Provisional COVID-19 infrastructure induces large, rapid increases in cycling.

The bicycle is a low-cost means of transport linked to low risk of transmission of infectious disease. During the COVID-19 crisis, governments have therefore incentivized cycling by provisionally redistributing street space. We evaluate the impact of this new bicycle infrastructure on cycling traffic using a generalized difference in differences design. We scrape daily bicycle counts from 736 bicycle counters in 106 European cities. We combine these with data on announced and completed pop-up bike lane road work projects. Within 4 mo, an average of 11.5 km of provisional pop-up bike lanes have been built per city and the policy has increased cycling between 11 and 48% on average. We calculate that the new infrastructure will generate between $1 and $7 billion in health benefits per year if cycling habits are sticky.

Who is Biking for? Urban Bikeshare Networks' Responses to the COVID-19 Pandemic, Disparities in Bikeshare Access, and a Way Forward.

Black, Latinx, and Indigenous people have contracted the SARS-CoV-2 virus and died of COVID-19 at higher rates than White people. Individuals rated public transit, taxis, and ride-hailing as the modes of transportation putting them at greatest risk of COVID-19 infection. Cycling may thus be an attractive alternative for commuting. Amid the increase in bikeshare usage during the early months of the pandemic, bikeshare companies made changes to membership requirements to increase accessibility, targeting especially essential workers. Essential workers in the United States are disproportionately Black and Latinx, underpaid, and reliant on public transit to commute to work. We document changes made by bikeshare companies, including benefits to various groups of essential workers, and we discuss such changes in the context of longstanding racial disparities in bikeshare access. While well intended, the arbitrary delineation in eligibility for such benefits by class of essential workers unwittingly curtailed access for many who may have benefited most. Given that equity in bikeshare is an important tool to improve access to safe transportation, critical changes in the distribution, accessibility, and usability of bikeshare networks is essential. Bikeshare companies, city planners, and policy makers should collaborate with community-based bike advocates to implement changes, as vocalized by those most in need of alternative forms of transportation.

Cost-effectiveness of mandatory bicycle helmet use to prevent traumatic brain injuries and death.

BACKGROUND: Traumatic brain injury (TBI) is the main cause of mortality and severe morbidity in cyclists admitted to Dutch emergency departments (EDs). Although the use of bicycle helmets is an effective way of preventing TBI, this is uncommon in the Netherlands. An option to increase its use is through a legal enforcement. However, little is known about the cost-effectiveness of such mandatory use of helmets in the Dutch context. The current study aimed to assess the cost-effectiveness of a law that enforces helmet use to reduce TBI and TBI-related mortality. METHODS: The cost-effectiveness was estimated through decision tree modelling. In this study, wearing bicycle helmets enforced by law was compared with the current situation of infrequent voluntary helmet use. The total Dutch cycling population, consisting of 13.5 million people, was included in the model. Model data and parameters were obtained from Statistics Netherlands, the National Road Traffic Database, Dutch Injury Surveillance System, and literature. Effects included were numbers of TBI, death, and disability-adjusted life years (DALY). Costs included were healthcare costs, costs of productivity losses, and helmet costs. Sensitivity analysis was performed to assess which parameter had the largest influence on the incremental cost-effectiveness ratio (ICER). RESULTS: The intervention would lead to an estimated reduction of 2942 cases of TBI and 46 deaths. Overall, the incremental costs per 1) death averted, 2) per TBI averted, and 3) per DALY averted were estimated at 1) € 2,002,766, 2) € 31,028 and 3) € 28,465, respectively. Most favorable were the incremental costs per DALY in the 65+ age group: € 17,775. CONCLUSIONS: The overall costs per DALY averted surpassed the Dutch willingness to pay threshold value of € 20,000 for cost-effectiveness of preventive interventions. However, the cost per DALY averted for the elderly was below this threshold, indicating that in this age group largest effects can be reached. If the price of a helmet would reduce by 20%, which is non-hypothetical in a situation of large-scale purchases and use of these helmets, the introduction of this regulation would result in an intervention that is almost cost-effective in all age groups.

The Cost-Effectiveness of Bike Share Expansion to Low-Income Communities in New York City.

