Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities

INTRODUCTION

Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not.

METHODS AND ANALYSIS

Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities.

ETHICS AND DISSEMINATION

This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.

Risk Factors and Inequities in Transportation Injury and Mortality in the Canadian Census Health and Environment Cohorts (CanCHECs)

BACKGROUND

Road traffic injury contributes substantially to morbidity and mortality. Canada stands out among developed countries in not conducting a national household travel survey, leading to a dearth of national transportation mode data and risk calculations that have appropriate denominators. Since traffic injuries are specific to the mode of travel used, these risk calculations should consider travel mode.

METHODS

Census data on mode of commute is one of the few sources of these data for persons aged 15 and over. This study leveraged a national data linkage cohort, the Canadian Census Health and Environment Cohorts, that connects census sociodemographic and commute mode data with records of deaths and hospitalizations, enabling assessment of road traffic injury associations by indicators of mode of travel (commuter mode). We examined longitudinal (1996-2019) bicyclist, pedestrian, and motor vehicle occupant injury and fatality risk in the Canadian Census Health and Environment Cohorts by commuter mode and sociodemographic characteristics using Cox proportional hazards models within the working adult population.

RESULTS

We estimated positive associations between commute mode and same mode injury and fatality, particularly for bicycle commuters (hazard ratios for bicycling injury was 9.1 and for bicycling fatality was 11). Low-income populations and Indigenous people had increased injury risk across all modes.

CONCLUSIONS

This study shows inequities in transportation injury risk in Canada and underscores the importance of adjusting for mode of travel when examining differences between population groups.

Associations between gentrification, census tract-level socioeconomic status, and cycling infrastructure expansions in Montreal, Canada

Background

Cycling infrastructure investments support active transportation, improve population health, and reduce health inequities. This study examines the relationship between changes in cycling infrastructure (2011-2016) and census tract (CT)-level measures of material deprivation, visible minorities, and gentrification in Montreal.

Methods

Our outcomes are the length of protected bike lanes, cyclist-only paths, multi-use paths, and on-street bike lanes in 2011, and change in total length of bike lanes between 2011 and 2016 at the CT level. Census data provided measures of the level of material deprivation and of the percentage of visible minorities in 2011, and if a CT gentrified between 2011 and 2016. Using a hurdle modeling approach, we explore associations among these CT-level socioeconomic measures, gentrification status, baseline cycling infrastructure (2011), and its changes (2011-2016). We further tested if these associations varied depending on the baseline level of existing infrastructure, to assess if areas with originally less resources benefited less or more.

Results

In 2011, CTs with higher level of material deprivation or greater percentages of visible minorities had less cycling infrastructure. Overall, between 2011 and 2016, cycling infrastructure increased from 7.0% to 10.9% of the road network, but the implementation of new cycling infrastructure in CTs with no pre-existing cycling infrastructure in 2011 was less likely to occur in CTs with a higher percentage of visible minorities. High-income CTs that were ineligible for gentrification between 2011 and 2016 benefited less from new cycling infrastructure implementations compared to low-income CTs that were not gentrified during the same period.

Conclusion

Montreal's municipal cycling infrastructure programs did not exacerbate socioeconomic disparities in cycling infrastructure from 2011 to 2016 in CTs with pre-existing infrastructure. However, it is crucial to prioritize the implementation of cycling infrastructure in CTs with high populations of visible minorities, particularly in CTs where no cycling infrastructure currently exists.

Association between a genetic index for digital dermatitis resistance and the presence of digital dermatitis, heel horn erosion and interdigital hyperplasia in Holstein cows

Digital dermatitis (DD) is a polybacterial disease endemic to most UK dairy farms. It poses a major financial and welfare threat and is characterized by high incidence and recurrence rates. We aimed to investigate the association between the UK estimated breeding value for resistance to digital dermatitis, the Digital Dermatitis Index (DDI) and the frequency of DD, heel horn erosion (HHE), and interdigital hyperplasia (IH) in a population of Holstein dairy cows. We enrolled and genotyped 2,352 cows from 4 farms in a prospective cohort study. Foot lesion records were recorded by veterinary surgeons for each animal at 4 time points during a production cycle, starting at approximately 2 mo before calving and ending in late lactation. Importantly, these records were not used in the calculation of the DDI. Lesion records were matched to the animal's own DDI (n = 2,101) and their sire's DDI (n = 1,812). Digital Dermatitis Index values in our study population ranged from -1.41 to +1.2 and were transformed to represent distance from the mean expressed in standard deviations. The relationship between the DDI and the presence of DD was investigated using a logistic regression model, with farm, parity, and a farm-parity interaction fitted as covariates. A multivariable logistic regression model was fitted to evaluate the relationship between HHE and DDI with farm fitted as a covariate. Finally, a univariable logistic regression model with DDI as explanatory variable was used to investigate the relationship between IH and DDI. The odds ratio of an animal being affected by DD was 0.69 for one standard deviation (SD) increase in the animal's DDI (95% confidence interval (CI) = 0.63-0.76). The odds of HHE and IH were 0.69 (95%CI = 0.62-0.76) and 0.58 (95%CI = 0.49-0.68) respectively for one SD increase in DDI. The adjusted probability of DD was 32% (95% CI = 27-36%) for cows with mean DDI value of 0 while it was 24% (95% CI = 20-29%) in cows with a DDI value of +1. Sire DDI breeding values were standardized in the same way and then binned into terciles creating an ordinal variable representing bulls of high, medium, and low genetic merit for DD resistance. The daughters of low genetic merit bulls were at 2.05 (95% CI = 1.60-2.64), 1.96 (95% CI = 1.53-2.50), and 2.85 (95% CI = 1.64-5.16) times greater odds of being affected by DD, HHE, and IH respectively compared with the daughters of high genetic merit bulls. The results of this study highlight the potential of digital dermatitis genetic indexes to aid herd management of DD, and suggest that breeding for resistance to DD, alongside environmental and management control practices, could reduce the prevalence of the disease.

Comparing Location Data From Smartphone and Dedicated Global Positioning System Devices: Implications for Epidemiologic Research

In this study, we compared location data from a dedicated Global Positioning System (GPS) device with location data from smartphones. Data from the Interventions, Equity, and Action in Cities Team (INTERACT) Study, a study examining the impact of urban-form changes on health in 4 Canadian cities (Victoria, Vancouver, Saskatoon, and Montreal), were used. A total of 337 participants contributed data collected for about 6 months from the Ethica Data smartphone application (Ethica Data Inc., Toronto, Ontario, Canada) and the SenseDoc dedicated GPS (MobySens Technologies Inc., Montreal, Quebec, Canada) during the period 2017-2019. Participants recorded an average total of 14,781 Ethica locations (standard deviation, 19,353) and 197,167 SenseDoc locations (standard deviation, 111,868). Dynamic time warping and cross-correlation were used to examine the spatial and temporal similarity of GPS points. Four activity-space measures derived from the smartphone app and the dedicated GPS device were compared. Analysis showed that cross-correlations were above 0.8 at the 125-m resolution for the survey and day levels and increased as cell size increased. At the day or survey level, there were only small differences between the activity-space measures. Based on our findings, we recommend dedicated GPS devices for studies where the exposure and the outcome are both measured at high frequency and when the analysis will not be aggregate. When the exposure and outcome are measured or will be aggregated to the day level, the dedicated GPS device and the smartphone app provide similar results.

Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users

BACKGROUND

The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners).

METHODS

Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs.

RESULTS

From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT.

CONCLUSIONS

Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

Gentrification, perceptions of neighborhood change, and mental health in Montréal, Québec

While census-defined measures of gentrification are often used in research on gentrification and health, surveys can be used to better understand how residents perceive neighborhood change, and the implications for mental health. Whether or not gentrification affects mental health may depend on the extent to which an individual perceives changes in their neighborhood. Using health and map-based survey data, collected from 2020 to 2021, from the Interventions, Research, and Action in Cities Team, we examined links between perceptions of neighborhood change, census-defined neighborhood gentrification at participant residential addresses, and mental health among 505 adults living in Montréal. After adjusting for age, gender, race, education, and duration at current residence, greater perceived affordability and more positive feelings about neighborhood changes were associated with better mental health, as measured by the mental health component of the short-form health survey. Residents who perceived more change to the social environment had lower mental health scores, after adjusting individual covariates. Census-defined gentrification was not significantly associated with mental health, and perceptions of neighborhood change did not significantly modify the effect of gentrification on mental health. Utilizing survey tools can help researchers understand the role that perceptions of neighborhood change play in the understanding how neighborhood change impacts mental health.

WalkRollMap.org: Crowdsourcing barriers to mobility

Walking is a simple way to improve health through physical activity. Yet many people experience barriers to walking from a variety of physical, social, and psychological factors that impact their mobility. A challenge for managing and studying pedestrian environments is that barriers often occur at local scales (e.g., sidewalk features), yet such fine scale data on pedestrian facilities and experiences are often lacking or out of date. In response, our team developed WalkRollMap.org an online mapping tool that empowers communities by providing them with tools for crowdsourcing their own open data source. In this manuscript we highlight key functions of the tool, discuss initial approaches to community outreach, and share trends in reporting from the first nine months of operation. As of July 27, 2022, there have been 897 reports, of which 53% served to identify hazards, 34% missing amenities, and 14% incidents. The most frequently reported issues were related to sidewalks (15%), driver behavior (19%), and marked crosswalks (7%). The most common suggested amenities were sidewalks, marked crosswalks, connections (i.e., pathways between streets), and curb cuts. The most common types of incidents all included conflicts with vehicles. Data compiled through WalkRollMap.org offer unique potential for local and timely information on microscale barriers to mobility and are available for use by anyone as data are open and downloadable.

Synthesizing the links between secure housing tenure and health for more equitable cities

Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.

The Canadian Bikeway Comfort and Safety metrics (Can-BICS): National measures of the bicycling environment for use in research and policy

BACKGROUND

The lack of consistent measures of the cycling environment across communities hampers cycling research and policy action. Our goal was to develop the first national dataset in Canada for metrics of the cycling environment at the dissemination area (DA) level - the Canadian Bikeway Comfort and Safety (Can-BICS) metrics.

DATA AND METHODS

The Can-BICS metrics are area-level metrics based on the quantity of cycling infrastructure within a 1 km buffer of the population-weighted centroid of DAs. The base data are a national cycling network dataset derived from OpenStreetMap (OSM) (extracted January 25, 2022) and classified by high-, medium- and low-comfort facilities. A Can-BICS continuous metric (sum of cycling infrastructure per square kilometre weighted by comfort class) and Can-BICS categorical metric were derived and mapped for all 56,589 DAs in Canada. The Can-BICS metrics were correlated with other national datasets (2016 Canadian Active Living Environments [Can-ALE] and 2016 Census journey-to-work data) to test for associations between Can-BICS and related measures. Additionally, city staff were engaged to provide feedback on metrics during the development phase.

RESULTS

One-third (34%) of neighbourhoods in Canada have no cycling infrastructure. According to the categorical measure, 5% of all DAs were assigned as the highest category of Can-BICS (corresponding to 6% of the population) and were nearly all within metro areas. The Can-BICS continuous metric had low correlation with bike-to-work rates (R = 0.29) and was more strongly correlated with sustainable-transportation-to-work rates (R = 0.56) and the Can-ALE metrics (R=0.62). These correlations were variable across cities.

INTERPRETATION

The Can-BICS metrics provide national research- and practice-ready measures of cycling infrastructure. The metrics complement existing measures of walking and transit environments (Can-ALE), collectively providing a cohesive set of active living measures. The datasets and code are publicly available, facilitating updates as new infrastructure is built.

Riding through the pandemic: Using Strava data to monitor the impacts of COVID-19 on spatial patterns of bicycling

COVID-19 prompted a bike boom and cities around the world responded to increased demand for space to ride with street reallocations. Evaluating these interventions has been limited by a lack of spatially-temporally continuous ridership data. Our paper aims to address this gap using crowdsourced data on bicycle ridership. We evaluate changes in spatial patterns of bicycling during the first wave of the COVID-19 pandemic (Apr - Oct 2020) in Vancouver, Canada using Strava data and a local indicator of spatial autocorrelation. We map statistically significant change in ridership and reference clusters of change to a high-resolution base map. Amongst streets where bicycling increased, we measured the proportion of increase occurring on pre-existing bicycle facilities or street reallocations compared to streets without. In all our analyses, we evaluate patterns across subsets of Strava data representing recreation, commuting, and ridership generated by women and older adults (55 + ). We found consistent and unique patterns by trip purpose and demographics: samples generated by women and older adults showed increases near green and blue spaces and on street reallocations that increased access to parks, and these patterns were also mirrored in the recreation sample. Commute ridership highlighted distinct patterns of increase around the hospital district. Across all subsets most increases occurred on bicycle facilities (pre-existing or provisional), with a strong preference for high-comfort facilities. We demonstrate that changes in spatial patterns of bicycle ridership can be monitored using Strava data, and that nuanced patterns can be identified using trip and demographic labels in the data.

Using combined Global Position System and accelerometer data points to examine how built environments and gentrification are associated with physical activity in four Canadian cities

Background

Built and social environments are associated with physical activity. Global Positioning Systems (GPS) and accelerometer data can capture how people move through their environments and provide promising tools to better understand associations between environmental characteristics and physical activity. The purpose of this study is to examine the associations between GPS-derived exposure to built environment and gentrification characteristics and accelerometer-measured physical activity in a sample of adults across four cities.

