Transport and health: en route to a healthier Australia?

Interventions Aiming to Promote Active Commuting in Children and Adolescents: An Evaluation From a Sex/Gender Perspective

Active commuting (AC) provides numerous health benefits and is one way to improve physical activity in children and adolescents. Boys are more likely to use active transport modes than girls. Girls and boys benefit differently from interventions that promote AC. The aim of this systematic review is to evaluate the effects of interventions on girls and boys and to appraise the extent to which previous studies have taken sex/gender into account. Eleven electronic databases were searched to identify all relevant randomized and non-randomized controlled trials based on a priori defined eligibility criteria. Two independent reviewers screened the literature for eligibility and assessed risk of bias. Semiquantitative analyses were conducted to evaluate the effects of intervention effects by taking sex/gender aspects into account. To evaluate sex/gender considerations in interventional studies, a recently developed sex/gender checklist was applied. Twelve studies were included that examined intervention effects on AC in girls and boys. Three intervention studies showed significant effects in increasing AC, with one study favoring girls, one favoring boys, and another focusing on a single sex/gender (only girls). According to the checklist, the overall sex/gender rating highlighted a lack of information in sex/gender consideration. Studies with and without significant effects indicated no differences in the sex/gender checklist. The results indicate that sex/gender is not considered adequately in primary interventional research on AC. To evaluate the effectiveness of intervention in boys and girls, detailed analyses of sex/gender are required, and better reporting about sex/gender-specific intervention content is necessary. In future health research to promote AC, sex/gender should be systematically taken into account.

A Conceptual Framework for Modelling Safe Walking and Cycling Routes to High Schools

Active transport to or from school presents an opportunity for adolescents to engage in daily physical activity. Multiple factors influence whether adolescents actively travel to/from school. Creating safe walking and cycling routes to school is a promising strategy to increase rates of active transport. This article presents a comprehensive conceptual framework for modelling safe walking and cycling routes to high schools. The framework has been developed based on several existing relevant frameworks including (a) ecological models, (b) the “Five Es” (engineering, education, enforcement, encouragement, and evaluation) framework of transport planning, and (c) a travel mode choice framework for school travel. The framework identifies built environment features (land use mix, pedestrian/cycling infrastructure, neighbourhood aesthetics, and accessibility to local facilities) and traffic safety factors (traffic volume and speed, safe road crossings, and quality of path surface) to be considered when modelling safe walking/cycling routes to high schools. Future research should test this framework using real-world data in different geographical settings and with a combination of tools for the assessment of both macro-scale and micro-scale built environment features. To be effective, the modelling and creation of safe routes to high schools should be complemented by other interventions, including education, enforcement, and encouragement in order to minimise safety concerns and promote active transport.

Environmental and Lifestyle Factors Associated with Overweight and Obesity in Perth, Australia

Purpose.

To examine associations between environmental and lifestyle factors and overweight or obesity.

Design.

A cross-sectional survey and an environmental scan of recreational facilities.

Setting.

Metropolitan Perth, Western Australia.

Subjects.

Healthy sedentary workers and homemakers aged 18 to 59 years (n = 1803) living in areas within the top and bottom quintiles of social disadvantage.

Measures.

Four lifestyle factors, one social environmental factor, and five physical environment factors (three objectively measured).

Results.

After adjustment for demographic factors and other variables in the model, overweight was associated with living on a highway (odds ratio [OR], 4.24; 95% confidence interval [CI], 1.62–11.09) or streets with no sidewalks or sidewalks on one side only (OR, 1.35; 95% CI, 1.03–1.78) and perceiving no paths within walking distance (OR, 1.42; 95% CI, 1.08–1.86). Poor access to four or more recreational facilities (OR, 1.68; 95% CI, 1.11–2.55) and sidewalks (OR, 1.62; 95% CI, .98–2.68) and perceiving no shop within walking distance (OR, 1.84; 95% CI, 1.01–3.36) were associated with obesity. Conversely, access to a motor vehicle all the time was negatively associated with obesity (OR, .56; 95% CI, .32–.99). Watching 3 or more hours of television daily (ORs, 1.92 and 1.85, respectively) and rating oneself as less active than others (ORs, 1.66 and 4.05, respectively) were associated with both overweight and obesity. After adjustment for individual demographic factors and all other variables in the model, socioeconomic status of area of residence and leisure-time physical activity were not associated with overweight or obesity.