The "Citi Bike" bike share program in New York City is the largest bike share program in the USA. We ask whether expanding this program to lower-income communities is cost-effective means of encouraging exercise and reducing pollution in New York City. We built a stochastic Markov model to evaluate the cost-effectiveness of the Citi Bike expansion program, an effort to extend bike share to areas with higher costs and risks over a 10-year time horizon. We used one-way sensitivity analyses and Monte Carlo simulation to test the model uncertainty. The incremental cost-effectiveness ratio of the Citi Bike expansion program relative to the current program (status quo) was $7869/quality-adjusted life year gained. The Citi Bike expansion program in New York City offers good value relative to most health interventions.

Estimated total costs from non-fatal and fatal bicycle crashes in the USA: 1997-2013.

INTRODUCTION: Emergency department visits and hospital admissions resulting from adult bicycle trauma have increased dramatically. Annual medical costs and work losses of these incidents last were estimated for 2005 and quality-of-life losses for 2000. METHODS: We estimated costs associated with adult bicycle injuries in the USA using 1997-2013 non-fatal incidence data from the National Electronic Injury Surveillance System with cost estimates from the Consumer Product Safety Commission's Injury Cost Model, and 1999-2013 fatal incidence data from the National Vital Statistics System costed by similar methods. RESULTS: Approximately 3.8 million non-fatal adult bicycle injuries were reported during the study period and 9839 deaths. In 2010 dollars, estimated adult bicycle injury costs totalled $24.4 billion in 2013. Estimated injury costs per mile bicycled fell from $2.85 in 2001 to $2.35 in 2009. From 1999 to 2013, total estimated costs were $209 billion due to non-fatal bicycle injuries and $28 billion due to fatal injuries. Inflation-free annual costs in the study period increased by 137% for non-fatal injuries and 23% for fatal injuries. The share of non-fatal costs associated with injuries to riders age 45 and older increased by 1.6% (95% CI 1.4% to 1.9%) annually. The proportion of costs due to incidents that occurred on a street or highway steadily increased by 0.8% (95% CI 0.4% to 1.3%) annually. CONCLUSIONS: Inflation-free costs per case associated with non-fatal bicycle injuries are increasing. The growth in costs is especially associated with rising ridership, riders 45 and older, and street/highway crashes.

The role of the built environment in explaining educational inequalities in walking and cycling among adults in the Netherlands.

BACKGROUND: This study examined whether characteristics of the residential built environment (i.e. population density, level of mixed land use, connectivity, accessibility of facilities, accessibility of green) contributed to educational inequalities in walking and cycling among adults. METHODS: Data from participants (32-82 years) of the 2011 survey of the Dutch population-based GLOBE study were used (N = 2375). Highest attained educational level (independent variable) and walking for transport, cycling for transport, walking in leisure time and cycling in leisure time (dependent variables) were self-reported in the survey. GIS-systems were used to obtain spatial data on residential built environment characteristics. A four-step mediation-based analysis with log-linear regression models was used to examine to contribution of the residential built environment to educational inequalities in walking and cycling. RESULTS: As compared to the lowest educational group, the highest educational group was more likely to cycle for transport (RR 1.13, 95% CI 1.04-1.23), walk in leisure time (RR 1.12, 95% CI 1.04-1.21), and cycle in leisure time (RR 1.12, 95% CI 1.03-1.22). Objective built environment characteristics were related to these outcomes, but contributed minimally to educational inequalities in walking and cycling. On the other hand, compared to the lowest educational group, the highest educational group was less likely to walk for transport (RR 0.91, 95% CI 0.82-1.01), which could partly be attributed to differences in the built environment. CONCLUSION: This study found that objective built environment characteristics contributed minimally to educational inequalities in walking and cycling in the Netherlands.

Understanding Municipal Officials' Involvement in Transportation Policies Supportive of Walking and Bicycling.