Methods

We used wave 1 data from the Interventions, Research, and Action in Cities Team, a cohort of adults living in the Canadian cities of Victoria, Vancouver, Saskatoon, and Montreal. A subsample of participants wore a SenseDoc device for 10 days during May 2017–January 2019 to record GPS and accelerometry data. Two physical activity outcomes were derived from SenseDoc data: time spent in light, moderate, and vigorous physical activity; and time spent in moderate or vigorous physical activity. Using corresponding GPS coordinates, we summarized physical activity outcomes by dissemination area—a Canadian census geography that represents areas where 400 to 700 people live- and joined to built (active living space, proximity to amenities, and urban compactness) and gentrification measures. We examined the associations between environmental measures and physical activity outcomes using multi-level negative binomial regression models that were stratified by city and adjusted for covariates (weekday/weekend), home dissemination area, precipitation, temperature) and participant-level characteristics obtained from a survey (age, gender, income, race).

Results

We found that adults spent more time being physically active near their homes, and in environments that were more walkable and near parks and less time in urban compact areas, regardless of where participants lived. Our analysis also highlighted how proximity to different amenities was linked to physical activity across different cities.

Conclusions

Our study provides insights into how built environment and gentrification characteristics are associated with the amount of time adults spend being physically active in four Canadian cities. These findings enhance our understanding of the influence that environments have on physical activity over time and space, and can support policies to increase physical activity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01306-z.

"We see each other from a distance": Neighbourhood social relationships during the COVID-19 pandemic matter for older adults' social connectedness

Introduction

We extend previous research to illustrate how individual, interpersonal and neighbourhood factors in a high-density urban setting in Vancouver, Canada, shape social connectedness experiences of community-dwelling older adults during the first wave of the COVID-19 pandemic.

Methods

We conducted 31 semi-structured interviews and collected objective measures of loneliness and social connectedness (surveys).

Results

Three dimensions of the neighbourhood environment influenced social connectedness: (i) interactions with neighbours, (ii) involvement with neighbourhood-based organizations, and (ii) outdoor pedestrian spaces. Seventy-one percent of participants felt a strong sense of belonging to their local community, while 39% were classified as high or extremely lonely.

Summary

Many participants leveraged pre-existing social ties to maintain connections during the pandemic. However, volunteer outreach was vital for more isolated older adults. Although many participants felt lonely and isolated at times, the relative ease and accessibility with which they could connect with others in their neighbourhood environment, may have helped mitigate persistent loneliness.

Conclusion

Strategies that foster social connectedness over the longer term, need to prioritize the needs of older adults who face multiple barriers to equitable social participation.

Is the 15-minute city within reach? Evaluating walking and cycling accessibility to grocery stores in Vancouver

Leaders around the world have embraced the idea of a "15-minute city". This urban planning concept proposes a city where residents can meet their essential needs within a short walking or cycling trip from their home. Local access to grocery stores is a necessary component for cities to achieve the 15-minute city. This study aims to evaluate local accessibility to grocery stores by walking and cycling in the City of Vancouver. We used a cu-mulative opportunity measure to count the number of grocery stores available within a 15-minute walk and cycle from people's homes. To evaluate accessibility from the perspective of younger and older travellers, we considered different travel speeds. Our results show there is good accessibility to grocery stores when cycling, with less than 1% of the city's population not having a grocery store within a 15-minute cycle. When assuming a walking speed of an older pedestrian, around one-fifth of the population did not have access to a grocery store in their local area. The neighbourhoods that did not have a store within a 15-minute walk had higher proportions of children, older adults, and visible minorities, and lower rates of employment and post-secondary education attainment. In seeking to improve accessibility via walking and cycling, cities should prioritize grocery store locations and investments in pedestrian and cycling infrastructure to underserved neighbourhoods and populations.

Rethinking walkability and developing a conceptual definition of active living environments to guide research and practice

Background

Walkability is a popular term used to describe aspects of the built and social environment that have important population-level impacts on physical activity, energy balance, and health. Although the term is widely used by researchers, practitioners, and the general public, and multiple operational definitions and walkability measurement tools exist, there are is no agreed-upon conceptual definition of walkability.

Method

To address this gap, researchers from Memorial University of Newfoundland hosted “The Future of Walkability Measures Workshop” in association with researchers from the Canadian Urban Environmental Health Research Consortium (CANUE) in November 2017. During the workshop, trainees, researchers, and practitioners worked together in small groups to iteratively develop and reach consensus about a conceptual definition and name for walkability. The objective of this paper was to discuss and propose a conceptual definition of walkability and related concepts.

Results

In discussions during the workshop, it became clear that the term walkability leads to a narrow conception of the environmental features associated with health as it inherently focuses on walking. As a result, we suggest that the term Active Living Environments, as has been previously proposed in the literature, are more appropriate. We define Active Living Environments (ALEs) as the emergent natural, built, and social properties of neighbourhoods that promote physical activity and health and allow for equitable access to health-enhancing resources.

Conclusions

We believe that this broader conceptualization allows for a more comprehensive understanding of how built, natural, and social environments can contribute to improved health for all members of the population.

Near-infrared spectroscopy during cardiopulmonary resuscitation for pediatric cardiac arrest: a prospective, observational study

AIM

Cerebral oxygenation (rSO2) is not routinely measured during pediatric cardiopulmonary resuscitation (CPR). We aimed to determine whether higher intra-arrest rSO2 was associated with return of spontaneous circulation (ROSC) and survival to hospital discharge.

METHODS

Prospective, single-center observational study of cerebral oximetry using near-infrared spectroscopy (NIRS) during pediatric cardiac arrest from 2016 to 2020. Eligible patients had ≥30 s of rSO2 data recorded during CPR. We compared median rSO2 and percentage of rSO2 measurements above a priori thresholds for the entire event and the final five minutes of the CPR event between patients with and without ROSC and survival to discharge.

RESULTS

Twenty-one patients with 23 CPR events were analyzed. ROSC was achieved in 17/23 (73.9%) events and five/21 (23.8%) patients survived to discharge. The median rSO2 was higher for events with ROSC vs. no ROSC for the overall event (62% [56%, 70%] vs. 45% [35%, 51%], p = 0.025) and for the final 5 minutes of the event (66% [55%, 72%] vs. 43% [35%, 44%], p = 0.01). Patients with ROSC had a higher percentage of measurements above 50% during the final five minutes of CPR (100% [100%, 100%] vs. 0% [0%, 29%], p = 0.01). There was no association between rSO2 and survival to discharge.

CONCLUSIONS

Higher cerebral rSO2 during CPR for pediatric cardiac arrest was associated with higher rates of ROSC but not with survival to discharge.

Child pedestrian and cyclist injuries, and the built and social environment across Canadian cities: the Child Active Transportation Safety and the Environment Study (CHASE)

Introduction

Traffic injury is a leading and preventable cause of child death and disability, with child pedestrians and cyclists particularly vulnerable. Examining built environment correlates of child pedestrian and cyclist motor vehicle collisions (PCMVC) in different settings is needed to promote an evidence-based approach to road safety.

Methods

We conducted a cross-sectional study across multiple urban/suburban environments in Canada (Calgary, Toronto, Montreal, Laval, Peel Region). All public elementary schools were included (n=1030). We examined the role of land use/social environments, road environments and traffic safety interventions on the rates of child PCMVC within 1000 m of schools. Multivariable negative binomial regression was conducted for all cities and by individual city. In a subset of schools (n=389), we examined associations when controlling for active school transportation (AST).

