Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities.

INTRODUCTION: Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not. METHODS AND ANALYSIS: Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities. ETHICS AND DISSEMINATION: This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.

Towards a post-COVID geography of economic activity: Using probability spaces to decipher Montreal's changing workscapes.

In March 2020, many workers were suddenly forced to work from home. This brought into stark relief the fact that urban economic activity is no longer attached to specific workplaces. This detachment has been analysed in research on organisations and workers, but has not yet been incorporated into concepts used to document and plan the economic geography of cities. In this article, three questions are explored by way of an original survey: first, how can a shift in the location of economic activity be measured at the urban scale whilst incorporating the idea that work is not attached to a single location? Second, what is the nature of the shift that occurred in March 2020? Third, what does this tell us about concepts that have underpinned the study of urban economic form by geographers and planners? Applying concepts developed in organisation studies and sociology, we operationalise the idea that economic activity happens across multiple spaces: it occurs within a probability space, and since March 2020 it has shifted within this space. To better understand and interpret the longer-term impact of this shift on cities - downtowns in particular - we draw upon interviews with people working from home.

Standardised criteria for classifying the International Classification of Activities for Time-use Statistics (ICATUS) activity groups into sleep, sedentary behaviour, and physical activity.

BACKGROUND: Globally, the International Classification of Activities for Time-Use Statistics (ICATUS) is one of the most widely used time-use classifications to identify time spent in various activities. Comprehensive 24-h activities that can be extracted from ICATUS provide possible implications for the use of time-use data in relation to activity-health associations; however, these activities are not classified in a way that makes such analysis feasible. This study, therefore, aimed to develop criteria for classifying ICATUS activities into sleep, sedentary behaviour (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA), based on expert assessment. METHOD: We classified activities from the Trial ICATUS 2005 and final ICATUS 2016. One author assigned METs and codes for wakefulness status and posture, to all subclass activities in the Trial ICATUS 2005. Once coded, one author matched the most detailed level of activities from the ICATUS 2016 with the corresponding activities in the Trial ICATUS 2005, where applicable. The assessment and harmonisation of each ICATUS activity were reviewed independently and anonymously by four experts, as part of a Delphi process. Given a large number of ICATUS activities, four separate Delphi panels were formed for this purpose. A series of Delphi survey rounds were repeated until a consensus among all experts was reached. RESULTS: Consensus about harmonisation and classification of ICATUS activities was reached by the third round of the Delphi survey in all four panels. A total of 542 activities were classified into sleep, SB, LPA, and MVPA categories. Of these, 390 activities were from the Trial ICATUS 2005 and 152 activities were from the final ICATUS 2016. The majority of ICATUS 2016 activities were harmonised into the ICATUS activity groups (n = 143). CONCLUSIONS: Based on expert consensus, we developed a classification system that enables ICATUS-based time-use data to be classified into sleep, SB, LPA, and MVPA categories. Adoption and consistent use of this classification system will facilitate standardisation of time-use data processing for the purpose of sleep, SB and physical activity research, and improve between-study comparability. Future studies should test the applicability of the classification system by applying it to empirical data.

Cross-border spatial accessibility of health care in the North-East Department of Haiti.

BACKGROUND: The geographical accessibility of health services is an important issue especially in developing countries and even more for those sharing a border as for Haiti and the Dominican Republic. During the last 2 decades, numerous studies have explored the potential spatial access to health services within a whole country or metropolitan area. However, the impacts of the border on the access to health resources between two countries have been less explored. The aim of this paper is to measure the impact of the border on the accessibility to health services for Haitian people living close to the Haitian-Dominican border. METHODS: To do this, the widely employed enhanced two-step floating catchment area (E2SFCA) method is applied. Four scenarios simulate different levels of openness of the border. Statistical analysis are conducted to assess the differences and variation in the E2SFCA results. A linear regression model is also used to predict the accessibility to health care services according to the mentioned scenarios. RESULTS: The results show that the health professional-to-population accessibility ratio is higher for the Haitian side when the border is open than when it is closed, suggesting an important border impact on Haitians' access to health care resources. On the other hand, when the border is closed, the potential accessibility for health services is higher for the Dominicans. CONCLUSION: The openness of the border has a great impact on the spatial accessibility to health care for the population living next to the border and those living nearby a road network in good conditions. Those findings therefore point to the need for effective and efficient trans-border cooperation between health authorities and health facilities. Future research is necessary to explore the determinants of cross-border health care and offers an insight on the spatial revealed access which could lead to a better understanding of the patients' behavior.

"Outta my way!" Individual and environmental correlates of interactions between pedestrians and vehicles during street crossings.

Because pedestrian crash rates remain lower than other collision types, surrogate measures such as traffic interactions are now used in road safety research to complement crash history. Using naturalistic data collection, we sought to assess 1) the likelihood of occurrence of interactions between pedestrians and vehicles based on individual and crossing characteristics; and 2) differences in interaction characteristics between children, adult and senior pedestrians. Observations of pedestrian crossing behaviours (n=4687) were recorded at 278 crossings. For recorded interactions (n=843), information was collected to characterize the behaviours of involved parties. A mixed-effect logit regression model was performed to assess the factors associated with interactions. Chi-square tests evaluated differences between age groups and characteristics of observed interactions. Older adults were those more likely to be involved in an interaction event. Bicycle paths, different crossing surface material and one-way streets were significantly associated with fewer interactions with vehicles, while parked vehicles nearby and crossings on arterial roads were significantly associated with more interactions. Children and the elderly (80 years of age or more) did have distinct patterns of interaction, with more careful drivers/cyclists behaviours being observed towards children and lesser regulation compliance towards the elderly. Given the growing emphasis and adoption of active transportation in many cities, the number of interactions between pedestrians and vehicles during street crossings is likely to increase. Educating drivers and pedestrians to respect each other's space requires an understanding of where, between whom, and under what circumstances interactions occur. Such an approach can also help identify which engineering and enforcement programs are needed to ensure safe pedestrian crossings since interactions can be good markers of uncomfortable crossing situations that may deter walking and lead to more collisions.

