Effectiveness of an Energy-Counseling Intervention in Reducing Energy Poverty: Evidence from a Quasi-Experimental Study in a Southern European City.

Energy poverty is a serious social problem with well-known adverse health consequences. This problem has been addressed mainly through improvements in the energy efficiency of housing. Still, little is known about the effects of information-based measures on energy poverty and their impacts on health. A quasi-experimental study was implemented to assess the effectiveness of an energy-counseling home visit intervention targeting the vulnerable population in a southern European city, Barcelona, in alleviating energy poverty and improving health. The intervention had beneficial impacts on keeping homes at an adequate indoor temperature and reducing primary care visits. No effects were found on self-perceived health or self-reported anxiety and depression. After the intervention, participants reported a decrease in arrears on utility bills, but less pronounced than in the comparison group. In conclusion, the study showed that information-based measures lead to psychosocial gains and reduced healthcare use. Nevertheless, the impact of these measures could be enhanced by combining them with policies and programmes that address the structural determinants of energy poverty.

Housing Insecurity and Mental Health: the Effect of Housing Tenure and the Coexistence of Life Insecurities.

While the adverse effects of housing insecurity on mental health are known, much less is known about the modifiers underlying these effects. The aim of this study was to analyze the mental health of people with housing insecurity by housing tenure and considering the coexistence of other life insecurities (energy poverty and food insecurity). We conducted a cross-sectional study through a survey performed in all people attending the Platform for People Affected by Mortgages or the Alliance against Energy Poverty of Barcelona for the first time between June 2017 and December 2019 and who reported housing insecurity. The dependent variables were the risk of poor mental health, self-reported anxiety and/or depression, and the use of psychotropic drugs. We fitted age-adjusted robust Poisson regression models for each dependent variable and estimated adjusted prevalence ratios (aPR). The study included 256 women and 104 men. The prevalence of poor mental health was 89% in women and 85.3% in men, which was much higher than that in the general population of Barcelona (19.5% and 14.5%, respectively). Among women, mental health was worse in those living in a squat (aPR 1.16; 95% CI: 1.02-1.31) and in those with food insecurity (aPR 1.11; 95% CI: 1.01-1.21). The number of coexisting insecurities showed a gradient effect (3 insecurities: aPR 1.21; 95% CI: 1.01-1.45). Among men, the results showed no clear pattern. Poor mental health was highly prevalent in people with housing insecurity and was exacerbated by the coexistence of life insecurities. Public policymakers should consider the complexity of persons with housing insecurity.

Energy poverty, its intensity and health in vulnerable populations in a Southern European city.

OBJECTIVE: To describe and compare the health status between vulnerable population participating in a program to tackle energy poverty (Energía, la justa) and the non-energy poor Barcelona (Spain) population and to analyse among participants the effect of energy poverty intensity on health. METHOD: Cross-sectional study based on data from program participants obtained before the intervention. Participants (1799 women and 671 men) were compared to non-energy poor population of Barcelona (1393 women and 1215 men) sampled from the Barcelona Public Health Survey (2016). Standardized prevalence and prevalence ratios of self-perceived poor health, asthma, chronic bronchitis, and depression and/or anxiety were estimated, and among participants the association between health status and energy poverty intensity was estimated with multivariate models. RESULTS: The probability of poor self-perceived physical and mental health ranged from 2.2 to 5.3 times greater in the program participants than non-energy poor Barcelona population. Among program participants, those most affected were found to be the most likely to report poor health outcomes, regardless of other sociodemographic factors. CONCLUSIONS: The prevalence of poor physical and mental health was considerably higher among women and men participating in the programme compared to the non-energy poor population and was even worse among those who were more severely affected. Public policies that tackle energy poverty and its consequences are urgently needed in Spain.

The effects of cohousing model on people's health and wellbeing: a scoping review.