CONTEXT: Local transportation policies can impact the built environment and physical activity. Municipal officials play a critical role in transportation policy and planning decisions, yet little is known about what influences their involvement. OBJECTIVE: To describe municipal officials' involvement in transportation policies that were supportive of walking and bicycling and to examine individual- and job-related predictors of involvement in transportation policies among municipal officials. DESIGN: A cross-sectional survey was administered online from June to July 2012 to municipal officials in 83 urban areas with a population of 50 000 or more residents across 8 states. PARTICIPANTS: A total of 461 municipal officials from public health, planning, transportation, public works, community and economic development, parks and recreation, city management, and municipal legislatures responded to the survey. MAIN OUTCOME MEASURE: Participation in the development, adoption, or implementation of a municipal transportation policy supportive of walking or bicycling. RESULTS: Multivariate logistic regression analyses, conducted in September 2013, revealed that perceived importance of economic development and traffic congestion was positively associated with involvement in a municipal transportation policy (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.02-1.70; OR = 1.59, 95% CI = 1.26-2.01, respectively). Higher perceived resident support of local government to address economic development was associated with an increased likelihood of participation in a transportation policy (OR = 1.70, 95% CI = 1.24-2.32). Respondents who perceived lack of collaboration as a barrier were less likely to be involved in a transportation policy (OR = 0.78, 95% CI = 0.63-0.97). Municipal officials who lived in the city or town in which they worked were significantly more likely to be involved in a transportation policy (OR = 1.83, 95% CI = 1.05-3.17). CONCLUSIONS: Involvement in a local transportation policy by a municipal official was associated with greater perceived importance of economic development and traffic congestion in job responsibilities, greater perceived resident support of local government to address economic development, and residence of the municipal official. Lack of collaboration represented a barrier to local transportation policy participation.

Dutch Cycling: Quantifying the Health and Related Economic Benefits.

The Netherlands is well known for their high bicycle use. We used the Health Economic Assessment Tool and life table calculations to quantify the population-level health benefits from Dutch cycling levels. Cycling prevents about 6500 deaths each year, and Dutch people have half-a-year-longer life expectancy because of cycling. These health benefits correspond to more than 3% of the Dutch gross domestic product. Our study confirmed that investments in bicycle-promoting policies (e.g., improved bicycle infrastructure and facilities) will likely yield a high cost-benefit ratio in the long term.

Effect of increasing active travel in urban England and Wales on costs to the National Health Service.

Increased walking and cycling in urban areas and reduced use of private cars could have positive effects on many health outcomes. We estimated the potential effect of increased walking and cycling in urban England and Wales on costs to the National Health Service (NHS) for seven diseases--namely, type 2 diabetes, dementia, cerebrovascular disease, breast cancer, colorectal cancer, depression, and ischaemic heart disease--that are associated with physical inactivity. Within 20 years, reductions in the prevalences of type 2 diabetes, dementia, ischaemic heart disease, cerebrovascular disease, and cancer because of increased physical activity would lead to savings of roughly UK£17 billion (in 2010 prices) for the NHS, after adjustment for an increased risk of road traffic injuries. Further costs would be averted after 20 years. Sensitivity analyses show that results are invariably positive but sensitive to assumptions about time lag between the increase in active travel and changes in health outcomes. Increasing the amount of walking and cycling in urban settings could reduce costs to the NHS, permitting decreased government expenditure on health or releasing resources to fund additional health care.

Health impact of motorised trips that could be replaced by walking.

BACKGROUND: We aimed to quantify the number of women and men, in Catalonia, among those not achieving physical activity recommendations, making short motorized trips which could have been made on foot, and to estimate the annual economic benefit due to reducing mortality as a result of replacing one short, daily, motorized journey with walking. METHODS: Cross-sectional study. Mobility data came from individuals >17 years who reported, in the 2006 Daily Mobility Survey, having travelled on the referred working day (N = 80,552). The health economic assessment tool for walking (HEAT) from the World Health Organization (WHO) Regional Office for Europe was used to calculate the economic benefit. RESULTS: Of those not meeting recommendations, 15.6% of men (95% CI 15.2-16.1) and 13.9% of women (95% CI 13.5-14.4) would go on to meet them if they were to replace at least one short motorized trip per day by walking. If applied to the entire population of Catalonia, this change would increase up to 326,557 men (95% CI 313 373-339,740) and up to 252,509 women (95% CI 240,855-264,163) who would achieve recommendations through walking rather than driving. According to HEAT estimations, this would suppose a saving of €124,216,000 (95% CI 120,182,000-128,250,000) in men and €84,927,000 (95% CI 81,774,000-88,079,000) in women, derived from the reduction in mortality gained from walking accumulated over one year. CONCLUSION: This study demonstrates the potential of trips on foot as a source of physical activity. It also points out that both benefits for the health of the population and a huge economic benefit could have been gained through active transportation interventions.

