Walking,bicycling, and urban landscapes: evidence from the San Francisco Bay Area

Some claim that car-dependent cities contribute to obesity by discouraging walking and bicycling. In this article, we use household activity data from the San Francisco region to study the links between urban environments and nonmotorized travel. We used factor analysis to represent the urban design and land-use diversity dimensions of built environments. Combining factor scores with control variables, like steep terrain, that gauge impediments to walking and bicycling, we estimated discrete-choice models. Built-environment factors exerted far weaker, although not inconsequential, influences on walking and bicycling than control variables. Stronger evidence on the importance of urban landscapes in shaping foot and bicycle travel is needed if the urban planning and public health professions are to forge an effective alliance against car-dependent sprawl.     

Reliability and validity of two instruments designed to assess the walking and bicycling suitability of sidewalks and roads

PURPOSE: Public health professionals hypothesize that when community environments provide suitable walking and bicycling conditions, community members will be more active. Measurement indicators and assessment instruments are needed to evaluate suitability. This study determined the reliability and validity of two instruments to assess the suitability of sidewalks for walking and roads for bicycling. METHODS: Two data collectors used walking and bicycling suitability assessment instruments to collect data on 31 road segments. In addition, three transportation experts used a 7-point Likert response system to subjectively evaluate walking and bicycling conditions for the same segments. Intraclass correlations determined the reliability of each assessment instrument and the reliability of the Likert response system. Pearson correlations (research staff assessments with expert assessments) were calculated to determine the criterion-related validity of the suitability measures. RESULTS: Intercoder reliability (intraclass) correlations for the walking and bicycling assessment instruments were r = .79 and .90, respectively. Intercoder reliability of the experts' Likert response system was r = .73 for the walking form and r = .77 for the bicycling form. Criterion-related validity (Pearson) correlations for the walking and bicycling assessment instruments were r = .58 and .62, respectively. CONCLUSION: Although some variables have lower reliability and validity than is ideal, the walking and bicycling suitability assessment instruments appear promising as instruments for community members and professionals to systematically assess key aspects of the physical environment.     

Environmental and demographic correlates of bicycling

Objective

The present study examined correlates of bicycle ownership and bicycling frequency, and projected increases in cycling if perceived safety from cars was improved.

Methods

Participants were 1780 adults aged 20–65 recruited from the Seattle, Washington and Baltimore, Maryland regions (48% female; 25% ethnic/racial minority) and studied in 2002–2005. Bicycling outcomes were assessed by survey. Multivariable models were conducted to examine demographic and built environment correlates of bicycling outcomes.

Results

About 71% of the sample owned bicycles, but 60% of those did not report cycling. Among bicycle owners, frequency of riding was greater among young, male, White, educated, and lean subgroups. Neighborhood walkability measures within 1 km were not consistently related to bicycling. For the whole sample, bicycling at least once per week was projected to increase from 9% to 39% if bicycling was safe from cars. Ethnic-racial minority groups and those in the least safe neighborhoods for bicycling had greater projected increases in cycling if safety from traffic was improved.

Conclusion

Implementing measures to improve bicyclists' safety from cars would primarily benefit racial-ethnic groups who cycle less but have higher rates of chronic diseases, as well as those who currently feel least safe bicycling.     

Endoscopic decontamination: an audit and practical review

A comprehensive audit of endoscopic decontamination practices throughout a 1200-bedded teaching hospital trust was undertaken, prior to a review of the current policy and consideration of alternative disinfectants. Pharmacy records of glutaraldehyde usage, occupational health staff survey data of glutaraldehyde exposure, discussions with all departments where endoscopy might be conducted and information from all companies supplying endoscopes and allied equipment were reviewed. In total, 56 endoscopes were found to be in use in 16 areas of the Trust. In the main designated endoscopy units, compliance with the established policy was generally good, but in other areas, equipment which could tolerate autoclaving was being disinfected with chemical sterilants; some units were still using endoscopes which were not fully immersible and there was widespread use of disinfectant troughs, rather than automated washer-disinfectors. In most cases, this was because staff were concerned about endoscopy equipment passing to a central processing department with potential delays and losses. An updated Trust-wide endoscopy policy, using glutaraldehyde and incorporating the current British Thoracic Society, British Gastroenterological Society and British Urological Society guidelines, has now been implemented. The issues around this and alternative disinfectants are discussed.     

Night eating syndrome: evaluation of two screening instruments

The purpose of the present study was to determine whether night eating syndrome was associated with treatment outcomes during a brief weight loss intervention for self-identified night snackers, and to evaluate the diagnostic utility of a screening question and the Night Eating Syndrome Questionnaire (NESQ) for the detection of night eating syndrome. Participants enrolled in a 4-week randomized clinical trial for obese and overweight persons who self-identified as night snackers were administered a structured clinical interview, a night eating screening question, and the NESQ. Treatment outcomes included adherence and weight loss. Results showed that night eating syndrome diagnoses were not associated with treatment outcomes. The screening question had adequate sensitivity but poor specificity. The night eating questionnaire was positively correlated with increasingly stringent definitions of night eating syndrome. Night eating syndrome is not the equivalent of night snacking. The definition of night eating syndrome must be expanded to include a sleep disturbance component accompanied by night eating.     