BACKGROUND: Housing is a social determinant of health. Extensive research has highlighted its adverse effects on health. However, less is known about the effects of cohousing typology on health, which has the potential to create lively social networks and healthy communities and environments. We report the findings of a scoping study designed to gather and synthesise all known evidence on the relationship between cohousing and wellbeing and health. METHOD: Using the scoping review method, we conducted a literature review in PubMed, ProQuest, Scopus, Web of Science, Science Direct and JSTOR in May 2019 and selected articles published from 1960 onwards, with no geographical limit and no design restrictions. Retrieved articles underwent three sequential screening phases. The results were described through a narrative synthesis of the evidence. RESULTS: Of the 2560 articles identified, we selected 25 full-text articles analysing 77 experiences. All of them were conducted in high-income countries. Ten studies analysed the impact of cohousing on physical and mental health or quality of life and wellbeing. Eight of the 10 studies found a positive association. In addition, 22 studies analysed one or more psychosocial determinants of health (such as social support, sense of community and physical, emotional and economic security) and most found a positive association. Through these determinants, quality of life, wellbeing and health could be improved. However, the quality of the evidence was low. DISCUSSION: The cohousing model could enhance health and wellbeing mediated by psychosocial determinants of health. However, extreme caution should be exercised in drawing any conclusions due to the dearth of data identified and the designs used in the included studies, with most being cross-sectional or qualitative studies, which precluded causal-based interpretations. Because housing is a major social determinant of health, more evidence is needed on the impact of this model on health through both psychosocial and material pathways.

Effects of Superblocks on health and health inequities: a proposed evaluation framework.

The following essay outlines the intervention and presents a framework that will serve as a guide in the evaluation of the different effects of the Superblocks. Superblocks consist of amalgamations of blocks throughout the city, with the goal of improving the habitability of public spaces, advancing sustainable mobility, increasing urban green, and promoting residents' participation and coresponsibility, while ultimately influencing residents' health and health inequities. The evaluation framework considers the following aspects: the interventions implemented in the Superblock strategy, the changes that occur at neighbourhood and individual level and the population turnover as intermediate factors and finally the health outcomes. Inequity dimensions are also considered.

Our lives in boxes: perceived community mediators between housing insecurity and health using a PHOTOVOICE approach.

BACKGROUND: While the negative effects of housing insecurity on health are well known, the mechanisms and mediators of these effects have been less well studied. The aim of this study is to identify perceived mediators involved in the relationship between housing insecurity and health. METHODS: We used a participatory action research approach, the Photovoice methodology. It promotes a reflective process where participants critically discuss housing insecurity and human health and make recommendations to find solutions for the issues identified. This study was conducted with 18 members of the Platform for People Affected by Mortgages who were living in a situation of housing insecurity in Barcelona during the first half of 2017. RESULTS: Participants took 990 photographs, of which 147 were printed for analysis in discussion sessions. 109 of these photographs were then selected for categorization by the participants. 11 major categories emerged, representing various factors related to housing insecurity and health. Most categories were acknowledged as possible mediators of the housing/health problem, including: psychological changes; housing-related material aspects; health-related behaviors; eviction; harassment by financial institutions; and family, neighbors and social network. Others were considered as modifiers that could alter the effects of housing insecurity on health. Co-existing determinants may interact with housing insecurity, thereby increasing negative effects on health. CONCLUSIONS: Through this participatory approach, the Photovoice project gives insight into the mechanisms underlying the relationship between housing insecurity and human health, and provides valuable recommendations to combat this serious public health issue.

El diagnóstico de salud del programa Barcelona Salut als Barris. Metodología para un proceso participativo / Community health assessment of the programme "Barcelona Health in the Neighbourhoods". Methodology for a participatory proces

Se describe la metodología usada en el diagnóstico de salud de un programa orientado a mejorar la salud en los barrios más desfavorecidos de la ciudad de Barcelona. En el proceso de diagnóstico se utiliza una metodología mixta (cuantitativa y cualitativa) para obtenera información sobre el estado de salud de la comunidad, sus determinantes y los recursos disponibles relacionados con la salud. Los datos cuantitativos corresponden a indicadores elaborados a partir de registros de diversas fuentes. La información cualitativa recoge las perspectivas de la comunidad mediante entrevistas, grupos focales y grupos nominales. Las diferentes formas de recogida de datos proporcionan una información más completa de la salud de la comunidad, de sus necesidades y de los recursos disponibles para afrontarlas. La participación comunitaria en el proceso fortalece los lazos entre la comunidad y los agentes implicados en las acciones para abordar los temas priorizados, y favorece su empoderamiento

