Elizabeth Webb

Active Travel to Work and Cardiovascular Risk Factors in the United Kingdom

BACKGROUND Increasing active travel (walking, cycling, public transport) is increasingly seen as integral to strategies to raise physical activity levels. PURPOSE This study examined (1) sociodemographic correlates of active travel to work and (2) associations between active travel and cardiovascular risk factors in the United Kingdom (UK). METHODS Data come from Understanding Society, a nationally representative survey of UK residents in 2009/2011, analyzed in 2012. Multinomial logistic regression assessed associations between sociodemographic factors and mode of transport to work. Linear and logistic regression was used to examine associations between mode of travel and overweight/obesity, and having hypertension or diabetes. RESULTS A total of 69% of participants traveled to work using private transport, with public transport, walking, and cycling used by 16%, 12%, and 3%, respectively. Use of any active travel was more likely in participants living in London. Black participants were more likely to walk (AOR=1.41, 95% CI=1.08, 1.84) or take public transport (AOR=2.34, 95% CI=1.88, 2.90) to work than whites. Using public transport, walking, or cycling to work was associated with a lower likelihood of being overweight (AOR=0.80, 95% CI=0.54, 0.88 for walking). Walking or cycling was associated with a lower likelihood of having diabetes, and walking was associated with a lower likelihood of having hypertension than private transport (AOR=0.83, 95% CI=0.71, 0.97). CONCLUSIONS There are wide variations in the mode of travel to work across regions and sociodemographic groups in the UK. The protective association between active travel and cardiovascular risk demonstrated in this nationally representative study adds to growing evidence that concerted policy focus in this area may benefit population health.

Free bus passes, use of public transport and obesity among older people in England

Background All residents of England aged 60 years and older became entitled to free travel on local buses on 1 April 2006. This study examines the impact of this policy on public transport use, a mode of active transport and levels of obesity. Methods Logistic regression analyses using three waves of data (2004, 2006 and 2008) from the English Longitudinal Study of Ageing. Our main outcome measures were changes in self-reported public transport use, body mass index, waist circumference and obesity. Results Eligibility for free bus travel was associated with increased use (adjusted odds ratio (AOR) 1.51, 95% CI 1.14 to 2.00) of public transport among older people. Older people who used public transport had reduced odds of being obese in 2008 compared with those who did not (AOR 0.75, 95% CI 0.65 to 0.86), as did those who were eligible for free local bus travel (AOR 0.75, 95% CI 0.59 to 0.97). Older people who used public transport had reduced odds of becoming obese between 2004 and 2008 (AOR 0.79, 95% CI 0.63 to 0.98). Conclusion The introduction of free bus travel for older residents of England appears to have increased public transport use and may have conferred a protective effect against obesity.

Proximal predictors of change in quality of life at older ages

Objective To investigate whether changes in health, social and economic circumstances predict change in quality of life (QoL) at older ages. Design Secondary analysis, using multiple regression analyses, of waves 1 and 3 of the English Longitudinal Study of Ageing. Setting England, 2002–6. Participants A nationally representative sample of non-institutionalised adults aged over 50 years living in England with non-missing data for the variables of interest (N=4848). Main Outcome Measure QoL in 2006, with reference to QoL in 2002, both measured using the CASP-19 score. Results Mean QoL decreased over the 4 years, with becoming depressed (β −0.12) and developing difficulties with activities of daily living (β −0.08) contributing to this decrease. Improvements in family relationships (β 0.10), the neighbourhood (β 0.08) and perceived financial position (β 0.07) each counteracted the decline in QoL. Initial QoL strongly predicted QoL at follow-up (β 0.46). Regression models explained 59% of variation in QoL, and there were small differences between age and gender groups. Conclusions The maintenance of good QoL in older aged people is enabled by the avoidance of depression, maintenance of physical function, good neighbourhood standards, family relationships and financial circumstances.

Estimation of secular trends in adult height, and childhood socioeconomic circumstances in three Eastern European populations

The objective of these analyses was to estimate the strength and direction of secular trends in adult height and childhood socioeconomic circumstances in eight towns in three Eastern European countries in the mid-20th century, and to assess the extent to which childhood conditions might explain the height differences. We used cross-sectional data from the baseline survey of the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study, conducted in 2002-2005. The study examined 24,012 men and women born between 1933 and 1957, randomly selected from the general populations of Novosibirsk (Russia), Krakow (Poland) and six towns of the Czech Republic. To allow for age-related height loss we estimated maximum attained height. Parental education and household item ownership at age 10 were used as markers of childhood socioeconomic conditions. In all 5-year birth cohorts, Novosibirsk men and women were shortest. There were positive and statistically significant secular trends in childhood conditions and in maximum adult height. Adjustment for childhood conditions explained about one third of the trend in height. There appeared to be a small reduction in height of persons born during the Second World War which was, however, only significant in Novosibirsk. These results suggest that secular trends in height mirror, but are not wholly explained by, trends in socioeconomic circumstances in early life.

