Individual Public Transportation Accessibility is Positively Associated with Self-Reported Active Commuting

Examining the impacts of public transit on healthy aging through a natural experiment: study protocols and lessons learned from the Active El Paso project

This paper describes protocols and experiences from a seven-year natural-experiment study in El Paso, Texas, a border city of predominantly Latino/Hispanic population. The study focuses on how Bus Rapid Transit (BRT) impacts physical activity and thus plays a role in alleviating obesity and related chronic diseases that impact healthy aging. Our protocols describe a longitudinal and case-comparison study, which compared residents exposed to new BRT stations with those who were not. This paper also introduces lessons and experiences to overcome the following challenges: delays in the BRT opening (the main intervention), the COVID-19 pandemic, methodological challenges, participant recruitment and retention, and predatory survey takers. Our transdisciplinary approach was pivotal in addressing these challenges. We also proposed and tested multi-level intervention strategies to reduce modifiable barriers to transit use. Our most important takeaway for researchers, practitioners, and policy makers is the importance of being flexible and ready to adapt to new circumstances. Future natural-experiment researchers need to become more versatile in an increasingly volatile and uncertain world.

Perceived benefits and barriers of walking among overweight and obese adults

The current study aimed to explore perceived barriers and benefits of walking of overweight and obese adults. Fifteen face-to-face, semistructured interviews were conducted. Content and thematic analyses were used. Findings revealed that informants were aware of more benefits from walking than barriers. Gaining health and fitness, losing weight, the opportunity to walk in a group, and setting goals and sharing achievements were more sited benefits of walking. Confusion about walking guidelines and walking location perceived as barriers to walking. The findings of this study would be applied to develop walking intervention.

The approaches to measuring the potential spatial access to urban health services revisited: distance types and aggregation-error issues

BACKGROUND

The potential spatial access to urban health services is an important issue in health geography, spatial epidemiology and public health. Computing geographical accessibility measures for residential areas (e.g. census tracts) depends on a type of distance, a method of aggregation, and a measure of accessibility. The aim of this paper is to compare discrepancies in results for the geographical accessibility of health services computed using six distance types (Euclidean and Manhattan distances; shortest network time on foot, by bicycle, by public transit, and by car), four aggregation methods, and fourteen accessibility measures.

METHODS

To explore variations in results according to the six types of distance and the aggregation methods, correlation analyses are performed. To measure how the assessment of potential spatial access varies according to three parameters (type of distance, aggregation method, and accessibility measure), sensitivity analysis (SA) and uncertainty analysis (UA) are conducted.

RESULTS

First, independently of the type of distance used except for shortest network time by public transit, the results are globally similar (correlation >0.90). However, important local variations in correlation between Cartesian and the four shortest network time distances are observed, notably in suburban areas where Cartesian distances are less precise. Second, the choice of the aggregation method is also important: compared with the most accurate aggregation method, accessibility measures computed from census tract centroids, though not inaccurate, yield important measurement errors for 10% of census tracts. Third, the SA results show that the evaluation of potential geographic access may vary a great deal depending on the accessibility measure and, to a lesser degree, the type of distance and aggregation method. Fourth, the UA results clearly indicate areas of strong uncertainty in suburban areas, whereas central neighbourhoods show lower levels of uncertainty.

CONCLUSION

In order to accurately assess potential geographic access to health services in urban areas, it is particularly important to choose a precise type of distance and aggregation method. Then, depending on the research objectives, the choices of the type of network distance (according to the mode of transportation) and of a number of accessibility measures should be carefully considered and adequately justified.

Accessibility of general practitioners and selected specialist physicians by car and by public transport in a rural region of Germany

Background

The accessibility of medical care facilities in sparsely populated rural regions is relevant especially for elderly people which often represent a large segment of the population in such regions. Elderly people have higher morbidity risks and a higher demand for medical care. Although travelling with private cars is the dominating traffic mode in rural regions, accessibility by public transport is increasingly important especially because of limited mobility of elderly people. The aim of this study was to determine accessibility both by car and public transport to general practitioners (GP) and selected specialist physicians for a whole region and to detect areas with poor to no access in the county Vorpommern-Greifswald, which is a rural and sparsely populated region in the very northeast of Germany.

Methods

Accessibility of medical care facilities by car was calculated on the basis of a network analysis within a geographic information system (GIS) with routable street data. Accessibility by public transport was calculated using GIS and a network analysis based on the implementation of Dijkstra’s algorithm.

Results

The travelling time to general practitioners (GP) by car in the study region ranges from 0.1 to 22.9 min. This is a significant difference compared to other physician groups. Traveling times to specialist physicians are 0.4 to 42.9 min. A minority of 80 % of the inhabitants reach the specialist physicians within 20 min. The accessibility of specialist physicians by public transport is poor. The travel time (round trip) to GPs averages 99.3 min, to internists 143.0, to ophthalmologists 129.3 and to urologists 159.9 min. These differences were significant. Assumed was a one hour appointment on a Tuesday at 11 am. 8,973 inhabitants (3.8 %) have no connection to a GP by public transport. 15,455 inhabitants (6.5 %) have no connection to specialist internists.

Conclusions

Good accessibility by public transport is not a question of distance but of transport connections. GIS analyses can detect areas with imminent or manifest deficits in the accessibility of health care providers. Accessibility analyses should be established instruments in planning issues.

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

Background

In this paper, we demonstrate why and how both temporality and multimodality should be integrated in health related studies that include accessibility perspective, in this case healthy food accessibility. We provide evidence regarding the importance of using multimodal spatio-temporal accessibility measures when conducting research in urban contexts and propose a methodological approach for integrating different travel modes and temporality to spatial accessibility analyses. We use the Helsinki metropolitan area (Finland) as our case study region to demonstrate the effects of temporality and modality on the results.

Methods

Spatial analyses were carried out on 250 m statistical grid squares. We measured travel times between the home location of inhabitants and open grocery stores providing healthy food at 5 p.m., 10 p.m., and 1 a.m. using public transportation and private cars. We applied the so-called door-to-door approach for the travel time measurements to obtain more realistic and comparable results between travel modes. The analyses are based on open access data and publicly available open-source tools, thus similar analyses can be conducted in urban regions worldwide.

Results

Our results show that both time and mode of transport have a prominent impact on the outcome of the analyses; thus, understanding the realities of accessibility in a city may be very different according to the setting of the analysis used. In terms of travel time, there is clear variation in the results at different times of the day. In terms of travel mode, our results show that when analyzed in a comparable manner, public transport can be an even faster mode than a private car to access healthy food, especially in central areas of the city where the service network is dense and public transportation system is effective.

Conclusions

This study demonstrates that time and transport modes are essential components when modeling health-related accessibility in urban environments. Neglecting them from spatial analyses may lead to overly simplified or even erroneous images of the realities of accessibility. Hence, there is a risk that health related planning and decisions based on simplistic accessibility measures might cause unwanted outcomes in terms of inequality among different groups of people.