Making children’s lives more active

Children are becoming fatter which has serious implications for their health. One reason is their decreasing levels of physical activity. This is related to their lifestyles and reductions in the amount of walking. This note illustrates these effects and draws conclusions about children’s physical activity and car use

A methodology for the incorporation of social inclusion into transport policy

4-8 July 2004. Istanbul, Turke

Increasing children's volume of physical activity through walk and play

This document looks at the contribution of walking and playing outside the home to children’s volume of physical activity. The document draws on research carried out at University College London (UCL) in which 200 children were fitted with three-dimensional motion sensors and asked to keep travel and activity diaries over a period of four days. From these it is possible to establish what the children did, how they travelled and how much energy they used. Using these data, the contributions of unstructured out-of-home events (playing) and walking to children’s volume of physical activity are demonstrated. It is also shown that these unstructured events tend to be associated with walking rather than use of the car, unlike structured out-of-home events. It is also shown that children who walk to events tend to be more active when they arrive than those who travel by car. The effect of an initiative to promote walking is considered. Conclusions are drawn about the need to remove various barriers to enable children to spend more time out of the home where they will be more active and so lead healthier lives, and the value of facilitating opportunities for walking

Mental health, gender and travel behavior

In 2019, 19% of the population in the US aged 18 or over had had a mental illness in the previous year, according to the National Survey on Drug Use and Health. There were gender differences: 15% of males and 23% of females. Evidence from the academic literature suggests that there are differences in the nature of the mental health of men and women, with women showing higher rates of mood and anxiety disorders, and men showing higher rates of antisocial personality and substance use disorders. This presentation will discuss gender differences in the travel behavior of people with mental health conditions based on the results of an on-line survey carried out in Great Britain in 2018. The results have been weighted by figures from Adult Psychiatric Morbidity Survey to make them representative of the population with mental illness in England. The analysis is based on 363 responses. The evidence from the survey in this presentation will show that more women than men have panic attacks, but that more men than women have communication difficulties. More women than men are prevented by their mental health condition from leaving home, using bus, rail and metro and from buying rail tickets in advance. Significantly more women than men suffered from the following anxieties when travelling: the need for support, concern about wayfinding, interacting with fellow travellers and concerns about the failure of the bus, train or car. For women, the greatest need seems to be policies and actions that will increase their confidence when travelling such as being confident that they will be able to talk to staff when assistance is required and knowing that there will be clear information available when they travel, plus the opportunity to receive travel training. More men than women wanted improvements to the traveling environment, such as less clutter on the street. Summing up, implementing improvements to increase confidence when travelling could help to reduce gender inequalities