Childhood socioeconomic circumstances and adult height and leg length in central and eastern Europe

Background: Adult height and leg length have been shown to be positively associated with childhood socioeconomic circumstances in several studies in western populations. This study will determine whether similar associations are observable in settings with different social histories, and will assess whether adult leg length is more strongly associated than adult height. Methods: Random samples of men and women aged 45–69 years were taken from population registers in Novosibirsk (Russia), Krakow (Poland) and six towns of the Czech Republic, recruiting nearly 29 000 people. Participants completed a questionnaire that included questions regarding their mother’s and father’s education (not available in the Czech Republic) and ownership of several household items when they were 10 years old. Participants’ standing and sitting heights were measured and from these an estimate of leg length was derived. Associations between indicators of childhood socioeconomic circumstances and anthropometric measures were analysed using linear regression. Results: Russian individuals were shorter and reported fewer household assets at the age of 10 years than Czech and Polish individuals. Parental education and household assets were strongly associated with each other and both were independently associated with height, leg length and trunk length. Height was associated with childhood circumstances more strongly than leg length. The associations of childhood circumstances with the leg/trunk ratio were weak and inconsistent. Conclusion: In these urban populations in eastern Europe, adult height is associated with childhood conditions at least as strongly as leg length.

The Impact of a Free Older Persons’ Bus Pass on Active Travel and Regular Walking in England

OBJECTIVES We assessed the potential public health benefit of the National Bus Pass, introduced in 2006, which permits free local bus travel for older adults (≥ 60 years) in England. METHODS We performed regression analyses with annual data from the 2005-2008 National Travel Survey. Models assessed associations between being a bus pass holder and active travel (walking, cycling, and use of public transport), use of buses, and walking 3 or more times per week. RESULTS Having a free pass was significantly associated with greater active travel among both disadvantaged (adjusted odds ratio [AOR] = 4.06; 95% confidence interval [CI] = 3.35, 4.86; P < .001) and advantaged groups (AOR = 4.72; 95% CI = 3.99, 5.59; P < .001); greater bus use in both disadvantaged and advantaged groups (AOR = 7.03; 95% CI = 5.53, 8.94; P < .001 and AOR = 7.11; 95% CI = 5.65, 8.94; P < .001, respectively); and greater likelihood of walking more frequently in the whole cohort (AOR = 1.15; 95% CI = 1.07, 1.12; P < .001). CONCLUSIONS Public subsidies enabling free bus travel for older persons may confer significant population health benefits through increased incidental physical activity.

Physical occupational exposures during working life and quality of life after labour market exit: results from the GAZEL study.

Objective: To investigate variations in quality of life at older ages, we take a life course perspective to analyse long-term effects of physical working conditions upon quality of life after retirement. In doing so, we study to what extent these associations are explained by individuals’ health at older ages. Method: We use administrative data and self-administered questionnaire responses from the French GAZEL cohort. Quality of life was assessed with CASP-19 in 2009 and related to three types of physical working conditions during previous working life: (1) ergonomic strain, (2) physical danger and (3) exposures to chemicals. Health was assessed in 2007 with the SF-36 Health Survey. Multiple regressions were calculated in retired men only, controlling for important confounders including social position. Results: In contrast to men, few women were exposed to strenuous and dangerous working conditions in this cohort and were not included in subsequent analyses. Negative effects on retired mens quality of life were found for the physical occupational exposures of ergonomic strain and physical danger, but not for chemical exposures. Effects were attenuated after the introduction of physical and mental health to the models, indicating an indirect effect of physical working conditions upon quality of life via health. Conclusion: Adverse physical working conditions have long-term consequences for health and quality of life at older ages. Improvements to physical working conditions may improve individuals’ quality of life over the long term.

