Negotiating multisectoral evidence: a qualitative study of knowledge exchange at the intersection of transport and public health.

BACKGROUND: For the prevention and control of chronic diseases, two strategies are frequently highlighted: that public health should be evidence based, and that it should develop a multisectoral approach. At the end of a natural experimental study of the health impacts of new transport infrastructure, we took the opportunity of a knowledge exchange forum to explore how stakeholders assessed, negotiated and intended to apply multisectoral evidence in policy and practice at the intersection of transport and health. We aimed to better understand the challenges they faced in knowledge exchange, as well as their everyday experiences with working in multisectoral remits. METHODS: In 2015, we conducted participant observation during an interactive event with 41 stakeholders from national and local government, the third sector and academia in Cambridge, UK. Formal and informal interactions between stakeholders were recorded in observational field notes. We also conducted 18 semistructured interviews reflecting on the event and on knowledge exchange in general. RESULTS: We found that stakeholders negotiated a variety of challenges. First, stakeholders had to negotiate relatively new formal and informal multisectoral remits; and how to reconcile the differing expectations of transport specialists, who tended to emphasise the importance of precedence in guiding action, and health specialists' concern for the rigour and synthesis of research evidence. Second, research in this field involved complex study designs, and often produced evidence with uncertain transferability to other settings. Third, health outcomes of transport schemes had political traction and were used strategically but not easily translated into cost-benefit ratios. Finally, knowledge exchange meant multiple directions of influence. Stakeholders were concerned that researchers did not always have skills to translate their findings into understandable evidence, and some stakeholders would welcome opportunities to influence research agendas. CONCLUSIONS: This case study of stakeholders' experiences indicates that multisectoral research, practice and policymaking requires the ability and capacity to locate, understand and communicate complex evidence from a variety of disciplines, and integrate different types of evidence into clear business cases beyond sectoral boundaries.

Changes in mode of travel to work: a natural experimental study of new transport infrastructure.

BACKGROUND: New transport infrastructure may promote a shift towards active travel, thereby improving population health. The purpose of this study was to determine the effect of a major transport infrastructure project on commuters' mode of travel, trip frequency and distance travelled to work. METHODS: Quasi-experimental analysis nested within a cohort study of 470 adults working in Cambridge, UK. The intervention consisted of the opening of a guided busway with a path for walking and cycling in 2011. Exposure to the intervention was defined as the negative of the square root of the shortest distance from home to busway. The outcome measures were changes in commute mode share and number of commute trips - both based on a seven-day travel-to-work record collected before (2009) and after (2012) the intervention - and change in objective commute distance. The mode share outcomes were changes in the proportions of trips (i) involving any active travel, (ii) involving any public transport, and (iii) made entirely by car. Separate multinomial regression models were estimated adjusting for commute and sociodemographic characteristics, residential settlement size and life events. RESULTS: Proximity to the busway predicted an increased likelihood of a large (>30 %) increase in the share of commute trips involving any active travel (relative risk ratio [RRR] 1.80, 95 % CI 1.27, 2.55) and a large decrease in the share of trips made entirely by car (RRR 2.09, 95 % CI 1.35, 3.21), as well as a lower likelihood of a small (<30 %) reduction in the share of trips involving any active travel (RRR 0.47, 95 % CI 0.28, 0.81). It was not associated with changes in the share of commute trips involving any public transport, the number of commute trips, or commute distance. CONCLUSIONS: The new infrastructure promoted an increase in the share of commuting trips involving active travel and a decrease in the share made entirely by car. Further analysis will show the extent to which the changes in commute mode share were translated into an increase in time spent in active commuting and consequent health gain.

Wellbeing Impact Study of High-Speed 2 (WISH2): Protocol for a mixed-methods examination of the impact of major transport infrastructure development on mental health and wellbeing.

Although research has demonstrated that transport infrastructure development can have positive and negative health-related impacts, most of this research has not considered mental health and wellbeing separately from physical health. There is also limited understanding of whether and how any effects might be experienced differently across population groups, whether this differs according to the stage of development (e.g. planning, construction), and how changes to planned infrastructure may affect mental health and wellbeing. This paper presents a protocol for the Wellbeing Impact Study of HS2 (WISH2), which seeks to address these questions using a high-speed rail development in the UK as an applied example. WISH2 is a 10-year, integrated, longitudinal, mixed-methods project using general practices (primary medical care providers in the UK) as an avenue for participant recruitment and for providing a geographically defined population for which aggregated data on mental health indicators are available. The research comprises: (i) a combined longitudinal and repeated cross-sectional cohort study involving multiple waves of survey data collection and data from medical records; (ii) longitudinal, semi-structured interviews and focus groups with residents and community stakeholders from exposed areas; (iii) analysis of administrative data aggregated at the general practice population level; and (iv) health economic analysis of mental health and wellbeing impacts. The study findings will support the development of strategies to reduce negative impacts and/or enhance positive mental health and wellbeing impacts of high-speed rail developments and other large-scale infrastructure projects.