Travel anxiety

A clearer version of this extended abstract has been uploaded to the RPS. Extended abstract of paper presented at the 51st Annual UTSG (Universities’ Transport Study Group) Conference, University of Leeds, Leeds, 8-10 July 2109. Travel anxiety Roger Mackett Emeritus Professor of Transport Studies Centre for Transport Studies University College London Gower Street London WC1E 6BT Great Britain Introduction In England, 26% of all adults report having been diagnosed with at least one mental illness, while a further 18% say that they have experienced a mental illness without being diagnosed (Bridges, 2014). Mental health conditions include: agoraphobia, anxiety, bipolar disorder, depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and schizophrenia. See NHS Choices (2018) for more information about these conditions. More women than men report having been diagnosed with a mental illness and the prevalence is highest between the ages of 27 and 74, peaking in the 55-64 age group. Travellers use a number of skills at different stages of the trip, such as concentration, interpretation of information, and the confidence to take decisions and interact with other people (Mackett, 2017). Mental health conditions can affect these abilities and so can affect the ability to travel. This presentation will discuss these issues by drawing on results from a survey carried out by the author, and then discuss the implications for transport policy and analysis. The survey The survey was carried out on-line by distributing a link to a questionnaire that used Opinio software made available through UCL. The link was distributed by eighteen organizations and three individuals using social media (mainly Twitter), websites and newsletters. The organizations included ones dealing with mental health including SANE, Anxiety UK and the Mental Health Action Group, and transport organizations such as Transport for London and Transport Scotland. Responses were received between 15 May and 26 July 2018. The survey was given ethical approval by the UCL Research Ethics Committee. There were 389 responses to the survey. Four were removed, two because they were blank and two because they were from people without a mental health condition, leaving 385 useable responses. Carers completed 22 of the responses on behalf of other people with a mental health condition. Of the respondents, 24% were male, 72% female, and 4% preferred not to state their gender. There was a wide age range with 11 under the age of 18 and 2 over the age of 70. Over half of the respondents were in the range 18 to 40. Results The mental health conditions of those in the survey are shown in Table 1. Anxieties, including social anxiety and panic attacks, were reported by 90% of the respondents and 68% reported having depression. Other conditions mentioned included post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), agoraphobia, and bi-polar disorder. TABLE 1 The mental health conditions of those in the survey Number of respondents with the condition % of respondents Anxiety (including social anxiety and panic attacks) 346 90 Depression 262 68 Post-traumatic stress disorder (PTSD) 83 22 Obsessive-compulsive disorder (OCD) 69 18 Agoraphobia 53 14 Bipolar disorder 30 8 Other conditions 85 22 Total 982 100 All 385 respondents answered this question, with many people giving more than one answer, reflecting the complex nature of their conditions. Since 90% of the respondents have anxiety, the presentation will focus on its effect on travel. The respondents were given a list of possible causes of anxiety whilst travelling, based on evidence in the literature and were free to indicate as many as they wished (3). The causes of anxiety when going out that were reported in the survey by the respondents are shown in Table 2. TABLE 2 Causes of anxieties that the respondents have when they go out Number of respondents reporting each cause of anxiety % of respondents What other people think about me 261 69% Feeling out of control 257 67% Having to mix with strangers 254 67% Feeling claustrophobic and unable to escape 221 58% How other people behave 197 52% Feeling disorientated 181 48% Failure of the bus, train or car 180 47% Having to talk to staff such as bus drivers 175 46% Finding suitable toilet facilities 154 40% Getting lost 149 39% Having to take decisions about where to go 141 37% Not being able to obtain help 132 35% Remembering where I am going to 76 20% Using ticket machines 70 18% Handling money 53 14% Something else 55 14% Total 2556 99% Total number of responses: 381 The top reason given was ‘What other people think about me’, cited by 69% of the respondents, followed by ‘Feeling out of control’ and ‘Having to mix with strangers’, both mentioned by 67%. Other factors cited by more than half of the respondents were ‘Feeling claustrophobic and unable to escape’ and ‘How other people behave’. It is clear from Table 2 that many factors cause anxiety while travelling. The reasons cited can be grouped under themes, for example: • Interacting with other people: o What other people think about me o Having to mix with strangers o How other people behave o Having to talk to staff such as bus drivers • Factors associated with wayfinding: o Remembering where I am going to o Having to take decisions about where to go o Feeling disorientated o Getting lost • Factors influenced by the actions of travel operators: o Failure of the bus, train or car o Finding suitable toilet facilities o Using ticket machines o Handling money • Factors stemming from their mental health condition: o Feeling out of control o Feeling claustrophobic and unable to escape o Not being able to obtain help It should be noted that some of these are combinations of factors: ‘Feeling disoriented’ and ‘Not being able to find help’ may be combinations of an effect of the person’s mental health condition and of wayfinding; ‘handling money’ may be to do with interacting with other people or to do with the way the transport operator requires travellers to handle money. As well as providing quantitative information such as that shown in the tables above, the respondents provided many descriptions of their travel experiences. For example, a man aged 41-50 said: ‘I was on a train, travelling to London …. I became so anxious that I just got off at the next stop and had no idea where I was at all. It took me over an hour to regain any sort of calm and control. I then had to get back on the train to be able to go home again. I have never been able to use public transport again since. That was 20+ years ago’. The implications for policy and analysis As example above shows, travel anxiety can have a decisive impact on travelling. The man quoted said that he has not been able to travel by public transport for over 20 years. It seems extremely likely that no action by policy makers or transport operators will encourage him to travel by public transport ever again. There were a number of people who said similar things about how a specific incident prevented them from using particular modes, particularly driving and the London Underground. Over one third of the respondents said that their mental health condition frequently prevented them from leaving home and making any journeys, and over half of them said that their health condition prevented them from buying rail tickets in advance, meaning that they had to pay the full fare rather than cheaper advance tickets for some journeys. Given the high proportion of the population who have anxiety while travelling, transport policies and procedures need to take into account their concerns. This phenomenon of people not using particular modes or having specific needs such as having to have a seat or being confident that they can access a toilet during their journey, may also distort travel analysis and forecasting since such factors are rarely, if ever taken into account. The presentation will reflect on these issues and how they might be addressed. Conclusions Many people in Britain have a mental health condition. In the presentation, the barriers to travel for people with mental health conditions, particularly those who suffer from anxiety when travelling, will be examined. A survey carried out by the author has revealed how complex some of the issues faced by such people when travelling. Two of the main areas where they have difficulty is interacting with other people, both staff and fellow travellers, and wayfinding. There are also some issues associated with travelling such as dealing with ticket machines and handling money. Other issues include finding toilet facilities and failure of the train, bus or car. The implications of these findings for transport policies and procedures and for analysis and forecasting will be considered in the presentation. References Bridges, S. (2014) Mental health problems, Chapter 2 in Volume 1 of the Health Survey for England 2014, Health, Social Care and Lifestyles, Health and Social Care Information Centre (2015). http://content.digital.nhs.uk/catalogue/PUB19295/HSE2014-ch2-mh-prob.pdf. Mackett, R. L. (2017) Building Confidence – Improving travel for people with mental impairments, Report produced for DPTAC (Disabled Persons Transport Advisory Committee), 2017. https://www.gov.uk/government/publications/exploring-the-barriers-to-travel-for-people-with-mental-impairments. NHS Choices (2018) Health A-Z https://www.nhs.uk/conditions/

