Urban environment, transport behaviours, and health

Urban environments are very complex systems with a myriad of factors intricately related. Built environment, transport, physical activity and sedentary behaviours, air pollution, and social contacts and feelings of loneliness can have effects on urban population’s health and well-being. Also, some of these determinants can be associated and can interact between them modifying their effects on health. According to the World Health Organisation (WHO), health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Taking into account this comprehensive health definition, this thesis covered different layers of health: general, mental, and physical. With four different studies, the results of the present thesis suggest that it is possible to design urban environments that can increase physical activity levels, mainly through active transport, and that the crime-safety perceptions can have an important role in terms of reinforcing the effects of the built environment on physical activity and sedentary behaviours. Furthermore, active transport, mainly bicycle use, seems to be a source of good mental health and well-being, and a tool to boost social capital production. Increasing physical activity levels also seems to be a good way to improve cardiovascular health through blood pressure levels reduction. The present thesis suggests that urban and transport planning have a great potential to promote healthy behaviours and ensure mental and physical health of city dwellers, mainly through active transport promotion. In order to improve the health promotion through urban environment, more research about aesthetics urban attributes, urban social capital production, effects on mental health and well-being, and effectiveness of urban interventions is needed.Los entornos urbanos son sistemas muy complejos con una miríada de factores intrincadamente relacionados. El entorno construido, el transporte, la actividad física y los comportamientos sedentarios, la contaminación del aire y los contactos sociales y los sentimientos de soledad pueden tener efectos en la salud y el bienestar de la población urbana. Además, algunos de estos determinantes se pueden asociar y pueden interactuar entre ellos modificando sus efectos sobre la salud. Según la Organización Mundial de la Salud (OMS), la salud es "un estado de completo bienestar físico, mental y social y no simplemente la ausencia de enfermedades o dolencias". Teniendo en cuenta esta definición integral de salud, esta tesis cubre diferentes niveles de salud: general, mental y física. Con cuatro estudios diferentes, los resultados de la presente tesis sugieren que es posible diseñar entornos urbanos que puedan aumentar los niveles de actividad física, principalmente a través del transporte activo, y que las percepciones de seguridad con respecto al crimen pueden tener un papel importante en términos de reforzar los efectos del entorno construido sobre la actividad física y los comportamientos sedentarios. Además, el transporte activo, principalmente el uso de bicicletas, parece ser una fuente de buena salud mental y bienestar, y una herramienta para impulsar la producción de capital social. El aumento de los niveles de actividad física también parece ser una buena forma de mejorar la salud cardiovascular a través de la reducción de los niveles de presión arterial. La presente tesis sugiere que la planificación urbana y de transporte tienen un gran potencial para promover comportamientos saludables y garantizar la salud mental y física de los habitantes de las ciudades, principalmente a través de la promoción del transporte activo. Para ir mejorando la promoción de la salud a través del entorno urbano, se necesita más investigación sobre los atributos urbanos estéticos, la producción de capital social urbano, los efectos sobre la salud mental y el bienestar, y la efectividad de las intervenciones urbana

Urban environment, transport behaviours, and health

Urban environments are very complex systems with a myriad of factors intricately related. Built environment, transport, physical activity and sedentary behaviours, air pollution, and social contacts and feelings of loneliness can have effects on urban population’s health and well-being. Also, some of these determinants can be associated and can interact between them modifying their effects on health. According to the World Health Organisation (WHO), health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Taking into account this comprehensive health definition, this thesis covered different layers of health: general, mental, and physical. With four different studies, the results of the present thesis suggest that it is possible to design urban environments that can increase physical activity levels, mainly through active transport, and that the crime-safety perceptions can have an important role in terms of reinforcing the effects of the built environment on physical activity and sedentary behaviours. Furthermore, active transport, mainly bicycle use, seems to be a source of good mental health and well-being, and a tool to boost social capital production. Increasing physical activity levels also seems to be a good way to improve cardiovascular health through blood pressure levels reduction. The present thesis suggests that urban and transport planning have a great potential to promote healthy behaviours and ensure mental and physical health of city dwellers, mainly through active transport promotion. In order to improve the health promotion through urban environment, more research about aesthetics urban attributes, urban social capital production, effects on mental health and well-being, and effectiveness of urban interventions is needed.Los entornos urbanos son sistemas muy complejos con una miríada de factores intrincadamente relacionados. El entorno construido, el transporte, la actividad física y los comportamientos sedentarios, la contaminación del aire y los contactos sociales y los sentimientos de soledad pueden tener efectos en la salud y el bienestar de la población urbana. Además, algunos de estos determinantes se pueden asociar y pueden interactuar entre ellos modificando sus efectos sobre la salud. Según la Organización Mundial de la Salud (OMS), la salud es "un estado de completo bienestar físico, mental y social y no simplemente la ausencia de enfermedades o dolencias". Teniendo en cuenta esta definición integral de salud, esta tesis cubre diferentes niveles de salud: general, mental y física. Con cuatro estudios diferentes, los resultados de la presente tesis sugieren que es posible diseñar entornos urbanos que puedan aumentar los niveles de actividad física, principalmente a través del transporte activo, y que las percepciones de seguridad con respecto al crimen pueden tener un papel importante en términos de reforzar los efectos del entorno construido sobre la actividad física y los comportamientos sedentarios. Además, el transporte activo, principalmente el uso de bicicletas, parece ser una fuente de buena salud mental y bienestar, y una herramienta para impulsar la producción de capital social. El aumento de los niveles de actividad física también parece ser una buena forma de mejorar la salud cardiovascular a través de la reducción de los niveles de presión arterial. La presente tesis sugiere que la planificación urbana y de transporte tienen un gran potencial para promover comportamientos saludables y garantizar la salud mental y física de los habitantes de las ciudades, principalmente a través de la promoción del transporte activo. Para ir mejorando la promoción de la salud a través del entorno urbano, se necesita más investigación sobre los atributos urbanos estéticos, la producción de capital social urbano, los efectos sobre la salud mental y el bienestar, y la efectividad de las intervenciones urbana