Results

Mean PCMVC rate per school ranged from 0.13 collisions/year in Peel to 0.35 in Montreal. Child PCMVC were correlated with land use, social and road environments and traffic safety interventions. In fully adjusted models, social and land use features remained the most important correlates. New immigrant population had the largest positive association with child PCMVC (incidence rate ratio (IRR): 1.26, 95% CI 1.06 to 1.50), while old housing (pre-1960) density was most protective (IRR: 0.83, 95% CI 0.77 to 0.90). AST was associated with PCMVC, but it had no effect on the relationships between PCMVC and other social/environmental correlates.

Conclusion

The built environment and social factors influence rates of child PCMVC. Opportunities to reduce child PCMVC exist through modifications to city design and road environments and implementing traffic safety interventions.

Synthesizing the links between secure housing tenure and health for more equitable cities

Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.

Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study

Background

Public health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases.

Objective

This study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities.

Methods

Over 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns.

Results

Overall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD $15.04 (US $11.57; including staff time) per completer. Mailed letters were the costliest, at CAD $108.30 (US $83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD $5.16 [US $3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days).

Conclusions

This study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research.

The Canadian Bikeway Comfort and Safety (Can-BICS) Classification System: A common naming convention for cycling infrastructure

There is no standard naming convention for cycling infrastructure across cities. Our aim was to develop a common nomenclature for cycling infrastructure in Canada, relevant to the context of public health practice. We drew on transportation engineering design guides and public health guidance to develop a bicycle facility classification system: the Canadian Bikeway Comfort and Safety (Can-BICS) classification system, a three-tiered classification scheme that groups five bicycle facilities based on safety performance and user comfort. Adopting consistent nomenclature as per the Can-BICS system will support regional and national surveillance efforts in public health, planning and sustainability.

The effects of road pricing on transportation and health equity: A scoping review

Road pricing is increasingly considered as an option to support transportation infrastructure costs, manage demand, and reduce emissions. However, the extent to which implementation of such approaches may impact transportation and health equity is unclear. In this scoping review, we examine the differential transportation and health effects of road pricing policies across population groups and geographic region. We conducted a systematic database search of Transport Research International Documentation, GEOBASE, Scopus, and Ovid Medline, supplemented by bibliographic review and internet searches. Fifteen studies were included in the review. The studies evaluated area and cordon road pricing systems in Singapore, London, Stockholm, Milan, and Gothenburg, and had a median follow-up period of 12 months. Outcomes evaluated include car commuting, mode shift to public transit, accessibility to destinations, affordability, welfare, social interactions, air pollution, traffic injuries and deaths, acute asthma attacks, and life expectancy. While more studies across diverse urban contexts and policy settings will be needed to strengthen the evidence base, the existing evidence suggests road pricing has mostly net positive effects related to a reduction in car trips, air pollution, asthma attacks, and road traffic collisions, and increases in life expectancy. Frequency and ease of social interactions were found to be negatively impacted, with fewer visits to family and friends. The population groups that generally fared better across transportation and health outcomes were those with higher incomes, men, and people between the ages of 35-55. Across space, there are benefits for both the areas inside and outside the cordon boundary, but to a greater degree for the area inside. Overall, the evidence base is limited by a narrow set of health-related outcomes and a lack of longer-term studies. We did not come across any studies assessing distributional effects of noise pollution, mode shifts to walking or cycling, or other morbidities in the general population that are not listed above. In addition, there are few evaluations that include non-work trips, therefore potentially missing effects for unemployed populations or women who are more likely to make non-work trips. We find that the limited body of evidence on area and cordon pricing policies suggests these policies are beneficial for a number of transportation and health outcomes, particularly for populations inside the cordon area, but that there may be some degree of inequities in the distribution of the benefits and burdens.

Not quite a block party: COVID-19 street reallocation programs in Seattle, WA and Vancouver, BC

The COVID-19 pandemic has exposed mobility inequities within cities. In response, cities are rapidly implementing street reallocation initiatives. These interventions provide space for walking and cycling, however, other mobility needs (e.g., essential workers, deliveries) may be impeded by these reallocation decisions. Informed by mobility justice frameworks, we examined socio-spatial differences in access to street reallocations in Seattle, Washington and Vancouver, British Columbia. In both cities, more interventions occurred in areas where people of color, particularly Black and Indigenous people, lived. In Seattle, more interventions occurred in areas where people with disabilities, on food stamps, and children lived. In Vancouver, more interventions occurred in areas where recent immigrants lived, or where people used public transit or cycled to work. Street reallocations could be opportunities for cities to redress inequities in mobility and access to public spaces. Going forward, it is imperative to monitor how cities use data and welcome communities to redesign these temporary spaces to be corridors for their own mobility.

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COVID-19 street reallocations are slow corridors, which impedes some mobility needs.

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Marginalized people, less likely to work from home, could be negatively impacted.

•

Interventions occurred where people of colour live in Seattle, WA and Vancouver, BC.

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Mobility justice addresses barriers to mobility, for individuals and communities.

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Cities need to fund community-led street reallocations for their own mobility needs.

COVID-19 street reallocation in mid-sized Canadian cities: socio-spatial equity patterns

Intervention

Street reallocation interventions in three Canadian mid-sized cities: Victoria (British Columbia), Kelowna (British Columbia), and Halifax (Nova Scotia) related to the COVID-19 pandemic.

Research question

What street reallocation interventions were implemented, and what were the socio-spatial equity patterns?

Methods

We collected data on street reallocations (interventions that expand street space for active transportation or physical distancing) from April 1 to August 15, 2020 from websites and media. For each city, we summarized length of street reallocations (km) and described implementation strategies and communications. We assessed socio-spatial patterning of interventions by comparing differences in where interventions were implemented by area-level mobility, accessibility, and socio-demographic characteristics.

Results

Two themes motivated street reallocations: supporting mobility, recreation, and physical distancing in populous areas, and bolstering COVID-19 recovery for businesses. The scale of responses ranged across cities, from Halifax adding an additional 20% distance to their bicycle network to Kelowna closing only one main street section. Interventions were located in downtown cores, areas with high population density, higher use of active transportation, and close proximity to essential destinations. With respect to socio-demographics, interventions tended to be implemented in areas with fewer children and areas with fewer visible minority populations. In Victoria, the interventions were in areas with lower income populations and higher proportions of Indigenous people.

Conclusion

In this early response phase, some cities acted swiftly even in the context of massive uncertainties. As cities move toward recovery and resilience, they should leverage early learnings as they act to create more permanent solutions that support safe and equitable mobility.

Successes and failures of built environment interventions: Using concept mapping to assess stakeholder perspectives in four Canadian cities

BACKGROUND

Healthy communities can be supported through built environment interventions that redesign cities for improved health outcomes. Understanding the context of these interventions is critical for assessing how an intervention impacts population health; such context is often poorly documented. This study uses concept mapping to capture stakeholders' perspectives on the factors that influence the success and failure of built environment interventions across cities.

