Meghan Winters

Built Environment Influences on Healthy Transportation Choices: Bicycling versus Driving

A growing body of evidence links the built environment to physical activity levels, health outcomes, and transportation behaviors. However, little of this research has focused on cycling, a sustainable transportation option with great potential for growth in North America. This study examines associations between decisions to bicycle (versus drive) and the built environment, with explicit consideration of three different spatial zones that may be relevant in travel behavior: trip origins, trip destinations, and along the route between. We analyzed 3,280 utilitarian bicycle and car trips in Metro Vancouver, Canada made by 1,902 adults, including both current and potential cyclists. Objective measures were developed for built environment characteristics related to the physical environment, land use patterns, the road network, and bicycle-specific facilities. Multilevel logistic regression was used to model the likelihood that a trip was made by bicycle, adjusting for trip distance and personal demographics. Separate models were constructed for each spatial zone, and a global model examined the relative influence of the three zones. In total, 31% (1,023 out of 3,280) of trips were made by bicycle. Increased odds of bicycling were associated with less hilliness; higher intersection density; less highways and arterials; presence of bicycle signage, traffic calming, and cyclist-activated traffic lights; more neighborhood commercial, educational, and industrial land uses; greater land use mix; and higher population density. Different factors were important within each spatial zone. Overall, the characteristics of routes were more influential than origin or destination characteristics. These findings indicate that the built environment has a significant influence on healthy travel decisions, and spatial context is important. Future research should explicitly consider relevant spatial zones when investigating the relationship between physical activity and urban form.

Route Infrastructure and the Risk of Injuries to Bicyclists: A Case-Crossover Study

OBJECTIVES We compared cycling injury risks of 14 route types and other route infrastructure features. METHODS We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip. RESULTS Of 14 route types, cycle tracks had the lowest risk (adjusted odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0.02, 0.54), about one ninth the risk of the reference: major streets with parked cars and no bike infrastructure. Risks on major streets were lower without parked cars (adjusted OR = 0.63; 95% CI = 0.41, 0.96) and with bike lanes (adjusted OR = 0.54; 95% CI = 0.29, 1.01). Local streets also had lower risks (adjusted OR = 0.51; 95% CI = 0.31, 0.84). Other infrastructure characteristics were associated with increased risks: streetcar or train tracks (adjusted OR = 3.0; 95% CI = 1.8, 5.1), downhill grades (adjusted OR = 2.3; 95% CI = 1.7, 3.1), and construction (adjusted OR = 1.9; 95% CI = 1.3, 2.9). CONCLUSIONS The lower risks on quiet streets and with bike-specific infrastructure along busy streets support the route-design approach used in many northern European countries. Transportation infrastructure with lower bicycling injury risks merits public health support to reduce injuries and promote cycling.

Route preferences among adults in the near market for bicycling: findings of the cycling in cities study.

Purpose. To provide evidence about the types of transportation infrastructure that support bicycling. Design. Population-based survey with pictures to depict 16 route types. Setting. Metro Vancouver, Canada. Subjects. 1402 adult current and potential cyclists, i.e., the “near market” for cycling (representing 31% of the population). Measures. Preference scores for each infrastructure type (scale from − 1, very unlikely to use, to +1, very likely to use); current frequency of use of each infrastructure type (mean number of times/y). Analyses. Descriptive statistics across demographic segments; multiple linear regression. Results. Most respondents were likely or very likely to choose to cycle on the following broad route categories: off-street paths (71%–85% of respondents); physically separated routes next to major roads (71%); and residential routes (48%–65%). Rural roads (21%–49%) and routes on major streets (16%–52%) were least likely to be chosen. Within the broad categories, routes with traffic calming, bike lanes, paved surfaces, and no on-street parking were preferred, resulting in increases in likelihood of choosing the route from 12% to 37%. Findings indicate a marked disparity between preferred cycling infrastructure and the route types that were currently available and commonly used. Conclusion. This study provides evidence for urban planners about bicycling infrastructure designs that could lead to an increase in active transportation.