Efficacy of strength and aerobic exercise on patient-reported outcomes and structural changes in patients with knee osteoarthritis: study protocol for a randomized controlled trial.

BACKGROUND: Despite an extensive literature on treatment interventions for patients with knee osteoarthritis, studies comparing the efficacy of different exercise interventions and living the life as usual on quality of life, cartilage quality and cost-effectiveness are lacking. The aim of the present study is to compare the efficacy of two different exercise programs compared to a control group in individuals with established radiographic and symptomatic knee osteoarthritis on self-reported knee-related quality of life, knee pain, physical function, and cartilage quality. METHODS/DESIGN: A three-armed randomized controlled trial involving two exercise interventions and a control group of individuals doing as they usually do is described. The patients will have mild to moderate radiographic osteoarthritis according to the Kellgren and Lawrence classification (grade 2-3), and fulfill the American College of Rheumatology clinical criteria, be aged between 45 and 65 years, and have no other serious physical or mental illnesses. The patients will be randomly allocated to a strength exercise group; a cycling group, or a control group. The primary outcome is the Knee injury and Osteoarthritis Outcome Score knee-related quality of life subscale. Secondary outcomes include all five Knee Injury and Osteoarthritis Outcome Score subscales, morphological evaluation of cartilage including focal thickness, subchondral bone marrow edema, proteoglycan content and collagen degradation (measured using magnetic resonance imaging clinical sequences, T2 mapping and T1ρ), specific serum biomarkers, isokinetic muscle strength, maximal oxygen uptake, quality of life (EuroQol 5D), and self-efficacy (Arthritis Self-Efficacy Scale). A sample size calculation on the primary outcome showed that 207 individuals, 69 in each group, is needed to detect a clinically relevant difference of 10 points with 80% power and a significance level of 5%. Assessments will be conducted at baseline, 14 weeks, 1 year and 2 years post-randomization. The interventions will be a 14 weeks exercise program. DISCUSSION: Although exercise therapy has been found to be effective in knee osteoarthritis, the knowledge of the underlying mechanisms for why exercise works is lacking. This study will contribute with knowledge on the efficacy of strength exercise versus cycling on patient-reported outcomes, cartilage quality and cost-effectiveness. TRIAL REGISTRATION: Clinicaltrial.gov Identifier: NCT01682980.

"Where have all the bicycles gone?" Are bicycle sales in Australia translated into health-enhancing levels of bicycle usage?

OBJECTIVE: To explore whether the reported increase in bicycle sales in Australia is corroborated by increases in numbers of cyclists. METHODS: Australian representative data on cycling from annual Exercise, Recreation and Sport Surveys (ERASS) from 2001 to 2008 were used. Based on the weighted proportion of cyclists and 'regular cyclists' each year, the number of 'new' riders each year was calculated. Generous assumptions about the number of new bicycle purchased by new riders plus replacement bicycles by regular riders were compared with industry sales figures. RESULTS: Any cycling increased from 9.5% of all adults in 2001 to 11.6% in 2008, an increase of 2.1% [95% CI: 1.14 to 2.76]. This 2.1% represents an overall increase in cyclists of around 343,552 (95% CI from 186,500 to 441,710 new cyclists). The difference between the estimated number bought and the actual industry total average number of bicycles sold (n=753,843 per annum) numbered at least 395,000 unused adult bicycles sold each year after sensitivity analyses. CONCLUSIONS: There appear to be many more bicycles sold in Australia than are used. Further improvements may be needed in the cycling environment before a possible latent desire for cycling translates to participation.

A study on bicycle-related injuries and their costs in Shanghai, China.

China is known as the Bicycle Kingdom, but the nature, extent, and costs of bicycle-related injuries remain largely unknown. The authors' findings showed that the bicycle-related mortality rate increased 99% from 1992 to 2004, and it increased with age, from 0.64 per 100,000 population in the 0-14 age group to 5.93 per 100,000 population in the 65 and older age group. Labor force groups represented the majority of fatalities (70.8%) and nonfatal injuries (81.5%). The male mortality rate was 2.4 times higher than the female mortality rate. Head injuries accounted for 71.9% of fatalities and 33.1% of the hospitalizations. People with lower levels of education had higher injury rates. The poorer districts located in the countryside had the highest mortality rates compared to those located in the central, wealthier regions. The total annual cost of bicycle-related injuries was 1.1 billion CHY (Chinese Yuan) (over $137 million U.S.). To reduce bicycle-related injuries, mandatory helmet legislations, environmental modifications, and representative monitoring systems in China are required.