This paper describes the methodology used for the assessment of health needs within a programme aimed at promoting health equity in disadvantaged neighbourhoods in the city of Barcelona (Spain). The assessment process involves the use of mixed methods (quantitative and qualitative) in order to obtain information regarding the health of the community, its determinants, and the availability of health-related assets. Quantitative data consists of indicators from different sources. Qualitative data collects the community's perspectives through interviews, focal groups and nominal groups. The combination of several data collection methods yields more complete information about the community, its needs and the resources available to meet them. Participation of community members in the process strengthens links between the community and the agents responsible for implementing the actions to address prioritised issues and favours community empowerment

La priorización comunitaria en el programa Barcelona Salut als Barri / Community prioritization in Barcelona Salut als Barris program

Priorizar es el proceso de selección y ordenación de las necesidades en salud identificadas tras el diagnóstico de necesidades y activos en salud de una comunidad. La valoración de las necesidades en salud se ha reforzado con la perspectiva comunitaria, lo que aporta múltiples beneficios: sensibiliza y empodera a la comunidad sobre su salud, fomenta el apoyo mutuo entre sus integrantes y promueve su protagonismo haciéndola corresponsable del proceso de mejora de su propia realidad. El objetivo de esta nota es describir el modelo de priorización de Barcelona Salut als Barris, estrategia de salud comunitaria liderada por la Agencia de Salud Pública de Barcelona para promover la equidad en salud en los barrios más desfavorecidos de la ciudad (AU)

Prioritizing corresponds to the process of selecting and managing health needs identified after diagnosing the community's health needs and assets. Recently, the health needs assessment has been reinforced with the community perspective, providing multiple benefits: it sensitizes and empowers the community about their health, encourages mutual support among its members and promotes their importance by making them responsible for the process of improving their own reality. The objective of this paper is to describe the prioritization of Barcelona Salut als Barris, a community health strategy led by the Barcelona Public Health Agency to promote equity in health in the most disadvantaged neighborhoods of the city (AU)

[Community health assessment of the programme "Barcelona Health in the Neighbourhoods". Methodology for a participatory process]. / El diagnóstico de salud del programa Barcelona Salut als Barris. Metodología para un proceso participativo.

This paper describes the methodology used for the assessment of health needs within a programme aimed at promoting health equity in disadvantaged neighbourhoods in the city of Barcelona (Spain). The assessment process involves the use of mixed methods (quantitative and qualitative) in order to obtain information regarding the health of the community, its determinants, and the availability of health-related assets. Quantitative data consists of indicators from different sources. Qualitative data collects the community's perspectives through interviews, focal groups and nominal groups. The combination of several data collection methods yields more complete information about the community, its needs and the resources available to meet them. Participation of community members in the process strengthens links between the community and the agents responsible for implementing the actions to address prioritised issues and favours community empowerment.

The Experience of Implementing Urban HEART Barcelona: a Tool for Action.

Urban Health Equity Assessment and Response Tool (HEART) is a tool developed by the World Health Organization whose objective is to provide evidence on urban health inequalities so as to help to decide the best interventions aimed to promote urban health equity. The aim of this paper is to describe the experience of implementing Urban HEART in Barcelona city, both the adaptation of Urban HEART to the city of Barcelona, its use as a means of identifying and monitoring health inequalities among city neighbourhoods, and the difficulties and barriers encountered throughout the process. Although ASPB public health technicians participated in the Urban HEART Advisory Group, had large experience in health inequalities analysis and research and showed interest in implementing the tool, it was not until 2015, when the city council was governed by a new left-wing party for which reducing health inequalities was a priority that Urban HEART could be used. A provisional matrix was developed, including both health and health determinant indicators, which allowed to show how some neighbourhoods in the city systematically fare worse for most of the indicators while others systematically fare better. It also allowed to identify 18 neighbourhoods-those which fared worse in most indicators-which were considered a priority for intervention, which entered the Health in the Barcelona Neighbourhoods programme and the Neighbourhoods Plan. This provisional version was reviewed and improved by the Urban HEART Barcelona Working Group. Technicians with experience in public health and/or in indicator and database management were asked to indicate suitability and relevance from a list of potential indicators. The definitive Urban HEART Barcelona version included 15 indicators from the five Urban HEART domains and improved the previous version in several requirements. Several barriers were encountered, such as having to estimate indicators in scarcely populated areas or finding adequate indicators for the physical context domain. In conclusion, the Urban HEART tool allowed to identify urban inequalities in the city of Barcelona and to include health inequalities in the public debate. It also allowed to reinforce the community health programme Health in the Barcelona Neighbourhoods as well as other city programmes aimed at reducing health inequalities. A strong political will is essential to place health inequalities in the political agenda and implement policies to tackle them.