METHODS

The INTErventions, Research, and Action in Cities Team (INTERACT) research program undertook concept mapping exercises related to interventions in four Canadian cities: public bike share program (Vancouver); a cycling network (Victoria); a bus rapid transit program (Saskatoon); and interventions related to the Montreal Sustainability Plan (Montreal). Concept mapping synthesised stakeholder perceptions and Go zones were used to prioritise factors based on importance and feasibility. Resulting themes were integrated into implementation science frameworks.

RESULTS

Across four cities, 95 stakeholders participated. An average of 38 factors were identified in each city, resulting in 5 emerging clusters in Victoria and Montreal and 6 clusters in Vancouver and Saskatoon. Clusters covered domains of economic and political context, intervention planning, equity considerations, user experience, and stakeholder engagement. Common across all cities was the importance of stakeholder engagement. Concerns for citizen safety were prominent in Victoria, Vancouver, and Saskatoon. Interventions in Saskatoon and Vancouver were related to programs, and reliability of service and ease of use emerged. Go zones highlighted 2-5 items in each city, which can inform priority actions.

CONCLUSION

Our study provides stakeholders' collective thinking on the contextual factors that influence the success and failure of built environment interventions. Organising context within an implementation science framework can provide a common language to synthesise stakeholder perspectives across settings. Go zone items can inform city-specific priority actions to support a common vision around implementing built environment interventions in pursuit of designing equitable and healthy cities.

What does crowdsourced data tell us about bicycling injury? A case study in a mid-sized Canadian city

With only ∼20 % of bicycling crashes captured in official databases, studies on bicycling safety can be limited. New datasets on bicycling incidents are available via crowdsourcing applications, with opportunity for analyses that characterize reporting patterns. Our goal was to characterize patterns of injury in crowdsourced bicycle incident reports from BikeMaps.org. We extracted 281 incidents reported on the BikeMaps.org global mapping platform and analyzed 21 explanatory variables representing personal, trip, route, and crash characteristics. We used a balanced random forest classifier to classify three outcomes: (i) collisions resulting in injury requiring medical treatment; (ii) collisions resulting in injury but the bicyclist did not seek medical treatment; and (iii) collisions that did not result in injury. Results indicate the ranked importance and direction of relationship for explanatory variables. By knowing conditions that are most associated with injury we can target interventions to reduce future risk. The most important reporting pattern overall was the type of object the bicyclist collided with. Increased probability of injury requiring medical treatment was associated with collisions with animals, train tracks, transient hazards, and left-turning motor vehicles. Falls, right hooks, and doorings were associated with incidents where the bicyclist was injured but did not seek medical treatment, and conflicts with pedestrians and passing motor vehicles were associated with minor collisions with no injuries. In Victoria, British Columbia, Canada, bicycling safety would be improved by additional infrastructure to support safe left turns and around train tracks. Our findings support previous research using hospital admissions data that demonstrate how non-motor vehicle crashes can lead to bicyclist injury and that route characteristics and conditions are factors in bicycling collisions. Crowdsourced data have potential to fill gaps in official data such as insurance, police, and hospital reports.

Cyclist crash rates and risk factors in a prospective cohort in seven European cities

Increased cycling uptake can improve population health, but barriers include real and perceived risks. Crash risk factors are important to understand in order to improve safety and increase cycling uptake. Many studies of cycling crash risk are based on combining diverse sources of crash and exposure data, such as police databases (crashes) and travel surveys (exposure), based on shared geography and time. When conflating crash and exposure data from different sources, the risk factors that can be quantified are only those variables common to both datasets, which tend to be limited to geography (e.g. countries, provinces, municipalities) and a few general road user characteristics (e.g. gender and age strata). The Physical Activity through Sustainable Transport Approaches (PASTA) project was a prospective cohort study that collected both crash and exposure data from seven European cities (Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zürich). The goal of this research was to use data from the PASTA project to quantify exposure-adjusted crash rates and model adjusted crash risk factors, including detailed sociodemographic characteristics, attitudes about transportation, neighbourhood built environment features and location by city. We used negative binomial regression to model the influence of risk factors independent of exposure. Of the 4,180 cyclists, 10.2 % reported 535 crashes. We found that overall crash rates were 6.7 times higher in London, the city with the highest crash rate, relative to Örebro, the city with the lowest rate. Differences in overall crash rates between cities are driven largely by crashes that did not require medical treatment and that involved motor-vehicles. In a parsimonious crash risk model, we found higher crash risks for less frequent cyclists, men, those who perceive cycling to not be well regarded in their neighbourhood, and those who live in areas of very high building density. Longitudinal collection of crash and exposure data can provide important insights into individual differences in crash risk. Substantial differences in crash risks between cities, neighbourhoods and population groups suggest there is great potential for improvement in cycling safety.

Causally speaking: Challenges in measuring gentrification for population health research in the United States and Canada

The planet is rapidly urbanizing, the need for actionable evidence to guide the design of cities that help (not hinder) our health has never felt more urgent. One essential component of healthy city design is improving neighborhood conditions in previously disinvested areas. To ensure equitable city design, policy makers, city planners, health practitioners, and researchers are interested in understanding the complex relationship between urban change, gentrification, and population health. Yet, the causal link between gentrification and health outcomes remain unclear. Without clear and consistent gentrification measures, researchers struggle to identify populations who are exposed to gentrification, and to compare health outcomes between exposed and unexposed populations. To move the science forward, this paper summarizes the challenges related to gentrification measurement in the United States and Canada when aspiring to conduct studies to analyze causal relationships between gentrification and health. The paper concludes with a series of recommendations for studies aimed at examining both causes and consequences of gentrification and health.

Evaluating the impact of implementing public bicycle share programs on cycling: the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS)

Background

Despite rapid expansion of public bicycle share programs (PBSP), there are limited evaluations of the population-level impacts of these programs on cycling, leaving uncertainty as to whether these programs lead to net health gains at a population level or attract those that already cycle and are sufficiently physically active. Our objective was to determine whether the implementation of PBSPs increased population-level cycling in cities across the US and Canada.

Methods

We conducted repeat cross-sectional surveys with 23,901 residents in cities with newly implemented PBSPs (Chicago, New York), existing PBSPs (Boston, Montreal, Toronto) and no PBSPs (Detroit, Philadelphia, Vancouver) at three time points (Fall 2012, 2013, 2014). We used a triple difference in differences analysis to assess whether there were increases in cycling over time amongst those living in closer proximity (< 500 m) to bicycle share docking stations in cities with newly implemented and existing PBSPs, relative to those in cities with no PBSPs.

Results

Living in closer proximity to bicycle share predicted increases in cycling over time for those living in cities with newly implemented PBSPs at 2-year follow-up. No change was seen over time for those living in closer proximity to bicycle share in cities with existing PBSPs relative to those in cities with no PBSP.

Conclusion

These findings indicate that PBSPs are associated with increases in population-level cycling for those who live near to a docking station in the second year of program implementation.

