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Li Ming Wen School of Public Health, University of Sydney

Promoting active transport: benefits, strategies and challenges. Li Ming Wen School of Public Health, University of Sydney South Western Sydney and Sydney Local Health Districts lmwen@email.cs.nsw.gov.au. Welcome to Sydney. Plan for the talk.

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Li Ming Wen School of Public Health, University of Sydney

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  1. Promoting active transport: benefits, strategies and challenges Li Ming Wen School of Public Health, University of Sydney South Western Sydney and Sydney Local Health Districts lmwen@email.cs.nsw.gov.au

  2. Welcome to Sydney

  3. Plan for the talk • Brief introduction of active transport/travel (AT) and health benefits • Potential strategies in promoting AT (our experience/journey) • Discuss challenges in promoting AT

  4. Active Transport (Travel) • Non-motorised transport involving physical activity, such as walking, cycling and public transport (trips that include walking or cycling components) • Widely promoted as a means of increasing physical activity at population level • 30 minutes of moderately vigorous physical activity per day on most days of the week recommended • Builds physical activity into routine travel activities.

  5. Trends in Active Transport 2001-2011 Proportion of journeys to work made by walking, bicycle and overall active travel (walking and cycling) in inner Sydney, outer Sydney and the Greater Metropolitan Region by Census year.

  6. Potential benefits of active transport • Increasing daily physical activity levels • Reducing overweight and obesity (+/-) • Reducing traffic congestion, air pollution and greenhouse gas emissions • Improved social well-being and greater sense of community • WHO identified vehicle transport as the main cause of air pollution, the key factor in road accidents and a major contributor to sedentary lifestyles.* *WHO Regional Office for Europe 1999, Charter on Transport, Environment and Health

  7. Driving to work and overweight/obesity • Cross-sectional data from the 2003 New South Wales Adult Health Survey • 6810 respondents • Study variables: SES Physical activity Usual modes of transport to work. Wen LM, Orr N, Millett C, Rissel C. Driving to work is associated with overweight and obesity: Findings from the 2003 New South Wales Health Survey. International Journal of Obesity. 2006;30.782-786

  8. Driving to work and overweight/obesity • Modes of transport to work: 69% driving 15% by public transport 7% walking only 2% cycled and 6% worked at home. • Overweight or obesity: 45.8% • Driving to work was associated with overweight or obese with an adjusted odds ratios of 1.13 (95%CI 1.01-1.27). Wen LM, Orr N, Millett C, Rissel C. Driving to work is associated with overweight and obesity: Findings from the 2003 New South Wales Health Survey. International Journal of Obesity. 2006;30.782-786

  9. Driving to work and overweight/obesity Men who cycled to work were significantly less likely to be: • Overweight and obese (39.8%) compared with those driving to work (60.8%), with an adjusted odds ratio of 0.49 (95% CI: 0.31-0.76) • Obese (5.4%) with an adjusted odds ratio 0.34 (95% CI: 0.13-0.87). Men who used public transport to work were also significantly less likely to be overweight and obese (44.6%) with an adjusted odds ratio of 0.65 (95% CI: 0.53-0.81). However, these inverse relationships were not found in women. Wen, LM., Rissel, C. (2008), Inverse associations between cycling to work, public transport, and overweight and obesity: Findings from a population based study in Australia. Preventive Medicine 46(1), 29-32.

  10. Active travel to work in NSW 2005–2010, individual characteristics and association with BMI • There were no changes in the proportions of employed respondents walking or cycling to work with estimates ranging from 5.1–7.3% usually walking, and 1.4–1.8% usually cycling • Walking and cycling were both independently and significantly associated with lower BMI for men, but only walking was associated with lower BMI for women • People who walked or cycled to work had higher levels of education, after adjusting for age, sex, income and residence. Rissel, C., Greenaway, M., Bauman, A. and Wen, L. M. (2013), Active travel to work in New South Wales 2005–2010, individual characteristics and association with body mass index. Australian and New Zealand Journal of Public Health. doi: 10.1111/1753-6405.12097

  11. Active transport and health outcomes: findings from a population study in Jiangsu, China • 8400 community residents aged 18 or above in 2010 • 50% actively travelled to work • AT respondents had a higher prevalence of cholesterol disorder • AT respondents had a higher risk of diabetes • Decreased AT had a lower risk of obesity, central obesity, and cholesterol disorder • Findings of this study do not support the notion that AT is beneficial to population health • Further research is needed in determining the negative side effects of AT. *Shu-rongLu et al Active Transport and Health Outcomes: Findings from a Population Study in Jiangsu, China. Journal of Environmental and Public Health Volume 2013 (2013), http://dx.doi.org/10.1155/2013/624194

  12. 2013 systematic review of the relationships between active transport and health outcomes • A total of 3887 articles were identified • 76 studies included in the review • Found active transport had a benefit effect on: Xu, H., Wen, LM., Rissel, C. (2013), The Relationships Between Active Transport to Work or School and Cardiovascular Health or Body Weight: A Systematic Review. Asia-Pacific Journal of Public Health. 25(4), 298-315.

