Li Ming Wen

School of Public Health, University of Sydney South Western Sydney and Sydney Local Health Districts lmwen@email.cs.nsw.gov.au

Promoting active transport: benefits, strategies and challenges

Welcome to Sydney

Brief introduction of active transport/travel (AT) and health benefits

Potential strategies in promoting AT (our experience/journey)

Discuss challenges in promoting AT

Plan for the talk

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.

Active Transport (Travel)

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.

Trends in Active Transport 2001-2011

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 Potential benefits of active transport

Cross-sectional data from the 2003 New South Wales Adult Health Survey

6810 respondents

Study variables: SESPhysical 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;30.782-786Driving to work and overweight/obesity

Modes of transport to work: 69% driving 15% by public transport 7% walking only2% cycled and6% 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

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.Driving to work and overweight/obesity

There were no changes in the proportions of employed respondents walking or cycling to work with estimates ranging from 5.17.3% usually walking, and 1.41.8% 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 20052010, individual characteristics and association with body mass index. Australian and New Zealand Journal of Public Health. doi: 10.1111/1753-6405.12097Active travel to work in NSW 20052010, individual characteristics and association with BMI

8400 community residents aged 18 or above in 201050% actively travelled to workAT respondents had a higher prevalence of cholesterol disorderAT respondents had a higher risk of diabetesDecreased AT had a lower risk of obesity, central obesity, and cholesterol disorderFindings of this study do not support the notion that AT is beneficial to population healthFurther research is needed in determining the negative side effects of AT.

*Shu-rong Lu 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 Active transport and health outcomes: findings from a population study in Jiangsu, China

A total of 3887 articles were identified76 studies included in the reviewFound 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. 2013 systematic review of the relationships between active transport and health outcomes

Strong Moderate Weak Cardiovascular health Lower body weight Diabetes Mental health Cancer

Evidence limited by:Lack of comparability of study outcomesWeak study designsSmall sample sizesLack 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), 298-3152013 systematic review of the relationships between active transport and health outcomes

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

Potential strategies in promoting AT

Generating evidence Advocacy Health PromotionLeadershipDemonstrated benefits Sustainability Potential strategies in promoting AT

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 International 2005; 20(2): 123-133.Interventions to promote AT: workplace

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. The role of workplaces in reducing driving to work by employees

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?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

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

Interventions to promote AT: communityRissel, 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.

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), 612-8Interventions to promote AT: school setting

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.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 programs 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

Central Sydney Walk to School program

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 parents 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.

Factors associated with modes of travel to school

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 .

Challenges for promoting active transport

Research design

Outcome measures

Long term follow-up

Sustainability

How to evaluate the effect of active transport interventions

Contact details:

A/Prof. Li Ming Wen Sydney Medical School, University of Sydney

Research & Evaluation Manager Health Promotion ServiceSouth Western Sydney & Sydney Local Health DistrictsLevel 9 North, King George V Building Missenden Rd. Camperdown NSW 2050, AustraliaEmail: lmwen@email.cs.nsw.gov.au

Thank You

Graph shows: proportion of journeys to work made by walking, bicycle and overall active travel in inner Sydney, outer Sydney and the Greater Metropolitan Region by Census yearOrientate:1st column is 2001... 2006... 2011Areas are Inner Sydney... We found that between 2001 and 2011, active travel increased in inner Sydney (relative increase of 24%), decreased slightly in outer Sydney and declined by 15% in the Greater Metropolitan Region.Can see that trends for walking and cycling mirror each other as well as the overall trends for AT*****Does infrastructure simply channel existing cyclists from other routes (but no overall increase in cyclists)?

Would successfully encouraging cycling infrastructure use increase overall population levels of physical activity (or take away from other activities)?**