An economic analysis of the health-related benefits associated with bicycle infrastructure investment in three Canadian cities.

OBJECTIVES: Decision-makers are increasingly requesting economic analyses on transportation-related interventions, but health is often excluded as a determinant of value. We assess the health-related economic impact of bicycle infrastructure investments in three Canadian cities (Victoria, Kelowna and Halifax), comparing a baseline reference year (2016) with the future infrastructure build-out (2020). METHODS: The World Health Organization's Health Economic Assessment Tool (HEAT; version 4.2) was used to quantify the economic value of health benefits associated with increased bicycling, using a 10-year time horizon. Outputs comprise premature deaths prevented, carbon emissions avoided, and a benefit:cost ratio. For 2016-2020, we derived cost estimates for bicycle infrastructure investments (including verification from city partners) and modelled three scenarios for changes in bicycling mode share: 'no change', 'moderate change' (a 2% increase), and 'major change' (a 5% increase). Further sensitivity analyses (32 per city) examined how robust the moderate scenario findings were to variation in parameter inputs. RESULTS: Planned bicycle infrastructure investments between 2016 and 2020 ranged from $28-69 million (CAD; in 2016 prices). The moderate scenario benefit:cost ratios were between 1.7:1 (Victoria) and 2.1:1 (Halifax), with the benefit estimate incorporating 9-18 premature deaths prevented and a reduction of 87-142 thousand tonnes of carbon over the 10-year time horizon. The major scenario benefit:cost ratios were between 3.9:1 (Victoria) and 4.9:1 (Halifax), with 19-43 premature deaths prevented and 209-349 thousand tonnes of carbon averted. Sensitivity analyses showed the ratio estimates to be sensitive to the time horizon, investment cost and value of a statistical life inputs. CONCLUSION: Within the assessment framework permitted by HEAT, the dollar value of health-related benefits exceeded the cost of planned infrastructure investments in bicycling in the three study cities. Depending on the decision problem, complementary analyses may be required to address broader questions relevant to decision makers in the public sector.

Factors associated with federal transportation funding for local pedestrian and bicycle programming and facilities.

Providing safe, convenient places for walking and bicycling can reduce barriers to participating in regular physical activity. We examined bicycle- and pedestrian-related investments authorized by federal transportation legislation in 3,140 counties in the United States by region, population size and urbanization, social and economic characteristics, and indicators of travel-related walking and bicycling. From 1992 to 2004, states and counties implemented 10,012 bicycle- and pedestrian-related projects representing $3.17 billion in federal expenditures. We found disparities in implementation and system-building outcomes according to population size and location and social and economic indicators. Counties characterized by persistent poverty (odds ratio=0.69, 95% confidence interval 0.53-0.91) or low educational status (odds ratio=0.66, 95% confidence interval 0.52-0.84) were less likely to implement projects. Three key policy recommendations for improving public health outcomes are drawn from this research: Improved data tracking, more explicit linkages between transportation projects and public health, and improved planning assistance to underserved communities are all seen as essential steps.

Associations of cycling with urban sprawl and the gasoline price.

PURPOSE: Determine the relationships between cycling and urban sprawl and between cycling and the gasoline price. ANALYSIS: Cross-sectional multivariate regression analyses using pooled data from two individual-level national surveys to analyze the effects of variations in levels of urban sprawl and the gasoline price on cycling as a form of physical activity. SETTING: Metropolitan areas representative of the U.S. population, 1990 to 2001. SUBJECTS: Behavioral Risk Factor Surveillance System: 146,730 individuals at least 18-years-old in the United States; Nationwide Personal Transportation Survey: 73,903 individuals at least 18-years-old in the United States. MEASURES: Self-reported information on bicycling served as the dependent variable. Urban sprawl and the gasoline price served as key independent variables. RESULTS: Living in a metropolitan area with a lower degree of urban sprawl increased the probability of cycling in the past month by 3.4 to 4.4 percentage points and 1.6 to 2.1 percentage points from the means for men and women, respectively. Increasing the gasoline price by one dollar increased the probability of cycling by 4.3 to 4.7 percentage points and 2.9 to 3.5 percentage points for men and women, respectively. CONCLUSION: Results indicate that the prevalence of cycling is higher in less sprawling areas and areas with higher gasoline prices. More research is needed to refine results on how individuals respond to incentives and the roles that monetary and time costs play in improving public health.

