities (São Paulo, Brazil; Stockholm, Sweden; Sydney, Australia; and Amsterdam, the Netherlands) at high spatial and temporal resolutions. We use real-world data to make realistic estimates of travel time by car and by PT and compare their performance by time of day and by travel distance across cities. Our results suggest that using PT takes on average 1.4–2.6 times longer than driving a car. The share of area where travel time favours PT over car use is very small: 0.62% (0.65%), 0.44% (0.48%), 1.10% (1.22%) and 1.16% (1.19%) for the daily average (and during peak hours) for São Paulo, Sydney, Stockholm, and Amsterdam, respectively. The travel time disparity, as quantified by the travel time ratio \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R$$\end{document}R (PT travel time divided by the car travel time), varies widely during an average weekday, by location and time of day. A systematic comparison between these two modes shows that the average travel time disparity is surprisingly similar across cities: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R < 1$$\end{document}R<1 for travel distances less than 3 km, then increases rapidly but quickly stabilises at around 2. This study contributes to providing a more realistic performance evaluation that helps future studies further explore what city characteristics as well as urban and transport policies make public transport more attractive, and to create a more sustainable future for cities.

Longitudinal spatial dataset on travel times and distances by different travel modes in Helsinki Region

Comparable data on spatial accessibility by different travel modes are frequently needed to understand how city regions function. Here, we present a spatial dataset called the Helsinki Region Travel Time Matrix that has been calculated for 2013, 2015 and 2018. This longitudinal dataset contains travel time and distance information between all 250 metres statistical grid cell centroids in the Capital Region of Helsinki, Finland. The dataset is multimodal and multitemporal by nature: all typical transport modes (walking, cycling, public transport, and private car) are included and calculated separately for the morning rush hour and midday for an average working day. We followed a so-called door-to-door principle, making the information between travel modes comparable. The analyses were based primarily on open data sources, and all the tools that were used to produce the data are openly available. The matrices form a time-series that can reveal the accessibility conditions within the city and allow comparisons of the changes in accessibility in the region, which support spatial planning and decision-making.

'Nutrition is out of our control': soldiers' perceptions of their local food environment

Objective:

To explore the perceptions of soldiers participating in a US Army Office of The Surgeon General’s worksite health promotion programme (WHPP) on the local food environment within their campus-style workplace.

Design:

Focus groups were conducted to evaluate the perceived effectiveness of the WHPP implementation. Further exploration of focus group data through thematic analysis focused on perceived contributions of the military campus-style food environment to soldiers’ nutrition behaviours.

Setting:

Three US Army installations located in the continental USA.

Participants:

Active duty soldiers (n 366) participating in one of the fifty-eight focus groups.

Results:

Soldiers shared a common belief of self-discipline and personal responsibility as the foothold to nutrition behaviour change. Soldiers described aspects of the military campus-style food environment as factors impeding achievement of optimal nutrition. Collectively, soldiers perceived the proximity and density of fast-food restaurants, lack of healthy alternatives on the installation and the cost of healthy food as inhibitors to choosing healthy foods. Overwhelmingly, soldiers also perceived time constraints as a factor contributing to unhealthy food choices.

Conclusions:

Although nutrition behaviour is individually driven, soldiers perceived the military campus-style food environment inhibits healthy decision making. Nutrition programming in military WHPP must integrate food environment changes to improve soldiers’ nutrition behaviour outcomes. Applicable to the military, food choice behaviour studies suggest environmental changes must be appealing to young adults. Considerations for environmental changes should include an increased portion size for healthy options, broadened use of soldiers’ daily food allowances on local produce and increased availability of grab-and-go options.

Identifying gaps in the food security safety net: the characteristics and availability of summer nutrition programmes in California, USA

Objective

The US Department of Agriculture’s Summer Food Service Program and Seamless Summer Option (summer nutrition programmes (SNP)) aim to relieve food insecurity for children and teens during summer months. More needs to be known about when and where SNP are available, and how availability varies by community characteristics, particularly in rural areas where food insecurity and reduced food access are more prevalent.

