Pathways linking car transport for young adults and the public health in Northern Ireland: a qualitative study to inform the evaluation of graduated driver licensing.

BACKGROUND: Novice drivers are at relatively high risk of road traffic injury. There is good evidence that Graduated Driving Licensing (GDL) schemes reduce collisions rates, by reducing exposure to risk and by extending learning periods. Legislation for a proposed scheme in Northern Ireland was passed in 2016, providing an opportunity for future evaluation of the full public health impacts of a scheme in a European context within a natural experiment. This qualitative study was designed to inform the logic model for such an evaluation, and provide baseline qualitative data on the role of private cars in health and wellbeing. METHODS: Nine group interviews with young people aged 16-23 (N = 43) and two group interviews with parents of young people (N = 8) were conducted in a range of settings in Northern Ireland in 2015. Data were analysed using thematic content analysis. RESULTS: Informal car-pooling within and beyond households led to routine expectations of lift provision and uptake. Experiences of risky driving situations were widespread. In rural areas, extensive use of farm vehicles for transport needs meant many learner drivers had both early driving experience and expectations that legislation may have to be locally adapted to meet social needs. Cars were used as a site for socialising, as well as essential means of transport. Alternative modes (public transport, walking and cycling) were held in low esteem, even where available. Recall of other transport-related public health messages and parents' existing use of GDL-type restrictions suggested GDL schemes were acceptable in principle. There was growing awareness and use of in-car technologies (telematics) used by insurance companies to reward good driving. CONCLUSIONS: Key issues to consider in evaluating the broader public health impact of GDL will include: changes in injury rates for licensed car occupants and other populations and modes; changes in exposure to risk in the licensed and general population; and impact on transport exclusion. We suggest an important pathway will be change in social norms around offering and accepting lifts and to risk-taking. The growing adoption of in-car telematics will have implications for future GDL programmes and for evaluation.

Is ethnic density associated with risk of child pedestrian injury? A comparison of inter-census changes in ethnic populations and injury rates.

OBJECTIVES: Research on inequalities in child pedestrian injury risk has identified some puzzling trends: although, in general, living in more affluent areas protects children from injury, this is not true for those in some minority ethnic groups. This study aimed to identify whether 'group density' effects are associated with injury risk, and whether taking these into account alters the relationship between area deprivation and injury risk. 'Group density' effects exist when ethnic minorities living in an area with a higher proportion of people from a similar ethnic group enjoy better health than those who live in areas with a lower proportion, even though areas with dense minority ethnic populations can be relatively more materially disadvantaged. DESIGN: This study utilised variation in minority ethnic densities in London between two census periods to identify any associations between group density and injury risk. Using police data on road traffic injury and population census data from 2001 to 2011, the numbers of 'White,' 'Asian' and 'Black' child pedestrian injuries in an area were modelled as a function of the percentage of the population in that area that are 'White,' 'Asian' and 'Black,' controlling for socio-economic disadvantage and characteristics of the road environment. RESULTS: There was strong evidence (p < 0.001) of a negative association between 'Black' population density and 'Black' child pedestrian injury risk [incidence (of injury) rate ratios (IRR) 0.575, 95% CI 0.515-0.642]. There was weak evidence (p = 0.083) of a negative association between 'Asian' density and 'Asian' child pedestrian injury risk (IRR 0.901, 95% CI 0.801-1.014) and no evidence (p = 0.412) of an association between 'White' density and 'White' child pedestrian injury risk (IRR 1.075, 95% CI 0.904-1.279). When group density effects are taken into account, area deprivation is associated with injury risk of all ethnic groups. CONCLUSIONS: Group density appears to protect 'Black' children living in London against pedestrian injury risk. These findings suggest that future research should focus on structural properties of societies to explain the relationships between minority ethnicity and risk.

Controlling for exposure changes the relationship between ethnicity, deprivation and injury: an observational study of child pedestrian injury rates in London.

