COVID-19 and working from home-related changes in physical activity in Sydney, Australia.

ISSUES ADDRESSED: Evidence on how COVID-19 lockdowns impacted physical activity (PA) is mixed. This study explores changes in PA following initial mobility restrictions, and their subsequent relaxation, in a sample of Sydney (Australia) residents using a natural experiment methodology. METHODS: Participants' health and travel behaviours were collected pre-pandemic in late 2019 (n = 1937), with follow-up waves during the pandemic in 2020 (n = 1706) and 2021 (n = 1514). Linear mixed-effects models were used to analyse changes in weekly duration of PA between the three waves. RESULTS: Compared with pre-pandemic, average weekly PA increased in 2021 by 42.6 min total PA (p = .001), 16 min walking PA (p = .02), and 26.4 min moderate-vigorous PA (MVPA) (p = .003). However, average weekly sessions of PA decreased in 2020 and remained lower in 2021. For participants who were sufficiently active in 2019, weekly total PA (-66.3 min) MVPA (-43.8 min) decreased in 2020 compared to pre-pandemic. Conversely, among participants who were insufficiently active in 2019, average weekly PA increased in both 2020 (total PA, +99.1 min; walking PA, +46.4 min; MVPA +52.8 min) and 2021 (total PA, +117.8 min; walking PA, +58.4 min; MVPA +59.2 min), compared to 2019. Participants who did more work from home increased their average weekly total PA in 2021 compared to pre-pandemic (+45.3 min). CONCLUSION: These findings reveal the complex variability in PA behaviour brought about by the pandemic. SO WHAT?: Strategies to support the population in achieving sufficient PA must focus on maintaining an appetite for PA as we move out of the pandemic and on promoting more frequent PA sessions.

trips4health: a single-blinded randomised controlled trial incentivising adult public transport use for physical activity gain.

BACKGROUND: Public transport users tend to accumulate more physical activity than non-users; however, whether physical activity is increased by financially incentivising public transport use is unknown. The trips4health study aimed to determine the impact of an incentive-based public transport intervention on physical activity. METHODS: A single-blinded randomised control trial of a 16-week incentive-based intervention involved Australian adults who were infrequent bus users (≥ 18 years; used bus ≤ 2 times/week) split equally into intervention and control groups. The intervention group were sent weekly motivational text messages and awarded smartcard bus credit when targets were met. The intervention group and control group received physical activity guidelines. Accelerometer-measured steps/day (primary outcome), self-reported transport-related physical activity (walking and cycling for transport) and total physical activity (min/week and MET-min/week) outcomes were assessed at baseline and follow-up. RESULTS: Due to the COVID pandemic, the trial was abandoned prior to target sample size achievement and completion of all assessments (N = 110). Steps/day declined in both groups, but by less in the intervention group [-557.9 steps (-7.9%) vs.-1018.3 steps/week (-13.8%)]. In the intervention group, transport-related physical activity increased [80.0 min/week (133.3%); 264.0 MET-min/week (133.3%)] while total physical activity levels saw little change [35.0 min/week (5.5%); 25.5 MET-min/week (1.0%)]. Control group transport-related physical activity decreased [-20.0 min/week (-27.6%); -41.3 MET-min/week (-17.3%)], but total physical activity increased [260.0 min/week (54.5%); 734.3 MET-min/week (37.4%)]. CONCLUSION: This study found evidence that financial incentive-based intervention to increase public transport use is effective in increasing transport-related physical activity These results warrant future examination of physical activity incentives programs in a fully powered study with longer-term follow-up. TRIAL REGISTRATION: This trial was registered with the Australian and New Zealand Clinical Trials Registry August 14th, 2019: ACTRN12619001136190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377914&isReview=true.

A prospective study of the impact of COVID-19-related restrictions on activities and mobility upon physical activity, travel behaviour and attitudes.

