Physical activity through sustainable transport approaches (PASTA): protocol for a multi-centre, longitudinal study

BACKGROUND: Physical inactivity is one of the leading risk factors for non-communicable diseases, yet many are not sufficiently active. The Physical Activity through Sustainable Transport Approaches (PASTA) study aims to better understand active mobility (walking and cycling for transport solely or in combination with public transport) as an innovative approach to integrate physical activity into individuals' everyday lives. The PASTA study will collect data of multiple cities in a longitudinal cohort design to study correlates of active mobility, its effect on overall physical activity, crash risk and exposure to traffic-related air pollution. METHODS/DESIGN: A set of online questionnaires incorporating gold standard approaches from the physical activity and transport fields have been developed, piloted and are now being deployed in a longitudinal study in seven European cities (Antwerp, Barcelona, London, Oerebro, Rome, Vienna, Zurich). In total, 14000 adults are being recruited (2000 in each city). A first questionnaire collects baseline information; follow-up questionnaires sent every 13 days collect prospective data on travel behaviour, levels of physical activity and traffic safety incidents. Self-reported data will be validated with objective data in subsamples using conventional and novel methods. Accelerometers, GPS and tracking apps record routes and activity. Air pollution and physical activity are measured to study their combined effects on health biomarkers. Exposure-adjusted crash risks will be calculated for active modes, and crash location audits are performed to study the role of the built environment. Ethics committees in all seven cities have given independent approval for the study. DISCUSSION: The PASTA study collects a wealth of subjective and objective data on active mobility and physical activity. This will allow the investigation of numerous correlates of active mobility and physical activity using a data set that advances previous efforts in its richness, geographical coverage and comprehensiveness. Results will inform new health impact assessment models and support efforts to promote and facilitate active mobility in cities

Transport mode choice and body mass index: Cross-sectional and longitudinal evidence from a European-wide study.

BACKGROUND: In the fight against rising overweight and obesity levels, and unhealthy urban environments, the renaissance of active mobility (cycling and walking as a transport mode) is encouraging. Transport mode has been shown to be associated to body mass index (BMI), yet there is limited longitudinal evidence demonstrating causality. We aimed to associate transport mode and BMI cross-sectionally, but also prospectively in the first ever European-wide longitudinal study on transport and health. METHODS: Data were from the PASTA project that recruited adults in seven European cities (Antwerp, Barcelona, London, Oerebro, Rome, Vienna, Zurich) to complete a series of questionnaires on travel behavior, physical activity levels, and BMI. To assess the association between transport mode and BMI as well as change in BMI we performed crude and adjusted linear mixed-effects modeling for cross-sectional (n = 7380) and longitudinal (n = 2316) data, respectively. RESULTS: Cross-sectionally, BMI was 0.027 kg/m2 (95%CI 0.015 to 0.040) higher per additional day of car use per month. Inversely, BMI was -0.010 kg/m2 (95%CI -0.020 to -0.0002) lower per additional day of cycling per month. Changes in BMI were smaller in the longitudinal within-person assessment, however still statistically significant. BMI decreased in occasional (less than once per week) and non-cyclists who increased cycling (-0.303 kg/m2, 95%CI -0.530 to -0.077), while frequent (at least once per week) cyclists who stopped cycling increased their BMI (0.417 kg/m2, 95%CI 0.033 to 0.802). CONCLUSIONS: Our analyses showed that people lower their BMI when starting or increasing cycling, demonstrating the health benefits of active mobility

Evaluation of Different Recruitment Methods: Longitudinal, Web-Based, Pan-European Physical Activity Through Sustainable Transport Approaches (PASTA) Project

