Richard Prins

Changes in active commuting and changes in physical activity in adults: a cohort study

BackgroundActive travel is associated with greater physical activity, but there is a dearth of research examining this relationship over time. We examined the longitudinal associations between change in time spent in active commuting and changes in recreational and total physical activity.MethodsAdult commuters working in Cambridge, United Kingdom completed questionnaires in 2009 and 2012, and a sub-set completed objective physical activity monitoring in 2010 and 2012. Commuting was assessed using a validated seven-day travel to work record. Moderate-to-vigorous physical activity was assessed using the Recent Physical Activity Questionnaire and combined heart rate and movement sensing. We used multivariable multinomial logistic regression models to examine associations between change in time spent in active commuting and tertiles of changes in time spent in recreational and total physical activity.ResultsFour hundred sixty-nine participants (67xa0% female, mean age 44xa0years) provided valid travel and self-reported physical activity data. Seventy-one participants (54xa0% female, mean age 45xa0years) provided valid travel and objectively measured physical activity data. A decrease in active commuting was associated with a greater likelihood of a decrease in self-reported total physical activity (relative risk ratio [RRR] 2.1, 95xa0% CI 1.1, 4.1). Correspondingly, an increase in active commuting was associated with a borderline significantly greater likelihood of an increase in self-reported total physical activity (RRR 1.8, 95xa0% CI 1.0, 3.4). No associations were seen between change in time spent in active commuting and change in time spent in either self-reported recreational physical activity or objectively measured physical activity.ConclusionsChanges in active commuting were associated with commensurate changes in total self-reported physical activity and we found no compensatory changes in self-reported recreational physical activity. Promoting active commuting has potential as a public health strategy to increase physical activity. Future longitudinal research would be useful to verify these findings.

Causal pathways linking environmental change with health behaviour change: Natural experimental study of new transport infrastructure and cycling to work

Background Mechanisms linking changes to the environment with changes in physical activity are poorly understood. Insights into mechanisms of interventions can help strengthen causal attribution and improve understanding of divergent response patterns. We examined the causal pathways linking exposure to new transport infrastructure with changes in cycling to work. Methods We used baseline (2009) and follow-up (2012) data (N = 469) from the Commuting and Health in Cambridge natural experimental study (Cambridge, UK). Exposure to new infrastructure in the form of the Cambridgeshire Guided Busway was defined using residential proximity. Mediators studied were changes in perceptions of the route to work, theory of planned behaviour constructs and self-reported use of the new infrastructure. Outcomes were modelled as an increase, decrease or no change in weekly cycle commuting time. We used regression analyses to identify combinations of mediators forming potential pathways between exposure and outcome. We then tested these pathways in a path model and stratified analyses by baseline level of active commuting. Results We identified changes in perceptions of the route to work, and use of the cycle path, as potential mediators. Of these potential mediators, only use of the path significantly explained (85%) the effect of the infrastructure in increasing cycling. Path use also explained a decrease in cycling among more active commuters. Conclusion The findings strengthen the causal argument that changing the environment led to changes in health-related behaviour via use of the new infrastructure, but also show how some commuters may have spent less time cycling as a result.

Urban form and psychosocial factors : Do they interact for leisure-time walking?

INTRODUCTIONnThis cross-sectional study uses an adaptation of a social-ecological model on the hierarchy of walking needs to explore direct associations and interactions of urban-form characteristics and individual psychosocial factors for leisure-time walking.nnnMETHODSnQuestionnaire data (n = 736) from adults (25-74 yr) and systematic field observations within 14 neighborhoods in Eindhoven (the Netherlands) were used. Multilevel logistic regression models were used to relate the urban-form characteristics (accessibility, safety, comfort, and pleasurability) and individual psychosocial factors (attitude, self-efficacy, social influence, and intention) to two definitions of leisure-time walking, that is, any leisure-time walking and sufficient leisure-time walking according to the Dutch physical activity norm and to explore their interactions.nnnRESULTSnLeisure-time walking was associated with psychosocial factors but not with characteristics of the urban environment. For sufficient leisure-time walking, interactions between attitude and several urban-form characteristics were found, indicating that positive urban-form characteristics contributed toward leisure-time walking only in residents with a less positive attitude toward physical activity. In contrast, living in a neighborhood that was accessible for walking was stronger associated with leisure-time walking among residents who experienced a positive social influence to engage in physical activity compared with those who reported less social influence.nnnCONCLUSIONSnThis study showed some evidence for an interaction between the neighborhood environment and the individual psychosocial factors in explaining leisure-time walking. The specific mechanism of interaction may depend on the specific combination of psychosocial factor and environmental factor. The lack of association between urban form and leisure-time walking could be partly due to the little variation in urban-form characteristics between neighborhoods.