Design

The present study examined the geographic availability of SNP and summer meal uptake rates in 2016, using state-wide administrative claims data.

Setting

Public schools and SNP in California, USA.

Participants

Schools (n8842) and SNP (n4685).

Results

Urban counties were more likely than rural counties to have higher summer uptake rates, calculated as the percentage of summer meals served relative to eligible students utilizing school meal programmes during the academic school year, but uptake overall was low at 18·2 % of target populations. Geographic availability analyses showed that 63·9 % of public urban schools had an SNP available within 1·6 km (1 mile), but availability was significantly higher within the proximity of larger, higher-poverty high schools with diverse or majority non-White students, and those with higher school-year breakfast participation rates. Availability of an SNP within 16 km (10 miles) of rural schools averaged 68·1 % but was significantly higher around larger schools, higher-poverty schools and those with diverse or majority non-White students.

Conclusions

While many communities have SNP available, much more work is needed to increase the availability of these programmes to reduce summer food insecurity for children, particularly in rural communities.

A multi-modal relative spatial access assessment approach to measure spatial accessibility to primary care providers

Two-step floating catchment area (2SFCA) methods that account for multiple transportation modes provide more realistic accessibility representation than single-mode methods. However, the use of the impedance coefficient in an impedance function (e.g., Gaussian function) introduces uncertainty to 2SFCA results. This paper proposes an enhancement to the multi-modal 2SFCA methods through incorporating the concept of a spatial access ratio (SPAR) for spatial access measurement. SPAR is the ratio of a given place's access score to the mean of all access scores in the study area. An empirical study on spatial access to primary care physicians (PCPs) in the city of Albuquerque, NM, USA was conducted to evaluate the effectiveness of SPAR in addressing uncertainty introduced by the choice of the impedance coefficient in the classic Gaussian impedance function. We used ESRI StreetMap Premium and General Transit Specification Feed (GTFS) data to calculate the travel time to PCPs by car and bus. We first generated two spatial access scores-using different catchment sizes for car and bus, respectively-for each demanding population location: an accessibility score for car drivers and an accessibility score for bus riders. We then computed three corresponding spatial access ratios of the above scores for each population location. Sensitivity analysis results suggest that the spatial access scores vary significantly when using different impedance coefficients (p < 0.05); while SPAR remains stable (p = 1). Results from this paper suggest that a spatial access ratio can significantly reduce impedance coefficient-related uncertainties in multi-modal 2SFCA methods.

Spatial access to restaurants and grocery stores in relation to frequency of home cooking

Background

Little is known about the relation between the neighbourhood food environment and home cooking. We explored the independent and combined associations between residential neighbourhood spatial access to restaurants and grocery stores with home cooking in European adults.

Methods

Data of 5076 participants of the SPOTLIGHT study were collected across five European countries in 2014. Food retailers were classified into grocery stores (supermarkets and local food shops) and restaurants (full-service restaurants, fast food and take-away restaurants, café/bars). We used multinomial logistic regression models to test the associations between tertiles of spatial access to restaurants and spatial to access grocery stores and the outcome ‘frequency of home cooking’ categorized into 0-3; 4-5; and 6-7 days/week. Additive interaction analysis was used to test the combined association between access to grocery stores and to restaurants with home cooking.

Results

Mean age was 52.3 years; most participants were women (55.5%) and completed higher education (53.8%). Residents with highest access to restaurants had a reduced likelihood of home cooking 6-7 days/week (vs. 0-3 days/week) (relative risk ratio (RRR) 0.42; 95%CI = 0.23-0.76) when compared with lowest access to restaurants. No association was found for spatial access to grocery stores. Additive interaction analysis showed that individuals with medium access to grocery stores and highest access to restaurants had the lowest likelihood (RRR = 0.29, 95%CI = 0.10-0.84) of cooking 6-7 days/week when compared to individuals with lowest access to restaurants and highest access to grocery stores.

Conclusion

Greater neighbourhood spatial access to restaurants was associated with lower frequency of home cooking, largely independent of access to grocery stores.

Electronic supplementary material

The online version of this article (10.1186/s12966-017-0640-6) contains supplementary material, which is available to authorized users.