An exploration of demand for physical activity

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The aim of this thesis is to contribute to the understanding of demand for physical activity. Given the government‟s target to increase the proportion of the population who are physically active, we need to know the determinants of demand for physical activity in order to identify target areas for policy. The relevant components of the demand function for physical activity, which were identified from reviews of theoretical and empirical literature on physical activity behaviour, established the need to account for costs (i.e. time and money costs) and perceived benefits among other factors in explaining physical activity behaviour. To date, there is a paucity of studies looking at this issue particularly from an economic perspective, mainly due to the lack of such data. This thesis therefore focussed on fitting varied econometric models (sample selection, count, linear, and probit) to understand how costs and perceived benefits explain indicators of physical activity behaviour (total time spent, number of days, and meeting the recommended level of participation or not); controlling for socio-economic, demographic and psychological variables. Data was sourced from the Health Survey for England (2006), Health Education Authority National Survey of Activity and Health (1991), and face-face interviews conducted in 2008 using a purposive sample. The findings suggest that time and money prices (costs per occasion of participation) of physical activity are inversely correlated with physical activity, and this is mitigated where the perceived benefits of physical activity, both health and non-health, are high. Indicators of demand were price inelastic except for meeting the recommended level of participation, which was highly responsive to changes in time price. Based on the findings, various policies including the use of economic instruments such as subsidies, particularly at the point of consumption, and mass media campaigns to increase awareness about the benefits of physical activity are discussed

Rural-Urban Linkages: The Case of Rural Migrants from Upper West Region to Obuasi Municipality in the Ashanti Region, Ghana

In migration studies, research on backward linkages has received a lot of attention. However, research on rural-urban forward linkages is scanty. This article explored the forward linkages from rural households in the Upper West Region of Ghana to urban migrants in the mining town of Obuasi, which has a long history of attracting migrant workers. The study employed a qualitative research design using in-depth interviews to gather data from 26 respondents in Tizza, Kojokpere, Issa, Kaleo and Jang; and 13 urban migrants in Obuasi. Four focus group discussions were conducted in Obuasi to support and validate the in-depth interviews conducted in the rural communities. The study shows that the resource ows from Tizza, Kojokpere, Issa, Kaleo and Jang to urban migrants in Obuasi are in the form of social support, nancial and food transfers. The rural households view the resource ows as necessary for sustaining the livelihoods of their migrant family members and for maintaining aective ties. The study establishes that reverse ows put nancial and social burdens on rural households and this burden drains resources of rural households.Keywords: Forward Linkages, Livelihood Strategy, Migrants, Obuasi, Upper West Regio

Quantifying the contribution of utility cycling to population levels of physical activity: an analysis of the Active People Survey.

Background Population levels of physical activity are far below recommendations limiting its public health benefits. Utility cycling (i.e. cycling for transport purposes) may be a means of increasing this activity. Empirical evidence quantifying the contribution of utility cycling to the population levels of physical activity is sparse. Methods The English Active People Survey (APS) was analysed to assess the likelihood of meeting UK physical activity guidelines in those who reported utility cycling compared with those who did not. Odds ratios were adjusted for important socioeconomic confounders using a logistic regression model. Results In the full sample, unadjusted odds ratio for meeting physical activity guidelines in favour of utility cyclists was 5.21 (95% confidence interval (CI) 4.96–5.47) and adjusted odds ratio was 4.08 (95% CI 3.88–4.29). The odds were even higher for utility cyclists in inner London [adjusted OR: 6.08 (4.07–7.86)]. The pattern was consistent regardless of the number of activities through which people met the physical activity guideline. Conclusion Utility cycling can make a significant contribution to levels of physical activity. As an activity that can easily integrate into everyday life, utility cycling appears to be a pragmatic policy option for public health decision-makers

The cost-effectiveness of exercise referral schemes

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Exercise referral schemes (ERS) aim to identify inactive adults in the primary care setting. The primary care professional refers the patient to a third party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the patient. This paper examines the cost-effectiveness of ERS in promoting physical activity compared with usual care in primary care setting.NIHR Health Technology Assessment programm

Behaviour Change in Public Health: Evidence and Implications

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420https://doi.org/10.1155/2015/598672pubpu

