Journal of Transport & Health最新文献

Introduction

Poor accessibility of immunization services coupled with limited options for transportation and socio-cultural norms that hinder women's mobility are among the key factors contributing to poor immunization coverage in rural areas. We assessed the feasibility and acceptability of establishing a free-of-cost, women-only carpool service for immunization in a rural setting in Pakistan and evaluated its preliminary impact on immunization coverage and timeliness among children.

Methods

We conducted a feasibility study in four selected immunization facilities in Shikarpur District, Sindh. A local transport vehicle was hired and branded as an immunization carpool service. Women having un- or under-immunized children aged ≤2 years were invited to visit immunization facilities using carpool vehicles. Information on demographic indicators and service experience was collected. Child immunization details were extracted using the government's provincial electronic immunization registry to estimate immunization coverage and timeliness.

Results

Between January and October 2020, six immunization carpool vehicles provided uninterrupted service and transported 2422 women-child pairs, completing 4691 immunization visits. Majority of women reported that the carpool service improved accessibility (99.6%) by offering group travel (82.9%) and reducing their dependency on family members (93.4%). Preliminary estimates reported an increase in immunization coverage and timeliness across antigens among participating children compared to non-participating children, with significant increase in proportion for BCG coverage (38.1%; p < 0.001, CI: 32.8%, 43.4%) and measles-2 timeliness (18%; p < 0.001, CI: 13.3%, 22.4%).

Conclusion

A women-only immunization carpool service implemented within a rural setting is feasible and highly acceptable. Key factors contributing to the model's success include increased mobility and independence of women, cost-savings, and a culturally and contextually appropriate mechanism of transport embedded within the local setting. Increased accessibility to health services also contributed to improved immunization coverage and timeliness among children.

Introduction

Injury and death from traffic incidents are still a major global concern and are associated with significant costs. Traffic incidents are preventable, but this requires planning based on accurate and complete injury data, otherwise efforts bypass targets.

Objectives

The objective was to compare the agreement between hospital and police records for parameters independently recorded by both datasets and to report the most frequent traffic incident setting reported by either dataset.

Methods

We analyzed routinely collected hospital records from Odense University Hospital, Denmark, for traffic injuries from 2015 to 2021. These include patient demographics and incident-related data (time and place of incident, road users involved, and collision mode) for all patients involved in traffic incidents. These injuries were then linked with police records from Funen Police District, which covers the same geographical area of the island Funen, Denmark.

Results

In total, 21,562 road users were injured and subsequently treated at the hospital, and 5176 (24.0%) of these suffered from severe injury.

The agreement between hospital and police records was for means of transport (passenger car/bicycle/moped/pedestrian/motorcycle) 93.9% [95% confidence interval: 93.0%, 94.9%], role (driver/passenger/pedestrian) 97.7% [97.1%, 98.3%], and use of seat belt/helmet 76.9% [75.2%, 78.6%]. The accuracy of police severity classification was 50.5% [47.0%, 54.0%], and the completeness of police-reported severe incidents was just 15.1% [14.1%, 16.0%] compared with hospital records.

The top-5 hospital-reported severe traffic incident setting was an injured cyclist with no counterpart on a city road (n = 1130), and 4 of 5 in this top-5 involved an injured cyclist.

The top-5 police-reported severe traffic incident setting was an injured cyclist with a passenger car counterpart on a city road (n = 116), and the remaining 4 in this top-5 involved an injured passenger car driver. Only one setting overlapped between hospital- and police-reported top-5 severe injury scenarios.

Conclusion

This study showed an extraordinarily high agreement between parameters independently recorded by hospital and police records, but police records misclassify severity and is not a reliable source for severe injuries.

Thus, road safety policies may not have the intended effect if preventive efforts are based solely on police-reported severe injuries. With the documented agreement on means of transport, role, and use of safety equipment we suggest that planning of preventive efforts is based on hospital records in areas where registration practices are sufficiently thorough supplemented by police data.