BACKGROUND: Research has suggested that inequalities in risk exposure may help explain identified ethnic inequalities in child pedestrian injury risk. However, addressing risk exposure in epidemiological research presents theoretical and methodological challenges. This article conceptualises the risk of child pedestrian injury as related to both exposure levels (the quantity of time children spend as pedestrians) and the probability of a hazard where that exposure takes place (the quality of the road environment). OBJECTIVE: To investigate the sensitivity of results on ethnic inequalities in child pedestrian injury risk in London to control for exposure and hazard levels. METHODS: Using police records of injury 2000-2009, we modelled the relationship between ethnicity, deprivation and child pedestrian injury rates in London using characteristics of the road environment to control for hazard levels and restricting the analysis to the time of the weekday morning commute (7.00-9.00 am), when most children must make a journey to school, to control for exposure levels. RESULTS: Controlling for risk exposure in this way fundamentally changed the nature of the relationship between ethnicity, deprivation and child pedestrian injury. During the time of the morning commute to school, 'Black' children were found to have higher pedestrian injury rates in the least-deprived areas. CONCLUSIONS: To inform effective strategies for reducing injury inequality, it is vital that exposure to risk is both acknowledged and considered.

The road most travelled: the geographic distribution of road traffic injuries in England.

BACKGROUND: Both road safety campaigns and epidemiological research into social differences in road traffic injury risk often assume that road traffic injuries occur close to home. While previous work has examined distance from home to site of collision for child pedestrians in local areas, less is known about the geographic distribution of road traffic injuries from other modes. This study explores the distribution of the distance between home residence and collision site (crash distance) by mode of transport, geographic area, and social characteristics in England. METHODS: Using 10 years of road casualty data collected by the police, we examined the distribution of crash distance by age, sex, injury severity, area deprivation, urban/rural status, year, day of week, and, in London only, ethnic group. RESULTS: 54% of pedestrians, 39% of cyclists, 17% of powered two-wheeler riders and 16% of car occupants were injured within 1 km of home. 82% of pedestrians, 83% of cyclists, 54% of powered two-wheeler and 53% of car occupants were injured within 5 km of home. We found some social and geographic differences in crash distance: for all transport modes injuries tended to occur closer to home in more deprived or urban areas; younger and older pedestrians and cyclists were also injured closer to home. Crash distance appears to have increased over time for pedestrian, cyclist and car occupant injuries, but has decreased over time for powered two-wheeler injuries. CONCLUSIONS: Injuries from all travel modes tend to occur quite close to home, supporting assumptions made in epidemiological and road safety education literature. However, the trend for increasing crash distance and the social differences identified may have methodological implications for future epidemiological studies on social differences in injury risk.

Cost benefit analysis of 20 mph zones in London.

Evidence suggests that 20 mph zones are an effective intervention to reduce casualties from road traffic crashes in urban areas. This analysis compares the costs of construction of the 20 mph zone intervention in high and low casualty areas in London to the value of casualties avoided over 5 and 10 year time horizons. Probabilistic sensitivity analyses were conducted to quantify uncertainty in the results associated with model parameters. Results indicate a net present value (NPV) of £18 947 (90% credible limits -£75 252 to £82 021 2005 prices) after 5 years and £67 306 (£-29 157 to £137 890) after 10 years when 20 mph zones are implemented in areas with one or more casualty per kilometre of road. Simulations from our model suggest that the 'threshold of casualties' where NPVs become positive using a 10 year time horizon is 0.7 casualties per kilometre.

Pedestrian injuries in collisions with pedal cycles in the context of increased active travel: Trends in England, 2005-2015.

Introduction: Increasing levels of active travel in the population brings many public health benefits, but may also change the risks of road injury for different road users. We examined changes in rates of pedestrian injuries resulting from collisions with pedal cycles and motor vehicles in England during 2005-2015, a period of increased cycling activity, and described the gender, age distribution and locations of pedestrians injured in collisions with pedal cycles and motor vehicles. Methods: Collisions data were obtained from police STATS19 datasets. We used two measures of cycle/motor vehicle use; miles per annum, and estimated average travel time, and assessed evidence for trends towards increase over time using Poisson regression analysis. Results: There were 3414 pedestrians injured in collisions with one or more pedal cycles in England during 2005-2015, 763 of whom were killed or seriously injured (KSI). This accounted for 1.3% of the total pedestrians KSI from all vehicles. Of those KSI in collisions with cycles, 62% were female; 42% over the age of 60; 26% were on the footway or verge and 24% were on a pedestrian crossing. There was a 6% (IRR 1.056; 95% CI 1.032-1.080, p < 0.001) annual increase in the pedestrian KSI rate per billion vehicle miles cycled in England over the time span. This increase was disproportionate to the increase in cycle use measured by vehicle miles or time spent cycling. Conclusions: Increases in cycling were associated with disproportionate increases in pedestrian injuries in collisions with pedal cycles in England, although these collisions remain a very small proportion of all road injury. Increased active travel is essential for meeting a range of public health goals, but needs to be planned for with consideration for potential impact on pedestrians, particularly older citizens.

