Effect of neighbourhood motorization rates on walking levels.

BACKGROUND: Motorized traffic may discourage people walking. This study analyses the influence of motorization on pedestrian mobility in the neighbourhoods of a European city, controlling for environmental, sociodemographic, mobility and road safety characteristics of the neighbourhood in which each trip was made. METHODS: Cross-sectional ecological study using the 38 neighbourhoods of Barcelona as the unit of analysis. Mobility information was obtained from the 2006 Daily Mobility Survey. Walking rates were calculated for 32.343 men and women who made walking trips, per 1000 men and women who made trips in the 38 neighbourhoods. Data were aggregated to calculate the total number of motorized trips made in each neighbourhood. ß coefficients and their confidence intervals were calculated using Poisson regression, in order to study the relationship between walking and motorization, in the different tertiles of motorization and adjusting for contextual factors and their corresponding interactions with motorization. RESULTS: Levels of motorization in the neighbourhood negatively influence walking, even when environmental variables of the neighbourhood are considered. In men we observe a gradient whereby walking rates fall as motorization rises (ß = -0.248; P < 0.001 and ß = -0.363; P < 0.001 in the second and third quartiles of motorization, respectively). In the case of women we find that only high levels of motorization have a negative influence on the rates of women who walk. (ß = -0.256; P < 0.001). CONCLUSION: Motorized traffic discourages people walking. Motorization is a modifiable environment-related factor which should be taken into account when designing policies to promote safe active travel.

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.

The Health Economic Assessment Tool (HEAT) for walking and cycling - experiences from 10 years of application of a health impact assessment tool in policy and practice.

Introduction: In recent years, walking and cycling have moved into the focus as promising approaches to achieve public health, sustainable transport, climate goals and better urban resilience. However, they are only realistic transport and activity options for a large proportion of the population when they are safe, inclusive and convenient. One way to increase their recognition in transport policy is the inclusion of health impacts of walking and cycling into transport economic appraisals. Methods: The Health Economic Assessment Tool (HEAT) for walking and cycling calculates: if x people walk or cycle a distance of y on most days, what is the economic value of impacts on premature mortality, taking into account effects of physical activity, air pollution and road fatalities, as well as effects on carbon emissions. Different data sources were collated to examine how the HEAT in more than 10 years of existence, and to identify lessons learned and challenges. Results: Since its launch in 2009, the HEAT has gained wide recognition as a user friendly, yet robust, evidence-based tool usable by academics, policymakers, and practitioners. Originally designed for use in Europe, it has since been expanded for global use. Discussion: Challenges for a wider uptake of health-impact assessment (HIA) tools including active transport such as HEAT are the promotion and dissemination to local practitioners and policy makers also outside European and English-speaking regions and in low- and middle-income contexts, further increasing usability, and more generally the advancement of systematic data collection and impact quantification related to walking and cycling.

Integrated Impact Assessment of Active Travel: Expanding the Scope of the Health Economic Assessment Tool (HEAT) for Walking and Cycling.

The World Health Organization's Health Economic Assessment Tool (HEAT) for walking and cycling is a user-friendly web-based tool to assess the health impacts of active travel. HEAT, developed over 10 years ago, has been used by researchers, planners and policymakers alike in appraisals of walking and cycling policies at both national and more local scales. HEAT has undergone regular upgrades adopting the latest scientific evidence. This article presents the most recent upgrades of the tool. The health impacts of walking and/or cycling in a specified population are quantified in terms of premature deaths avoided (or caused). In addition to the calculation of benefits derived from physical activity, HEAT was recently expanded to include assessments of the burden associated with air pollution exposure and crash risks while walking or cycling. Further, the impacts on carbon emissions from mode shifts to active travel modes can now be assessed. The monetization of impacts using Value of Statistical Life and Social Costs of Carbon now uses country-specific values. As active travel inherently results in often substantial health benefits as well as not always negligible risks, assessments of active travel behavior or policies are incomplete without considering health implications. The recent developments of HEAT make it easier than ever to obtain ballpark estimates of health impacts and carbon emissions related to walking and cycling.

Transport mode choice and body mass index: Cross-sectional and longitudinal evidence from a European-wide study.