Introduction

An active lifestyle, including regular participation in physical activity and use of active travel, are associated with adolescent health and well-being; however, global levels of adolescent physical activity are low. This study was designed to further understand factors contributing to adolescent active travel behaviors, including policy, environment, community, social media platforms and social norms.

Methods

We conducted a cross-sectional survey at secondary schools across Israel during advanced stages of the COVID-19 pandemic (N = 2911; [ages 13–17]). Linear regression analyses investigate important factors associated with these behaviors. Discriminant analysis was used to determine which of the investigated variables made the greatest contribution to youth physical activity and active travel.

Results

Adolescent physical activity and active travel are associated with correlates at the community, interpersonal and personal levels of influence in line with the ecological model. Participation, messaging and message-sharing on social media platforms related to physical activity were associated with active behaviors. There is evidence regarding the cumulative effects of different active travel behaviors and physical activity. Adolescent active school travel is associated with active leisure travel, while engaging in active school travel and active leisure travel are associated with physical activity.

Conclusions

The findings regarding contribution of the environment, community, social norms and social media platforms to both physical activity and active travel behaviors support design of multilevel health promotion interventions for youth. Programs incorporating social media platforms and peer-to-peer communication in support of active travel may offer new opportunities to promote active and healthy adolescent behaviors.

Introduction

The built environment plays an important role in individuals’ propensity to walk and cycle and local authorities increasingly invest financial resources towards its development. Organisations responsible for the built environment have developed auditing tools as guidelines to inspect routes and identify improvements to support active travel.

Methods

Using these auditing tools as a starting point, this study developed 21 walking and 25 cycling investment-relevant factors that were embedded into two choice-based survey instruments, respectively. The study used cognitive interview pre-testing to internally validate a preference-based elicitation approach known as Best-Worst Scaling (BWS), which aimed to capture pedestrian and cyclist preferences. We report findings from cognitive interviews (data analysed thematically) with 20 participants (10 pedestrians and 10 cyclists).

Results

In both sets of interviews, four themes emerged regarding how the participants approached the BWS task and five themes related to the understanding of the factors. The BWS choice tasks required refinement regarding the ‘frame of reference’, ‘travel context’, the ‘decision-making strategy’, and the ‘concrete thinking’ (finding some factors easier to interpret). Additionally, issues with understanding the factors, the wording, ‘overlapping’, negatively phrased factors, and technical jargon all pointed towards the need to refine auditing tools if these were to be introduced in a preference elicitation context.

Conclusions

This study helps to empirically uncover how citizens interpret infrastructure related aspects of walking and cycling by pointing to nuanced aspects that auditing tools may miss. The findings also helped develop an internally consistent preference elicitation survey-instrument that any local authority can implement to determine which walking and cycling infrastructure investments are a priority in their area.

Introduction

Persons with disabilities still face numerous barriers in their everyday lives, especially in transportation. The problem of access to transportation is identified through fewer daily trips and more barriers in public transport. These problems indicate transportation equity issues among persons with disabilities. Another issue recognized in previous studies was a gender imbalance in the samples that could indicate gender equality problems among persons with disabilities. This paper aims to investigate mobility and accessibility indicators among persons with disabilities, with a particular emphasis on the impact of gender, in order to explore two critical transportation equity issues: inclusivity and social justice.

Methods

The mobility and accessibility indicators analyzed in this research were the Number of daily trips, Mobility satisfaction, Infrastructure accessibility satisfaction, and Modal distributions of daily trips. The data about indicators was collected by an online version of a questionnaire. The research was performed on 100 persons with disabilities from Serbia, equally distributed by gender. The most common recorded diagnosis of the respondents was spinal cord injury.

Results

In general, respondents made 3.26 trips per day. At two transportation modes, we identified significant differences between males and females. Males frequently tripped as passenger car drivers, and females often traveled as passengers in passenger cars. Additionally, nine Bayesian linear regression models with weak informative prior distributions brought much helpful information.