How Far Out of the Way Will We Travel? Built Environment Influences on Route Selection for Bicycle and Car Travel

Current travel demand models are calibrated for motorized transportation and do not perform as well for nonmotorized modes. Little evidence exists on how much, and for what reasons, the routes people travel deviate from the shortest-path or least-cost routes generated by transportation models. This paper investigates differences in total distance, road type used, and built environment features for shortest-path routes versus actual routes for utilitarian bicycle trips (n = 50) and car trips (n = 67) in Metro Vancouver, Canada. Bike trips were, on average, 360 m longer than the shortest possible route; car trips were 540 m longer. Regardless of mode, people do not detour far off the shortest route: detour ratios (actual distance/shortest distance) were similar, with three-fourths of trips within 10% of the shortest distance and at least 90% within 25%. Differences in the built environment measures en route suggest why bike commuters chose to detour: the actual routes had significantly more bicycle facilities (traffic-calming features, bike stencils, and signage) than did the shortest-path routes. Compared with shortest-path routes, cyclists spent significantly less of their travel distance along arterial roads and significantly more along local roads, off-street paths, and routes with bike facilities. As expected, car trips were more likely to be along highways and less likely to be along local roads than predicted by the shortest route. The results illustrate factors that might be included in travel models to more accurately model nonmotorized transportation and provide guidance for how dense bike facilities need to be when infrastructure to support cycling is designed.

Comparing the effects of infrastructure on bicycling injury at intersections and non-intersections using a case–crossover design

Background This study examined the impact of transportation infrastructure at intersection and non-intersection locations on bicycling injury risk. Methods In Vancouver and Toronto, we studied adult cyclists who were injured and treated at a hospital emergency department. A case–crossover design compared the infrastructure of injury and control sites within each injured bicyclists route. Intersection injury sites (N=210) were compared to randomly selected intersection control sites (N=272). Non-intersection injury sites (N=478) were compared to randomly selected non-intersection control sites (N=801). Results At intersections, the types of routes meeting and the intersection design influenced safety. Intersections of two local streets (no demarcated traffic lanes) had approximately one-fifth the risk (adjusted OR 0.19, 95% CI 0.05 to 0.66) of intersections of two major streets (more than two traffic lanes). Motor vehicle speeds less than 30 km/h also reduced risk (adjusted OR 0.52, 95% CI 0.29 to 0.92). Traffic circles (small roundabouts) on local streets increased the risk of these otherwise safe intersections (adjusted OR 7.98, 95% CI 1.79 to 35.6). At non-intersection locations, very low risks were found for cycle tracks (bike lanes physically separated from motor vehicle traffic; adjusted OR 0.05, 95% CI 0.01 to 0.59) and local streets with diverters that reduce motor vehicle traffic (adjusted OR 0.04, 95% CI 0.003 to 0.60). Downhill grades increased risks at both intersections and non-intersections. Conclusions These results provide guidance for transportation planners and engineers: at local street intersections, traditional stops are safer than traffic circles, and at non-intersections, cycle tracks alongside major streets and traffic diversion from local streets are safer than no bicycle infrastructure.

Generating GPS activity spaces that shed light upon the mobility habits of older adults: a descriptive analysis

BackgroundMeasuring mobility is critical for understanding neighborhood influences on older adults’ health and functioning. Global Positioning Systems (GPS) may represent an important opportunity to measure, describe, and compare mobility patterns in older adults.MethodsWe generated three types of activity spaces (Standard Deviation Ellipse, Minimum Convex Polygon, Daily Path Area) using GPS data from 95 older adults in Vancouver, Canada. Calculated activity space areas and compactness were compared across sociodemographic and resource characteristics.ResultsArea measures derived from the three different approaches to developing activity spaces were highly correlated. Participants who were younger, lived in less walkable neighborhoods, had a valid driver’s license, had access to a vehicle, or had physical support to go outside of their homes had larger activity spaces. Mobility space compactness measures also differed by sociodemographic and resource characteristics.ConclusionsThis research extends the literature by demonstrating that GPS tracking can be used as a valuable tool to better understand the geographic mobility patterns of older adults. This study informs potential ways to maintain older adult independence by identifying factors that influence geographic mobility.