Background and aims: Public health measures adopted to contain the spread of COVID-19 included restrictions on activities and mobility as people were asked to stay at home and schools moved to online learning. This may have increased risk of non-communicable disease by limiting recreational and transport-related physical activity. Building on an existing study, we assessed changes in self-reported and device-measured physical activity and travel behaviour before, during and after the peak of local COVID-19 outbreak and restrictions (March-July 2020). We examined beliefs in effectiveness of strategies to increase active and public transport after restrictions were reduced. Methods: A longitudinal study of adult infrequent bus users (average ≤ 2 trips per week; n = 70; 67% women) in Hobart, Australia. One-week assessment periods at four separate timepoints (before, during, 0-3 months after, and 3-6 months after the peak restrictions period) involved wearing an accelerometer, daily transport diaries, online surveys and tracking bus smartcard boardings. Results: Physical activity (especially among older participants), bus use and private motor vehicle use declined significantly during or 0-3 months after the peak restrictions period and returned to pre-restrictions levels by 3-6 months after the peak restrictions period, except bus use which remained significantly lower. Retrospective surveys overstated declines in bus use and active transport and self-reports understated declines in physical activity. Social distancing and improving service efficiency and frequency were seen as effective strategies for increasing bus use after restrictions but belief in effectiveness of distancing decreased over time. Conclusions: When restrictions on mobility are increased, supportive health promotion measures are needed to prevent declines in physical activity, particularly for older adults. Public transport systems need capacity to implement temporary distancing measures to prevent communicable disease transmission. Providing convenient, flexible, and efficient options for public transport may help to replenish public transport use after restrictions are reduced.

Perceptions of air quality and concern for health in relation to long-term air pollution exposure, bushfires, and COVID-19 lockdown: A before-and-after study.

Background: Air pollution is a major health burden and the leading environmental risk factor for non-communicable diseases worldwide. People's perceptions and concerns about air pollution are important as they may predict protective behaviour or support for climate change mitigation policies. Methods: This repeat cross-sectional study uses survey data collected from participants in Sydney, Australia in September-November 2019 (n = 1,647) and October-December 2020 (n = 1,458), before and after the devastating 2019/2020 bushfires and first COVID-19 lockdown restrictions in Sydney in 2020. Participants' perceptions of air quality and concerns for health in relation to air quality were modeled against estimates of annual average NO2 and PM2.5 concentrations in their neighbourhood. Results: Participants in suburbs with higher estimated air pollution concentrations generally perceived poorer air quality and were more concerned for health in relation to air quality. A 5 µg/m3 increase in NO2 was associated with perceived poorer air quality (OR 1.32, 95%CI 1.18-1.47). A 1 µg/m3 increase in estimated PM2.5 was associated with perceived poorer air quality (OR 1.37, 95%CI 1.24-1.52) and greater concern for health (OR 1.18, 95%CI 1.05-1.32). Air quality was perceived as better in 2020 than in 2019 in both NO2 and PM2.5 models (p<0.001). Air quality concern increased in 2020 in both models. Discussion: This study provides the first Australian data on the association between estimated air quality exposure and air quality perceptions and concerns, contributing new evidence to inform public health approaches that increase awareness for air pollution and reduce the health burden.

Interventions Designed to Support Physical Activity and Disease Prevention for Working from Home: A Scoping Review.

Working from home (WfH) has public health implications including changes to physical activity (PA) and sedentary behavior (SB). We reviewed published and grey literature for interventions designed to support PA or reduce SB in WfH contexts. From 1355 published and grey literature documents since 2010, we screened 136 eligible documents and extracted ten intervention studies. Interventions designed specifically for WfH were limited and included structured exercise programs, infrastructure (e.g., sit-stand workstations), online behavioral and educational programs, health professional advice and peer support, activity trackers and reminder prompts. Evidence of interventions to improve PA and reduce SB in WfH contexts is emergent but lacking in variety and in utilization of local environments to promote good health. Evidence is needed on the adaptation of existing workplace interventions for home environments and exploration of opportunities to support PA through alternative interventions, such as urban planning and recreational strategies.

How equitable are the distributions of the physical activity and accessibility benefits of bicycle infrastructure?