The factors influencing car use in a cycle-friendly city: the case of Cambridge.

Encouraging people out of their cars and into other modes of transport, which has major advantages for health, the environment and urban development, has proved difficult. Greater understanding of the influences that lead people to use the car, particularly for shorter journeys, may help to achieve this. This paper examines the predictors of car use compared with the bicycle to explore how it may be possible to persuade more people to use the bicycle instead of the car. Multivariable logistic regression was used to examine the socio-demographic, transport and health-related correlates of mode choice for work, shopping and leisure trips in Cambridge, a city with high levels of cycling by UK standards. The key findings are that commuting distance and free workplace parking were strongly associated with use of the car for work trips, and car availability and lower levels of education were associated with car use for leisure, shopping and short-distanced commuting trips. The case of Cambridge shows that more policies could be adopted, particularly a reduction in free car parking, to increase cycling and reduce the use of the car, especially over short distances.

Correlates of time spent walking and cycling to and from work: baseline results from the commuting and health in Cambridge study.

PURPOSE: Environmental perceptions and psychological measures appear to be associated with walking and cycling behaviour; however, their influence is still unclear. We assessed these associations using baseline data from a quasi-experimental cohort study of the effects of major transport infrastructural developments in Cambridge, UK. METHODS: Postal surveys were sent to adults who travel to work in Cambridge (n = 1582). Questions asked about travel modes and time spent travelling to and from work in the last week, perceptions of the route, psychological measures regarding car use and socio-demographic characteristics. Participants were classified into one of two categories according to time spent walking for commuting ('no walking' or 'some walking') and one of three categories for cycling ('no cycling', '1-149 min/wk' and ' ≥ 150 min/wk'). RESULTS: Of the 1164 respondents (68% female, mean (SD) age: 42.3 (11.4) years) 30% reported any walking and 53% reported any cycling to or from work. In multiple regression models, short distance to work and not having access to a car showed strong positive associations with both walking and cycling. Furthermore, those who reported that it was pleasant to walk were more likely to walk to or from work (OR = 4.18, 95% CI 3.02 to 5.78) and those who reported that it was convenient to cycle on the route between home and work were more likely to do so (1-149 min/wk: OR = 4.60, 95% CI 2.88 to 7.34; ≥ 150 min/wk: OR = 3.14, 95% CI 2.11 to 4.66). Positive attitudes in favour of car use were positively associated with time spent walking to or from work but negatively associated with cycling to or from work. Strong perceived behavioural control for car use was negatively associated with walking. CONCLUSIONS: In this relatively affluent sample of commuters, a range of individual and household characteristics, perceptions of the route environment and psychological measures relating to car use were associated with walking or cycling to and from work. Taken together, these findings suggest that social and physical contexts of travel decision-making should be considered and that a range of influences may require to be addressed to bring about behaviour change.

Activity compensation and activity synergy in British 8-13 year olds.

OBJECTIVES: To examine whether children compensate for participating in physically active behaviors by reducing activity at other times (the 'activitystat' hypothesis); or alternatively become more active at other times (activity synergy). METHODS: In 2002-2006, 345 British children (8-13 years) completed activity diaries and wore accelerometers. This generated 1077 days of data which we analyzed between-children (comparing all days) and within-child (comparing days from the same child). RESULTS: On week and weekend days, each extra 1% of time in PE/games, school breaks, school active travel, non-school active travel, structured sports and out-of-home play predicted a 0.21 to 0.60% increase in the proportion of the day in moderate-to-vigorous physical activity (MVPA). None of these behaviors showed evidence of reduced MVPA at other times, i.e. activity compensation (all p>0.15). Moreover, each 1% increase in weekday non-school active travel predicted 0.38% more time in MVPA at other times (95% CI 0.18, 0.58). This activity synergy reflected children using active travel for playing and visiting friends. CONCLUSIONS: Contrary to the 'activitystat' hypothesis, we found no evidence of activity compensation. This suggests that interventions increasing activity in specific behaviors may increase activity overall. The activity synergy of non-school active travel underlines the need for further research into this neglected behavior.

Commuting and health in Cambridge: a study of a 'natural experiment' in the provision of new transport infrastructure.