Mapping bikeability: a spatial tool to support sustainable travel

The built environment has been shown to influence active transportation. Although spatial data for the built environment is increasingly available, there has been little effort to use existing data and knowledge to define and map ‘bikeability’ as an approach to promoting travel by bicycle. Our goal was to build a tool to identify areas that are more conducive and less conducive to cycling. We used empirical research to develop a bikeability index and geographic information systems to map the index across the Metro Vancouver region. Results of an opinion survey, travel behaviour studies, and focus groups were used to identify the components of the index and their relative importance. Pertinent geospatial data layers were scored and combined using a flexible weighting scheme to create a composite map highlighting both high and low bikeability areas. The bikeability index was comprised of five factors shown to consistently influence cycling: Bicycle facility availability; bicycle facility quality; street connectivity; topography; and land use. For mapping purposes, we created corresponding metrics: density of bicycle facilities; separation from motor vehicle traffic; connectivity of bicycle-friendly roads (local streets, bicycle routes, and off-street paths); slope; and density of destination locations. Using empirical evidence to combine data layers for these metrics we generated a high-resolution (10 m) bikeability surface for the region, depicting bicycle-friendly areas and areas where cycling conditions need to be improved. Built environment interventions for specific locations are informed by evaluating scores for the five individual component layers. Mapping bikeability provides a powerful visual aid to identify zones where changes are needed to support sustainable travel. This evidence-based tool presents data in a user-friendly way for planners and policy makers. The overall bikeability score and its five component scores can guide local action to stimulate changes in cycling rates. It uses widely available data types, thus facilitating easy application in other cities. Furthermore, the flexible parameters and weighting scheme enable users elsewhere to tailor it to evidence about local preferences and conditions.

A framework for stakeholder identification in concept mapping and health research: a novel process and its application to older adult mobility and the built environment

BackgroundStakeholders, as originally defined in theory, are groups or individual who can affect or are affected by an issue. Stakeholders are an important source of information in health research, providing critical perspectives and new insights on the complex determinants of health. The intersection of built and social environments with older adult mobility is an area of research that is fundamentally interdisciplinary and would benefit from a better understanding of stakeholder perspectives. Although a rich body of literature surrounds stakeholder theory, a systematic process for identifying health stakeholders in practice does not exist. This paper presents a framework of stakeholders related to older adult mobility and the built environment, and further outlines a process for systematically identifying stakeholders that can be applied in other health contexts, with a particular emphasis on concept mapping research.MethodsInformed by gaps in the relevant literature we developed a framework for identifying and categorizing health stakeholders. The framework was created through a novel iterative process of stakeholder identification and categorization. The development entailed a literature search to identify stakeholder categories, representation of identified stakeholders in a visual chart, and correspondence with expert informants to obtain practice-based insight.ResultsThe three-step, iterative creation process progressed from identifying stakeholder categories, to identifying specific stakeholder groups and soliciting feedback from expert informants. The result was a stakeholder framework comprised of seven categories with detailed sub-groups. The main categories of stakeholders were, (1) the Public, (2) Policy makers and governments, (3) Research community, (4) Practitioners and professionals, (5) Health and social service providers, (6) Civil society organizations, and (7) Private business.ConclusionsStakeholders related to older adult mobility and the built environment span many disciplines and realms of practice. Researchers studying this issue may use the detailed stakeholder framework process we present to identify participants for future projects. Health researchers pursuing stakeholder-based projects in other contexts are encouraged to incorporate this process of stakeholder identification and categorization to ensure systematic consideration of relevant perspectives in their work.