BACKGROUND: Cycling for transport provides many health and social benefits - including physical activity and independent access to jobs, education, social opportunities, health care and other services (accessibility). However, some population groups have less opportunity to reach everyday destinations, and public transport stops, by bicycle - owing in part to their greater aversion to riding amongst motor vehicle traffic. Health equity can therefore be improved by providing separated cycleway networks that give more people the opportunity to access places by bicycle using traffic-free routes. The aim of this study was to assess the health equity benefits of two bicycle infrastructure development scenarios - a single cycleway, and a complete network of cycleways - by examining the distributions of physical activity and accessibility benefits across gender, age and income groups. METHODS: Travel survey data collected from residents in Sydney (Australia) were used to train a predictive transport mode choice model, which was then used to forecast the impact of the two intervention scenarios on transport mode choice, physical activity and accessibility. The latter was measured using a utility-based measure derived from the mode choice model. The distributions of the forecast physical activity and accessibility benefits were then calculated across gender, age and income groups. RESULTS: The modelled physical activity and accessibility measures improve in both intervention scenarios. However, in the single cycleway scenario, the benefits are greatest for the male, high-income and older age groups. In the complete network scenario, the benefits are more equally distributed. Forecast increases in cycling time are largely offset by decreases in walking time - though the latter is typically low-intensity physical activity, which confers a lesser health benefit than moderate-intensity cycling. CONCLUSIONS: Separated cycleway infrastructure can be used to improve health equity by providing greater opportunities for transport cycling in population groups more averse to riding amongst motor vehicle traffic. Disparities in the opportunity to access services and economic/social activities by bicycle - and incorporate more physical activity into everyday travel - could be addressed with connected, traffic-free cycleway networks that cater to people of all genders, ages and incomes.

Socio-demographic, behavioural and health-related characteristics associated with active commuting in a regional Australian state: Evidence from the 2016 Tasmanian Population Health Survey.

ISSUE ADDRESSED: Physical activity is lower and rates of preventable common diseases are higher in regional/rural than urban Australia. Active commuting (walking/bicycling to get from one place to another) may benefit health through increased physical activity, but most evidence of its correlates come from urban studies. This study aimed to investigate associations between active commuting, socio-demographic characteristics, behaviours, total physical activity and health in a regional/rural Australian state. METHODS: This study used data from the 2016 Tasmanian Population Health Survey, a representative cross-sectional self-report survey of 6,300 adults in Tasmania, Australia. Logistic regression modelling investigated associations between socio-demographic, behavioural and health characteristics and past week active commuting frequency. RESULTS: In multivariable models, being younger, having tertiary qualifications, living in a socio-economically advantaged area, being physically active, having a healthy body mass index and good/excellent self-rated health were associated with engaging in more active commuting. Inner regional dwellers were no more likely than outer regional dwellers to actively commute after covariate adjustment. CONCLUSION: Strategies to promote active commuting in regional/rural areas might consider targeting older adults, those less educated, those living in socio-economically disadvantaged areas, those less physically active, those with poorer health and those with higher body mass index. Research could further investigate why these groups appear to be less active for commuting purposes. SO WHAT?: Increasing physical activity and active commuting may help to reduce rates of preventable common diseases in regional/remote areas.

Public support for bicycling and transport policies in inner Sydney, Australia: a cross-sectional survey.

OBJECTIVE: To describe the degree of community support - and factors associated with this support - for a number of potential transport policy options among an inner-city sample of residents in Sydney, Australia. METHODS: This study analysed data collected from a cross-sectional online survey: Wave 3 of the Sydney Transport and Health Study, conducted in September-October 2015 (n=418). RESULTS: There was a high level of overall support for policies to make public transport cheaper (85%), have more bicycle paths separated from motor vehicles (82%) and have a public bike-share program (72%), with similar levels of support across usual commute mode, age and sex. CONCLUSIONS: Despite a natural tendency for respondents to support transport policies that were of most relevance to themselves, it appeared that, in this sample, public support for public transport and bicycling policies remained strong across all respondents. Implications for public health: Policies that support public transport and active travel and achieve positive health outcomes would be well received by inner-Sydney residents.

Correcting bias in self-rated quality of life: an application of anchoring vignettes and ordinal regression models to better understand QoL differences across commuting modes.