BACKGROUND: Modifying transport infrastructure to support active travel (walking and cycling) could help to increase population levels of physical activity. However, there is limited evidence for the effects of interventions in this field, and to the best of our knowledge no study has convincingly demonstrated an increase in physical activity directly attributable to this type of intervention. We have therefore taken the opportunity presented by a 'natural experiment' in Cambridgeshire, UK to establish a quasi-experimental study of the effects of a major transport infrastructural intervention on travel behaviour, physical activity and related wider health impacts. DESIGN AND METHODS: The Commuting and Health in Cambridge study comprises three main elements: a cohort study of adults who travel to work in Cambridge, using repeated postal questionnaires and basic objective measurement of physical activity using accelerometers; in-depth quantitative studies of physical activity energy expenditure, travel and movement patterns and estimated carbon emissions using household travel diaries, combined heart rate and movement sensors and global positioning system (GPS) receivers; and a longitudinal qualitative interview study to elucidate participants' attitudes, experiences and practices and to understand how environmental and social factors interact to influence travel behaviour, for whom and in what circumstances. The impacts of a specific intervention - the opening of the Cambridgeshire Guided Busway - and of other changes in the physical environment will be examined using a controlled quasi-experimental design within the overall cohort dataset. DISCUSSION: Addressing the unresolved research and policy questions in this area is not straightforward. The challenges include those of effectively combining different disciplinary perspectives on the research problems, developing common methodological ground in measurement and evaluation, implementing robust quantitative measurement of travel and physical activity behaviour in an unpredictable 'natural experiment' setting, defining exposure to the intervention, defining controls, and conceptualising an appropriate longitudinal analytical strategy.

Children's Transport Built Environments: A Mixed Methods Study of Associations between Perceived and Objective Measures and Relationships with Parent Licence for Independent Mobility in Auckland, New Zealand.

Children's independent mobility is declining internationally. Parents are the gatekeepers of children's independent mobility. This mixed methods study investigates whether parent perceptions of the neighbourhood environment align with objective measures of the neighbourhood built environment, and how perceived and objective measures relate to parental licence for children's independent mobility. Parents participating in the Neighbourhood for Active Kids study (n = 940) answered an open-ended question about what would make their neighbourhoods better for their child's independent mobility, and reported household and child demographics. Objective measures of the neighbourhood built environment were generated using geographic information systems. Content analysis was used to classify and group parent-reported changes required to improve their neigbourhood. Parent-reported needs were then compared with objective neighbourhood built environment measures. Linear mixed modelling examined associations between parental licence for independent mobility and (1) parent neighbourhood perceptions; and (2) objectively assessed neighbourhood built environment features. Parents identified the need for safer traffic environments. No significant differences in parent reported needs were found by objectively assessed characteristics. Differences in odds of reporting needs were observed for a range of socio-demographic characteristics. Parental licence for independent mobility was only associated with a need for safer places to cycle (positive) and objectively assessed cycling infrastructure (negative) in adjusted models. Overall, the study findings indicate the importance of safer traffic environments for children's independent mobility.

Does exposure to new transport infrastructure result in modal shifts? Patterns of change in commute mode choices in a four-year quasi-experimental cohort study.

BACKGROUND: Intervention studies suggest that changing the built environment may encourage a modal shift from car travel towards active travel. However, little is known about the detail of patterns of changes in travel behaviour. METHOD: Adult commuters working in Cambridge (UK) completed annual questionnaires between 2009 and 2012. Commuting was assessed using a validated seven-day travel-to-work record. The intervention consisted of the opening of a guided busway with a path for walking and cycling in 2011. Exposure to the intervention was defined as the negative of the square root of the shortest road distance from home to the busway. We investigated the association between exposure to the intervention and specific modal shifts and patterns of change, along with individual mode choice patterns over the entire four-year period. RESULTS: Five groups of patterns of change were found in our in-depth explorations: (1) no change, (2) a full modal shift, (3) a partial modal shift, (4) non-stable but patterned behaviour, and (5) complicated or apparently random patterns. A minority of participants had a directed change of either a full modal shift or, more commonly, a partial modal shift, whereas a large proportion showed a highly variable pattern. No significant associations were found between exposure to the intervention and specific modal shifts or patterns of change. CONCLUSION: Our analyses revealed a large diversity in (changes in) travel behaviour patterns over time, and showed that the intervention did not result in one specific pattern of behaviour change or produce only full modal shifts. These insights are important for improving the measurement of travel behaviour, improving our understanding of how changes in travel behaviour patterns occur, and fully capturing the potential impacts of interventions.

