Rebecca Steinbach

What are the health benefits of active travel? A systematic review of trials and cohort studies.

Background Increasing active travel (primarily walking and cycling) has been widely advocated for reducing obesity levels and achieving other population health benefits. However, the strength of evidence underpinning this strategy is unclear. This study aimed to assess the evidence that active travel has significant health benefits. Methods The study design was a systematic review of (i) non-randomised and randomised controlled trials, and (ii) prospective observational studies examining either (a) the effects of interventions to promote active travel or (b) the association between active travel and health outcomes. Reports of studies were identified by searching 11 electronic databases, websites, reference lists and papers identified by experts in the field. Prospective observational and intervention studies measuring any health outcome of active travel in the general population were included. Studies of patient groups were excluded. Results Twenty-four studies from 12 countries were included, of which six were studies conducted with children. Five studies evaluated active travel interventions. Nineteen were prospective cohort studies which did not evaluate the impact of a specific intervention. No studies were identified with obesity as an outcome in adults; one of five prospective cohort studies in children found an association between obesity and active travel. Small positive effects on other health outcomes were found in five intervention studies, but these were all at risk of selection bias. Modest benefits for other health outcomes were identified in five prospective studies. There is suggestive evidence that active travel may have a positive effect on diabetes prevention, which may be an important area for future research. Conclusions Active travel may have positive effects on health outcomes, but there is little robust evidence to date of the effectiveness of active transport interventions for reducing obesity. Future evaluations of such interventions should include an assessment of their impacts on obesity and other health outcomes.

Effect of 20 mph traffic speed zones on road injuries in London, 1986-2006: controlled interrupted time series analysis

Objective To quantify the effect of the introduction of 20 mph (32 km an hour) traffic speed zones on road collisions, injuries, and fatalities in London. Design Observational study based on analysis of geographically coded police data on road casualties, 1986-2006. Analyses were made of longitudinal changes in counts of road injuries within each of 119 029 road segments with at least one casualty with conditional fixed effects Poisson models. Estimates of the effect of introducing 20 mph zones on casualties within those zones and in adjacent areas were adjusted for the underlying downward trend in traffic casualties. Setting London. Main outcome measures All casualties from road collisions; those killed and seriously injured (KSI). Results The introduction of 20 mph zones was associated with a 41.9% (95% confidence interval 36.0% to 47.8%) reduction in road casualties, after adjustment for underlying time trends. The percentage reduction was greatest in younger children and greater for the category of killed or seriously injured casualties than for minor injuries. There was no evidence of casualty migration to areas adjacent to 20 mph zones, where casualties also fell slightly by an average of 8.0% (4.4% to 11.5%). Conclusions 20 mph zones are effective measures for reducing road injuries and deaths.

The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health

The Lancet Countdown tracks progress on health and climate change and provides an independent assessment of the health effects of climate change, the implementation of the Paris Agreement, 1 and th ...

The Travelling Citizen: Emergent Discourses of Moral Mobility in a Study of Cycling in London

Drawing on accounts of travelling within London, this article explores the ways in which mobility discourses are tied to the responsibilities of ‘a good citizen’ and suggests that car-dominated automobility has been significantly fractured, at least in one urban setting. A consensus hierarchy of transport modes now configures driving as immoral, as well as dysfunctional, and cycling, in contrast, as particularly laudable. Within this new moral economy of transport, cycling holds the promise of conscientious automobility, enabling a number of explicit and implied citizenship responsibilities to be met. These include ecological responsibilities to the city and global ecosystem, but also responsibilities to enact the ‘new citizen’: a knowledgeable and alert risk-assessor competent to travel in ways that maximize independence, efficiency and health. However, cycling has its own contradictions: whilst enabling some to enact a new ‘moral’ citizenship, it simultaneously underlines the marginal citizenship of less mobile Londoners.

