By your own two feet: factors associated with active transportation in Canada

OBJECTIVE: The purpose of this study is to examine socio-demographic, geographic and physical activity correlates of walking and cycling for non-leisure purposes, i.e., to work, school, or errands, in Canada. METHODS: Cross-sectional data from the Canadian Community Health Survey (CCHS) 2003 (n = 127,610) were analyzed using logistic regression to identify factors associated with active transportation. The dependent variables were walking 6+ hours per week and any cycling per week. Independent variables were based on age; marital, education, working and immigrant status; income; geographic location; smoking; and other physical activity. RESULTS: Age and income were associated with both walking and cycling, as was geographic location and other physical activity. The results demonstrated that, while similar, walking and cycling are associated with different factors, and that socio-demographic, geographic and health behaviour variables must be taken into consideration when modelling these transportation modes. CONCLUSIONS: Although walking and cycling are relatively easy means to incorporate physical activity in daily life, these results suggest that it is the young and the physically active who engage in them. This research points to a need to address barriers among those who could benefit the most from increased use of both modes of travel.     

Relationships among community characteristics and walking and bicycling for transportation or recreation

PURPOSE: Compare walking and bicycling for transportation and recreation with the percentage of the community devoted to parklands. METHODS: Behavioral Risk Factor Surveillance System (N = 206,992), Nationwide Personal Transportation Survey (N = 409,025), and Trust for Public Land (N = 55) data were used to estimate recreational walking and bicycling, utilitarian walking and bicycling, and parkland as a percentage of city acreage. Data were linked at the metropolitan statistical area or city level (N = 34). Pearson correlation coefficients were used to assess the associations among recreational and utilitarian walking and bicycling and parkland acreage. RESULTS: Utilitarian walking and bicycling and parkland acreage were significantly correlated (r = .62, p < .0001). No significant relationships were observed for leisure time walking or bicycling. DISCUSSION: Communities with more parks had significantly higher levels of walking and bicycling for transportation. Urban design features associated with leisure time physical activity might differ from those associated with transportation-related physical activity. Further studies are needed to articulate the relationships among community attributes and purposes of physical activity.     

Built Environment Influences on Healthy Transportation Choices: Bicycling versus Driving

A growing body of evidence links the built environment to physical activity levels, health outcomes, and transportation behaviors. However, little of this research has focused on cycling, a sustainable transportation option with great potential for growth in North America. This study examines associations between decisions to bicycle (versus drive) and the built environment, with explicit consideration of three different spatial zones that may be relevant in travel behavior: trip origins, trip destinations, and along the route between. We analyzed 3,280 utilitarian bicycle and car trips in Metro Vancouver, Canada made by 1,902 adults, including both current and potential cyclists. Objective measures were developed for built environment characteristics related to the physical environment, land use patterns, the road network, and bicycle-specific facilities. Multilevel logistic regression was used to model the likelihood that a trip was made by bicycle, adjusting for trip distance and personal demographics. Separate models were constructed for each spatial zone, and a global model examined the relative influence of the three zones. In total, 31% (1,023 out of 3,280) of trips were made by bicycle. Increased odds of bicycling were associated with less hilliness; higher intersection density; less highways and arterials; presence of bicycle signage, traffic calming, and cyclist-activated traffic lights; more neighborhood commercial, educational, and industrial land uses; greater land use mix; and higher population density. Different factors were important within each spatial zone. Overall, the characteristics of routes were more influential than origin or destination characteristics. These findings indicate that the built environment has a significant influence on healthy travel decisions, and spatial context is important. Future research should explicitly consider relevant spatial zones when investigating the relationship between physical activity and urban form.     

Promoting safe walking and cycling to improve public health: lessons from The Netherlands and Germany

OBJECTIVES: We examined the public health consequences of unsafe and inconvenient walking and bicycling conditions in American cities to suggest improvements based on successful policies in The Netherlands and Germany. METHODS: Secondary data from national travel and crash surveys were used to compute fatality trends from 1975 to 2001 and fatality and injury rates for pedestrians and cyclists in The Netherlands, Germany, and the United States in 2000. RESULTS: American pedestrians and cyclists were much more likely to be killed or injured than were Dutch and German pedestrians and cyclists, both on a per-trip and on a per-kilometer basis. CONCLUSIONS: A wide range of measures are available to improve the safety of walking and cycling in American cities, both to reduce fatalities and injuries and to encourage walking and cycling.     