Conclusion.

Factors that influence overweight and obesity appear to differ, but aspects of the physical environment may be important. Objectively measured neighborhood environment factors warrant further investigation.

The effects of extreme heat on human mortality and morbidity in Australia: implications for public health

Most regions of Australia are exposed to hot summers and regular extreme heat events; and numerous studies have associated high ambient temperatures with adverse health outcomes in Australian cities. Extreme environmental heat can trigger the onset of acute conditions, including heat stroke and dehydration, as well as exacerbate a range of underlying illnesses. Consequently, in the absence of adaptation, the associated mortality and morbidity are expected to increase in a warming climate, particularly within the vulnerable populations of the elderly, children, those with chronic diseases, and people engaged in physical labour in noncooled environments. There is a need for further research to address the evidence needs of public health agencies in Australia. Building resilience to extreme heat events, especially for the most vulnerable groups, is a priority. Public health professionals and executives need to be aware of the very real and urgent need to act now.

School site and the potential to walk to school: the impact of street connectivity and traffic exposure in school neighborhoods

The impact of neighborhood walkability (based on street connectivity and traffic exposure) within 2 km of public primary schools on children regularly walking to school was examined. The most (n=13) and least walkable (n=12) schools were selected using a school-specific 'walkability' index and a cross sectional study undertaken of Year 5, 6 and 7 children (n=1480) and consenting parents (n=1332). After adjustment, regularly walking to school was higher in children attending schools in high walkable neighborhoods (i.e, high street connectivity and low traffic volume) (Odds ratio (OR) 3.63; 95% Confidence Interval (CI) 2.01-6.56), and less likely in neighborhoods with high connectivity but high traffic volume (OR 0.32; 95% CI 0.22-0.47). Connected street networks provide direct routes to school but when designed for heavy traffic, the potential for children to walk to school is reduced. This highlights the importance of carefully considering school siting and, particularly, street design in school neighborhoods.

Encouraging walking for transport and physical activity in children and adolescents: how important is the built environment?

In the post-World War II era, there have been dramatic changes to the environment that appear to be having a detrimental impact on the lifestyles and incidental physical activities of young people. These changes are not trivial and have the potential to influence not only physical health, but also mental health and child development. However, the evidence of the impact of the built environment on physical activity to date is inconsistent. This review examines the evidence on the association between the built environment and walking for transport as well as physical activity generally, with a focus on methodological issues that may explain inconsistencies in the literature to date. It appears that many studies fail to measure behaviour-specific environmental correlates, and insufficient attention is being given to differences according to the age of study participants. Higher levels of out-of-school-hours physical activity and walking appear to be significantly associated with higher levels of urban density and neighbourhoods with mixed-use planning, especially for older children and adolescents. Proximate recreational facilities also appear to predict young people's level of physical activity. However, there are inconsistencies in the literature involving studies with younger children. Independent mobility increases with age. For younger children, the impact of the built environment is influenced by the decision-making of parents as the gatekeepers of their behaviour. Cross-cultural differences may also be present and are worthy of greater exploration. As children develop and are given more independent mobility, it appears that the way neighbourhoods are designed - particularly in terms of proximity and connectivity to local destinations, including schools and shopping centres, and the presence of footpaths - becomes a determinant of whether children are able, and are permitted by their parents, to walk and use destinations locally. If older children and adolescents are to enjoy health and developmental benefits of independent mobility, a key priority must be in reducing exposure to traffic and in increasing surveillance on streets (i.e. 'eyes-on-the-street') through neighbourhood and building design, by encouraging others to walk locally, and by discouraging motor vehicle use in favour of walking and cycling. Parents need to be assured that the rights and safety of pedestrians (and cyclists) - particularly child pedestrians and cyclists - are paramount if we are to turn around our 'child-free streets', now so prevalent in contemporary Australian and US cities. There remains a need for more age- and sex-specific research using behaviour- and context-specific measures, with a view to building a more consistent evidence base to inform future environmental interventions.

Increasing active travel to school: are we on the right track? A cluster randomised controlled trial from Sydney, Australia

OBJECTIVE

To evaluate the effectiveness of a program to increase walking to and from school.

DESIGN

A cluster randomised controlled trial.

SETTING

24 primary public schools in inner west Sydney, Australia.