Conclusions

The obtained results bring stakeholders valuable information in creating policies, practices, and recommendations to achieve specific goals related to transportation equity. Improving flexibility and time efficiency of females’ trips and resolving the problem of females’ fear of abuse and harassment in taxi cars were recognized as the two most critical topics.

Introduction

The COVID-19 pandemic has produced a profound impact on travel behavior. Yet, few studies explored how individuals resist such impact to maintain their daily life from the perspective of people's responses. A comprehensive theoretical framework to elucidate individual travel behavior changes and a quantitative analysis of the pivotal factors driving these changes was lacking.

Methods

This study constructed a framework for individuals' travel behavior in response to COVID-19 and utilized anonymized mobile phone trajectory data before and during COVID-19 in Guangzhou to explore the changes of individuals’ travel behavior on workdays. Gradient boosting decision trees was used to quantify the degree of the factors driving travel changes.

Results

During the pandemic workdays, non-essential trips experienced a reduction of 51.4%, while essential trips decreased by 30.94%; Subway trips decreased by 1.63%, whereas motorized trips increased by 8.75%. The most significant decrease was observed in travel duration (50.92%), followed by travel frequency (41.28%), and travel distance (39.19%). The three travel indices displayed significant social disparities and spatial disparities. However, the relative relationships among these three travel indices did not vary with groups and spaces. Risk perception and intervention measures, emerged as primary drivers of individuals’ travel changes, contributing to 27%–35% of the total impact, while individual socio-economic characteristics and built environment accounting for less than 10%.

Implications

The results indicated that individuals curtailed both their essential and non-essential trips and adjusted their travel mode in response to the epidemic. These changes in travel purpose and mode led to differing reduction rates in travel frequency, duration, and distance. These findings contribute to individual travel changes prediction and fine-grained epidemic modelling during other public health emergencies like COVID-19.

Introduction

Active commuting to school (ACS) and independent mobility (IM) are opportunities to increase physical activity among adolescents. Social norms might be related to these behaviours. The aim of this study was threefold, first to describe parents' perception of the social norm; second, to determine the associations between sociodemographic characteristics and parents' perception of the social norm; and third, to analyse the associations between parents' perception of the social norm and their adolescent’s commuting behaviour to and from school, according to the genders of parents and adolescents in Spain.

Methods

Data were collected through a questionnaire from 12 different public schools. The cross-sectional sample comprised 573 parents (61.8% mothers). The average age of adolescents was 13.2 years (SD = 2.21).

Results

Parents' perception of the social norm were low but linear regression analysis showed that it was higher when the adolescents were younger and the distance to school were shorter. Mothers' perception of the social norm were higher when the educational level and family socioeconomic status were higher. Logistic regression analysis showed that a higher perception of the social norm among parents increased the odds of their adolescents commuting actively to (OR = 1.58; CI; 1.23, 2.02) and from (OR = 1.63; CI; 1.25, 2.10) school. However, in separate analyses, this did not apply for ACS among boys from school (OR = 1.23; CI; 0.84, 1.80). The odds of girls using IM to school increased when parents' perception of the social norm was higher (OR = 1.39; CI; 1.04, 1.86).

Conclusion

Parents' perception of the social norm are relevant for ACS and IM during adolescence. The family sociodemographic characteristics influence the mothers' perception of the social norm. The importance of the social norm among parents differs between adolescent’s genders regarding their use of ACS and IM. To promote these behaviours, a social-norm approach is important targeting the visibility of ACS.

Objective

Safe Routes to School (SRTS) programs promote walking, bicycling, and other alternative transportation modes to school for children. These programs have shown increases in active transportation in children and implement programs through non-infrastructure (e.g., education) and infrastructure (e.g., sidewalks) projects. Although SRTS have been shown to be successful in increasing active transportation and promoting healthy lifestyles, many state SRTS representatives have noted many barriers to reaching disadvantaged populations (e.g., low-income, communities of color, individuals with disabilities, non-English speakers, etc.), which may be contributing to the various participation/injury/fatality disparities seen within these populations.