BACKGROUND: In the fight against rising overweight and obesity levels, and unhealthy urban environments, the renaissance of active mobility (cycling and walking as a transport mode) is encouraging. Transport mode has been shown to be associated to body mass index (BMI), yet there is limited longitudinal evidence demonstrating causality. We aimed to associate transport mode and BMI cross-sectionally, but also prospectively in the first ever European-wide longitudinal study on transport and health. METHODS: Data were from the PASTA project that recruited adults in seven European cities (Antwerp, Barcelona, London, Oerebro, Rome, Vienna, Zurich) to complete a series of questionnaires on travel behavior, physical activity levels, and BMI. To assess the association between transport mode and BMI as well as change in BMI we performed crude and adjusted linear mixed-effects modeling for cross-sectional (n = 7380) and longitudinal (n = 2316) data, respectively. RESULTS: Cross-sectionally, BMI was 0.027 kg/m2 (95%CI 0.015 to 0.040) higher per additional day of car use per month. Inversely, BMI was -0.010 kg/m2 (95%CI -0.020 to -0.0002) lower per additional day of cycling per month. Changes in BMI were smaller in the longitudinal within-person assessment, however still statistically significant. BMI decreased in occasional (less than once per week) and non-cyclists who increased cycling (-0.303 kg/m2, 95%CI -0.530 to -0.077), while frequent (at least once per week) cyclists who stopped cycling increased their BMI (0.417 kg/m2, 95%CI 0.033 to 0.802). CONCLUSIONS: Our analyses showed that people lower their BMI when starting or increasing cycling, demonstrating the health benefits of active mobility.

Reducing inequalities from injuries in Europe.

Injuries cause 9% of deaths and 14% of ill health in the WHO European Region. This problem is neglected; injuries are often seen as part of everyday life. However, although western Europe has good safety levels, death and disability from injury are rising in eastern Europe. People in low-to-middle-income countries in the Region are 3.6 times more likely to die from injuries than those in high-income countries. Economic and political change have led to unemployment, income inequalities, increased traffic, reduced restrictions on alcohol, and loss of social support. Risks such as movement of vulnerable populations and transfer of lifestyles and products between countries also need attention. In many countries, the public-health response has been inadequate, yet the cost is devastating to individuals and health-service budgets. More than half a million lives could be saved annually in the Region if recent knowledge could be used to prevent injuries and thus redress social injustice in this area.

Supporting Active Mobility and Green Jobs through the Promotion of Cycling.

This article is a summary of the main findings of the study "Riding towards the green economy: cycling and green jobs", which was developed in the context of the Transport, Health and Environment pan-European Programme (THE PEP). It builds on previous work under THE PEP, which demonstrated the job creation potential of cycling and of green and healthy transport more generally. The report summarized in this article collected data on jobs associated with cycling directly from city authorities and analysed these to re-assess previous estimates of the job creation potential of cycling. It concluded that the number of cycling-related jobs in the pan-European Region could increase by 435,000 in selected major cities if they increased their cycling share to that of the Danish capital Copenhagen. The implications and potential role of municipal and sub-national authorities in facilitating cycling while supporting economic development are then discussed. These findings indicate that investment in policies that promote cycling could deliver not only important benefits for health, the environment and the quality of urban life, but could also contribute to a sizable creation of job opportunities. Authorities need to be proactive in promoting cycling in order to deliver these benefits.

Cancer incidence and mortality in the industrial city of Sumgayit, Azerbaijan.

This study, the first environmental cancer study in Azerbaijan, addressed concerns that residents of the industrial city of Sumgayit have an increased cancer burden as a consequence of intense occupational and environmental pollution from industry. Vital statistics data were used to calculate annual crude cancer incidence and mortality rates for selected cancers and regions in Azerbaijan for the years 1980-2000. Poisson regression analysis of age- and sex-specific data from 1995-2000 demonstrates an increased risk for selected cancers in Sumgayit relative to the rest of the country, as measured by adjusted rate ratios [aRR (95% CI))]: larynx 1.39 (1.04, 1.85), lung 1.67 (1.44, 1.92), bladder 2.49 (1.93, 3.22), and all sites 1.51 (1.43, 1.58). Sumgayit appears to suffer from an increased cancer burden; poor data quality and suspected underreporting, however, prevent accurate estimates of incidence or mortality rates. Construction of a modern cancer registry would be prerequisite to more detailed examinations of cancer rates in the country.

Physical Activity through Sustainable Transport Approaches (PASTA): a study protocol for a multicentre project.

INTRODUCTION: Only one-third of the European population meets the minimum recommended levels of physical activity (PA). Physical inactivity is a major risk factor for non-communicable diseases. Walking and cycling for transport (active mobility, AM) are well suited to provide regular PA. The European research project Physical Activity through Sustainable Transport Approaches (PASTA) pursues the following aims: (1) to investigate correlates and interrelations of AM, PA, air pollution and crash risk; (2) to evaluate the effectiveness of selected interventions to promote AM; (3) to improve health impact assessment (HIA) of AM; (4) to foster the exchange between the disciplines of public health and transport planning, and between research and practice. METHODS AND ANALYSIS: PASTA pursues a mixed-method and multilevel approach that is consistently applied in seven case study cities. Determinants of AM and the evaluation of measures to increase AM are investigated through a large scale longitudinal survey, with overall 14,000 respondents participating in Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich. Contextual factors are systematically gathered in each city. PASTA generates empirical findings to improve HIA for AM, for example, with estimates of crash risks, factors on AM-PA substitution and carbon emissions savings from mode shifts. Findings from PASTA will inform WHO's online Health Economic Assessment Tool on the health benefits from cycling and/or walking. The study's wide scope, the combination of qualitative and quantitative methods and health and transport methods, the innovative survey design, the general and city-specific analyses, and the transdisciplinary composition of the consortium and the wider network of partners promise highly relevant insights for research and practice. ETHICS AND DISSEMINATION: Ethics approval has been obtained by the local ethics committees in the countries where the work is being conducted, and sent to the European Commission before the start of the survey. The PASTA website (http://www.pastaproject.eu) is at the core of all communication and dissemination activities.