Walk, Bicycle, and Transit Trips of Transit-Dependent and Choice Riders in the 2009 United States National Household Travel Survey.

BACKGROUND: Previous research has shown that public transit use may be associated with active transportation. Access to a car may influence active transportation of transit riders. METHODS: Using the 2009 United States National Household Travel Survey (NHTS), transit users ≥ 16 years old (n = 25,550) were categorized according to driver status and number of cars and drivers in the household. This typology ranged from choice transit riders (ie, "fully motorized drivers") to transit-dependent riders (ie, "unmotorized nondriver"). Transit trips, walking trips, and bicycling trips of transit users are estimated in negative binomial models against the car availability typology. RESULTS: Sixteen percent of participants took transit in the past month; most (86%) lived in car-owning households. As income increased, car availability also increased. Transit user groups with lower car availability were generally more likely than fully motorized drivers to take more public transit, walking, and bicycle trips. Transit riders have varying levels of vehicle access; their use of combinations of alternative modes of transportation fluctuates accordingly. Transit-dependent individuals without cars or sharing cars used active transportation more frequently than car owners. CONCLUSION: Policies to reduce vehicle ownership in households may enable increases in the use of alternative modes of transportation for transit users, even when cars are still owned.

Teaching children about bicycle safety: an evaluation of the New Jersey Bike School program.

There are multiple health and environmental benefits associated with increasing bicycling among children. However, the use of bicycles is also associated with severe injuries and fatalities. In order to reduce bicycle crashes, a bicycling education program was implemented in selected New Jersey schools and summer camps as part of the New Jersey Safe Routes to School Program. Using a convenience sample of participants to the program, an opportunistic study was designed to evaluate the effectiveness of two bicycle education programs, the first a more-structured program delivered in a school setting, with no on-road component, and the other a less structured program delivered in a summer camp setting that included an on-road component. Tests administered before and after training were designed to assess knowledge acquired during the training. Questions assessed children's existing knowledge of helmet use and other equipment, bicycle safety, as well as their ability to discriminate hazards and understand rules of the road. Participating children (n=699) also completed a travel survey that assessed their bicycling behavior and their perception of safety issues. Response to individual questions, overall pre- and post-training test scores, and changes in test scores were compared using comparison of proportion, t-tests, and ordinary least-squares (OLS) regression. Improvements between the pre-training and post-training test are apparent from the frequency distribution of test results and from t-tests. Both summer camps and school-based programs recorded similar improvements in test results. Children who bicycled with their parents scored higher on the pre-training test but did not improve as much on the post-training test. Without evaluating long-term changes in behavior, it is difficult to ascertain how successful the program is on eventual behavioral and safety outcomes.

Commuting by public transit and physical activity: where you live, where you work, and how you get there.

BACKGROUND: Most public transit users walk to and from transit. We analyzed the relationship between transit commuting and objectively measured physical activity. METHODS: Adults aged 20 to 65 working outside the home (n = 1237) were randomly selected from neighborhoods in Seattle and Baltimore regions. Neighborhoods had high or low median income and high or low mean walkability. Mean daily minutes of accelerometer-measured moderate-intensity physical activity (MPA) were regressed on frequency of commuting by transit and neighborhood walkability, adjusting for demographic factors and enjoyment of physical activity. Interaction terms and stratification were used to assess moderating effect of walkability on the relation between transit commuting and MPA. Associations between transit commuting and self-reported days walked to destinations near home and work were assessed using Chi Square tests. RESULTS: Regardless of neighborhood walkability, those commuting by transit accumulated more MPA (approximately 5 to 10 minutes) and walked more to services and destinations near home and near the workplace than transit nonusers. Enjoyment of physical activity was not associated with more transit commute, nor did it confound the relationships between MPA and commuting. CONCLUSION: Investments in infrastructure and service to promote commuting by transit could contribute to increased physical activity and improved health.

Transit and health: mode of transport, employer-sponsored public transit pass programs, and physical activity.

Increased provision of transit service and policy incentives that favor transit use can support a physically active lifestyle. We used the smartraq travel survey in metropolitan Atlanta, Georgia (in 2001-2002) to assess whether transit and car trips were associated with meeting the recommended levels of physical activity by using walking as a means of transportation. Additionally, we assessed associations between walking and using an employer-sponsored public transit pass. We controlled for demographics, neighborhood density, presence of services near workplaces, distance from home to transit, and car availability in our sample of 4,156 completed surveys. Walking distances from origin to destination were derived by a geographical information system and categorized as: no walking, moderate walking, or meeting recommendation (walking>or=2.4 km (1.5 miles) a day, approximately>or=30 min). In a multinomial logistic regression controlling for other covariates, transit trips were associated with an odds ratio (OR) of 3.87 (confidence interval (CI) 95%, 2.93-5.11) of meeting recommendation. In a multinominal logistical regression controlling for other covariates, transit users were associated with meeting recommendation, OR 2.23 (CI 95%, 1.27-3.90).