Daniel Fuller

Use of a new public bicycle share program in Montreal, Canada.

BACKGROUND Cycling contributes to physical activity and health. Public bicycle share programs (PBSPs) increase population access to bicycles by deploying bicycles at docking stations throughout a city. Minimal research has systematically examined the prevalence and correlates of PBSP use. PURPOSE To determine the prevalence and correlates of use of a new public bicycle share program called BIXI (name merges the word BIcycle and taXI) implemented in May 2009 in Montreal, Canada. METHODS A total of 2502 adults were recruited to a telephone survey in autumn 2009 via random-digit dialing according to a stratified random sampling design. The prevalence of BIXI bicycle use was estimated. Multivariate logistic regression allowed for identification of correlates of use. Data analysis was conducted in spring and summer 2010. RESULTS The unweighted mean age of respondents was 47.4 (SD=16.8) years and 61.4% were female. The weighted prevalence for use of BIXI bicycles at least once was 8.2%. Significant correlates of BIXI bicycle use were having a BIXI docking station within 250 m of home, being aged 18-24 years, being university educated, being on work leave, and using cycling as the primary mode of transportation to work. CONCLUSIONS A newly implemented public bicycle share program attracts a substantial fraction of the population and is more likely to attract younger and more educated people who currently use cycling as a primary transportation mode.

Physical activity in women with arthritis: Examining perceived barriers and self‐regulatory efficacy to cope

OBJECTIVE To examine whether the theory-based social cognitions of perceived barrier frequency, barrier limitation, and self-regulatory efficacy to cope were predictors of planned physical activity among adult women with arthritis. A secondary purpose was to identify and provide a phenomenologic description of the relevant barriers and coping strategies reported by study participants. METHODS Eighty adult women (mean +/- SD age 49.09 +/- 12.89 years) with self-reported doctor-diagnosed arthritis participated in this observational study. Participants completed online survey measures of barriers to physical activity and, for each barrier, reported the frequency of occurrence and the extent of limitation. Measures of coping strategies for each barrier, efficacy to cope, and physical activity were also obtained. RESULTS A multiple hierarchical regression analysis resulted in a model that significantly predicted physical activity (F[9,70] = 6.80, P < 0.01, adjusted R(2) = 0.40). Barrier limitation (standardized beta = -0.56) and efficacy (standardized beta = 0.20) were significant independent predictors. Phenomenologic findings indicated that arthritis-specific personal barriers (e.g., pain and fatigue due to arthritis) and arthritis-specific coping strategies (e.g., activity modification) were more commonly reported than generic barriers and coping strategies. CONCLUSION Self-regulatory efficacy to cope and relevant perceived physical activity barriers, which were primarily arthritis-specific and moderately or more limiting to planned physical activity, were important social cognitive predictors of physical activity, a key nonpharmacologic arthritis treatment, among women with arthritis. Future research direction should examine potential moderators of the relationship between these predictors and physical activity, such as pain acceptance.

Does transportation mode modify associations between distance to food store, fruit and vegetable consumption, and BMI in low-income neighborhoods?

BACKGROUND A consistent body of research has shown that the neighborhood food environment is associated with fruit and vegetable (F&V) consumption and obesity in deprived neighborhoods in the United States. However, these studies have often neglected to consider how transportation can moderate associations between food accessibility and diet-related outcomes. OBJECTIVE This study examined associations between distance to primary food store, fruit and vegetable consumption, and BMI and whether mode of transportation to the primary food store moderates this relation. DESIGN Cross-sectional data from the baseline wave of the Philadelphia Neighborhood Food Environment Study were used. A telephone survey of adult (≥18 y of age) household primary food shoppers residing in 2 Philadelphia neighborhoods was conducted (n = 1440). RESULTS In a bivariate linear regression analysis, distance to primary food store did not predict F&V consumption (β = 0.04; 95% CI: -0.00, 0.09). Linear regression analysis stratified by transportation mode to the main F&V store showed no difference in F&V consumption between car, public, and multimodal transportation users. Compared with respondents using multimodal transportation, those using public transit had a significantly lower BMI (β = -1.31; 95% CI: -2.50, -0.10), whereas those using an automobile did not (β = -0.41; 95% CI: -1.36, 0.54). CONCLUSIONS The assumption that using an automobile to access food stores results in increased F&V consumption was not confirmed. Significant associations were found for the relation between transportation mode and BMI. Theory-based mechanisms explaining relationships between the primary transportation mode used to access food stores and BMI should be further explored.

Impact Evaluation of a Public Bicycle Share Program on Cycling: A Case Example of BIXI in Montreal, Quebec

OBJECTIVES We examined associations between residential exposure to BIXI (BIcycle-taXI)-a public bicycle share program implemented in Montreal, Quebec, in 2009, which increases accessibility to cycling by making available 5050 bicycles at 405 bicycle docking stations-and likelihood of cycling (BIXI and non-BIXI) in Montreal over the first 2 years of implementation. METHODS Three population-based samples of adults participated in telephone surveys. Data collection occurred at the launch of the program (spring 2009), and at the end of the first (fall 2009) and second (fall 2010) seasons of implementation. Difference in differences models assessed whether greater cycling was observed for those exposed to BIXI compared with those not exposed at each time point. RESULTS We observed a greater likelihood of cycling for those exposed to the public bicycle share program after the second season of implementation (odds ratio = 2.86; 95% confidence interval = 1.85, 4.42) after we controlled for weather, built environment, and individual variables. CONCLUSIONS The implementation of a public bicycle share program can lead to greater likelihood of cycling among persons living in areas where bicycles are made available.