BACKGROUND: Sufficient sample size and minimal sample bias are core requirements for empirical data analyses. Combining opportunistic recruitment with a Web-based survey and data-collection platform yields new benefits over traditional recruitment approaches. OBJECTIVE: This paper aims to report the success of different recruitment methods and obtain data on participants' characteristics, participation behavior, recruitment rates, and representativeness of the sample. METHODS: A longitudinal, Web-based survey was implemented as part of the European PASTA (Physical Activity through Sustainable Transport Approaches) project, between November 2014 and December 2016. During this period, participants were recruited from 7 European cities on a rolling basis. A standardized guide on recruitment strategy was developed for all cities, to reach a sufficient number of adult participants. To make use of the strengths and minimize weakness, a combination of different opportunistic recruitment methods was applied. In addition, the random sampling approach was applied in the city of Örebro. To reduce the attrition rate and improve real-time monitoring, the Web-based platform featured a participant's and a researchers' user interface and dashboard. RESULTS: Overall, 10,691 participants were recruited; most people found out about the survey through their workplace or employer (2300/10691, 21.51%), outreach promotion (2219/10691, 20.76%), and social media (1859/10691, 17.39%). The average number of questionnaires filled in per participant varied significantly between the cities (P<.001), with the highest number in Zurich (11.0, SE 0.33) and the lowest in Örebro (4.8, SE 0.17). Collaboration with local organizations, the use of Facebook and mailing lists, and direct street recruitment were the most effective approaches in reaching a high share of participants (P<.001). Considering the invested working hours, Facebook was one of the most time-efficient methods. Compared with the cities' census data, the composition of study participants was broadly representative in terms of gender distribution; however, the study included younger and better-educated participants. CONCLUSIONS: We observed that offering a mixed recruitment approach was highly effective in achieving a high participation rate. The highest attrition rate and the lowest average number of questionnaires filled in per participant were observed in Örebro, which also recruited participants through random sampling. These findings suggest that people who are more interested in the topic are more willing to participate and stay in a survey than those who are selected randomly and may not have a strong connection to the research topic. Although direct face-to-face contacts were very effective with respect to the number of recruited participants, recruiting people through social media was not only effective but also very time efficient. The collected data are based on one of the largest recruited longitudinal samples with a common recruitment strategy in different European cities

Concern over health effects of air pollution is associated to NO<inf>2</inf>in seven European cities

Subjective perception of air pollution is important and can have impacts on health in its own rights, can lead to protective behaviour, or it can be leveraged to engage citizens and stakeholders in support of cleaner air policies. The aim of the current analysis was to examine associations between level of concern over health effects of air pollution and personal and environmental factors. In seven European cities, 7622 adult participants were recruited to complete an online questionnaire on travel and physical activity behaviour, perceptions and attitudes on active mobility and the environment, and sociodemographics. Air pollution at the home address was determined using Europe-wide PM2.5and NO2land use regression models. Mixed effects logistic regression was used to model concern over air pollution (worried versus not worried; city as random effect). Fifty-eight percent of participants were worried over health effects of air pollution with large differences across cities (Antwerp 78%, Barcelona 81%, London 64%, Orebro 11%, Rome 72%, Vienna 43%, Zurich 33%). Linking mean modelled air pollution to mean level of concern per city gave a good correlation for NO2(r2= 0.75), and a lower correlation for PM2.5(r2= 0.49). In the regression model, sex, having children in the household, levels of physical activity, and NO2at the home address were significantly linked to individual concern over health effects of air pollution. We found that NO2but not PM2.5at the home address was associated with concern over health effects of air pollution

Concern over health effects of air pollution is associated to NO2 in seven European cities

Subjective perception of air pollution is important and can have impacts on health in its own rights, can lead to protective behaviour, or it can be leveraged to engage citizens and stakeholders in support of cleaner air policies. The aim of the current analysis was to examine associations between level of concern over health effects of air pollution and personal and environmental factors. In seven European cities, 7622 adult participants were recruited to complete an online questionnaire on travel and physical activity behaviour, perceptions and attitudes on active mobility and the environment, and sociodemographics. Air pollution at the home address was determined using Europe-wide PM2.5 and NO2 land use regression models. Mixed effects logistic regression was used to model concern over air pollution (worried versus not worried; city as random effect). Fifty-eight percent of participants were worried over health effects of air pollution with large differences across cities (Antwerp 78%, Barcelona 81%, London 64%, Orebro 11%, Rome 72%, Vienna 43%, Zurich 33%). Linking mean modelled air pollution to mean level of concern per city gave a good correlation for NO2 (r2 = 0.75), and a lower correlation for PM2.5 (r2 = 0.49). In the regression model, sex, having children in the household, levels of physical activity, and NO2 at the home address were significantly linked to individual concern over health effects of air pollution. We found that NO2 but not PM2.5 at the home address was associated with concern over health effects of air pollution