Efectividad en las intervenciones para incrementar la actividad física en el lugar de trabajo: revisión de revisiones sistemáticas

Directors: Consol Serra, Fernando G. BenavidesTutor UPF: Fernando G. BenavidesObjetivo: Evaluar la evidencia científica disponible en forma de revisiones sistemáticas publicadas sobre la efectividad de las intervenciones para incrementar la actividad física realizadas en el lugar de trabajo

Efectividad en las intervenciones para incrementar la actividad física en el lugar de trabajo: revisión de revisiones sistemáticas

Directors: Consol Serra, Fernando G. BenavidesTutor UPF: Fernando G. BenavidesObjetivo: Evaluar la evidencia científica disponible en forma de revisiones sistemáticas publicadas sobre la efectividad de las intervenciones para incrementar la actividad física realizadas en el lugar de trabajo

The climate change mitigation effects of daily active travel in cities

Active travel (walking or cycling for transport) is considered the most sustainable form of personal transport. Yet its net effects on mobility-related CO2 emissions are complex and under-researched. Here we collected travel activity data in seven European cities and derived life cycle CO2 emissions across modes and purposes. Daily mobility-related life cycle CO2 emissions were 3.2 kgCO2 per person, with car travel contributing 70% and cycling 1%. Cyclists had 84% lower life cycle CO2 emissions than non-cyclists. Life cycle CO2 emissions decreased by −14% per additional cycling trip and decreased by −62% for each avoided car trip. An average person who ‘shifted travel modes’ from car to bike decreased life cycle CO2 emissions by 3.2 kgCO2/day. Promoting active travel should be a cornerstone of strategies to meet net zero carbon targets, particularly in urban areas, while also improving public health and quality of urban life.This work was supported by the European project Physical Activity through Sustainable Transportation Approaches (PASTA). PASTA (http://www.pastaproject.eu/) was a four-year project funded by the European Union’s Seventh Framework Program (EU FP7) under European Commission ‐ Grant Agreement No. 602624. CB is also supported by UK Research and Innovation (UKRI) under the Centre for Research on Energy Demand Solutions (CREDS, Grant agreement number EP/R035288/1). ED is also supported by a postdoctoral scholarship from FWO – Research Foundation Flanders. ML held a joint PASTA/VITO PhD scholarship. SS is supported by the Martin Filko Scholarship from the Ministry of Education in Slovakia

Active commuting through natural environments is associated with better mental health: Results from the PHENOTYPE project