Teaching social accountability by making the links: Qualitative evaluation of student experiences in a service-learning project

Background: Many medical students come into medicine with altruistic motives; few carry this altruism into their practice. As a result rural, remote and international areas are underserved by the medical community. Teaching social accountability may help students remain altruistic and encourage work in underserved areas. Making The Links (MTL) is a project designed to teach medical students the social aspects of medicine via service-learning. Aims: The purpose of the study was to explore student reflections on their experiences during the MTL program. Methods: Qualitative data analysis was conducted using structured open-ended written questionnaires. Fourteen students, representing three student cohorts, participated in the study. Data was collected between 2005 and 2007. Results: Six themes emerged from qualitative data analysis. (1) relationships, (2) social determinants of health in real life, (3) community development, (4) interdisciplinarity, (5) linking health and communities, and (6) personal learning. Themes reflected the opportunities and challenges experienced by the students during the MTL project. Students reported that MTL was an essential component of their medical training. Conclusions: MTL is a promising model for using service-learning to teach social accountability in medical training.

School Sports Opportunities Influence Physical Activity in Secondary School and Beyond

BACKGROUND The purpose of the present study was to examine whether the availability of intramural or extramural sports in secondary schools is associated with physical activity levels in youth throughout secondary school and at age 20. METHODS Eight hundred and eight adolescents from 10 secondary schools in Montreal, Canada, provided physical activity data every 3 months during the school year from ages 13 to 17, and again at age 20. School administrators completed questionnaires on the availability of intramural and extramural sports. Three-level general linear models were used to examine associations among the number of intramural and extramural sports, moderate and vigorous physical activity controlling for age, sex, body mass index, mothers education, and school-level socioeconomic status. RESULTS Regardless of whether or not they reported participating in intramural sports, adolescents in schools with more intramural sports engaged in 3.6 (p = .03) more total, and 1.3 (p = 0.03) more vigorous activities per week than those attending schools with fewer intramural sports. Number of extramural sports was not statistically significantly associated with physical activity, regardless of whether or not individual students participated. CONCLUSION Providing more opportunities for intramural sports in secondary schools may be an effective strategy to help adolescents attain physical activity recommendations.

The Impact of Public Transportation Strikes on Use of a Bicycle Share Program in London: Interrupted Time Series Design

OBJECTIVE To investigate the immediate and sustained effects of two London Underground strikes on use of a public bicycle share program. METHODS An interrupted time series design was used to examine the impact of two 24 hour strikes on the total number of trips per day and mean trip duration per day on the London public bicycle share program. The strikes occurred on September 6th and October 4th 2010 and limited service on the London Underground. RESULTS The mean total number of trips per day over the whole study period was 14,699 (SD=5390) while the mean trip duration was 18.5 minutes (SD=3.7). Significant increases in daily trip count were observed following strike 1 (3864: 95% CI 125 to 7604) and strike 2 (11,293: 95% CI 5169 to 17,416). CONCLUSIONS Events that greatly constrain the primary motorised mode of transportation for a population may have unintended short-term effects on travel behaviour. These findings suggest that limiting transportation options may have the potential to increase population levels of physical activity by promoting the use of cycling.

The potential modal shift and health benefits of implementing a public bicycle share program in Montreal, Canada

BackgroundThis study estimated the modal shift associated with the implementation of a public bicycle share program in Montreal, Canada.MethodsA population-based sample of adults participated in two cross sectional telephone surveys. Self-reported travel behaviors were collected at the end of the first (fall 2009) and second (fall 2010) season of implementation. The sample included 2502 (Mean age=47.8 years, 61.8% female), and 2509 (Mean age=48.9 years, 59.0% female) adult respondents in each survey.ResultsThe estimated modal shift associated with the implementation of the PBSP from motor vehicle use to walking, cycling, and public transportation was 6483 and 8023 trips in 2009 and 2010. This change represents 0.34% and 0.43% of all motor vehicle trips in Montreal.ConclusionsThe implementation of a PBSP was associated with a shift toward active transportation. The modal shift was complex and not simply the result of a discrete shift from one mode to another. Promotion of active transportation should encourage integration of multiple active transportation modes to better reflect people’s actual transportation behaviors.

The impact of implementing a public bicycle share program on the likelihood of collisions and near misses in Montreal, Canada.

OBJECTIVE This study aimed to estimate the impact of implementing a public bicycle share program (PBSP) on the likelihood of self-reported collisions and near misses between cyclists and motor vehicles among cyclists living in Montreal. METHODS A repeated cross sectional design was used. Surveys were conducted at the launch of the PBSP, at the end of the first and second seasons of implementation. Logistic regression estimated changes in the likelihood of reporting collisions or near misses. RESULTS There was no evidence of a change in likelihood of reporting a collision or near miss after implementing the PBSP. PBSP users were not at a greater risk of reporting a collision (OR=1.53, 95% CI: 0.77-3.02) or near miss (OR=1.37, 95% CI: 0.94-1.98), although confidence intervals were wide. The number of days of cycling per week was associated with collisions (OR=1.27, 95% CI: 1.17-1.39) and near misses (OR=1.34, 95% CI: 1.26-1.42). CONCLUSIONS There was no evidence of a change in the likelihood of reporting collisions or near misses in Montreal between the implementation of the PBSP and the end of the second season. Time spent cycling was associated with reporting a collision or near miss.

Context by treatment interactions as the primary object of study in cluster randomized controlled trials of population health interventions

Cluster randomized controlled trials are increasingly used in population health intervention research. Through randomization, researchers attempt to isolate the treatment effect and remove all other effects, including any effects of social context. In many cases, the constant effect assumption cannot be satisfied in cluster randomized controlled trials. We argue that when studying population health interventions, the effective mechanism of intervention lies in the interaction between the treatment and social context. Researchers should be cognizant that attempts to remove the effect of social context using CRTC may fail. The interaction between the treatment and social context should be the primary object of study in population health intervention research.