  13. 2013 systematic review of the relationships between active transport and health outcomes • Evidence limited by: Lack of comparability of study outcomes Weak study designs Small sample sizes Lack of experimental studies. • Review called for stronger research designs (e.g. RCT). *Xu, H., Wen, L.M, Rissel, C. (2013), The Relationships Between Active Transport to Work or School and Cardiovascular Health or Body Weight: A Systematic Review. Asia-Pacific Journal of Public Health. 25(4), 298-315

  14. Potential strategies in promoting AT • Urban structure/planning designed so walking and cycling trips are convenient, pleasant and safe • New growth areas that have a variety of destinations (such as schools and shops) within walking or cycling distance • A traffic network with a highly interconnected cycling/walking path network and a coordinated network of streets with bike lanes, pedestrian • Major public transport interchanges located within activity centres, and these activity centres located ‘on the way’ to somewhere else • Bicycle storage facilities at public transport stations to enable users to cycle and then connect with public transport

  15. Potential strategies in promoting AT • Generating evidence • Advocacy • Health Promotion • Leadership • Demonstrated benefits • Sustainability

  16. Interventions to promote AT: workplace • Health Service staff targeted over 12 months • Combination of social marketing strategies and personal travel plans • Before/after assessment • Positive improvements in knowledge and attitude • % drive to work on five days decreased (82 to 62%) • Zero trips by car on weekend increased (20 to 29%) Wen LM, Orr N, Bindon J, Rissel C. Promoting active transport in a workplace setting: evaluation of a pilot study in Australia. Health Promotion International2005; 20(2): 123-133.

  17. The role of workplaces in reducing driving to work by employees • Role of workplaces in promoting active travel relatively unexplored • Cross-sectional survey with 888 respondents • Significant inverse association between workplace encouragement for active travel and driving to work • More workplaces encouraging employee active travel to work could lead to fewer employees driving to work • Promoting active travel to work needs to include positive workplace policies and supportive environments, making the choice of active travel easier than driving. Wen, L.M, Kite, J., Rissel, C. (2010), Is there a role for workplaces in reducing employees' driving to work? Findings from a cross-sectional survey from inner-west Sydney, Australia. BMC Public Health. 10, 50.

  18. Interventions to promote AT: community Cycling Connecting Communities • Quasi-experimental design • Three year intervention study • Does promoting new infrastructure increase cycling? • Would an increase in cycling mean an increase in population levels of physical activity?

  19. Interventions to promote AT: community • Major Events e.g. Ride to Work, launch, Spring Cycle, path discovery day • Minor events e.g. BUG rides • Skills courses

  20. Interventions to promote AT: community • Two newly built bike paths – one intervention and one comparison area – with bike counters • Telephone survey of residents living within 2 kilometres of bicycle path - pre and post with cohort of respondents • Significant increase in use of bicycle paths • No changes in overall physical activity Rissel, C., New, C., Wen, LM., Merom, D., Bauman, A., Garrard, J. (2010), The effectiveness of community-based cycling promotion: findings from the Cycling Connecting Communities project in Sydney, Australia. The international journal of behavioral nutrition and physical activity. 7(1), 8.

  21. Interventions to promote AT: school setting • Cluster randomised trial (2005-2007) • Over 2200 students and their parents at 24 public primary schools • Goal – to increase the number of students (aged 10-12 years) who walk all or some of the way to and from school Wen, L,M, Fry, D., Rissel, C., Dirkis, H., Balafas, A., Merom, D. (2008), Factors associated with children being driven to school: implications for walk to school programs. Health education research. 23(0), 325-34. Wen, LM., Fry, D., Merom, D., Rissel, C., Dirkis, H., Balafas, A. (2008), Increasing active travel to school: Are we on the right track? A cluster randomised controlled trial from Sydney, Australia. Preventive Medicine. 47(6), 612-8

  22. Central Sydney Walk to School program • Schools – diverse in size, location, safety and proximity to public transport, and in socio-economic status and cultural mix of students and parents. • Activities for schools: teacher Professional Development, student and parent surveys, parent newsletters, development of a Travel Access Guide for each school, pedometer programs, preparing for high school. • Work with councils to identify and fix barriers to active and safe travel near schools.

  23. Central Sydney Walk to School program • In both the intervention and control groups, the number of students who walked to and from school increased • The program’s intervention had a small positive effect, but the difference was not statistically significant • High variability in results from school to school (increases in walking ranged from -14% to 17%). Wen, LM., Fry, D., Merom, D., Rissel, C., Dirkis, H., Balafas, A. (2008), Increasing active travel to school: Are we on the right track? A cluster randomised controlled trial from Sydney, Australia. Preventive Medicine. 47(6), 612-8

  24. Factors associated with modes of travel to school • Most students went to and from school by car • Student travel patterns vary within the week • High variation from school to school • 80% of students taken to school by their mothers • The factor most strongly associated with students being driven to school is their parent’s car journey to work Wen, L.M, Fry, D., Rissel, C., Dirkis, H., Balafas, A., Merom, D. (2008), Factors associated with children being driven to school: implications for walk to school programs. Health education research. 23(0), 325-34.

  25. Challenges for promoting active transport • At macro level: A multi-sector/partnership approach is needed, involving (urban planning, transport, health, workplace, school, community, etc.). • At micro level (from public health perspective): Generating evidence Advocacy Health Promotion Leadership Demonstrated benefits Sustainability .

  26. How to evaluate the effect of active transport interventions • Research design • Outcome measures • Long term follow-up • Sustainability

  27. Thank You Contact details: A/Prof. Li Ming Wen Sydney Medical School, University of Sydney Research & Evaluation Manager Health Promotion Service South Western Sydney & Sydney Local Health Districts Level 9 North, King George V Building Missenden Rd. Camperdown NSW 2050, Australia Email: lmwen@email.cs.nsw.gov.au

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