Health impact assessment of cycling network expansions in European cities

We conducted a health impact assessment (HIA) of cycling network expansions in seven European cities. We modeled the association between cycling network length and cycling mode share and estimated health impacts of the expansion of cycling networks. First, we performed a non-linear least square regression to assess the relationship between cycling network length and cycling mode share for 167 European cities. Second, we conducted a quantitative HIA for the seven cities of different scenarios (S) assessing how an expansion of the cycling network [i.e. 10% (S1); 50% (S2); 100% (S3), and all-streets (S4)] would lead to an increase in cycling mode share and estimated mortality impacts thereof. We quantified mortality impacts for changes in physical activity, air pollution and traffic incidents. Third, we conducted a cost-benefit analysis. The cycling network length was associated with a cycling mode share of up to 24.7% in European cities. The all-streets scenario (S4) produced greatest benefits through increases in cycling for London with 1210 premature deaths (95% CI: 447-1972) avoidable annually, followed by Rome (433; 95% CI: 170-695), Barcelona (248; 95% CI: 86-410), Vienna (146; 95% CI: 40-252), Zurich (58; 95% CI: 16-100) and Antwerp (7; 95% CI: 3-11). The largest cost-benefit ratios were found for the 10% increase in cycling networks (S1). If all 167 European cities achieved a cycling mode share of 24.7% over 10,000 premature deaths could be avoided annually. In European cities, expansions of cycling networks were associated with increases in cycling and estimated to provide health and economic benefits

Cyclist crash rates and risk factors in a prospective cohort in seven European cities

Increased cycling uptake can improve population health, but barriers include real and perceived risks. Crash risk factors are important to understand in order to improve safety and increase cycling uptake. Many studies of cycling crash risk are based on combining diverse sources of crash and exposure data, such as police databases (crashes) and travel surveys (exposure), based on shared geography and time. When conflating crash and exposure data from different sources, the risk factors that can be quantified are only those variables common to both datasets, which tend to be limited to geography (e.g. countries, provinces, municipalities) and a few general road user characteristics (e.g. gender and age strata). The Physical Activity through Sustainable Transport Approaches (PASTA) project was a prospective cohort study that collected both crash and exposure data from seven European cities (Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zürich). The goal of this research was to use data from the PASTA project to quantify exposure-adjusted crash rates and model adjusted crash risk factors, including detailed sociodemographic characteristics, attitudes about transportation, neighbourhood built environment features and location by city. We used negative binomial regression to model the influence of risk factors independent of exposure. Of the 4,180 cyclists, 10.2 % reported 535 crashes. We found that overall crash rates were 6.7 times higher in London, the city with the highest crash rate, relative to Örebro, the city with the lowest rate. Differences in overall crash rates between cities are driven largely by crashes that did not require medical treatment and that involved motor-vehicles. In a parsimonious crash risk model, we found higher crash risks for less frequent cyclists, men, those who perceive cycling to not be well regarded in their neighbourhood, and those who live in areas of very high building density. Longitudinal collection of crash and exposure data can provide important insights into individual differences in crash risk. Substantial differences in crash risks between cities, neighbourhoods and population groups suggest there is great potential for improvement in cycling safety

The climate change mitigation impacts of active travel: Evidence from a longitudinal panel study in seven European cities

Active travel (walking or cycling for transport) is considered the most sustainable and low carbon form of getting from A to B. Yet the net effects of changes in active travel on changes in mobility-related CO2 emissions are complex and under-researched. Here we collected longitudinal data on daily travel behavior, journey purpose, as well as personal and geospatial characteristics in seven European cities and derived mobility-related lifecycle CO2 emissions over time and space. Statistical modelling of longitudinal panel (n = 1849) data was performed to assess how changes in active travel, the ‘main mode’ of daily travel, and cycling frequency influenced changes in mobility-related lifecycle CO2 emissions. We found that changes in active travel have significant lifecycle carbon emissions benefits, even in European urban contexts with already high walking and cycling shares. An increase in cycling or walking consistently and independently decreased mobility-related lifecycle CO2 emissions, suggesting that active travel substituted for motorized travel – i.e. the increase was not just additional (induced) travel over and above motorized travel. To illustrate this, an average person cycling 1 trip/day more and driving 1 trip/day less for 200 days a year would decrease mobility-related lifecycle CO2 emissions by about 0.5 tonnes over a year, representing a substantial share of average per capita CO2 emissions from transport. The largest benefits from shifts from car to active travel were for business purposes, followed by social and recreational trips, and commuting to work or place of education. Changes to commuting emissions were more pronounced for those who were younger, lived closer to work and further to a public transport station. Even if not all car trips could be substituted by active travel the potential for decreasing emissions is considerable and significant. The study gives policy and practice the empirical evidence needed to assess climate change mitigation impacts of urban transport measures and interventions aimed at mode shift to more sustainable modes of transport. Investing in and promoting active travel whilst ‘demoting’ private car ownership and use should be a cornerstone of strategies to meet ‘net zero’ carbon targets, particularly in urban areas, while also reducing inequalities and improving public health and quality of urban life in a post-COVID-19 world