A Comparison of Antibiotic Use in Children Between Canada and Denmark

Background: High rates of antibiotic prescribing in children lead to antibiotic resistance in the community. Surveillance on utilization rates and comparisons with other jurisdictions are methods for benchmarking. Surveillance on antibiotic use is well established in Europe, including Denmark, but until recently, similar data from Canada were lacking. Objective: To compare pediatric antibiotic prescribing rates in British Columbia, Canada, with those in Denmark. Methods: Population-based data on antibiotic prescriptions from British Columbia and Denmark were obtained from 1999 to 2003 for children less than 15 years of age. Annual trends in prescription rates per 1000 children were analyzed by using generalized linear models for all children less than 15 years of age; they were stratified by age group (0–4, 5–9, 10–14 y) for all antibiotics. Class-specific trends were also evaluated for penicillins, cephalosporins, macrolides, sulfonamides and trimethoprim, tetracyclines, and fluoroquinolones. Results: From 1999 to 2003, the overall British Columbia prescription rate was significantly higher than that of Denmark (p < 0.0001) at all age stratifications. In 2003, the British Columbia prescription rate was twice that of Denmark, at 608 versus 385 prescriptions per 1000 children, respectively. In both jurisdictions, the majority of antibiotics used were penicillins (Anatomical Therapeutic Chemical class J01C), However, in British Columbia, most penicillins used were extended-spectrum (83% in 2003); in Denmark, 34% of penicillins used in 2003 were extended-spectrum and 56% were β-lactamase sensitive. In British Columbia, use of penicillins (−4.5%), cephalosporins (−5.5%), trimethoprim/sulfamethoxazole (−36%), and tetracycline (−1.6%) decreased over time, whereas in Denmark, use of penicillins increased by 11% over time and non-penicillin antibiotics remained stable. A significant increase in macrolide consumption was seen in British Columbia due to use of clarithromycin and azithromycin; in contrast, macrolide consumption declined in Denmark. Conclusions: Compared with Denmark, the antibiotic prescription rate for children is substantially higher in British Columbia. In addition, there has been a significant increase in the use of macrolides, especially the second-generation agents, in British Columbia compared with the use in Denmark. Further studies are required to delineate reasons for antibiotic prescribing patterns in these 2 jurisdictions.

Sustained impact of community-based physical activity interventions: key elements for success

BackgroundCompelling evidence supports the cost effectiveness and potential impact of physical activity on chronic disease prevention and health promotion. Quality of evidence is one piece, but certainly not the sole determinant of whether public health interventions, physical activity focused or otherwise, achieve their full potential for impact. Health promotion at both population and community levels must progress beyond health intervention models that isolate individuals from social, environmental, and political systems of influence.We offer a critical evaluation of lessons learned from two successful research initiatives to provide insights as to how health promotion research contributes to sustained impact. We highlight factors key to success including the theoretical and methodological integration of: i) a social ecological approach; ii) participatory action research (PAR) methods; and iii) an interdisciplinary team.MethodsTo identify and illustrate the key elements of our success we layered an evaluation of steps taken atop a review of relevant literature.ResultsIn the school-based case study (Action Schools! BC), the success of our approach included early and sustained engagement with a broad cross-section of stakeholders, establishing partnerships across sectors and at different levels of government, and team members across multiple disciplines. In the neighbourhood built environment case study, the three domains guided our approach through study design and team development, and the integration of older adults’ perspectives into greenway design plans. In each case study we describe how elements of the domains serve as a guide for our work.ConclusionTo sustain and maximize the impact of community-based public health interventions we propose the integration of elements from three domains of research that acknowledge the interplay between social, environmental and poilitical systems of influence. We emphasize that a number of key factors determine whether evidence from public health interventions in school and built environment settings is applied in practice and policy sectors. These include relationship building at individual, community, and societal levels of the social ecological model, using participatory action research methods, and involving an engaged and committed interdisciplinary team.