Background: Commuting routes with natural features could promote walking or cycling for commuting. Commuting through natural environments (NE) could have mental health benefits as exposure to NE can reduce stress and improve mental health, but there is little evidence. This study evaluates the association between NE and commuting, whether active or not, and the association between commuting (through NE), whether active or not, and mental health. We also evaluate the moderating effect of NE quality on the association between NE commuting and mental health. Methods: This cross-sectional study was based on adult respondents (n = 3599) of the Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe (PHENOTYPE) project. Data were collected in four European cities in Spain, the Netherlands, Lithuania and the United Kingdom. Data on commuting behavior (active commuting at least one day/week, daily NE commuting) and mental health were collected with questionnaires. Associations were estimated with multilevel analyses including random intercepts at city- and neighborhood level. Results: Adjusted multilevel analyses showed that daily NE commuters were more often active commuters (OR 1.42; 95% CI 1.19, 1.70). There was no association between active commuting and mental health, but daily NE commuters had on average a 2.74 (95% CI 1.66, 3.82) point higher mental health score than those not commuting through NE. The association with mental health was stronger among active commuters (4.03, 95% CI 2.13, 5.94) compared to non-active commuters (2.21; 95% CI 0.90, 3.51) when daily commuting through NE, but NE quality did not have a moderating effect. Conclusions: Daily NE commuting was associated with better mental health, especially for active commuters. Daily NE commuters were likely to be active commuters. Active commuting itself was not associated with mental health. These findings suggest that cities should invest in commuting routes with nature for cycling and walking.The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 282996. W.L. Zijlema is supported by a Sara Borrell grant from the Instituto de Salud Carlos III (CD17/00195)

Effectiveness of very early workplace interventions to reduce sickness absence: a systematic review of the literature and meta-analysis.

OBJECTIVE: The aim of this review was to investigate the effectiveness of workplace return-to-work (RTW) interventions delivered at very early stages (<15 days) of sickness absence (SA). METHODS: A systematic literature search was conducted in PubMed, Health Management Information Consortium (HMIC), Cochrane library database, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychInfo and Embase. Using pre-established criteria, independent pairs of researchers carried out the study selection, quality appraisal and data extraction. Workplace interventions before day 15 of SA, were included. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA. RESULTS: We found limited available evidence on the benefits of "very early" workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomized controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction in the duration and recurrence of SA. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders. CONCLUSION: Our review has identified a lack of evidence from the literature at this time point to support "very early" intervention compared to usual care. The methodological design of the studies, notably the extent and timing of usual care provided and variable compliance/crossover between groups could however explain the lack of demonstrated benefit. Consensus is required on the definition of "early" and "very early" interventions, and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.E Demou was supported by the MRC Strategic Award MC_PC_13027

The effects of transport mode use on self-perceived health, mental health, and social contact measures: A cross-sectional and longitudinal study

Background: Transport mode choice has been associated with different health risks and benefits depending on which transport mode is used. We aimed to evaluate the association between different transport modes use and several health and social contact measures. Methods: We based our analyses on the Physical Activity through Sustainable Transport Approaches (PASTA) longitudinal study, conducted over a period of two years in seven European cities. 8802 participants finished the baseline questionnaire, and 3567 answered the final questionnaire. Participants were 18 years of age or older (16 years of age or older in Zurich) and lived, worked and/or studied in one of the case-study cities. Associations between transport mode use and health/social contact measures were estimated using mixed-effects logistic regression models, linear regression models, and logistic regression models according to the data available. All the associations were assessed with single and multiple transport mode models. All models were adjusted for potential confounders. Results: In multiple transport mode models, bicycle use was associated with good self-perceived health [OR (CI 95%) = 1.07 (1.05, 1.08)], all the mental health measures [perceived stress: coef (CI 95%) = −0.016 (−0.028, −0.004); mental health: coef (CI 95%) = 0.11 (0.05, 0.18); vitality: coef (CI 95%) = 0.14 (0.07, 0.22)], and with fewer feelings of loneliness [coef (CI 95%) = −0.03 (−0.05, −0.01)]. Walking was associated with good self-perceived health [OR (CI 95%) = 1.02 (1.00, 1.03)], higher vitality [coef (CI 95%) = 0.14 (0.05, 0.23)], and more frequent contact with friends/family [OR (CI 95%) = 1.03 (1.00, 1.05)]. Car use was associated with fewer feelings of loneliness [coef (CI 95%) = −0.04 (−0.06, −0.02)]. The results for e-bike and public transport use were non-significant, and the results for motorbike use were inconclusive. Conclusions: Similarity of findings across cities suggested that active transport, especially bicycle use, should be encouraged to improve population health and social outcomes.This work was supported by the European project PASTA, which had partners in London, Rome, Antwerp, Örebro, Vienna, Zurich, and Barcelona. PASTA (http://www.pastaproject.eu/) was a 4-year project funded by the European Union's Seventh Framework Program under EC-GA No. 602624-2 (FP7-HEALTH-2013-INNOVATION-1). ED was supported by a postdoctoral scholarship from FWO – Research Foundation Flanders. JPO was financed by the Colombian Government, Colciencias Scholarship for PhD's abroad number 646. The funding sources had no involvement in the study. MJN had full access to all the data in the study and had final responsibility for the decision to submit for publication