Purpose/methods

This study attempted to qualitatively understand the current barriers, successful strategies, and future resources/tools needed to provide equitable SRTS programming by interviewing state SRTS representatives/coordinators (or similar) (n = 13). Thematic analysis was conducted on interview transcripts, and eight common themes arose.

Results

Themes noted barriers to funding, community involvement, lack of personnel, and lack of proper education/experience/expertise within stakeholders., Common desired resources/tools were increased funding, the hiring of consultants, and a federal SRTS mandate. Strategies to address disparities focused on strategic partnerships, both within the government and with community organizations, providing consulting to communities, and access to funding.

Conclusion

Various barriers were seen among state SRTS coordinators when attempting to reach disadvantaged populations. State SRTS coordinators should attempt to implement strategies to increase their capacity to reaching disadvantaged populations, including early contact with disadvantaged communities, hiring consultants for communities, and partnering with other government organizations who attempt to address the needs of disadvantaged students.

Introduction

Research has demonstrated the relationships between living in peri-urban areas and cardiometabolic risk. However, little is known about what types of travel behaviours are involved in the relationship. We examined the mediating roles of multiple measures of active and sedentary travel in the association between the residential proximity to the city centre and cardiometabolic risk among mid-to-older aged Australians.

Methods

Data were from 2259 adults living in and around major Australian cities. The network distance from participants’ residences to the nearest city centre was assessed. A clustered cardiometabolic risk (CCR) score was constructed based on five biomarkers. Four metrics for walking for transport (active travel) and car use (sedentary travel) were measured: weekly frequency, any use of the mode, any use without the other mode, and the use for commuting. Multilevel regression models examined the associations between residential proximity to the city centre and mediators (α) and between mediators and CCR (β). The joint-significance tests identified mediation.

Results

Living farther away from the city centre was associated with a higher CCR score: each 10 km increment in the distance was associated with 0.03 (95%CI: 0.00, 0.05) higher CCR score. The association was partially mediated by walking for transport and car use without walking, for which coefficients α and β were both statistically significant.

Conclusion

Residents of peri-urban areas were at higher cardiometabolic risk than those of inner urban areas, partly due to the former's car-dependent lifestyles. Public health and transport initiatives/policies encouraging walking for transport and discouraging car use in peri-urban suburbs may help to reduce cardiometabolic risk.

Introduction

Globally, there has been a recent resurgence in planning policies focused on local living (such as the 20-min neighbourhood) with proposed benefits of creating sustainable and healthy places. The policies aim to provide improved spatial access to local amenities within short walkable distances of home to encourage walking and cycling and discourage car use, however these pathways have not been examined. This study aimed to quantify the density and diversity of local amenities and their association with daily/weekly travel behaviours.

Methods

We used data from Understanding Society, a national panel survey of UK adults. Spatial data were used to quantify the number and diversity of amenities that have previously been associated with active travel and focused on in 20-min neighbourhood policies within small geographical areas across the UK. These were linked to individual-level data describing daily and weekly travel behaviour for: walking (at least 10-min), cycling, car and bus use. Logistic regression models measured the association between individual amenities, their diversity and daily/weekly travel, whilst controlling for individual factors such as age, sex and employment, residing in a retail centre, as well as area-level urbanicity and deprivation.

Results

Our analysis revealed variations in active travel and car usage patterns by sex, employment status, urbanicity, and area-level deprivation. Local amenities were associated with daily travel behaviours with more amenities generally associated with more frequent walking and less regular bus and car travel. Furthermore, increased amenity diversity was associated with reduced daily car use (OR: 0.77, p < 0.001). Similar patterns were apparent for weekly travel outcomes.

Conclusions

Both access to specific local amenities as well as their diversity are both important neighbourhood factors for achieving shifts from motorised to active transport modes. Policy makers and planners need to ensure the diversity of local amenities are included in local living policies.