Estimating the Size of the MSM Population in Metro Vancouver,Canada, Using Multiple Methods and Diverse Data Sources

Men who have sex with men (MSM) are disproportionately affected by HIV globally, regionally in Canada, and locally in Vancouver. Lack of reliable population size estimates of MSM impedes effective implementation of health care services and limits our understanding of the HIV epidemic. We estimated the population size of MSM residing in Metro Vancouver drawing on four data sources: the Canadian Community Health Survey (CCHS), a cross-sectional bio-behavioural MSM survey, HIV testing services data from sexually transmitted infection (STI) clinics serving MSM, and online social networking site Facebook. Estimates were calculated using (1) direct estimates from the CCHS, (2) “Wisdom of the Crowds” (WOTC), and (3) the multiplier method using data from a bio-behavioural MSM survey, clinic-based HIV testing, and online social media network site Facebook. Data sources requiring greater public disclosure of sexual orientation resulted in our mid-range population estimates (Facebook 23,760, CCHS 30,605). The WOTC method produced the lowest estimate, 10,000. The multiplier method using STI clinic HIV testing data produced the largest estimate, 41,777. The median of all estimates was 27,183, representing 2.9% of the Metro Vancouver census male adult population, with an interquartile range of 1.1–4.5%. Using multiple data sources, our estimates of the MSM population in Metro Vancouver are similar to population prevalence estimates based on population data from other industrialized nations. These findings will support understanding of the HIV burden among MSM and corresponding public health and health services planning for this key population.     

Evaluation of daily time spent in transportation and traffic-influenced microenvironments by urban Canadians

Exposure to traffic and traffic-related air pollution is associated with a wide array of health effects. Time spent in a vehicle, in active transportation, along roadsides, and in close proximity to traffic can substantially contribute to daily exposure to air pollutants. For this study, we evaluated daily time spent in transportation and traffic-influenced microenvironments by urban Canadians using the Canadian Human Activity Pattern Survey (CHAPS) 2 results. Approximately 4–7% of daily time was spent in on- or near-road locations, mainly associated with being in a vehicle and smaller contributions from active transportation. Indoor microenvironments can be impacted by traffic emissions, especially when located near major roadways. Over 60% of the target population reported living within one block of a roadway with moderate to heavy traffic, which was variable with income level and city, and confirmed based on elevated NO₂ exposure estimated using land use regression. Furthermore, over 55% of the target population ≤?18 years reported attending a school or daycare in close proximity to moderate to heavy traffic, and little variation was observed based on income or city. The results underline the importance of traffic emissions as a major source of exposure in Canadian urban centers, given the time spent in traffic-influenced microenvironments.     

Walking and bicycling: an evaluation of environmental audit instruments

PURPOSE: This paper reviews existing environmental audit instruments used to capture the walkability and bikability of environments. The review inventories and evaluates individual measures of environmental factors used in these instruments. It synthesizes the current state of knowledge in quantifying the built environment. The paper provides health promotion professionals an understanding of the essential aspects of environments influencing walking and bicycling for both recreational and transportation purposes. It serves as a basis to develop valid and efficient tools to create activity-friendly communities. DATA SOURCES: Keyword searches identified journal articles from the computer-based Academic Citation Databases, including the National Transportation Library, the Web of Science Citation Database, and MEDLINE. Governmental publications and conference proceedings were also searched. STUDY INCLUSION AND EXCLUSION CRITERIA: All instruments to audit physical environments have been included in this review, considering both recreation- and transportation related walking and bicycling. Excluded are general methods devised to estimate walking and cycling trips, those used in empirical studies on land use and transportation, and research on walking inside buildings. DATA EXTRACTION METHODS: Data have been extracted from each instrument using a template of key items developed for this review. The data were examined for quality assurance among three experienced researchers. DATA SYNTHESIS: A behavioral model of the built environment guides the synthesis according to three components: the origin and destination of the walk or bike trip, the characteristics of the road traveled, and the characteristics of the areas surrounding the trip's origin and destination. These components, combined with the characteristics of the instruments themselves, lead to a classification of the instruments into the four categories of inventory, route quality assessment, area quality assessment, and approaches to estimating latent demand for walking and bicycling. Furthermore, individual variables used in each instrument to measure the environment are grouped into four classes: spatiophysical, spatiobehavioral, spatiopsychosocial, and policy-based. MAJOR CONCLUSIONS: Individually, existing instruments rely on selective classes of variables and therefore assess only parts of built environments that affect walking and bicycling. Most of the instruments and individual measures have not been rigorously tested because of a lack of available data on walking and bicycling and because of limited research budgets. Future instrument development will depend on the acquisition of empirical data on walking and bicycling, on inclusion of all three components of the behavioral model, and on consideration of all classes of variables identified.     