Roadmap for free-floating bikeshare research and practice in North America

The deployment of smartphone-operated, non-station-based bicycle fleets ("dockless" or "free-floating" bikeshare) represents a new generation of bikesharing. Users locate bikes in these free-floating systems using Global Positioning Systems (GPS) and lock bikes in place at their destinations. In this paper, we review current free-floating bikesharing systems in North America and discuss priorities for future research and practice. Since launching in 2017, free-floating bikeshare has expanded rapidly to encompass 200+ systems operating 40,000+ bikes within 150+ cities. In contrast with previous systems, free-floating systems operate almost exclusively using commercial "for-profit" models, amidst concerns of financial sustainability. Governance for these systems is in early stages and can include operating fees, fleet size caps, safety requirements, parking restrictions, data sharing, and equity obligations. We identify research and practice gaps within the themes of usage, equity, sharing resources, business model, and context. While some existing bikesharing literature translates to free-floating systems, novel topics arise due to the ubiquity, fluidity, and business models of these new systems. Systems have numerous obstacles to overcome for long-term sustainability, including barriers common to station-based systems: limited supportive infrastructure, equity, theft or vandalism, and funding. Other unique obstacles arise in free-floating bikeshare around parking, sidewalk right of ways, varied bicycle types, and data sharing. This review offers background in and critical reflection on the rapidly evolving free-floating bikeshare landscape, including priorities for future research and practice. If concerns can be overcome, free-floating bikeshare may provide unprecedented opportunities to bypass congested streets, encourage physical activity, and support urban sustainability.

Defined co-cultures of yeast and bacteria modify the aroma, crumb and sensory properties of bread

AIMS

Yeast and bacterial communities inhabit a sourdough starter to make artisanal bread. This study shows whether the interactions of micro-organisms derived from Australian sourdough starters provide some of the positive flavour, and aroma properties to bread by using defined sourdough cultures as the sole leaven in bread production.

METHODS AND RESULTS

An investigation of Australian sourdough starters found that they contained Saccharomyces cerevisiae and Kazachstania exigua yeasts. When these yeasts were inoculated alone to ferment wheat flour in an extended fermentation, the bread had a heterogeneous crumb structure, a deeper colour and a distinctive chemical aroma profile than those made with commercial baker's yeast. When bread was made combining these yeasts individually and in combinations with lactic acid bacteria also isolated from these sourdough starters, including Lactobacillus plantarum, L. brevis, L. rossiae, L. casei, the bread aroma profiles and crumb structure were more distinctive, with compounds associated with sour aromas produced, and preferred by sensory panels.

CONCLUSIONS

The use of defined mixed cultures as the leaven in bread making, by exploiting the microbial diversity of artisanal Australian starters, can produce bread with distinctive and attractive aromas.

SIGNIFICANCE AND IMPACT OF THE STUDY

Understanding and identifying the community ecosystems found in sourdough cultures and using them as the sole leaven in bread production provide novel insights into microbial interactions and how they affect food quality by removing the effects of commercial yeast strains.

Getting at Mode Share: Comparing 3 Methods of Travel Mode Measurement for School Travel Research

BACKGROUND

Mode share is an important metric for active school travel programs. Common methods for measuring mode share include Hands Up surveys and family surveys, but these require teacher and parental involvement. We used these methods as part of an evaluation of a school-based bicycle training program, and added a novel observational count approach. This paper compares mode share results across the 3 methods.

METHODS

We collected data over 2015-2017 at 16 elementary schools. Our outcome of interest was mode share (walk, drive, and bicycle).

RESULTS

We found variations in travel mode estimates between methods and across schools. Overall most school journeys were made by walking (55.7% by observational counts, 46.3% by Hands Up surveys, and 51.5% by family surveys) or car (42.5%, 51.4%, and 46.2%, respectively), and a small proportion by bicycle (1.8%, 2.3%, and 2.2%, respectively). At individual schools, Hands Up and family survey results were similar; there was less agreement between these and observational counts.

CONCLUSION

School travel practitioners face pragmatic choices in data collection. Observational counts are a nonintrusive method suited for school-wide travel patterns. Hands up and family surveys may be more appropriate for assessing differences between classrooms, ages, or family characteristics.

A dose ranging study of 2 different formulations of 15-valent pneumococcal conjugate vaccine (PCV15) in healthy infants

BACKGROUND

Two new formulations of an investigational 15-valent pneumococcal conjugate vaccine (PCV15-A and PCV15-B) were developed using 2 different protein-polysaccharide conjugation processes and evaluated in separate phase I/II studies (NCT02037984 [V114-004] and NCT02531373 [V114-005]) to assess optimal concentrations of pneumococcal polysaccharide (PnPs) and Aluminum Phosphate Adjuvant.

METHODS

Various lots of PCV15-A and PCV15-B containing different concentrations of PnPs and/or adjuvant were compared to PCV13 in young adults and infants. Adults received single dose and infants received 4 doses at 2, 4, 6, and 12-15 months of age. Adverse events (AEs) were collected after each dose. Serotype-specific immunoglobulin G (IgG) concentrations and opsonophagocytic activity (OPA) were measured prior and 30 days postvaccination in adults, at 1 month postdose 3 (PD3), pre-dose4, and postdose 4 (PD4) in infants.

RESULTS

Safety profiles were comparable across vaccination groups. At PD3, serotype-specific IgG GMCs were generally lower for either PCV15 formulation than PCV13 for most shared serotypes. PCV15 consistently elicited higher antibody responses to the 2 serotypes unique to the vaccine (22F and 33F) and serotype 3 for which PCV13 was shown to be ineffective. Except for serotypes 6A and 6B, no dose-response effect was observed with increasing concentrations of PnPs and/or adjuvant.

CONCLUSION

PCV15 is safe and induces IgG and OPA responses to all 15 serotypes in the vaccine. No significant differences in antibody responses were observed with increases in PnPs and/or Aluminum Phosphate Adjuvant.

INTERACT: A comprehensive approach to assess urban form interventions through natural experiments

BACKGROUND

Urban form interventions can result in positive and negative impacts on physical activity, social participation, and well-being, and inequities in these outcomes. Natural experiment studies can advance our understanding of causal effects and processes related to urban form interventions. The INTErventions, Research, and Action in Cities Team (INTERACT) is a pan-Canadian collaboration of interdisciplinary scientists, urban planners, and public health decision makers advancing research on the design of healthy and sustainable cities for all. Our objectives are to use natural experiment studies to deliver timely evidence about how urban form interventions influence health, and to develop methods and tools to facilitate such studies going forward.

METHODS

INTERACT will evaluate natural experiments in four Canadian cities: the Arbutus Greenway in Vancouver, British Columbia; the All Ages and Abilities Cycling Network in Victoria, BC; a new Bus Rapid Transit system in Saskatoon, Saskatchewan; and components of the Sustainable Development Plan 2016-2020 in Montreal, Quebec, a plan that includes urban form changes initiated by the city and approximately 230 partnering organizations. We will recruit a cohort of between 300 and 3000 adult participants, age 18 or older, in each city and collect data at three time points. Participants will complete health and activity space surveys and provide sensor-based location and physical activity data. We will conduct qualitative interviews with a subsample of participants in each city. Our analysis methods will combine machine learning methods for detecting transportation mode use and physical activity, use temporal Geographic Information Systems to quantify changes to urban intervention exposure, and apply analytic methods for natural experiment studies including interrupted time series analysis.