The public health implications of telematic technologies: An exploratory qualitative study in the UK.

INTRODUCTION: Reducing motorised transport is crucial for achieving public health goals, but cars will continue to be essential for many in the medium term. The role of emerging technologies in mitigating the public health disadvantages of this private car use has been under-examined to date. Telematics are increasingly used by novice drivers in the UK to reduce insurance premiums. An exploratory study of novice drivers' experiences of telematics identified implications for public health that warrant urgent further research. METHODS: An exploratory qualitative study, using semi-structured interviews with 12 drivers aged 17-25 in three regions of the UK (Aberdeenshire, Hertfordshire and London). RESULTS: Telematics were acceptable to young drivers, and reported to mitigate some negative health consequences of driving (injury risks, over-reliance on car transport), without reducing access to determinants of health such as employment or social life. However, there were suggestions that those at higher risk were less likely to adopt telematics. CONCLUSION: Market-based mechanisms such as telematics are potential alternatives to well-evaluated policy interventions such as Graduated Driver Licensing for reducing road injury risks for novice drivers, with a different mix of risks and benefits. However, claims to date from insurance companies about the contribution of telematics to public health outcomes should be evaluated carefully to account for biases in uptake.

Red light camera interventions for reducing traffic violations and traffic crashes: A systematic review.