An exploration of demand for physical activity

The aim of this thesis is to contribute to the understanding of demand for physical activity. Given the government‟s target to increase the proportion of the population who are physically active, we need to know the determinants of demand for physical activity in order to identify target areas for policy. The relevant components of the demand function for physical activity, which were identified from reviews of theoretical and empirical literature on physical activity behaviour, established the need to account for costs (i.e. time and money costs) and perceived benefits among other factors in explaining physical activity behaviour. To date, there is a paucity of studies looking at this issue particularly from an economic perspective, mainly due to the lack of such data. This thesis therefore focussed on fitting varied econometric models (sample selection, count, linear, and probit) to understand how costs and perceived benefits explain indicators of physical activity behaviour (total time spent, number of days, and meeting the recommended level of participation or not); controlling for socio-economic, demographic and psychological variables. Data was sourced from the Health Survey for England (2006), Health Education Authority National Survey of Activity and Health (1991), and face-face interviews conducted in 2008 using a purposive sample. The findings suggest that time and money prices (costs per occasion of participation) of physical activity are inversely correlated with physical activity, and this is mitigated where the perceived benefits of physical activity, both health and non-health, are high. Indicators of demand were price inelastic except for meeting the recommended level of participation, which was highly responsive to changes in time price. Based on the findings, various policies including the use of economic instruments such as subsidies, particularly at the point of consumption, and mass media campaigns to increase awareness about the benefits of physical activity are discussed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The demand for sports and exercise: Results from an illustrative survey

Funding from the Department of Health policy research programme was used in this study.There is a paucity of empirical evidence on the extent to which price and perceived benefits affect the level of participation in sports and exercise. Using an illustrative sample of 60 adults at Brunel University, West London, we investigate the determinants of demand for sports and exercise. The data were collected through face-to-face interviews that covered indicators of sports and exercise behaviour; money/time price and perceived benefits of participation; and socio- economic/demographic details. Count, linear and probit regression models were fitted as appropriate. Seventy eight per cent of the sample participated in sports and exercise and spent an average of £27 per month and an average of 20 min travelling per occasion of sports and exercise. The demand for sport and exercise was negatively associated with time (travel or access time) and ‘variable’ price and positively correlated with ‘fixed’ price. Demand was price inelastic, except in the case of meeting the UK government’s recommended level of participation, which is time price elastic (elasticity = −2.2). The implications of data from a larger nationally representative sample as well as the role of economic incentives in influencing uptake of sports and exercise are discussed.This article is available through the Brunel Open Access Publishing Fund

Is brief advice in primary care a cost-effective way to promote physical activity?

This article is made available through the Brunel Open Access Publishing Fund. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.Aim: This study models the cost-effectiveness of brief advice (BA) in primary care for physical activity (PA) addressing the limitations in the current limited economic literature through the use of a time-based modelling approach. Methods: A Markov model was used to compare the lifetime costs and outcomes of a cohort of 100 000 people exposed to BA versus usual care. Health outcomes were expressed in terms of quality-adjusted life years (QALYs). Costs were assessed from a health provider perspective (£2010/11 prices). Data to populate the model were derived from systematic literature reviews and the literature searches of economic evaluations that were conducted for national guidelines. Deterministic and probability sensitivity analyses explored the uncertainty in parameter estimates including short-term mental health gains associated with PA. Results: Compared with usual care, BA is more expensive, incurring additional costs of £806 809 but it is more effective leading to 466 QALYs gained in the total cohort, a QALY gain of 0.0047/person. The incremental cost per QALY of BA is £1730 (including mental health gains) and thus can be considered cost-effective at a threshold of £20 000/QALY. Most changes in assumptions resulted in the incremental cost-effectiveness ratio (ICER) falling at or below £12 000/QALY gained. However, when short-term mental health gains were excluded the ICER was £27 000/QALY gained. The probabilistic sensitivity analysis showed that, at a threshold of £20 000/QALY, there was a 99.9% chance that BA would be cost-effective. Conclusions: BA is a cost-effective way to improve PA among adults, provided short-term mental health gains are considered. Further research is required to provide more accurate evidence on factors contributing to the cost-effectiveness of BA.NICE Centre for Public Health Excellenc