[Community prioritization in Barcelona Salut als Barris program]. / La priorización comunitaria en el programa Barcelona Salut als Barris.

Prioritizing corresponds to the process of selecting and managing health needs identified after diagnosing the community's health needs and assets. Recently, the health needs assessment has been reinforced with the community perspective, providing multiple benefits: it sensitizes and empowers the community about their health, encourages mutual support among its members and promotes their importance by making them responsible for the process of improving their own reality. The objective of this paper is to describe the prioritization of Barcelona Salut als Barris, a community health strategy led by the Barcelona Public Health Agency to promote equity in health in the most disadvantaged neighborhoods of the city.

Infobarris: una herramienta interactiva para monitorizar y divulgar información sobre la salud y sus determinantes en los barrios de Barcelona / Infobarris: an interactive tool to monitor and disseminate information on health and its determinants in the neighbourhoods of Barcelona (Spain)

Para conocer la salud de la población es necesario realizar un análisis conjunto y continuado de su estado de salud y de sus determinantes. El objetivo de esta nota de campo es describir el desarrollo y el funcionamiento de la herramienta Infobarris, que permite visualizar una amplia batería de indicadores y determinantes de la salud de la población de la ciudad de Barcelona según el barrio de residencia. Para el desarrollo de Infobarris se ha usado una metodología ágil que permite el desarrollo de un proyecto de forma iterativa e incremental en etapas: selección de indicadores, diseño del prototipo, desarrollo de la herramienta de visualización, carga de datos, revisión y mejora de la herramienta. Infobarris permite la visualización interactiva de 64 indicadores de salud y de sus determinantes, mediante gráficos, mapas y tablas, lo que facilita la vigilancia de la salud y de sus determinantes en los barrios de la ciudad de Barcelona (AU)

In order to know about the health of the population, it is necessary to perform a systematic and continuous analysis of their health status and social and economic health determinants. The objective of this paper is to describe the development and implementation of the Infobarris tool, which allows to visualize a wide battery of indicators and social determinants of health by neighbourhoods in the city of Barcelona (Spain). For the development of the Infobarris tool, we used an agile methodology that allows the development of a project in iterative and incremental stages, which are the following: selection of indicators, design of the prototype, development of the tool, data loading, and tool review and improvements. Infobarris displays 64 indicators of health and its determinants through graphics, maps and tables, in a friendly, interactive and attractive way, which facilitates health surveillance in the neighbourhoods of Barcelona (AU)

[Infobarris: an interactive tool to monitor and disseminate information on health and its determinants in the neighbourhoods of Barcelona (Spain)]. / Infobarris: una herramienta interactiva para monitorizar y divulgar información sobre la salud y sus determinantes en los barrios de Barcelona.

In order to know about the health of the population, it is necessary to perform a systematic and continuous analysis of their health status and social and economic health determinants. The objective of this paper is to describe the development and implementation of the Infobarris tool, which allows to visualize a wide battery of indicators and social determinants of health by neighbourhoods in the city of Barcelona (Spain). For the development of the Infobarris tool, we used an agile methodology that allows the development of a project in iterative and incremental stages, which are the following: selection of indicators, design of the prototype, development of the tool, data loading, and tool review and improvements. Infobarris displays 64 indicators of health and its determinants through graphics, maps and tables, in a friendly, interactive and attractive way, which facilitates health surveillance in the neighbourhoods of Barcelona.

Housing Policies and Health Inequalities.

A large body of literature shows the link between inadequate housing conditions and poor physical and mental health. The aim of this paper is to summarize the research on the impact of local housing policies on health inequalities, focusing on the issues of access to housing and fuel poverty as studied in the SOPHIE project. Our case studies in Spain showed that people facing housing insecurity, experienced intense levels of mental distress. We found that access to secure and adequate housing can improve the health of these populations, therefore, public policies that address housing instability and their consequences are urgently needed. Housing conditions related to fuel poverty are associated with poorer health and are unevenly distributed across Europe. We found possible positive effects of façade insulation interventions on cold-related mortality in women living in social housing; but not in men. Policies on housing energy efficiency can reduce the health consequences of fuel poverty, but need to be free to users, target the most vulnerable groups and be adaptable to their needs.