Background: Road traffic crashes are a major and increasing cause of injury and death around the world. In 2015, there were almost 6.3 million motor vehicle traffic crashes in the United States. Of these, approximately 1.7 million (27%) involved some form of injury and 32,166 (0.5%) resulted in one or more fatalities (National Highway Traffic Safety Administration, 2016, Traffic Safety Facts 2013: A Compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System). The most common cause of urban crashes appears to be drivers running red lights or ignoring other traffic controls and injuries occur in 39% of all of these types of crashes (Insurance Institute for Highway Safety, IIHS, 2018, Red light running). While many drivers obey traffic signals, the possibility for violations exists due to issues such as driver distraction, aggressive driving behaviors, or a deliberate decision to ignore the traffic signal. One researcher suggests that eliminating traffic violations could reduce road injury crashes by up to 40% (Zaal, 1994, Traffic law enforcement: A review of the literature). Red light cameras (RLCs) are an enforcement mechanism that permit police to remotely enforce traffic signals; they may serve as a deterrent to drivers who intentionally engage in red light running (RLR). The one previous systematic review of RLCs found that they were effective in reducing total casualty crashes but also found that evidence on the effectiveness of cameras on red light violations, total crashes, or specific types of casualty crashes was inconclusive. However, this review searched only a small number of electronic databases and was limited to a handful of studies published in 2002 or earlier. Objectives: This report updates and expands upon the previous Cochrane systematic review of RLCs. The aim of this review is to systematically review and synthesize the available evidence on the effectiveness of RLCs on the incidence of red light violations and the incidence and severity of various types of traffic crashes. Search Methods: This study uses a four-part search strategy that involves: (a) searching 27 online electronic bibliographic databases for published and unpublished evaluations of RLCs; (b) searching the websites of 46 international institutes and research agencies focusing on transportation issues for reports and other gray literature; (c) searching the reference lists of published studies to identify additional published and unpublished works; and (d) conducting a keyword search using Google and Google Scholar to search for additional gray literature. Selection Criteria: The criteria for inclusion were determined before the search process began. To be eligible, studies must have assessed the impact of RLCs on red light violations and/or traffic crashes. Studies must have employed a quantitative research design that involved randomized controlled trials, quasi-random controlled trials, a controlled before-after design, or a controlled interrupted time series. Research that incorporated additional interventions, such as speed cameras or enhanced police enforcement, were excluded, although normal routine traffic enforcement in the nonintervention control condition was not excluded. Both published and unpublished reports were included. Studies were eligible regardless of the country in which they were conducted or the date of publication. Qualitative, observational, or descriptive studies that did not include formal comparisons of treatment and control groups were excluded from this research. Data Collection and Analysis: Initial searches produced a total of 5,708 references after duplicates were removed. After title and abstract screening, a total of 121 references remained. Full-text review of these works identified 28 primary studies meeting the inclusion criteria, in addition to the 10 studies identified in the prior Cochrane review. Because several of the primary studies reported on multiple independent study areas, this report evaluates 41 separate analyses. At least two review authors independently assessed all records for eligibility, assessed methodological risk of bias, and extracted data from the full-text reports; disagreements were resolved by discussion with a third review author. To facilitate comparisons between studies, a standardized summary measure based on relative effects, rather than differences in effects, was defined for each outcome. Summary measures were calculated for all studies when possible. When at least three studies reported the same outcome, the results were pooled in a meta-analysis. Pooled meta-analyses were carried out when at least three studies reported the same outcome; otherwise, the results of individual studies were described in a narrative. Heterogeneity among effect estimates was assessed using χ 2 tests at a 5% level of significance and quantified using the I 2 statistic. EMMIE framework data were coded using the EPPIE Reviewer database. Results: The results of this systematic review suggest that RLCs are associated with a statistically significant reduction in crash outcomes, although this varies by type of crash, and suggest a reduction in red light violations. RLCs are associated with a a 20% decrease in total injury crashes, a 24% decrease in right angle crashes and a 29% decrease in right angle injury crashes. Conversely, however, RLCs are also associated with a statistically significant increase in rear end crashes of 19%. There was also some evidence that RLCs were associated with a large reduction in crashes due to red light violations. There is no evidence to suggest that study heterogeneity is consistently explained by either country or risk of bias, nor did the presence or absence of warning signs appear to impact the effectiveness of RLCs. Studies accounting for regression to the mean tend to report more moderate decreases for right angle crashes resulting in injury than studies not accounting for regression to the mean. Studies with better control for confounders reported a nonsignificant decrease in right angle crashes, compared with a significant decrease for all studies. Authors' Conclusions: The evidence suggests that RLCs may be effective in reducing red light violations and are likely to be effective in reducing some types of traffic crashes, although they also appear linked to an increase in rear end crashes. Several implications for policymakers and practitioners have emerged from this research. The costs and benefits of RLCs must be considered when implementing RLC programs. The potential benefits of a reduction in traffic violations and in some types of injury crashes must be weighed against the increased risk of other crash types. The economic implications of operating an RLC program also must be considered, including the costs of installation and operation as well as the economic impact of RLC effects.

Ethical issues associated with conducting genetic family studies of complex disease.

PURPOSE: To examine subjects' recognition of the risks and ethical issues associated with enrollment in genetic family studies (GFS) and explore how this recognition affects their informed and voluntary participation. METHODS: A cross-sectional study design including both quantitative and qualitative data was employed. Structured interviews using the Contextual Assessment Approach Questionnaire (CAA-Q) were conducted with 246 Mexican American (MA) participants. To gain in-depth understanding of questionnaire responses, semi-structured interviews with 30 participants were conducted. All participants were interviewed before their enrollment in the Family Investigation of Nephropathy and Diabetes (FIND). RESULTS: Subjects' average age was 56 years; 62% were females. Seventy-eight percent of participants were not formally educated beyond high school and 72% reported an annual household income of < or =20,000 dollars. Eighty-five percent agreed to provide researchers with information on relatives' ages, gender, and education. Sixty-five percent of participants were willing to provide identifiable information such as names, addresses, and phone numbers of relatives. Sixty-three percent of participants indicated that there were direct benefits (i.e., supporting research) to disclosing relatives' information. Seventy-six percent stated that there were no risks associated with participation in GFS (e.g., discrimination or confidentiality of genetic information) compared with 10% who said that there were such risks. While discussing potential risks, subjects did not consider these to influence their decision to participate. CONCLUSIONS: Subjects enrolled in GFS did not recognize and tended to underestimate the social and cultural risks associated with their participation in GFS. If subjects do not fully comprehend the risks, this raises questions concerning their ability to provide informed consent and to voluntarily participate. We propose a subject-centered approach that views enrollment as an active process in which subjects and recruiters give and receive information on risks and ethical issues related to participation, which enhances protection of the rights and welfare of subjects participating in GFS.