PARTICIPANTS

1996 students aged 10-12 years and their parents.

INTERVENTION

A two-year multi-component program included classroom activities, development of school Travel Access Guides, parent newsletters and improving environments with local councils.

MEASURES

Two measures were used: a survey completed by students on how they travelled to and from school over five days, and a survey completed by their parents on how their child travelled to and from school in a usual week.

RESULTS

The percentage of students who walked to and from school increased in both the intervention and control schools. Data from parent surveys found that 28.8% of students in the intervention group increased their walking, compared with 19% in the control group (a net increase of 9.8%, p=0.05). However this effect was not evident in the student data.

CONCLUSION

The study produced a mixed result, with a high variation in travel patterns from school to school. Intervention research should address the complexity of multiple factors influencing student travel to school with a focus on changing local environments and parents' travel to work.

The NHF-NRG In Balance-project: the application of Intervention Mapping in the development, implementation and evaluation of weight gain prevention at the worksite

Very few examples of theory-driven and systematically developed weight gain prevention interventions for adults have been described in the literature. The present paper systematically describes the development, implementation and evaluation framework of a weight gain prevention programme directed at young adults at the worksite, namely the NHF-NRG In Balance-project. It not only can be used as a guide to systematically develop weight gain prevention interventions, but also gives an overview of the current theoretical and empirical knowledge-base in the field of obesity prevention. The outline of the paper follows the Intervention Mapping protocol, which includes a systematic inventory of important health issues, their risk behaviours and determinants of these risk behaviours, and specification of the proximal objectives of the programme directed at both energy intake and energy expenditure. The objectives are translated into behaviour change methods and strategies, which are combined in a stepwise intervention programme, and used for a detailed evaluation plan (process and effect evaluation). The NHF-NRG In Balance-project combines mass media and individually tailored communications with worksite environmental changes to raise awareness, to motivate and to enable energy balance behaviour changes. A quasi-experimental pre-test-multiple post-test control group design was applied in 12 worksites (>500 employees).

The place of motorsport in public health: an Australian perspective

The sport of motor racing provides various public health messages and impacts. Positive messages include road safety campaigns aimed at discouraging drink driving. Negative messages include the sponsorship of racing teams by cigarette companies. Locating motorsport events in significant public places can magnify any health messages or impacts of motorsport in two ways. First, the total local impact of the motor racing events (e.g. through pollution or disruption to healthy modes of transport) is greater in city street circuits than in dedicated racing circuits away from urban areas. Second, the symbolic characteristics of locations with special significance and meaning can enhance the impacts on health by adding legitimacy to the events, thus helping to promote products or activities that either undermine or support public health. This paper explores the health messages and impacts of major motorsport events in Australia, and argues that the distinctive geographies of Australian motorsport work to exacerbate the negative impacts of motorsport on public health.

Health and road transport in Pakistan

OBJECTIVE

The 1998 Global Burden of Disease Study estimated that road traffic injuries (RTIs) will become the third leading cause of lost disability-adjusted life years, with two-thirds of the deaths occurring in the least developed nations. Moreover, automobile-based transport systems are associated with air pollution (lead toxicity, asthma and greenhouse gas accumulation), noise disturbances, physical inactivity and obesity.

STUDY DESIGN

This study (1) reviewed road transport literature in Pakistan and the impacts on health outcomes; (2) examined health policies to assess their focus on transport-related health problems; and (3) identified policy gaps for future research.

METHODS

A methodological review of the literature on direct and indirect effects of road transportation in Pakistan. This review includes government documents, memos, statements and draft policies as well as relevant articles indexed in MEDLINE.

RESULTS

A systematic review revealed no approved transport policy in Pakistan, despite three national health policy documents. The Health Chapter of the 9th Five Year Plan appreciates the grave threat of unchecked RTI, but fails to offer specific policy interventions. Despite ambitious plans by the Pakistan Environmental Protection Agency, actual projects and their implementation remain scarce, resulting in ever-increasing air pollution. The health impact of lead toxicity, noise pollution and RTIs remain high, while obesity is on the rise.

CONCLUSION

The increasing health impact of road transport on 140 million people calls for immediate policy action. Government agencies must intervene effectively to establish monitoring and decentralised enforcement nationwide, while simultaneously supporting alternative modes of transportation.