Change in commute mode and body-mass index: prospective, longitudinal evidence from UK Biobank

Summary Background Insufficient physical activity is a determinant of obesity and cardiovascular disease. Active travel to work has declined in high-income countries in recent decades. We aimed to determine which socioeconomic and demographic characteristics predicted switching to or from active commuting, whether switching from passive to active commuting (or the reverse) independently predicts change in objectively measured body-mass index (BMI), and to ascertain whether any association is attenuated by socioeconomic, demographic, or behavioural factors. Methods This study used longitudinal data from UK Biobank. Baseline data collection occurred at 22 centres between March, 2006, and July, 2010, with a repeat assessment at one centre (Stockport) between August, 2012, and June, 2013, for a subset of these participants. Height and weight were objectively measured at both timepoints. We included individuals present at both timepoints with complete data in the analytic sample. Participants were aged 40–69 years and commuted from home to a workplace on a regular basis at both baseline and follow-up. Two exposures were investigated: transition from car commuting to active or public transport commuting and transition from active or public transport to car commuting. Change in BMI between baseline and repeat assessment was the outcome of interest, assessed with bivariate and multivariate logistic regression models. Findings 502 656 individuals provided baseline data, with 20 346 participating in the repeat assessment after a median of 4·4 years (IQR 3·7–4·9). 5861 individuals were present at both timepoints and had complete data for all analytic variables. Individuals who transitioned from car commuting at baseline to active or public transportation modes at follow-up had a decrease in BMI of −0·30 kg/m2 (95% CI −0·47 to −0·13; p=0·0005). Conversely, individuals who transitioned from active commuting at baseline to car commuting at follow-up had a BMI increase of 0·32 kg/m2 (0·13 to 0·50; p=0·008). These effects were not attenuated by adjustment for hypothesised confounders. Change in household income emerged as a determinant of commute mode transitions. Interpretation Incorporation of increased levels of physical activity as part of the commute to work could reduce obesity among middle-aged adults in the UK. Funding UK Medical Research Council.

Housing and respiratory health at older ages

Background A large proportion of the population of England live in substandard housing. Previous research has suggested that poor-quality housing, particularly in terms of cold temperatures, mould, and damp, poses a health risk, particularly for older people. The present study aimed to examine the association between housing conditions and objectively measured respiratory health in a large general population sample of older people in England. Data and methods Data on housing conditions, respiratory health and relevant covariates were obtained from the second wave of the English Longitudinal Study of Ageing. Multivariate regression methods were used to test the association between contemporary housing conditions and respiratory health while accounting for the potential effect of other factors; including social class, previous life-course housing conditions and childhood respiratory health. Results Older people who were in fuel poverty or who did not live in a home they owned had significantly worse respiratory health as measured by peak expiratory flow rates. After accounting for covariates, these factors had no effect on any other measures of respiratory health. Self-reported housing problems were not consistently associated with respiratory health. Conclusions The housing conditions of older people in England, particularly those associated with fuel poverty and living in rented accommodation, may be harmful to some aspects of respiratory health. This has implications for upcoming UK government housing and energy policy decisions.

Free Bus Travel and Physical Activity, Gait Speed, and Adiposity in the English Longitudinal Study of Ageing.

OBJECTIVES We investigated associations between having a bus pass, enabling free local bus travel across the United Kingdom for state pension-aged people, and physical activity, gait speed, and adiposity. METHODS We used data on 4650 bus pass-eligible people (aged ≥ 62 years) at wave 6 (2012-2013) of the English Longitudinal Study of Ageing in regression analyses. RESULTS Bus pass holders were more likely to be female (odds ratio [OR] = 1.67; 95% confidence interval [CI] = 1.38, 2.02; P < .001), retired (OR = 2.65; 95% CI = 2.10, 3.35; P < .001), without access to a car (OR = 2.78; 95% CI = 1.83, 4.21; P < .001), to use public transportation (OR = 10.26; 95% CI = 8.33, 12.64; P < .001), and to be physically active (OR = 1.43; 95% CI = 1.12, 1.84; P = .004). Female pass holders had faster gait speed (b = 0.06 meters per second; 95% CI = 0.02, 0.09; P = .001), a body mass index 1 kilogram per meter squared lower (b = -1.20; 95% CI = -1.93, -0.46; P = .001), and waist circumference 3 centimeters smaller (b = -3.32; 95% CI = -5.02, -1.62; P < .001) than women without a pass. CONCLUSIONS Free bus travel for older people helps make transportation universally accessible, including for those at risk for social isolation. Those with a bus pass are more physically active. Among women in particular, the bus pass is associated with healthier aging.