PURPOSE: Likert scales are frequently used in public health research, but are subject to scale perception bias. This study sought to explore scale perception bias in quality-of-life (QoL) self-assessment and assess its relationships with commuting mode in the Sydney Travel and Health Study. METHODS: Multilevel ordinal logistic regression analysis was used to analyse the association between two global QoL items about overall QoL and health satisfaction, with usual travel mode to work or study. Anchoring vignettes were applied using parametric and simpler nonparametric methods to detect and adjust for differences in reporting behaviour across age, sex, education, and income groups. RESULTS: The anchoring vignettes exposed differences in scale responses across demographic groups. After adjusting for these biases, public transport users (OR = 0.37, 95 % CI 0.21-0.65), walkers (OR = 0.44, 95 % CI 0.24-0.82), and motor vehicle users (OR = 0.47, 95 % CI 0.25-0.86) were all found to have lower odds of reporting high QoL compared with bicycle commuters. Similarly, the odds of reporting high health satisfaction were found to be proportionally lower amongst all competing travel modes: motor vehicle users (OR = 0.31, 95 % CI 0.18-0.56), public transport users (OR = 0.34, 95 % CI 0.20-0.57), and walkers (OR = 0.35, 95 % CI 0.20-0.64) when compared with cyclists. Fewer differences were observed in the unadjusted models. CONCLUSION: Application of the vignettes by the two approaches removed scaling biases, thereby improving the accuracy of the analyses of the associations between travel mode and quality of life. The adjusted results revealed higher quality of life in bicycle commuters compared with all other travel mode users.

Satisfaction with transport and enjoyment of the commute by commuting mode in inner Sydney.

Issue addressed Travel satisfaction has become an increasingly popular construct for the assessment and monitoring of transport systems and services. However, satisfaction may not adequately assess emotion or mood towards walking and cycling, especially when infrastructure is biased towards motor vehicle modes. In this exploratory study we sought to examine the associations of both satisfaction with transport and enjoyment from the commute to work or study by commute mode in an Australian inner city context where transport mode choices are readily available. Methods As part of the Sydney Transport and Health Study, 675 baseline study participants (2013) were invited to complete an online questionnaire in September/October 2014 and 512 did so (76% response rate). Participants who did not travel to work were removed from analyses, giving complete data for 473. Participants provided data on usual travel mode to work or study, satisfaction with transport, enjoyment from their commute, and demographics and neighbourhood factors. Results The main mode of travel to work or study in this inner city sample was public transport (41%), followed by motor vehicle (27%), walking (21%) and cycling (10%). Most participants were satisfied with their transport (82%), with little variation by mode. Walkers (49%) and cyclists (52%) reported far higher levels of enjoyment from their commute than car drivers (14%) or public transport users (10%), with an adjusted odds ratio of 6.18 (95% confidence interval 3.10-12.29, P<0.001) for walking and an adjusted odds ratio of 6.15 (95% confidence interval 2.68-14.08, P<0.001) for cycling. Conclusions People who walked or cycled to work or study in inner Sydney reported higher levels of enjoyment from their commute compared with those who drove. This suggests enjoyment may be another benefit of active travel. So what? Focusing on 'enjoyment' associated with walking or cycling to work may be a positive motivator to encourage active travel.

Speeding in urban environments: Are the time savings worth the risk?

Perceived time savings by travelling faster is often cited as a motivation for drivers' speeding behaviour. These time savings, however, come at a cost of significant road injuries and fatalities. While it is known that drivers tend to overestimate the time savings attributable to speeding there is little empirical evidence on how much time drivers genuinely save during day-to-day urban driving and how this relates to speeding-related crashes. The current paper reports on a study to address the lack of empirical evidence on this issue using naturalistic driving data collected from 106 drivers over a period of five weeks. The results show that the average driver saves 26s/day or 2min/week by speeding. More importantly, the cost of these time savings is one fatality for every 24,450h saved by the population on 100km/h roads in dry conditions and one injury for every 2458h saved on the same roads. Full speed compliance - and consequently a dramatic reduction in the road toll - could be achieved through almost imperceptible increases in travel time by each driver.

Use of and short-term impacts of new cycling infrastructure in inner-Sydney, Australia: a quasi-experimental design.