COVID-19 street reallocation in mid-sized Canadian cities: socio-spatial equity patterns

InterventionStreet reallocation interventions in three Canadian mid-sized cities: Victoria (British Columbia), Kelowna (British Columbia), and Halifax (Nova Scotia) related to the COVID-19 pandemic.Research questionWhat street reallocation interventions were implemented, and what were the socio-spatial equity patterns?MethodsWe collected data on street reallocations (interventions that expand street space for active transportation or physical distancing) from April 1 to August 15, 2020 from websites and media. For each city, we summarized length of street reallocations (km) and described implementation strategies and communications. We assessed socio-spatial patterning of interventions by comparing differences in where interventions were implemented by area-level mobility, accessibility, and socio-demographic characteristics.ResultsTwo themes motivated street reallocations: supporting mobility, recreation, and physical distancing in populous areas, and bolstering COVID-19 recovery for businesses. The scale of responses ranged across cities, from Halifax adding an additional 20% distance to their bicycle network to Kelowna closing only one main street section. Interventions were located in downtown cores, areas with high population density, higher use of active transportation, and close proximity to essential destinations. With respect to socio-demographics, interventions tended to be implemented in areas with fewer children and areas with fewer visible minority populations. In Victoria, the interventions were in areas with lower income populations and higher proportions of Indigenous people.ConclusionIn this early response phase, some cities acted swiftly even in the context of massive uncertainties. As cities move toward recovery and resilience, they should leverage early learnings as they act to create more permanent solutions that support safe and equitable mobility.     

Seasonal variation in leisure-time physical activity among Canadians

BACKGROUND: Cardiovascular disease (CVD) mortality is higher in winter than summer, particularly in cold climates. Physical activity reduces CVD risk but climate impacts participation in physical activity. Canada has substantial climatic variation but its relation with physical activity is understudied. In this investigation, we evaluated the relation between seasonality and physical activity among Canadians. METHODS: We used public domain data from the Canadian Community Health Survey, Cycle 2.2 (CCHS 2.2), a representative, cross-sectional sample of free-living Canadians in 2004. Leisure-time physical activity was measured using a modified version of the Physical Activity Monitor that was validated. Season was determined by the time of the interview, i.e., Winter: January 1 to March 31, Spring: April 1 to June 30, Summer: July 1 to September 30, and Fall: October 1 to December 31. In all multivariate models, we adjusted for age, sex, education, and income adequacy. RESULTS: There were 20,197 persons aged 19 years and older in this analysis. In the winter, 64% of Canadians were inactive as compared with 49% in the summer. Total average daily energy expenditure was 31.0% higher in summer than winter after multivariate adjustment. Leisure-time physical activity was 86% more likely in the summer than winter (multivariate OR = 1.86, 95% CI 1.40, 2.45). The relation between seasonality and physical activity was weakest in Newfoundland and Labrador and stronger in Saskatchewan and British Columbia (p-value for interaction = 0.02). INTERPRETATION: Seasonality impacts physical activity patterns in Canada and varies across the provinces. This needs to be considered in physical activity programming.     

Effect modification by community characteristics on the short-term effects of ozone exposure and mortality in 98 US communities

Previous research provided evidence of an association between short-term exposure to ozone and mortality risk and of heterogeneity in the risk across communities. The authors investigated whether this heterogeneity can be explained by community-specific characteristics: race, income, education, urbanization, transportation use, particulate matter and ozone levels, number of ozone monitors, weather, and use of air conditioning. Their study included data on 98 US urban communities for 1987 to 2000 from the National Morbidity, Mortality, and Air Pollution Study; US Census; and American Housing Survey. On average across the communities, a 10-ppb increase in the previous week's ozone level was associated with a 0.52% (95% posterior interval: 0.28, 0.77) increase in mortality. The authors found that community-level characteristics modify the relation between ozone and mortality. Higher effect estimates were associated with higher unemployment, fraction of the Black/African-American population, and public transportation use and with lower temperatures or prevalence of central air conditioning. These differences may relate to underlying health status, differences in exposure, or other factors. Results show that some segments of the population may face higher health burdens of ozone pollution.     