The effect of reduced street lighting on road casualties and crime in England and Wales: controlled interrupted time series analysis

Background Many local authorities in England and Wales have reduced street lighting at night to save money and reduce carbon emissions. There is no evidence to date on whether these reductions impact on public health. We quantified the effect of 4 street lighting adaptation strategies (switch off, part-night lighting, dimming and white light) on casualties and crime in England and Wales. Methods Observational study based on analysis of geographically coded police data on road traffic collisions and crime in 62 local authorities. Conditional Poisson models were used to analyse longitudinal changes in the counts of night-time collisions occurring on affected roads during 2000–2013, and crime within census Middle Super Output Areas during 2010–2013. Effect estimates were adjusted for regional temporal trends in casualties and crime. Results There was no evidence that any street lighting adaptation strategy was associated with a change in collisions at night. There was significant statistical heterogeneity in the effects on crime estimated at police force level. Overall, there was no evidence for an association between the aggregate count of crime and switch off (RR 0.11; 95% CI 0.01 to 2.75) or part-night lighting (RR 0.96; 95% CI 0.86 to 1.06). There was weak evidence for a reduction in the aggregate count of crime and dimming (RR 0.84; 95% CI 0.70 to 1.02) and white light (RR 0.89; 95% CI 0.77 to 1.03). Conclusions This study found little evidence of harmful effects of switch off, part-night lighting, dimming, or changes to white light/LEDs on road collisions or crime in England and Wales.

‘We Can All Just Get on a Bus and Go’: Rethinking Independent Mobility in the Context of the Universal Provision of Free Bus Travel to Young Londoners

Abstract This paper uses qualitative data from interviews with 118 young Londoners (age 12–18) to examine how the universal provision of free bus travel has affected young people’s independent mobility. Drawing on Sen’s capabilities approach, we argue that free bus travel enhanced young Londoners’ capabilities to shape their daily mobility, both directly by increasing financial access and indirectly by facilitating the acquisition of the necessary skills, travelling companions and confidence. These capabilities in turn extended both opportunity freedoms (e.g. facilitating non-‘necessary’ recreational and social trips) and process freedoms (e.g. feeling more independent by decreasing reliance on parents). Moreover, the universal nature of the entitlement rendered buses a socially inclusive way for groups to travel and spend time together, thereby enhancing group-level capabilities. We believe this attention to individual and group capabilities for self-determination provides the basis for a broader and more child-centred view of independent mobility than the typical research focus upon travelling without an adult and acquiring parental permissions.

The impact of 20 mph traffic speed zones on inequalities in road casualties in London

Background Road traffic casualties show some of the widest socioeconomic differentials of any cause of morbidity or mortality, and as yet there is little evidence on what works to reduce them. This study quantified the current and potential future impact of the introduction of 20 mph zones on socioeconomic inequalities in road casualties in London. Methods An observational study based on analysis of geographically coded police road casualties data, 1987–2006. Changes in counts of casualties from road collisions, those killed and seriously injured and pedestrian injuries by quintile of deprivation were calculated. Results The effect of 20 mph zones was similar across quintiles of socioeconomic deprivation, being associated with a 41.8% (95% CI 21.0% to 62.6%) decline in casualties in areas in the least deprived quintile versus 38.3% (31.5% to 45.0%) in the most deprived quintile. Because of the greater number of road casualties in deprived areas and the targeting of zones to such areas, the number of casualties prevented by zones was substantially larger in areas of greater socioeconomic deprivation. However, the underlying decline in road casualties on all roads was appreciably greater in less deprived areas (p<0.001 for trend) so that despite the targeting of 20 mph zones, socioeconomic inequalities in road injuries in London have widened over time. Extending 20 mph schemes has only limited the potential to reduce differentials further. Conclusions The implementation of 20 mph zones targeted at deprived areas has mitigated widening socioeconomic differentials in road injury in London and to some degree narrowed them, but there is limited potential for further gain.

