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Li Ming Wen
School of Public Health, University of Sydney South Western Sydney and Sydney Local Health Districts
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;30.782-786
Driving 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 5.1–7.3% 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
Active travel to work in NSW 2005–2010, individual characteristics and association with BMI
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-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 identified
76 studies included in the review
Found active transport had a benefit effect on:
Strong Moderate Weak
Cardiovascular health
Lower body weight
Diabetes
Mental health Cancer
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
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), 298-315
2013 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 Promotion
Leadership
Demonstrated 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: community
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.
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
Interventions 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 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
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 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.
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: [email protected]
Thank You