Communicating about medications during primary care outpatient visits: the role of electronic medical records.

OBJECTIVES: To assess the role of electronic medical records (EMR) in facilitating the content and process of patient-provider exchanges about medications during outpatient primary care visits. METHODS: Fifty encounters with six physicians using the EMR were videotaped, transcribed and content-analysed by applying conversation analysis and ethnomethodology techniques. The analysis focused on three aspects of medication communication: (1) process of care: practices by patients and physicians to implement medication decisions; (2) themes: medication topics that consistently emerge; and (3) names: ways patients and physicians refer to medications. In-depth analysis of 20 encounters examined the extent to which either or both parties initiated, expanded and concluded medication discussions. RESULTS: On average 21.2 (range: 8-35; SD=7.4) distinct exchanges per encounter were observed. Of those, 33% were related to medication. Of the 350 medication-related exchanges throughout the encounters, 56% were categorised as routine medication discussion such as ordering and/or refilling medications. Mailing issues were the next most common medication-related exchanges (10.6%), followed by partial adherence (8.9%), self-regulation (7.4%), alternative therapy/over-the-counter medication (6.6%), side effects (6%) and formulary issues (4.6%). Patients and providers used three ways to name medications: generic/scientific name (42%); physical description (39.7%) and brand name (18.3%). Forty-one percent of exchanges included initiation by one or both parties but no further discussion of the issue; 42% included initiation and expansion by both parties but not conclusion; only 17% of exchanges contained complete medication exchanges (initiation, expansion and conclusion) by both parties. CONCLUSIONS: EMR facilitated content and process of communication regarding medications during outpatient encounters, especially among patients taking multiple medications and patients who used physical descriptions to identify their medications. EMR use stimulated medication exchanges, leading to further expansion about the topic. However, fewer than one-fifth of exchanges ended with clear conclusions by both parties regarding prescribed medication regimens.

Reduced street lighting at night and health: A rapid appraisal of public views in England and Wales.

Financial and carbon reduction incentives have prompted many local authorities to reduce street lighting at night. Debate on the public health implications has centred on road accidents, fear of crime and putative health gains from reduced exposure to artificial light. However, little is known about public views of the relationship between reduced street lighting and health. We undertook a rapid appraisal in eight areas of England and Wales using ethnographic data, a household survey and documentary sources. Public concern focused on road safety, fear of crime, mobility and seeing the night sky but, for the majority in areas with interventions, reductions went unnoticed. However, more private concerns tapped into deep-seated anxieties about darkness, modernity 'going backwards', and local governance. Pathways linking lighting reductions and health are mediated by place, expectations of how localities should be lit, and trust in local authorities to act in the best interests of local communities.

The effect of reduced street lighting on road casualties and crime in England and Wales: controlled interrupted time series analysis.

BACKGROUND: Many local authorities in England and Wales have reduced street lighting at night to save money and reduce carbon emissions. There is no evidence to date on whether these reductions impact on public health. We quantified the effect of 4 street lighting adaptation strategies (switch off, part-night lighting, dimming and white light) on casualties and crime in England and Wales. METHODS: Observational study based on analysis of geographically coded police data on road traffic collisions and crime in 62 local authorities. Conditional Poisson models were used to analyse longitudinal changes in the counts of night-time collisions occurring on affected roads during 2000-2013, and crime within census Middle Super Output Areas during 2010-2013. Effect estimates were adjusted for regional temporal trends in casualties and crime. RESULTS: There was no evidence that any street lighting adaptation strategy was associated with a change in collisions at night. There was significant statistical heterogeneity in the effects on crime estimated at police force level. Overall, there was no evidence for an association between the aggregate count of crime and switch off (RR 0.11; 95% CI 0.01 to 2.75) or part-night lighting (RR 0.96; 95% CI 0.86 to 1.06). There was weak evidence for a reduction in the aggregate count of crime and dimming (RR 0.84; 95% CI 0.70 to 1.02) and white light (RR 0.89; 95% CI 0.77 to 1.03). CONCLUSIONS: This study found little evidence of harmful effects of switch off, part-night lighting, dimming, or changes to white light/LEDs on road collisions or crime in England and Wales.