Trends in mental health inequalities in urban Canada

ObjectivesCanadians do not all enjoy equal levels of health. The presence of income-related health inequalities has been well established in Canada, but there is a lack of consistent reporting of mental health inequalities in Canada’s largest cities. This study reports the prevalence and inequalities in mental health outcomes at the city, provincial, and national levels over time.MethodsSelf-reported poor mental health, life stress, and physician-diagnosed self-reported mood and anxiety disorder from the Canadian Community Health Survey were pooled over five-year intervals and combined with neighbourhood income information from the Canadian Census. First, prevalence rates were calculated for each interval at the neighbourhood level for urban communities. Second, the distributions of these neighbourhood rates were summarized at the city level and for Canada as a whole using overall prevalence rates and concentration indices of inequality. Finally, trends in these city- and country-level outcomes were also explored.ResultsAt the national level, starting from 2001 to 2005, the prevalence of poor mental health (27.9%), mood disorder (7.3%), and anxiety disorder (6.8%) had significantly increased by 2011–2015. Inequalities were present in 2001–2005 and worsened over time. The prevalence rate at the national level of life stress was 66.6% in 2001–2005 and decreased over time.ConclusionThe large and increasing values of inequalities and the difference in prevalence rates and inequalities in cities highlight the necessity for mental disorder-specific data and for city-level analysis of inequalities. The next steps in reducing inequalities involve deconstructing the health inequalities, and continued monitoring.     

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.     

我国中小学生上下学交通方式分析

目的分析我国中小学生上下学交通方式,为制定相应干预措施提供基础资料。方法利用2002年中国居民营养与健康状况调查的数据,对我国中小学生上下学交通情况进行分析。采取多阶段分层整群随机抽样的方法,由经过培训的调查员采用面对面询问方式进行资料收集,调查问卷为《一年回顾性身体活动调查表》中交通方式部分,内容包括中小学生上下学采取的交通方式和平均每天上下学时间。结果共11113名中小学生完成了调查表,其中男生5878人,女生5235人。中小学生上下学的主要交通方式是步行,占73．4％（8152人）,其次为骑车、坐车及多种交通方式,分别为15．1％（1682人）、6．1％（674人）和5．4％（605人）。小学生、农村学生、低收入家庭学生以步行交通方式为主,初中生、高中生／中专生、城市学生采取步行和骑车交通方式的比例均较高。中小学生平均每天上下学的时间：步行为36．5±27．0分钟,骑车为43．5±28．6分钟,坐车为43．2±34．5分钟。初中生、高中生／中专生骑车上下学时间较长,农村学生和低收入家庭学生步行和骑车时间均较长,高中生／中专生、城市学生坐车上下学时间较长。结论我国中小学生步行和骑车上下学比例较高,年龄、地区和家庭收入影响中小学生的交通模式。     

Association between passively collected walking and bicycling data and purposefully collected active commuting survey data—United States, 2019

Commercially-available location-based services (LBS) data derived primarily from mobile devices may provide an alternative to surveys for monitoring physically-active transportation. Using Spearman correlation, we compared county-level metrics of walking and bicycling from StreetLight with metrics of physically-active commuting among U.S. workers from the American Community Survey. Our strongest pair of metrics ranked counties (n = 298) similarly for walking (rho = 0.53 [95% CI: 0.44–0.61]) and bicycling (rho = 0.61 [0.53–0.67]). Correlations were higher for denser and more urban counties. LBS data may offer public health and transportation professionals timely information on walking and bicycling behavior at finer geographic scales than some existing surveys.     

The burden of multiple sclerosis: A community health survey

Background  

Health-related quality of life (HRQL) in persons with multiple sclerosis (MS) who reside within the community relative to the general population is largely unknown. Data from the Canadian Community Health Survey Cycle 1.1 (CCHS 1.1) were used to compare HRQL of persons with MS and the general population.     

Changes in job stressors in the Canadian working population

OBJECTIVES: To determine the changes in levels of work stressors in a nationally representative sample of Canadian workers from 1994/95 to 2000/01. METHODS: We compared responses for an abbreviated version of the Job Content Questionnaire in two waves of the National Population Health Survey (NPHS). Other items and scales related to work and health were also analyzed. Data were transformed to range from 0 to 10. Comparisons of the 2000/01 data were also made with the Canadian Community Health Survey (CCHS) conducted in 2000. RESULTS: There were only very small absolute differences between NPHS 2000/01 data and CCHS 2000 data. The NPHS comparison from 1994/95 to 2000/01 showed an increase in job security (change in means = 0.49, 95% CI 0.39 to 0.58) and a decrease in job physical demands (change in means = 0.45, 95% CI 0.35 to 0.54). Other changes in work characteristics were small in absolute value. The combined "overall work stressors" index dropped by 0.12 (95% CI 0.08 to 0.15). CONCLUSIONS: Levels of work stressors did not increase over the period. Some subscales showed an improvement.     