Changes in Health Following Housing Improvement in a Vulnerable Population in Spain: A Follow-up Study.

The objective of this study is to compare changes in health among a sample of families living in substandard dwellings or with housing affordability problems assisted by Caritas Diocesana de Barcelona, according to the improvement of their socioeconomic and housing situation during the study period. A quasi-experimental study was performed, including 232 families assisted by Caritas who were interviewed in 2012 and one year later. Participants could have received a set of interventions, including relocation and different types of economic subsidies. Regression models were fitted to identify the association of participants' changes in self-rated general health and mental health between baseline and follow-up with improvements across three dimensions: socioeconomic situation and housing affordability, physical housing characteristics, and neighborhood. An improvement in self-reported health status was associated with having found a job and reporting fewer problems in meeting monthly housing costs. Mental health improved among participants with an increased household income, with a reduction in the perceived risk of losing their house, and with reduced housing-related material deprivations. The study shows that health gains can derive from improvements in housing conditions, especially those related to housing affordability.

[Health reports as the centrepiece of public health services]. / Los informes de salud como eje de los servicios de salud pública.

The main objective of health reports is to contribute to the health improvement of a specific population. They are an essential support tool for the design and planning of health policies and can also be used for accountability and evaluation. This study assesses various types of health report, including that used by the City of Barcelona (Spain), with a focus on social determinants, as well as an international health report more centred on the impact of health services. Some suggestions are proposed about the appropriateness and best use of these documents, including: the need for effective communication between technical professionals and politicians through meetings and dialogue; commitment to transparency, both authors (by means of the declaration of interests) and in terms of the information reported and with the maximum level of participation; to promote the use of a conceptual framework of social determinants of health; a focus on health inequalities; the inclusion of information relevant to policy action; the organisation of information in such a way that it allows comparison or benchmarking with similar areas and prospectively; presenting the information in an attractive way using elements such as rankings, maps or other tools; and the design of communication strategies adapted to key stakeholders.

How substandard dwellings and housing affordability problems are associated with poor health in a vulnerable population during the economic recession of the late 2000s.

INTRODUCTION: Given the increasing number of people in Spain struggling to pay housing-related costs during the economic recession, it is important to assess the health status of these communities as compared to the general population and to better understand the different housing dimensions that are related with poor mental health. This study aims to describe the housing conditions and health status of a sample of people assisted by Caritas Barcelona (Spain) and living in inadequate housing and/or struggling to pay their rent or mortgage, to compare the health outcomes of this population with those of the overall population of Barcelona, and to analyze the association between housing dimensions and mental health. METHODS: We used a cross-sectional design. The participating adults (n = 320) and children (n = 177) were those living in the dioceses of Barcelona, Sant Feliu and Terrassa (Spain) in 2012 and assisted by Cáritas. They were asked to answer to three questionnaires on housing and health conditions. Eight health related variables were used to compare participants with Barcelona's residents and associations between housing conditions and poor mental health were examined with multivariate logistic regression models. RESULTS: In Barcelona, people seeking Caritas's help and facing serious housing problems had a much poorer health status than the general population, even when compared to those belonging to the most deprived social classes. For example, 69.4 % of adult participants had poor mental health compared to 11.5 % male and 15.2 % female Barcelona residents. Moreover, housing conditions were associated with poor mental health. CONCLUSIONS: This study has shown how, in a country hit by the financial recession, those people facing housing problems have much worse health compared to the general population.

Head-on crashes on two-way interurban roads: a public health concern in road safety.

OBJECTIVE: To describe the magnitude and characteristics of crashes and drivers involved in head-on crashes on two-way interurban roads in Spain between 2007 and 2012, and to identify the factors associated with the likelihood of head-on crashes on these roads compared with other types of crash. METHODS: A cross-sectional study was conducted using the National Crash Register. The dependent variables were head-on crashes with injury (yes/no) and drivers involved in head-on crashes (yes/no). Factors associated with head-on crashes and with being a driver involved in a head-on crash versus other types of crash were studied using a multivariate robust Poisson regression model to estimate proportion ratios (PR) and confidence intervals (95% CI). RESULTS: There were 9,192 head-on crashes on two-way Spanish interurban roads. A total of 15,412 men and 3,862 women drivers were involved. Compared with other types of crash, head-on collisions were more likely on roads 7 m or more wide, on road sections with curves, narrowings or drop changes, on wet or snowy surfaces, and in twilight conditions. Transgressions committed by drivers involved in head-on crashes were driving in the opposite direction and incorrectly overtaking another vehicle. Factors associated with a lower probability of head-on crashes were the existence of medians (PR=0.57; 95%CI: 0.48-0.68) and a paved shoulder of less than 1.5 meters (PR=0.81; 95%CI: 0.77-0.86) or from 1.5 to 2.45 meters (PR=0.90; 95%CI: 0.84-0.96). CONCLUSIONS: This study allowed the characterization of crashes and drivers involved in head-on crashes on two-way interurban roads. The lower probability observed on roads with median strips point to these measures as an effective way to reduce these collisions.