DISCUSSION

INTERACT aims to advance the evidence base on population health intervention research and address challenges related to big data, knowledge mobilization and engagement, ethics, and causality. We will collect ~ 100 TB of sensor data from participants over 5 years. We will address these challenges using interdisciplinary partnerships, training of highly qualified personnel, and modern methodologies for using sensor-based data.

Association of Prenatal Exposure to Air Pollution With Autism Spectrum Disorder

IMPORTANCE

The etiology of autism spectrum disorder (ASD) is poorly understood, but prior studies suggest associations with airborne pollutants.

OBJECTIVE

To evaluate the association between prenatal exposures to airborne pollutants and ASD in a large population-based cohort.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort encompassed nearly all births in Metro Vancouver, British Columbia, Canada, from 2004 through 2009, with follow-up through 2014. Children were diagnosed with ASD using a standardized assessment with the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. Monthly mean exposures to particulate matter with a diameter less than 2.5 µm (PM2.5), nitric oxide (NO), and nitrogen dioxide (NO2) at the maternal residence during pregnancy were estimated with temporally adjusted, high-resolution land use regression models. The association between prenatal air pollution exposures and the odds of developing ASD was evaluated using logistic regression adjusted for child sex, birth month, birth year, maternal age, maternal birthplace, and neighborhood-level urbanicity and income band. Data analysis occurred from June 2016 to May 2018.

EXPOSURES

Mean monthly concentrations of ambient PM2.5, NO, and NO2 at the maternal residence during pregnancy, calculated retrospectively using temporally adjusted, high-resolution land use regression models.

MAIN OUTCOMES AND MEASURES

Autism spectrum disorder diagnoses based on standardized assessment of the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. The hypothesis being tested was formulated during data collection.

RESULTS

In a cohort of 132 256 births, 1307 children (1.0%) were diagnosed with ASD by the age of 5 years. The final sample size for the PM2.5-adjusted model was 129 439 children, and for NO and NO2, it was 129 436 children; of these, 1276 (1.0%) were diagnosed with ASD. Adjusted odds ratios for ASD per interquartile range (IQR) were not significant for exposure to PM2.5 during pregnancy (1.04 [95% CI, 0.98-1.10] per 1.5 μg/m3 increase [IQR] in PM2.5) or NO2 (1.06 [95% CI, 0.99-1.12] per 4.8 ppb [IQR] increase in NO2) but the odds ratio was significant for NO (1.07 [95% CI, 1.01-1.13] per 10.7 ppb [IQR] increase in NO). Odds ratios for male children were 1.04 (95% CI, 0.98-1.10) for PM2.5; 1.09 (95% CI, 1.02-1.15) for NO; and 1.07 (95% CI, 1.00-1.13) for NO2. For female children, they were for 1.03 (95% CI, 0.90-1.18) for PM2.5; 0.98 (95% CI, 0.83-1.13) for NO; and 1.00 (95% CI, 0.86-1.16) for NO2.

CONCLUSIONS AND RELEVANCE

In a population-based birth cohort, we detected an association between exposure to NO and ASD but no significant association with PM2.5 and NO2.

Freedom from the Station: Spatial Equity in Access to Dockless Bike Share

BACKGROUND

Bike sharing systems have potential to substantially boost active transportation levels (and consequent physical and mental health) in urban populations. We explored equity of spatial access in a novel 'dockless' bike share system that does not that constrain bike pickup and drop-off locations to docking stations.

METHODS

Starting in July 2017, Seattle, Washington piloted a dockless bike share system that made 10,000 bikes available. We merged data on resident sociodemographic and economic characteristics from the American Community Survey about 93 defined neighborhoods with data about bike locations, bike idle time, and which neighborhoods operators rebalanced bikes to. We used mapping and descriptive statistics to compare access between neighborhoods along sociodemographic and economic lines.

RESULTS

With many bikes available, no neighborhood was consistently excluded from access. However, the average availability ranged from 3 bikes per day to 341 per day. Neighborhoods with more bikes had more college-educated residents (median 75% college-educated vs. 65%) and local community resources (median opportunity index score of 24 vs. 19), and higher incomes (median 83,202 vs. 71,296). Rebalancing destinations were strongly correlated with neighborhood demand (r=0.61).

CONCLUSIONS

The overall scale of the dockless system ensured there was baseline access throughout Seattle. We observed modest inequities in access along sociodemographic lines, similar to prior findings in studies of docked bike share systems. Dockless bike share systems hold promise for offering equitable spatial access to bike sharing.

Who is in the near market for bicycle sharing? Identifying current, potential, and unlikely users of a public bicycle share program in Vancouver, Canada

Background

Public bicycle share programs in many cities are used by a small segment of the population. To better understand the market for public bicycle share, this study examined the socio-demographic and transportation characteristics of current, potential, and unlikely users of a public bicycle share program and identified specific motivators and deterrents to public bicycle share use.

Methods

We used cross-sectional data from a 2017 Vancouver public bicycle share (Mobi by Shaw Go) member survey (n = 1272) and a 2017 population-based survey of Vancouver residents (n = 792). We categorized non-users from the population survey as either potential or unlikely users based on their stated interest in using public bicycle share within the next year. We used descriptive statistics to compare the demographic and transportation characteristics of current users to non-users, and multiple logistic regression to compare the profiles of potential and unlikely users.

Results

Public bicycle share users in Vancouver tended to be male, employed, and have higher educations and incomes as compared to non-users, and were more likely to use active modes of transportation. The vast majority of non-users (74%) thought the public bicycle share program was a good idea for Vancouver. Of the non-users, 23% were identified as potential users. Potential users tended to be younger, have lower incomes, and were more likely to use public transit for their main mode of transportation, as compared to current and unlikely users. The most common motivators among potential users related to health benefits, not owning a bicycle, and stations near their home or destination. The deterrents among unlikely users were a preference for riding their own bicycle, perceived inconvenience compared to other modes, bad weather, and traffic. Cost was a deterrent to one-fifth of unlikely users, notable given they tended to have lower incomes than current users.

Conclusion

Findings can help inform targeted marketing and outreach to increase public bicycle share uptake in the population.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6246-3) contains supplementary material, which is available to authorized users.