Distributed forecasting and ant colony optimization for the bike-sharing rebalancing problem with unserved demands.

Bike-sharing systems (BSS) have widely spread over many cities in the world as an environmentally friendly means to reduce air pollution and traffic congestion. This paper focuses on the bike-sharing rebalancing problem (BRP), which consists of two aspects: determining desired demands at each station and designing routes to redistribute bikes among stations. For the first task, we firstly apply the random forest, a very efficient machine learning algorithm, to forecast desired demands for each station, which can be easily implemented with distributed computing. For the second task, it belongs to the broad class of the vehicle routing problem with pickup and delivery (VRPPD). In most existing settings, all of the demands being strictly satisfied can lead to longer routes and add operational costs. In this paper, we propose a new model with unserved demands by relaxing demands satisfying constraints. Then, we design a distributed ant colony optimization (ACO) based algorithm with some specific modifications to increase its efficiency for the proposed model. We propose to use the percentage of average cost saving per bike as a metric to evaluate the performance of our method on cost-reducing and compare with existing methods and best-known values. Computational results on benchmarks show the advantage of our approach. Finally, we provide a real case study of BSS in Hangzhou, China, with insightful elaborations.

Electric bicycle cost calculation models and analysis based on the social perspective in China.

Electric bicycles (EBs) are increasingly popular around the world. In April 2014, EB ownership in China reached 181 million. While some aspects of the impact of EBs have been studied, most of the literature analyzing the cost of EBs has been conducted from the buyer's point of view and the perspective of social cost has not been covered, which is therefore the focus of this paper. From the consumer's point of view, only the costs paid from purchase until retirement are included in the cost of EBs, i.e., the EB acquisition cost, battery replacement cost, charging cost, and repair and maintenance cost are included. Considered from the perspective of the social cost (including impact on the environment), costs that are not paid directly by consumers should also be included in the cost of EBs, i.e., the lead-acid battery scrap processing cost, the cost of pollution caused by wastewater, and the traffic-related costs. Data are obtained from secondary sources and surveys, and calculations demonstrate that in the life cycle of an EB, the consumer cost is 6386.2 CNY, the social cost is 10,771.2 CNY, and the ratio of consumer to social cost is 1:1.69. By comparison, the ratio for motor vehicles is 1:1.06, so that the share of the life cycle cost of EBs that is not borne by the consumer is much higher than that for motor vehicles, which needs to be addressed.

Evaluating the impact of Mobike on automobile-involved bicycle crashes at the road network level.

As a booming system, free-floating bicycle-sharing (denoted as Mobike) attracts a large number of users due to the convenient utilization procedure. However, it brings about a rapid increase of bicycle volume on roadways, resulting in safety problems especially on road segments shared by automobiles and bikes. This study aimed to evaluate impacts of Mobike on automobile-involved bicycle crashes on shared roadways at a macro level, the network level. Relation between traffic volumes and crashes was first established. Then, the travel mode choice before and after supplying Mobike in the market was analyzed, based on which the multi-class multi-modal user equilibrium (MMUE) models were formulated and solved. Two attributes of Mobike, supply quantity and fare, were investigated via various scenarios. Results suggested the Mobike attracted more walkers than auto-users in travel mode choices, which caused the volume increase of bicycles but few volume decline of automobiles and resulted in more crashes. The supply quantity of Mobike had a negative impact on safety, while the fare had a positive effect. The total supply of Mobike in the market should be regulated by governments to avoid over-supply and reduce bicycle crashes. The fares should be also regulated by including taxes and insurances, which can be used to build up more separated bicycle facilities and cover the Mobike accidents, respectively. The findings of this study provide useful information for governments and urban transportation managers to improve bicycle safety and regulate the Mobike market.