Socioeconomic status and lung cancer risk in Canada

BACKGROUND: Several epidemiological studies have found that lung cancer is inversely related to socioeconomic status (SES) and suggest it as a possible risk factor for lung cancer. This study examines SES and lung cancer risk in Canada. METHODS: Mailed questionnaires with telephone follow-up were used to obtain data on 3280 newly diagnosed, histologically confirmed lung cancer cases and 5073 population controls, between 1994 and 1997, in eight Canadian provinces. Measurement included information on SES, smoking habits, alcohol use, diet, residential and occupational histories and both residential and occupational exposure to environmental tobacco smoke (ETS). Odds ratios (OR) and 95% CI were derived from unconditional logistic regression analysis. RESULTS: Compared with high income adequacy, an increased risk was found among low income males and females, with adjusted OR of 1.7 (95% CI : 1.3-2.2) and 1.5 (95% CI : 1.1-2.0), respectively. Compared with < or = 8 years of education, the adjusted OR were 0.6 (95% CI : 0.5-0.7) and 0.6 (95% CI : 0.5-0.8) for > or = 14 years education among males and females, respectively. Lung cancer risk was significantly increased for males of some social classes. The population attributable risk for income adequacy, education and social class was 24%, 25% and 21% among males, respectively, and 14% and 19% for income adequacy and education among females, respectively, in this Canadian population. CONCLUSIONS: A statistically significant association between income adequacy, education social class and lung cancer risk was found.     

Determinants of influenza immunization uptake in Canadian youths

Objective

To describe rate and determinants of influenza vaccination among Canadian youths.

Methods

We conducted an analysis of cross-sectional data from the Canadian Community Health Survey (CCHS) cycle 3.1 collected by Statistics Canada in 2005. This is a population-based survey collecting information pertaining to the Canadian population health status, health care utilization and health determinants. The CCHS 3.1 included 12,170 respondents age 12–17 years old who answered questions pertaining to influenza vaccination. We used multivariate logistic regression to estimate the odds of having received the influenza vaccination in the last 12 months, adjusting for potential confounders.

Results

Less than a quarter of Canadian youth reported receiving the influenza vaccination in the previous year. The most common reason for not getting the vaccination was “did not think it was necessary” (40.82%). Having chronic illness, and being an immigrant was significantly associated with a higher odds of receiving the influenza vaccination, while having an allergy and increasing frequency of alcohol drinking was associated with lower odds of receiving influenza vaccination. Smoking status acted as an effect modifier for many variables except for immigration status.

Conclusions

Influenza vaccination rate in Canadian youths is low. Judgement values on its necessity are a major factor in the decision to receive influenza vaccination. Strategies to involve youths in influenza vaccination programs and campaigns will be essential to achieve better national coverage.     

Consumption of Ultra-Processed Foods Is Associated with Free Sugars Intake in the Canadian Population

Excess sugar consumption can lead to noncommunicable diseases (NCDs) such as type 2 diabetes. Increasingly, ultra-processed foods (UPF) are suspected to be great contributors to free sugars intake in the population’s diet. Thus, the aim of this study was to investigate the association between UPF consumption and free sugars intake in the Canadian population. We used data from one 24 h-recall of the nationally representative 2015 Canadian Community Health Survey–Nutrition (CCHS). Food items were classified according to the NOVA system, and to estimate free sugars intake, we used the University of Toronto’s Food Label Information Program (FLIP) 2017 database. Results: Almost half of the population’s energy intake (45.7%) came from UPF. On average, 221.5 kcal/day came from free sugars, and most of these calories (71.5%) came from UPF. Public health policies aiming to decrease consumption of UPF should be a priority considering their important contribution to sugar intake in the population.     

The impact of transportation infrastructure on bicycling injuries and crashes: a review of the literature

Background  

Bicycling has the potential to improve fitness, diminish obesity, and reduce noise, air pollution, and greenhouse gases associated with travel. However, bicyclists incur a higher risk of injuries requiring hospitalization than motor vehicle occupants. Therefore, understanding ways of making bicycling safer and increasing rates of bicycling are important to improving population health. There is a growing body of research examining transportation infrastructure and the risk of injury to bicyclists.