Entitlement to concessionary public transport and wellbeing: a qualitative study of young people and older citizens in London, UK.

Access to transport is an important determinant of health, and concessionary fares for public transport are one way to reduce the 'transport exclusion' that can limit access. This paper draws on qualitative data from two groups typically at risk of transport exclusion: young people (12-18 years of age, n = 118) and older citizens (60+ years of age, n = 46). The data were collected in London, UK, where young people and older citizens are currently entitled to concessionary bus travel. We focus on how this entitlement is understood and enacted, and how different sources of entitlement mediate the relationship between transport and wellbeing. Both groups felt that their formal entitlement to travel for free reflected their social worth and was, particularly for older citizens, relatively unproblematic. The provision of a concessionary transport entitlement also helped to combat feelings of social exclusion by enhancing recipients' sense of belonging to the city and to a 'community'. However, informal entitlements to particular spaces on the bus reflected less valued social attributes such as need or frailty. Thus in the course of travelling by bus the enactment of entitlements to space and seats entailed the negotiation of social differences and personal vulnerabilities, and this carried with it potential threats to wellbeing. We conclude that the process, as well as the substance, of entitlement can mediate wellbeing; and that where the basis for providing a given entitlement is widely understood and accepted, the risks to wellbeing associated with enacting that entitlement will be reduced.

What are the health benefits of active travel? A systematic review of trials and cohort studies.

BACKGROUND: Increasing active travel (primarily walking and cycling) has been widely advocated for reducing obesity levels and achieving other population health benefits. However, the strength of evidence underpinning this strategy is unclear. This study aimed to assess the evidence that active travel has significant health benefits. METHODS: The study design was a systematic review of (i) non-randomised and randomised controlled trials, and (ii) prospective observational studies examining either (a) the effects of interventions to promote active travel or (b) the association between active travel and health outcomes. Reports of studies were identified by searching 11 electronic databases, websites, reference lists and papers identified by experts in the field. Prospective observational and intervention studies measuring any health outcome of active travel in the general population were included. Studies of patient groups were excluded. RESULTS: Twenty-four studies from 12 countries were included, of which six were studies conducted with children. Five studies evaluated active travel interventions. Nineteen were prospective cohort studies which did not evaluate the impact of a specific intervention. No studies were identified with obesity as an outcome in adults; one of five prospective cohort studies in children found an association between obesity and active travel. Small positive effects on other health outcomes were found in five intervention studies, but these were all at risk of selection bias. Modest benefits for other health outcomes were identified in five prospective studies. There is suggestive evidence that active travel may have a positive effect on diabetes prevention, which may be an important area for future research. CONCLUSIONS: Active travel may have positive effects on health outcomes, but there is little robust evidence to date of the effectiveness of active transport interventions for reducing obesity. Future evaluations of such interventions should include an assessment of their impacts on obesity and other health outcomes.

Health impacts of free bus travel for young people: evaluation of a natural experiment in London.

BACKGROUND: We used the introduction of free bus travel for young people in London in 2005 as a natural experiment with which to assess its effects on active travel, car use, road traffic injuries, assaults, and on one measure of social inclusion, total number of trips made. METHODS: A controlled before-after analysis was conducted. We estimated trips by mode and distances travelled in the preintroduction and postintroduction periods using data from London Travel Demand Surveys. We estimated rates of road traffic injury and assault in each period using STATS19 data and Hospital Episode Statistics, respectively. We estimated the ratio of change in the target age group (12-17 years) to the change in adults (ages 25-59 years), with 95% CIs. RESULTS: The proportion of short trips travelled by bus by young people increased postintroduction. There was no evidence for an increase in the total number of bus trips or distance travelled by bus by young people attributable to the intervention. The proportion of short trips by walking decreased, but there was no evidence for any change to total distance walked. Car trips declined in both age groups, although distance travelled by car decreased more in young people. Road casualty rates declined, but the pre-post ratio of change was greater in young people than adults (ratio of ratios 0.84; 95% CI 0.82 to 0.87). Assaults increased and the ratio of change was greater in young people (1.20; 1.13 to 1.27). The frequency of all trips by young people was unchanged, both in absolute terms and relative to adults. CONCLUSIONS: The introduction of free bus travel for young people had little impact on active travel overall and shifted some travel from car to buses that could help broader environmental objectives.