BACKGROUND: Given increasing investment in new cycling infrastructure, it is important to understand its impacts. The Sydney Transport and Health Study evaluates a new 2.4 km bi-directional separated bicycle path in inner-Sydney. This paper describes the users of the new bicycle path, and examines its short-term impacts upon cycling behaviour and perceptions of the local environment. METHODS: Data were collected from two bike counts at two intersections on the new bicycle path in the intervention area in 2013 and 2014. On-line surveys collected individual participant data in the intervention area and a similar comparison area before the bicycle path was built (2013), and 12 months later (four months after completion) (n = 512). The data included self-reported cycling behaviour, use of the new bicycle path and perceptions of changes in the local environment. RESULTS: Bike counts at two sites on the new bicycle path reported an increase of 23% and 97% respectively at 12 months. However, among the participants in the cohort, there was no change in the self-reported weekly frequency of cycling. One in six (approximately 15%) participants reported using the new bicycle path, with most users (76%) living in the intervention area. Bicycle path users were most likely to be frequent riders (at least weekly) [adjusted odds ratio (AOR) = 7.50, 95 % CI 3.93-14.31], be a high intensity recreational rider (AOR = 4.38, 95 % CI 1.53-12.54) or a low intensity transport rider (AOR = 2.42, 95 % CI 1.17-5.04) and live closer to the bicycle path (AOR = 1.24, 1.13-1.37). Perceptions that the neighbourhood was more pleasant, that there were more people walking and cycling were significantly higher in the intervention area at 12 months (both P values <0.05). CONCLUSIONS: Existing cycling behaviour and proximity to the bicycle path were associated with the use of the new bicycle path. Increased use of the new bicycle path as reported by the participants in the intervention area and increased cycling recorded by the bike counts may be due to existing cyclists changing routes to use the new path, and more cyclists from outside the study area using the new path, as study participants did not increase their frequency of cycling. Increases in cycling frequency in the intervention neighbourhood may require a longer lead time, additional promotional activities and further maturation of the Sydney bicycle path network. KEY MESSAGE: Understanding how new cycling infrastructure impacts communities can influence the promotion of such infrastructure.

Time-series analysis of continuously monitored blood glucose: the impacts of geographic and daily lifestyle factors.

Type 2 diabetes is known to be associated with environmental, behavioral, and lifestyle factors. However, the actual impacts of these factors on blood glucose (BG) variation throughout the day have remained relatively unexplored. Continuous blood glucose monitors combined with human activity tracking technologies afford new opportunities for exploration in a naturalistic setting. Data from a study of 40 patients with diabetes is utilized in this paper, including continuously monitored BG, food/medicine intake, and patient activity/location tracked using global positioning systems over a 4-day period. Standard linear regression and more disaggregated time-series analysis using autoregressive integrated moving average (ARIMA) are used to explore patient BG variation throughout the day and over space. The ARIMA models revealed a wide variety of BG correlating factors related to specific activity types, locations (especially those far from home), and travel modes, although the impacts were highly personal. Traditional variables related to food intake and medications were less often significant. Overall, the time-series analysis revealed considerable patient-by-patient variation in the effects of geographic and daily lifestyle factors. We would suggest that maps of BG spatial variation or an interactive messaging system could provide new tools to engage patients and highlight potential risk factors.

Driver behaviour profiles for road safety analysis.

Driver behaviour is a contributing factor in over 90 percent of road crashes. As a consequence, there is significant benefit in identifying drivers who engage in unsafe driving practices. Driver behaviour profiles (DBPs) are introduced here as an approach for evaluating driver behaviour as a function of the risk of a casualty crash. They employ data collected using global positioning system (GPS) devices, supplemented with spatiotemporal information. These profiles are comprised of common risk scores that can be used to compare drivers between each other and across time and space. The paper details the development of these DBPs and demonstrates their use as an input into modelling the factors that influence driver behaviour. The results show that even having controlled for the influence of the road environment, these factors remain the strongest predictors of driver behaviour suggesting different spatiotemporal environments elicit a variety of psychological responses in drivers. The approach and outcomes will be of interest to insurance companies in enhancing the risk-profiling of drivers with on-road driving and government through assessing the impacts of behaviour-change interventions.

Evaluating changes in driver behaviour: a risk profiling approach.