Capacity building for epidemiologic research: a case study in the newly independent state of Azerbaijan.

PURPOSE: Because many emerging economies lack local capacity for scientific research, capacity building has become a priority for many international development organizations. This article describes and critiques an approach used for building local capacity for applied health research in Azerbaijan, one of the newly independent states (NIS) of the former USSR. METHODS: In 2000, environmental epidemiology training courses were conducted in Azerbaijan. Several local participants of these courses received hands-on training in the planning and conduct of a subsequent cancer study as a practical extension of the training exercises. RESULTS: The research demonstrated that international collaboration can not only result in the successful completion of health research in NIS such as Azerbaijan, but also impart research knowledge and experience to local experts. Several practical issues were encountered in the conduct of the training activities that limited their effectiveness. The most desired result (the proposal and conduct of new research by local experts trained through these exercises) has yet to be achieved to the levels expected. CONCLUSIONS: International collaborations such as the approach described here are useful for imparting expertise to researchers in less affluent countries. However, comprehensive capacity building programs providing ongoing professional development, support, and an enabling environment, rather than scientific training alone, are required to achieve long-term sustainability and measurable outcomes.

Economic impact of reduced mortality due to increased cycling.

Increasing regular physical activity is a key public health goal. One strategy is to change the physical environment to encourage walking and cycling, requiring partnerships with the transport and urban planning sectors. Economic evaluation is an important factor in the decision to fund any new transport scheme, but techniques for assessing the economic value of the health benefits of cycling and walking have tended to be less sophisticated than the approaches used for assessing other benefits. This study aimed to produce a practical tool for estimating the economic impact of reduced mortality due to increased cycling. The tool was intended to be transparent, easy to use, reliable, and based on conservative assumptions and default values, which can be used in the absence of local data. It addressed the question: For a given volume of cycling within a defined population, what is the economic value of the health benefits? The authors used published estimates of relative risk of all-cause mortality among regular cyclists and applied these to levels of cycling defined by the user to produce an estimate of the number of deaths potentially averted because of regular cycling. The tool then calculates the economic value of the deaths averted using the "value of a statistical life." The outputs of the tool support decision making on cycle infrastructure or policies, or can be used as part of an integrated economic appraisal. The tool's unique contribution is that it takes a public health approach to a transport problem, addresses it in epidemiologic terms, and places the results back into the transport context. Examples of its use include its adoption by the English and Swedish departments of transport as the recommended methodologic approach for estimating the health impact of walking and cycling.

Systematic review and quality assessment of economic evaluation studies of injury prevention.

OBJECTIVE: To review and assess the quality of economic evaluation studies on injury prevention measures. DESIGN: Systematic review. DATA SOURCES: Electronic databases searched included Medline (Pubmed), EMBASE, Web of Science, PsycINFO, and Safetylit. INCLUSION CRITERIA: Empirical studies published in English in international peer-reviewed journals in the period 1998-2009. The subject of the study was economic evaluation of prevention of unintentional injury. Cost-effectiveness (CEA), cost-benefit (CBA) and cost utility (CUA) analyses were included. METHODS: Methodological details, study designs, and analysis and interpretation of results of the included articles were reviewed and extracted into summary tables. Study quality was judged using the criteria recommended by the Panel on cost-effectiveness in health and medicine and the British Medical Journal (BMJ) checklist for economic evaluations. RESULTS: Forty-eight studies met the inclusion criteria of our review. Interventions assessed most frequently were hip protectors and exercise programs for the elderly. A wide variety of methodological approaches was found, including differences in type of economic evaluation, perspective, time horizon, study design, cost categories, effect outcomes, and adjustments for timing and uncertainty used. The majority of studies performed a cost-effectiveness analysis from a societal perspective with a time horizon of one to five years, in which the effect was expressed in terms of injuries prevented and only direct health care costs were included. Most studies deviated from one or more of the Panel recommendations or BMJ guidelines; e.g. not adopting the societal perspective, not including all relevant costs, no incremental analysis. CONCLUSIONS: This review has shown that approaches to economic evaluation of injury prevention vary widely and most studies do not fulfill methodological rigour. Improving quality and harmonization of economic evaluation studies in the field of injury prevention is needed. One way of achieving this would be to establish international guidelines on economic evaluation for injury prevention interventions, based on established economic evaluation checklists, to assist researchers in the design and reporting of economic evaluations.