Effects of living near an urban motorway on the wellbeing of local residents in deprived areas: Natural experimental study

Background Health and wellbeing are partly shaped by the neighbourhood environment. In 2011, an eight kilometre (five mile) extension to the M74 motorway was opened in Glasgow, Scotland, constructed through a predominantly urban, deprived area. We evaluated the effects of the new motorway on wellbeing in local residents. Methods This natural experimental study involved a longitudinal cohort (n = 365) and two cross-sectional samples (baseline n = 980; follow-up n = 978) recruited in 2005 and 2013. Adults from one of three study areas—surrounding the new motorway, another existing motorway, or no motorway—completed a postal survey. Within areas, individual measures of motorway proximity were calculated. Wellbeing was assessed with the mental (MCS-8) and physical (PCS-8) components of the SF-8 scale at both time points, and the short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) at follow-up only. Results In multivariable linear regression analyses, cohort participants living nearer to the new M74 motorway experienced significantly reduced mental wellbeing over time (MCS-8: -3.6, 95% CI -6.6 to -0.7) compared to those living further away. In cross-sectional and repeat cross-sectional analyses, an interaction was found whereby participants with a chronic condition living nearer to the established M8 motorway experienced reduced (MCS-8: -3.7, 95% CI -8.3 to 0.9) or poorer (SWEMWBS: -1.1, 95% CI -2.0 to -0.3) mental wellbeing compared to those living further away. Conclusions We found some evidence that living near to a new motorway worsened local residents’ wellbeing. In an area with an existing motorway, negative impacts appeared to be concentrated in those with chronic conditions, which may exacerbate existing health inequalities and contribute to poorer health outcomes. Health impacts of this type of urban regeneration intervention should be more fully taken into account in future policy and planning.

Physical activity and the environment: conceptual review and framework for intervention research

BackgroundChanging the physical environment is one way to promote physical activity and improve health, but evidence on intervention effectiveness is mixed. The theoretical perspectives and conceptual issues discussed or used in evaluative studies and related literature may contribute to these inconsistencies. We aimed to advance the intervention research agenda by systematically searching for and synthesising the literature pertaining to these wider conceptual issues.MethodsWe searched for editorials, commentaries, reviews, or primary qualitative or quantitative studies in multiple disciplines by electronic searches of key databases (MEDLINE and MEDLINE In-Process, Web of Science, Cochrane Reviews, ProQuest for dissertations, Health Evidence, EPPI-Centre, TRID and NICE) and snowballing. We extracted theoretical and conceptual material and used thematic analysis in an in-depth, configurative narrative approach to synthesis.ResultsOur initial searches identified 2760 potential sources from fields including public health, sociology, behavioural science and transport, of which 104 were included. By first separating out and then drawing together this material, we produced a synthesis that identified five high-level conceptual themes: one concerning outcomes (physical activity as a behaviour and a socially embedded practice), one concerning exposures (environmental interventions as structural changes) and three concerning how interventions bring about their effects (the importance of social and physical context; (un) observable mechanisms linking interventions and changes in physical activity; and interventions as events in complex systems). These themes are inter-related but have rarely been considered together in the disparate literatures. Drawing on these insights, we present a more generalisable way of thinking about how environmental interventions work which could be used in future evaluation studies.ConclusionsEnvironmental and policy interventions are socially embedded and operate within a system. Evaluators should acknowledge this, and the philosophical perspective taken in their evaluation. Across disciplinary fields, future studies should seek to understand how interventions work through considering these systems, the context in which interventions take place, and the (un) observable mechanisms that may operate. This will help ensure that findings can be more easily interpreted and widely applied by policymakers. We hope that highlighting these conceptual issues will help others to interpret and improve upon a somewhat contested evidence base.