Impact of new rapid transit on physical activity: A meta-analysis

New rapid transit investments have been motivated by environmental, economic, and health benefits. Given transit's potential to increase active travel, recent research leverages transit changes for natural experiment studies to examine physical activity outcomes. We aimed to quantify the association size, critically examine existing literature, and make recommendations for future studies to advance research and policies on active travel, transportation, and physical activity. Studies of physical activity impacts following transit interventions were systematically reviewed using seven health and transport databases (May-July 2017). Two investigators extracted data on sample size, intervention, pre- and post-intervention physical activity, and relevant measurement information. Inconsistency of results and estimated overall mean physical activity change post-intervention were assessed. Forest plots were created from physical activity change in each study using a general variance-based random effects model. Of 18 peer-reviewed articles examining health behaviors, 15 addressed physical activity and five were natural experiment studies with pre- and post- intervention measurements. Studies varied by intervention, duration, outcome measurement, sampling location, and spatial method. Q (201) and I2 (98%) indicated high study heterogeneity. Among these five studies, after transit interventions, total physical activity decreased (combined mean - 80.4 min/week, 95% CI - 157.9, -2.9), but transport-related physical activity increased (mean 6.7 min/week, 95% CI - 10.1, 23.5). Following new transit infrastructure, total physical activity may decline but transport-related physical activity may increase. Positive transit benefits were location, sociodemographic, or activity-specific. Future studies should address context, ensure adequate follow-up, utilize controls, and consider non-residential environments or participants.

Monitoring city wide patterns of cycling safety

Many cities are making significant financial investments in cycling infrastructure with the aim of making cycling safer for riders of all ages and abilities. Methods for evaluating cycling safety tend to summarize average change for a city or emphasize change on a single road segment. Few spatially explicit approaches are available to evaluate how patterns of safety change throughout a city due to cycling infrastructure investments or other changes. Our goal is to demonstrate a method for monitoring changes in the spatial-temporal distribution of cycling incidents across a city. Using cycling incident data provided by the Insurance Corporation of British Columbia, we first compare planar versus network constrained kernel density estimation for visualizing incident intensity across the street network of Vancouver, Canada. Second, we apply a change detection algorithm explicitly designed for detecting statistically significant change in kernel density estimates. The utility of network kernel density change detection is demonstrated through the comparison of cycling incident densities following the construction of two cycle tracks in the downtown core of Vancouver. The methods developed and demonstrated for this study provide city planners, transportation engineers and researchers a means of monitoring city-wide change in the intensity of cycling incidents following enhancements to cycling infrastructure or other significant changes to the transportation network.

Impacts of Bicycle Infrastructure in Mid-Sized Cities (IBIMS): protocol for a natural experiment study in three Canadian cities

INTRODUCTION

Bicycling is promoted as a transportation and population health strategy globally. Yet bicycling has low uptake in North America (1%-2% of trips) compared with European bicycling cities (15%-40% of trips) and shows marked sex and age trends. Safety concerns due to collisions with motor vehicles are primary barriers.To attract the broader population to bicycling, many cities are making investments in bicycle infrastructure. These interventions hold promise for improving population health given the potential for increased physical activity and improved safety, but such outcomes have been largely unstudied. In 2016, the City of Victoria, Canada, committed to build a connected network of infrastructure that separates bicycles from motor vehicles, designed to attract people of 'all ages and abilities' to bicycling.This natural experiment study examines the impacts of the City of Victoria's investment in a bicycle network on active travel and safety outcomes. The specific objectives are to (1) estimate changes in active travel, perceived safety and bicycle safety incidents; (2) analyse spatial inequities in access to bicycle infrastructure and safety incidents; and (3) assess health-related economic benefits.

METHODS AND ANALYSIS

The study is in three Canadian cities (intervention: Victoria; comparison: Kelowna, Halifax). We will administer population-based surveys in 2016, 2018 and 2021 (1000 people/city). The primary outcome is the proportion of people reporting bicycling. Secondary outcomes are perceived safety and bicycle safety incidents. Spatial analyses will compare the distribution of bicycle infrastructure and bicycle safety incidents across neighbourhoods and across time. We will also calculate the economic benefits of bicycling using WHO's Health Economic Assessment Tool.

ETHICS AND DISSEMINATION

This study received approval from the Simon Fraser University Office of Research Ethics (study no. 2016s0401). Findings will be disseminated via a website, presentations to stakeholders, at academic conferences and through peer-reviewed journal articles.

Multiuse trail intersection safety analysis: A crowdsourced data perspective

Real and perceived concerns about cycling safety are a barrier to increased ridership in many cities. Many people prefer to bike on facilities separated from motor vehicles, such as multiuse trails. However, due to underreporting, cities lack data on bike collisions, especially along greenways and multiuse paths. We used a crowdsourced cycling incident dataset (2005-2016) from BikeMaps.org for the Capital Regional District (CRD), BC, Canada. Our goal was to identify design characteristics associated with unsafe intersections between multiuse trails and roads. 92.8% of mapped incidents occurred between 2014 and 2016. We extracted both collision and near miss incidents at intersections from BikeMaps.org. We conducted site observations at 32 intersections where a major multiuse trail intersected with roads. We compared attributes of reported incidents at multiuse trail-road intersections to those at road-road intersections. We then used negative binomial regression to model the relationship between the number of incidents and the infrastructure characteristics at multiuse trail-road intersections. We found a higher proportion of collisions (38%, or 17/45 total reports) at multiuse trail-road intersections compared to road-road intersections (23%, or 62/268 total reports). A higher proportion of incidents resulted in an injury at multiuse trail-road intersections compared to road-road intersections (33% versus 15%). Cycling volumes, vehicle volumes, and trail sight distance were all associated with incident frequency at multiuse trail-road intersections. Supplementing traditional crash records with crowdsourced cycling incident data provides valuable evidence on cycling safety at intersections between multiuse trails and roads, and more generally, when conflicts occur between diverse transportation modes.

Developing a comprehensive measure of mobility: mobility over varied environments scale (MOVES)

Background

While recent work emphasizes the multi-dimensionality of mobility, no current measure incorporates multiple domains of mobility. Using existing conceptual frameworks we identified four domains of mobility (physical, cognitive, social, transportation) to create a “Mobility Over Varied Environments Scale” (MOVES). We then assessed expected patterns of MOVES in the Canadian population.

Methods

An expert panel identified survey items within each MOVES domain from the Canadian Community Health Survey- Healthy Aging Cycle (2008–2009) for 28,555 (weighted population n = 12,805,067) adults (≥45 years). We refined MOVES using principal components analysis and Cronbach’s alpha and weighted items so each domain was 10 points. Expected mobility trends, as assessed by average MOVES, were examined by sociodemographic and health factors, and by province, using Analysis of Variance (ANOVA).

Results

MOVES ranged from 0 to 40, where 0 represents individuals who are immobile and 40 those who are fully mobile. Mean MOVES was 29.58 (95% confidence interval (CI) 29.49, 29.67) (10th percentile: 24.17 (95% CI 23.96, 24.38), 90th percentile: 34.70 (CI 34.55, 34.85)). MOVES scores were lower for older, female, and non-white Canadians with worse health and lower socioeconomic status. MOVES was also lower for those who live in less urban areas.

Conclusions

MOVES is a holistic measure of mobility for characterizing older adult mobility across populations. Future work should examine individual or neighborhood predictors of MOVES and its relationship to broader health outcomes. MOVES holds utility for research, surveillance, evaluation, and interventions around the broad factors influencing mobility in older adults.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4450-1) contains supplementary material, which is available to authorized users.