Look who's walking: social and environmental correlates of children's walking in London.

A substantial literature examines the social and environmental correlates of walking to school but less addresses walking outside the school commute. Using travel diary data from London, we examined social and environmental correlates of walking: to school; outside the school commute during term time; and during the summer and weekends. Living in a household without a car was associated with all journey types; 'Asian' ethnicity was negatively associated with walking for non-school travel; environmental factors were associated with non-school journeys, but not the school commute. Interventions aiming to increase children's active travel need to take account of the range of journeys they make.

Rethinking passive transport: bus fare exemptions and young people's wellbeing.

Much recent public health research has emphasised the health impacts for young people of 'active travel' modes, typically defined as walking and cycling. Less research has focused on public transport modes. Drawing on qualitative data, we examine the links between bus travel and wellbeing in London, where young people currently have free bus travel. Our findings indicate that bus travel can be both a physically and socially active experience for young people. We suggest a more nuanced understanding of 'active travel' is now needed, alongside greater attention to urban public transport networks as key sites that impact on important determinants of wellbeing such as independent mobility and social inclusion.

Cycling and the city: a case study of how gendered, ethnic and class identities can shape healthy transport choices.

As a form of 'active transport', cycling has been encouraged as a route to improving population health. However, in many high-income countries, despite being widely seen as a 'healthy' choice, few people do cycle for transport. Further, where cycling is rare, it is not a choice made equally across the population. In London, for instance, cycling is disproportionately an activity of affluent, White, men. This paper takes London as a case study to explore why the meanings of cycling might resonate differently across urban, gendered, ethnic and class identities. Drawing on qualitative interview data with 78 individuals, we suggest first that the relative visibility of cycling when few do it means that it is publicly gendered in a way that more normalised modes of transport are not; conversely, the very invisibility of Black and Asian cyclists reduces their opportunities to see cycling as a candidate mode of transport. Second, following Bourdieu, we argue that the affinities different population groups have for cycling may reflect the locally constituted 'accomplishments' contained in cycling. In London, cycling represents the archetypal efficient mode for autonomous individuals to travel in ways that maximise their future-health gain, and minimise wasted time and dependence on others. However, it relies on the cultivation of a particular 'assertive' style to defend against the risks of road danger and aggression. While the identities of some professional (largely White) men and women could be bolstered by cycling, the aesthetic and symbolic goals of cycling were less appealing to those with other class, gendered and ethnic identities.

The impact of 20 mph traffic speed zones on inequalities in road casualties in London.

BACKGROUND: Road traffic casualties show some of the widest socioeconomic differentials of any cause of morbidity or mortality, and as yet there is little evidence on what works to reduce them. This study quantified the current and potential future impact of the introduction of 20 mph zones on socioeconomic inequalities in road casualties in London. METHODS: An observational study based on analysis of geographically coded police road casualties data, 1987-2006. Changes in counts of casualties from road collisions, those killed and seriously injured and pedestrian injuries by quintile of deprivation were calculated. RESULTS: The effect of 20 mph zones was similar across quintiles of socioeconomic deprivation, being associated with a 41.8% (95% CI 21.0% to 62.6%) decline in casualties in areas in the least deprived quintile versus 38.3% (31.5% to 45.0%) in the most deprived quintile. Because of the greater number of road casualties in deprived areas and the targeting of zones to such areas, the number of casualties prevented by zones was substantially larger in areas of greater socioeconomic deprivation. However, the underlying decline in road casualties on all roads was appreciably greater in less deprived areas (p<0.001 for trend) so that despite the targeting of 20 mph zones, socioeconomic inequalities in road injuries in London have widened over time. Extending 20 mph schemes has only limited the potential to reduce differentials further. CONCLUSIONS: The implementation of 20 mph zones targeted at deprived areas has mitigated widening socioeconomic differentials in road injury in London and to some degree narrowed them, but there is limited potential for further gain.