Wayfinding and mental health

Wayfinding uses a range of skills including recalling information from memory, interpreting information from the environment, and taking decisions based on this information. Mental health conditions such as anxiety or depression can adversely affect these skills. A significant proportion of the population has one or more mental health conditions. This presentation will examine the issues that such people face when wayfinding. It is based on a study which used the results from an on-line survey of domestic travel by people with mental health conditions. The findings are based on the responses from 363 questionnaires. They were weighted to match the age and gender profile of the population of England with mental health conditions. The anxieties associated with wayfinding such as feeling disorientated and becoming lost are examined. The roles that mobile phone apps and information play in wayfinding are discussed. Gender and age differences are considered where relevant. Many of the respondents indicated that initiatives such as clearer information about bus and train services, the provision of information on board buses and trains, better signposting on the street, and travel training would encourage them to travel more

Reducing travel anxiety by making infrastructure and services more accessible

The purpose of this presentation is to discuss the difficulties faced by people with mental health conditions (for example, anxiety and depression) when they travel and ways in which infrastructure and services can be made more accessible to enable them to travel more. The evidence in the paper comes from an on-line survey of 385 people, all with mental health conditions. The paper concentrates on people with anxiety issues, which 90% of the respondents have. The anxieties are considered under five headings: interacting with fellow travelers, interacting with staff and purchasing tickets, wayfinding and obtaining help, the nature of the journey, and internal feelings. Various interventions to help improve access to infrastructure and services to help address the anxieties are discussed under these headings. The number of respondents who say that they would travel more if some of the interventions were introduced is then examined. The paper concludes that there are ways in which many of travel anxieties can be addressed and that it seems that introducing these types of intervention would produce more trips. For some types of travel this would generate extra revenue which would contribute to meeting the cost of the interventions to improve the accessibility of infrastructure and services