Pap smear screening at an urban Aboriginal health service: report of a practice audit and an evaluation of recruitment strategies

A culturally appropriate women's health service was established at an Aboriginal community-controlled health service in Darwin in 1994. An initial file audit found that 48% of included women had ever been screened with a Pap smear and 37% of women were considered to have been adequately screened. The enhancement of opportunistic screening by file tagging had a modest effect on screening coverage over a 12-month period for women who attended the health service. The proportion of these women who were adequately screened increased from 43% to 48% and of those ever screened increased from 54% to 62%. A randomised trial of recruitment interventions including personal approach, letter and control groups was subsequently performed for women for whom Pap smears were overdue or not recorded. The impact of both interventions on the number of Pap smears performed was low, with 7% of women in the personal approach group, 2% of women in the letter group and no women in the control group having Pap smears during the three-month follow-up period. Low rates of abnormalities were observed for women having Pap smears over a two-year period. The minimal effect of a formal reminder system and letters at this urban Aboriginal health service has resulted in a re-orientation of activities towards strengthening opportunistic screening and the continued promotion of Pap smears in a range of clinic and community settings. It is important to place Pap smear screening in the context of other social, economic and health priorities for Aboriginal women and health workers.     

Occupational health management: an audit tool

BACKGROUND: Organizations must manage occupational health risks in the workplace and the UK Health & Safety Executive (HSE) has published guidance on successful health and safety management. AIMS: This paper describes a method of using the published guidance to audit the management of occupational health and safety, first at an organizational level and, secondly, to audit an occupational health service provider's role in the management of health risks. The paper outlines the legal framework in the UK for health risk management and describes the development and use of a tool for qualitative auditing of the efficiency, effectiveness and reliability of occupational health service provision within an organization. The audit tool is presented as a question set and the paper concludes with discussion of the strengths and weaknesses of using this tool, and recommendations on its use.     

Leg ulcer care: an audit of cost-effectiveness

Our objective was to establish an audit mechanism to determine the cost and effectiveness of leg ulcer care across two Health Authorities. Following identification of all patients with active ulcers over a two-month period, leg ulcer treatment, costs and outcome were prospectively audited over three months. We found that leg ulcer care is currently expensive and appears to be largely ineffective, especially when compared to the community clinic approach.     

Unification of medical instruments and evaluation of its level

Consideration is given to the general methodologic approach to unify medical instruments. It is based on an analysis of specific parameters of medical instruments to be unified and on characteristics of medical instrumentation production. The technique of calculating the unification level for an individual product and for a group of uniform products is demonstrated as exemplified by medical forceps.     

Incomplete excision of basal cell carcinomas: an audit

The Plastic Surgery Department undertook an audit of the rate of excision of basal cell carcinomas (BCCs) at St George's Hospital. The aim of the audit was to determine the rate of incomplete excision of BCCs excised by the department over a six-month period and compare it with national audit figures. The rate of incomplete excision was 13.73 per cent or seven out of 51 BCCs, which compared favourably with the rates quoted in the literature. No change in the management of basal cell carcinomas was made.     

Utilitarian bicycling: a multilevel analysis of climate and personal influences

BACKGROUND: Increasing utilitarian bicycling in urban areas is a means to reduce air and noise pollution, increase physical activity, and reduce the risk of chronic diseases. We investigated the impact of individual- and city-level characteristics on bicycling in Canadian cities to inform transportation and public health policies. METHODS: The study population included 59,899 respondents to the 2003 Canadian Community Health Survey (CCHS) living in cities with populations greater than 50,000. In 2005, data on individual characteristics were drawn from the CCHS, and city-level climate data from Environment Canada records. Separate multilevel logistic regression models were developed for the general (nonstudent) and student populations. RESULTS: The proportion of the urban population reporting bicycling in a typical week was 7.9%, with students cycling more than nonstudents (17.2% vs 6.0%). In the general population, older age, female gender, lower education, and higher income were associated with lower likelihood of cycling. More days of precipitation per year and more days of freezing temperatures per year were both associated with lower levels of utilitarian cycling (odds ratios [ORs] for every 30-day increase in precipitation=0.84, 95% confidence interval [CI]=0.74-0.94, and for every 30-day increase in freezing temperatures OR=0.91, 95% CI=0.86-0.97). There was less variation in the proportion of students who cycled by age and income, and only the number of days with freezing temperatures influenced bicycling. CONCLUSIONS: Bicycling patterns are associated with individual demographic characteristics and the climate where one lives. This evidence might be useful to guide policy initiatives for targeted health promotion and transportation infrastructure.     

Formative evaluation of AARP's Active for Life campaign to improve walking and bicycling environments in two cities

AARP conducted a 2.5-year social-marketing campaign to improve physical activity levels among older adults in Richmond, Virginia and Madison, Wisconsin. This article presents formative evaluation findings from the campaign's policy/environmental change component. Evaluation data were abstracted from technical-assistance documentation and telephone interviews. Results include 11 policy and 14 environmental changes attained or in-process by campaign closure. Differences between the cities' results are explained through differences in program implementation (e.g., types of changes planned, formalization of partnerships). Project teams took less time deciding to pursue policy change than environmental change; however, planning the policy activities took longer than planning environmental-change activities. Recommendations for future policy/environmental change interventions focus on the selection of strategies; planning for administrative resources; formalizing partnerships to ensure sustainability of impact; ensuring training and technical assistance; and documenting progress. Similar intervention results may be attainable with a multi-year timeframe, adequate part-time coordination, and committed volunteers.