Effects of living near a new urban motorway on the travel behaviour of local residents in deprived areas: Evidence from a natural experimental study

ABSTRACT We evaluated the effects of a new motorway built through deprived neighbourhoods on travel behaviour in residents. This natural experiment comprised a longitudinal cohort (n=365) and two cross‐sectional samples (baseline n=980; follow‐up n=978) recruited in 2005 and 2013. Adults from one of three study areas ‐ surrounding the new motorway (South), an existing motorway (East), or no motorway (North) ‐ completed a previous day travel record. Adjusted two‐part regression models examined associations between exposure and outcome. Compared to the North, cohort participants in the South were more likely to undertake travel by any mode (OR 2.1, 95% CI 1.0–4.2) at follow‐up. Within the South study area, cohort participants living closer to a motorway junction were more likely to travel by any mode at follow‐up (OR 4.7, 95% CI 1.1–19.7), and cross‐sectional participants living closer were more likely to use a car at follow‐up (OR 3.4, 95% CI 1.1–10.7), compared to those living further away. Overall, the new motorway appeared to promote travel and car use in those living nearby, but did not influence active travel. This may propagate socioeconomic inequalities in non‐car owners.

Physical and social environmental changes to promote walking among Dutch older adults in deprived neighbourhoods: the NEW.ROADS study

BackgroundPhysical activity is important for healthy ageing, and daily walking is seen as a feasible way to be active at older ages. Yet, many older persons, particularly in lower socioeconomic groups and residing in deprived neighbourhoods, are insufficiently active. Creating a physical and social neighbourhood environment that is more supportive for walking has the potential to improve walking behaviour. Current evidence of the impact of changes to the physical and/or social environmental on walking behaviour is scarce. The aim of the NEW.ROADS study is to design, implement and evaluate changes to the physical and social environment for the purpose of increasing walking behaviour among older residents of deprived neighbourhoods.MethodsPhysical and social environmental interventions were developed by matching scientific evidence on environmental determinants of walking, with input from the target population and stakeholders, and ongoing neighbourhood activities. Specifically, a neighbourhood walking route was designed and marked, and neighbourhood walking groups were organised. These environmental interventions were evaluated in a four-armed experimental study. In addition, the design of the study to evaluate the effect of these environmental changes on walking behaviour is described.DiscussionDesigning and implementing environmental interventions is a complex endeavour, challenged by limited available theory and evidence. Input from the target population and professional stakeholders is essential, but may also put constraints on the evaluation.Trial registrationNTR3800 (registered 9/1/2013)

Health-related behaviours mediate the relation between ethnicity and (mental) health in the Netherlands

ABSTRACT Objective: Ethnic minorities in the Netherlands experience worse (mental) health than Dutch natives. So far, socioeconomic factors, discrimination, and the migration process have been identified as underlying factors, neglecting the potential role of health-related behaviours. This study investigates the mediating effect of lack of physical activity, smoking and alcohol consumption on ethnic inequalities in (mental) health in the Netherlands. Design: Data from a municipal health survey (2012) in the four largest cities in the Netherlands, including 15,633 Dutch natives, 1,297 Surinamese, 850 Turks and 779 Moroccans were analysed. Mediation analyses were performed on the associations between ethnicity and psychological distress (range 10–50) and self-rated health (range 1–5). Results: Being from an ethnic minority was associated with higher distress and poorer self-rated health, especially for Turks (higher distress 4.69, 95%CI 4.22–5.16; poorer health 0.35, 95%CI 0.30–0.40). Moroccans and Turks were the least physically active, Turks smoked the most, and Dutch natives drank the most. Lack of physical activity partially mediated the association between Turks (6% respectively 11%) and Moroccans (13% respectively 9%) for psychological distress and self-rated health. Smoking played a mediating role (3%) in Turks. Conclusion: Lower physical activity and smoking more cigarettes partly explained ethnic health inequalities in the Netherlands. The current findings suggest that intervening and facilitating certain ethnic groups in engaging in health behaviours could contribute to improving their health and reduce ethnic health inequalities.