Head-on crashes on two-way interurban roads: a public health concern in road safety / Colisiones frontales en vías interurbanas de doble sentido: un problema de salud pública en seguridad vial

Objective: To describe the magnitude and characteristics of crashes and drivers involved in head-on crashes on two-way interurban roads in Spain between 2007 and 2012, and to identify the factors associated with the likelihood of head-on crashes on these roads compared with other types of crash. Methods: A cross-sectional study was conducted using the National Crash Register. The dependent variables were head-on crashes with injury (yes/no) and drivers involved in head-on crashes (yes/no). Factors associated with head-on crashes and with being a driver involved in a head-on crash versus other types of crash were studied using a multivariate robust Poisson regression model to estimate proportion ratios (PR) and confidence intervals (95% CI). Results: There were 9,192 head-on crashes on two-way Spanish interurban roads. A total of 15,412 men and 3,862 women drivers were involved. Compared with other types of crash, head-on collisions were more likely on roads 7 m or more wide, on road sections with curves, narrowings or drop changes, on wet or snowy surfaces, and in twilight conditions. Transgressions committed by drivers involved in head-on crashes were driving in the opposite direction and incorrectly overtaking another vehicle. Factors associated with a lower probability of head-on crashes were the existence of medians (PR=0.57; 95%CI: 0.48-0.68) and a paved shoulder of less than 1.5 meters (PR=0.81; 95%CI: 0.77-0.86) or from 1.5 to 2.45 meters (PR=0.90; 95%CI: 0.84-0.96). Conclusions: This study allowed the characterization of crashes and drivers involved in head-on crashes on two-way interurban roads. The lower probability observed on roads with median strips point to these measures as an effective way to reduce these collisions (AU)

Objetivo: Describir la magnitud y las características de las colisiones y de los conductores/as implicados/as en colisiones frontales en carretera convencional, e identificar los factores asociados a la probabilidad de colisión frontal respecto a otro tipo de colisiones, en España, en 2007-2012. Métodos: Estudio de diseño transversal utilizando el Registro de víctimas y accidentes. Las variables dependientes fueron la colisión frontal con víctimas (sí/no) y ser un conductor implicado en colisión frontal (sí/no). Se estudiaron los factores asociados a colisión o a ser un conductor implicado en colisión frontal respecto a los otros tipos de colisión, mediante un modelo multivariado de regresión de Poisson robusta, estimando razones de proporción (RP) y sus intervalos de confianza del 95% (IC95%). Resultados: Ocurrieron 9192 colisiones frontales en carretera convencional, con 15.412 hombres y 3862 mujeres involucrados/as. Hubo una mayor probabilidad de colisión frontal respecto a otro tipo de colisión en carreteras con 7 m o más de calzada, en curvas, estrechamiento de calzada o cambios de rasante, con superficie húmeda o nevada, y durante el crepúsculo. Conducir en dirección contraria y realizar un adelantamiento indebido se asocian a colisión frontal en conductores/as. La existencia de mediana (RP=0,57; IC95%: 0,48-0,68) o de arcén de menos de 1,5m (PR=0,81; IC95%: 0,77-0,86) o de 1,5m a 2,45m (PR=0,90; IC95%: 0,84-0,96) se asocian a menor probabilidad de colisión frontal. Conclusiones: Este estudio ha permitido caracterizar las colisiones y los conductores/as implicados en colisiones frontales en carretera convencional. La menor probabilidad de colisión frontal cuando existen medianas hace recomendable su implementación como medida efectiva para disminuir este tipo de colisiones (AU)

Effect of neighbourhood motorization rates on walking levels.

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