Impact of New Transport Infrastructure on Walking, Cycling, and Physical Activity.

INTRODUCTION: Walking and cycling bring health and environmental benefits, but there is little robust evidence that changing the built environment promotes these activities in populations. This study evaluated the effects of new transport infrastructure on active commuting and physical activity. STUDY DESIGN: Quasi-experimental analysis nested within a cohort study. SETTING/PARTICIPANTS: Four hundred and sixty-nine adult commuters, recruited through a predominantly workplace-based strategy, who lived within 30 kilometers of Cambridge, United Kingdom and worked in areas of the city to be served by the new transport infrastructure. INTERVENTION: The Cambridgeshire Guided Busway opened in 2011 and comprised a new bus network and a traffic-free walking and cycling route. Exposure to the intervention was defined using the shortest distance from each participant's home to the busway. MAIN OUTCOME MEASURES: Change in weekly time spent in active commuting between 2009 and 2012, measured by validated 7-day recall instrument. Secondary outcomes were changes in total weekly time spent walking and cycling and in recreational and overall physical activity, measured using the validated Recent Physical Activity Questionnaire. Data were analyzed in 2014. RESULTS: In multivariable multinomial regression models--adjusted for potential sociodemographic, geographic, health, and workplace confounders; baseline active commuting; and home or work relocation-exposure to the busway was associated with a significantly greater likelihood of an increase in weekly cycle commuting time (relative risk ratio=1.34, 95% CI=1.03, 1.76) and with an increase in overall time spent in active commuting among the least active commuters at baseline (relative risk ratio=1.76, 95% CI=1.16, 2.67). The study found no evidence of changes in recreational or overall physical activity. CONCLUSIONS: Providing new sustainable transport infrastructure was effective in promoting an increase in active commuting. These findings provide new evidence to support reconfiguring transport systems as part of public health improvement strategies.

Neighbourhoods for Active Kids: study protocol for a cross-sectional examination of neighbourhood features and children's physical activity, active travel, independent mobility and body size.

INTRODUCTION: New Zealand children's physical activity, including independent mobility and active travel, has declined markedly over recent decades. The Neighbourhoods for Active Kids (NfAK) study examines how neighbourhood built environments are associated with the independent mobility, active travel, physical activity and neighbourhood experiences of children aged 9-12 years in primary and intermediate schools across Auckland, New Zealand's largest city. METHODS AND ANALYSIS: Child-specific indices of walkability, destination accessibility and traffic exposure will be constructed to measure the built environment in 8 neighbourhoods in Auckland. Interactive online-mapping software will be used to measure children's independent mobility and transport mode to destinations and to derive measures of neighbourhood use and perceptions. Physical activity will be measured using 7-day accelerometry. Height, weight and waist circumference will be objectively measured. Parent telephone interviews will collect sociodemographic information and parent neighbourhood perceptions. Interviews with school representative will capture supports and barriers for healthy activity and nutrition behaviours at the school level. Multilevel modelling approaches will be used to understand how differing built environment variables are associated with activity, neighbourhood experiences and health outcomes. DISCUSSION: We anticipate that children who reside in neighbourhoods considered highly walkable will be more physically active, accumulate more independent mobility and active travel, and be more likely to have a healthy body size. This research is timely as cities throughout New Zealand develop and implement plans to improve the liveability of intensifying urban neighbourhoods. Results will be disseminated to participants, local government agencies and through conventional academic avenues.

Day length and weather effects on children's physical activity and participation in play, sports, and active travel.

BACKGROUND: Children in primary school are more physically active in the spring/summer. Little is known about the relative contributions of day length and weather, however, or about the underlying behavioral mediators. METHODS: 325 British children aged 8 to 11 wore accelerometers as an objective measure of physical activity, measured in terms of mean activity counts. Children simultaneously completed diaries in which we identified episodes of out-of-home play, structured sports, and active travel. Our main exposure measures were day length, temperature, rainfall, cloud cover, and wind speed. RESULTS: Overall physical activity was higher on long days (≥ 14 hours daylight), but there was no difference between short (< 9.5 hours) and medium days (10.2-12.6 hours). The effect of long day length was largest between 5 PM and 8 PM, and persisted after adjusting for rainfall, cloud cover, and wind. Up to half this effect was explained by a greater duration and intensity of out-of-home play on long days; structured sports and active travel were less affected by day length. CONCLUSIONS: At least above a certain threshold, longer afternoon/evening daylight may have a causal role in increasing child physical activity. This strengthens the public health arguments for daylight saving measures such as those recently under consideration in Britain.