New road safety strategies continue to be devised by researchers and policy makers with pay-as-you-drive (PAYD) schemes gaining increasing attention. However, empirically measuring the effectiveness of these strategies is challenging due to the influence of the road environment and other factors external to the driver. The analysis presented here applies Temporal and Spatial Identifiers to control for the road environment and Driver Behaviour Profiles to provide a common measure of driving behaviour based on the risk of a casualty crash for assessing the effectiveness of a PAYD scheme on reducing driving risks. The results show that in many cases personalised feedback alone is sufficient to induce significant changes, but the largest reductions in risk are observed when drivers are also awarded a financial incentive to change behaviour. Importantly, the more frequent the exposure to the speeding information, the greater the magnitude of the change. However, the changes are disproportionately associated with those that were already safer drivers in the baseline period suggesting that some drivers may be predisposed to changing their behaviour. These results suggest that it would be beneficial to provide real-time or daily feedback on speeding behaviour in conjunction with a financial reward scheme, potentially as a component of insurance premiums.

Associations between the frequency of cycling and domains of quality of life.

ISSUE ADDRESSED: This study examined the association between domains of quality of life (QoL) and the frequency of cycling by men and women. METHOD: A cross-sectional survey of 846 healthy adults in Sydney, Australia measured cycling behaviour and self-reported QoL. Participants were aged 18-55 years and were living within 5km of the centre. Cycling frequency for all purposes was recorded as weekly, less than weekly or never cycling. QoL was measured using the four QoL domains of the WHOQOL-BREF: physical psychological, social and environment. Linear regression was used to assess the association between cycling and QoL. RESULTS: Among men, at least weekly cycling was associated with physical QoL (P=0.002) and any cycling was positively associated with psychological wellbeing (at least weekly P=0.01, less than weekly P=0.01) after adjusting for age, education and income. No significant associations were observed for women. CONCLUSION: Frequent cycling was associated with higher physical and psychological QoL in men, but not among women in this sample. No relationship was observed between cycling and the environment and social QoL domains. SO WHAT?: These findings suggest that cycling offers physical and psychological QoL benefits for men.

Evaluating the transport, health and economic impacts of new urban cycling infrastructure in Sydney, Australia - protocol paper.

BACKGROUND: There are repeated calls to build better cycling paths in Australian cities if the proportion of people cycling is to increase. Yet the full range of transport, health, environmental and economic impacts of new cycling infrastructure and the extent to which observed changes are sustained is not well understood. The City of Sydney is currently building a new bicycle network, which includes a new bicycle path separated from road traffic in the south Sydney area. This protocol paper describes a comprehensive method to evaluate this new cycling infrastructure. METHOD: A cohort of residents within two kilometres of the new bicycle path will be surveyed at baseline before a new section of bicycle path is built, and again 12 and 24 months later to assess changes in travel behaviour, sense of community, quality of life and health behaviours. Residents in a comparable area of Sydney that will not get a new separated bike path will act as a comparison group. At baseline a sub-set of residents who volunteer will also take a small GPS device with them for one week to assess travel behaviour. DISCUSSION: This research should contribute to the advancement in evaluation and appraisal methods for cycling projects.

Personality, risk aversion and speeding: an empirical investigation.

Evidence suggests that in addition to demographics, there are strong relationships between facets of drivers' personality (e.g., aggression, thrill-seeking, altruism), aversion to risk and driving behaviour, particularly speeding. However, evidence is muted by the reliance on self-reported driving behaviour, which is thought to not accurately reflect actual driving behaviour. This paper reports on a study of 133 drivers in Sydney, who were asked to complete a short survey to develop their personality and risk aversion profiles and self-reported speeding behaviour. A Global Positioning System (GPS) device was then installed in their vehicle for several weeks as part of a major investigation of driving behaviour from which empirical measures of speeding are derived. Among the most pertinent findings are: (1) the tendency for drivers to both under and over-estimate their propensity to speed, (2) significant heterogeneity in speeding with a small, but notable number of drivers exceeding the limit for more than 20 percent of the distance driven, (3) weak relationships between the personality/risk-aversion measures and actual speeding, and (4) the suggestion that different personality traits appear to influence behaviour in different situations both from self-reported and actual speeding behaviour.