'We can all just get on a bus and go': rethinking independent mobility in the context of the universal provision of free bus travel to young Londoners

Abstract This paper uses qualitative data from interviews with 118 young Londoners (age 12–18) to examine how the universal provision of free bus travel has affected young people’s independent mobility. Drawing on Sen’s capabilities approach, we argue that free bus travel enhanced young Londoners’ capabilities to shape their daily mobility, both directly by increasing financial access and indirectly by facilitating the acquisition of the necessary skills, travelling companions and confidence. These capabilities in turn extended both opportunity freedoms (e.g. facilitating non-‘necessary’ recreational and social trips) and process freedoms (e.g. feeling more independent by decreasing reliance on parents). Moreover, the universal nature of the entitlement rendered buses a socially inclusive way for groups to travel and spend time together, thereby enhancing group-level capabilities. We believe this attention to individual and group capabilities for self-determination provides the basis for a broader and more child-centred view of independent mobility than the typical research focus upon travelling without an adult and acquiring parental permissions.

The road most travelled: the geographic distribution of road traffic injuries in England

BackgroundBoth road safety campaigns and epidemiological research into social differences in road traffic injury risk often assume that road traffic injuries occur close to home. While previous work has examined distance from home to site of collision for child pedestrians in local areas, less is known about the geographic distribution of road traffic injuries from other modes. This study explores the distribution of the distance between home residence and collision site (crash distance) by mode of transport, geographic area, and social characteristics in England.MethodsUsing 10 years of road casualty data collected by the police, we examined the distribution of crash distance by age, sex, injury severity, area deprivation, urban/rural status, year, day of week, and, in London only, ethnic group.Results54% of pedestrians, 39% of cyclists, 17% of powered two-wheeler riders and 16% of car occupants were injured within 1 km of home. 82% of pedestrians, 83% of cyclists, 54% of powered two-wheeler and 53% of car occupants were injured within 5 km of home. We found some social and geographic differences in crash distance: for all transport modes injuries tended to occur closer to home in more deprived or urban areas; younger and older pedestrians and cyclists were also injured closer to home. Crash distance appears to have increased over time for pedestrian, cyclist and car occupant injuries, but has decreased over time for powered two-wheeler injuries.ConclusionsInjuries from all travel modes tend to occur quite close to home, supporting assumptions made in epidemiological and road safety education literature. However, the trend for increasing crash distance and the social differences identified may have methodological implications for future epidemiological studies on social differences in injury risk.

Health impacts of free bus travel for young people: evaluation of a natural experiment in London

Background We used the introduction of free bus travel for young people in London in 2005 as a natural experiment with which to assess its effects on active travel, car use, road traffic injuries, assaults, and on one measure of social inclusion, total number of trips made. Methods A controlled before–after analysis was conducted. We estimated trips by mode and distances travelled in the preintroduction and postintroduction periods using data from London Travel Demand Surveys. We estimated rates of road traffic injury and assault in each period using STATS19 data and Hospital Episode Statistics, respectively. We estimated the ratio of change in the target age group (12–17 years) to the change in adults (ages 25–59 years), with 95% CIs. Results The proportion of short trips travelled by bus by young people increased postintroduction. There was no evidence for an increase in the total number of bus trips or distance travelled by bus by young people attributable to the intervention. The proportion of short trips by walking decreased, but there was no evidence for any change to total distance walked. Car trips declined in both age groups, although distance travelled by car decreased more in young people. Road casualty rates declined, but the pre–post ratio of change was greater in young people than adults (ratio of ratios 0.84; 95% CI 0.82 to 0.87). Assaults increased and the ratio of change was greater in young people (1.20; 1.13 to 1.27). The frequency of all trips by young people was unchanged, both in absolute terms and relative to adults. Conclusions The introduction of free bus travel for young people had little impact on active travel overall and shifted some travel from car to buses that could help broader environmental objectives.