Concepts and mechanisms linking environmental change with changes in physical activity: a systematic review

Abstract Background Interventions to change the built environment offer a promising approach for promoting physical activity and improving health. However, there has been little theoretical consideration of the underlying mechanisms. In a systematic review we aimed first, to map the potential causal pathways linking environmental changes with changes in physical activity, and second, to review the evidence for specific mechanisms. Here we focus on the first stage of the review. Methods We searched seven electronic databases (Cochrane, Medline, ProQuest, HealthEvidence, National Institute for Health and Care Excellence, Transport Research International Documentation, and Web of Science) representing a range of disciplines using a systematic, transparent, iterative process, which was completed in April, 2015. We did not assess study quality or apply date restrictions. Theoretical and conceptual material was extracted from review articles, theoretical papers, and intervention studies. We used thematic analysis in an in-depth, configurative, narrative approach to synthesis, aiming to derive a set of plausible generalisable pathways by which environmental changes could promote changes in physical activity. Findings Our initial searches identified 2760 potential sources from specialties that included public health, sociology, behavioural science, and transport. We included 79 papers. Broad overarching themes were related to physical activity as a behaviour and a practice, environmental interventions as structural changes, complexity and systems, contexts and observable or unobservable mechanisms. We devised a more generalisable set of hypothesised mechanisms linking environmental changes with changes in physical activity through combinations of changes in both attributes and judgments of both physical and social environments, as well as in individual reasoning. Mechanisms were either conscious or unconscious and operated at the individual and societal levels. Interpretation This conceptual and theoretical synthesis provides a new generalisable conceptual framework to contribute to the design and conduct of assessments of environmental interventions. Future research should seek to understand judgments and interpretations of the environment and how environmental and behavioural changes become embedded. Our thematic analysis highlights conceptual areas of dissonance and common ground for multidisciplinary research teams. In the second part of the review, we will search for evidence on specific mechanisms to assess what environmental interventions work, for whom, in what contexts, and how. Funding Medical Research Council (unit programme number MC_UU_12015/6). JP was also supported by a National Institute for Health Research postdoctoral research fellowship.

Health impacts of the M74 urban motorway extension: a natural experimental study

Abstract Background Increasing peoples mobility can improve access to diverse opportunities, but new roads are associated with noise and community severance, and their effects on physical activity, injuries, and health inequalities are poorly understood. This study investigated how an urban motorway, opened in Glasgow in 2011, affected travel and activity patterns, injuries, and wellbeing in local communities, and how these impacts were experienced and brought about. Methods This was a mixed-method, controlled, before and after natural experimental study. We conducted multivariable cohort, cross-sectional, and repeat cross-sectional analyses of survey responses from adults resident in the M74 corridor (intervention area) and two matched control areas, one surrounding the existing M8 motorway and one with no motorway (numbers by area: baseline [in 2005] 449, 431, 465, respectively; follow-up [in 2013] 430, 446, 467; cohort participants 126, 112, 127). We also conducted interrupted time-series analyses of police casualty data (STATS19 forms, 1997–2014; n=78u2008919), and thematic analysis of ethnographic data from 42 participants using constant comparison. Graded exposure measures based on the log distance of the motorway from each participants home served as a further basis for controlled comparisons. The study was approved by the University of Glasgow Faculty of Medicine (ref FM01304) and Social Sciences (refs 400120077, 400130156, and 400130157) ethics committees. Findings Living closer to the new motorway was associated with an estimated 3·6 unit (95% CI 0·7–6·6) reduction over time in mental wellbeing (mental component summary score [MCS-8] of SF-8) per unit of proximity in cohort analysis, and associated with a greater likelihood of car use at follow-up in repeat cross-sectional analysis (odds ratio 3·4, 95% CI 1·1–10·7). We found some evidence that participation in physical activity declined among cohort participants living closer to the existing M8 motorway (0·4, 0·2–0·9). We found no evidence of changes in active travel (survey data) or casualties (STATS19 data). Although the new motorway improved connectivity for individuals with more dispersed social networks and access to a motor vehicle, the impacts on those with neither of them were more complex and sometimes negative. Changes in community composition and cohesion, and perceptions of personal safety, were widely perceived as more important influences than was the opening of the motorway. Interpretation Although the study identified both benefits and harms, overall these findings highlight the potential for new major road infrastructure to add further burdens to already disadvantaged communities, exacerbating inequalities and contributing to poorer health outcomes. Funding National Institute for Health Research (NIHR) Public Health Research Programme. The funder had no role in the design of the study, the analysis or interpretation of the data, the writing of the abstract, or the decision to submit it for publication.