JTH – Abstracts: 2014 – Volume 1 – Issue 2

2014 Volume 1 Issue 2

The impact of health problems on driving status among older adults

Abstract

Objective

This study assessed the impact of health problems on driving status (current driver vs. ex-driver) among older adults to identify which of those health problems have the greatest individual and population impact on driving cessation.

Methods

Data were from baseline and a 5 year follow-up wave of a longitudinal survey of adults aged 55 years and older (N=1279). The impact of several health problems on driving status was assessed using a relative risk ratio and a population attributable risk percent. Analyses controlled for age, gender, and the presence of additional baseline health problems.

Results

Many health conditions were not associated with driving cessation. Functional limitations, cognitive function, and measures of vision were significant predictors of driving cessation. Self-care functional limitations were associated with the highest risk for driving cessation, while visual function was associated with the highest attributable risks.

Discussion

In order to effectively address healthy aging and mobility transitions, it is important to consider the implications of targeting individuals or populations who are most at risk for driving cessation. The risk ratio is relevant for evaluating individuals; the attributable risk is relevant for developing interventions in populations.

The need for consistency and equity in driver education and assessment post-stroke

Abstract

People who are unable to resume driving after a stroke often experience reduced participation. Return to driving is made difficult by inconsistencies in knowledge regarding legislation, the occupational therapy driving assessment process and access to services. As a result, inequities exist between and within states and territories of Australia. Some drivers miss out on, or bypass formal assessment, while other drivers experience rigorous assessment which may result in licence cancellation. In this viewpoint, the authors propose a way forward to increase the equity of access to driver education and assessment post-stroke in Australia. Strategies proposed to improve consistency and equity include greater education, evidence based written documentation of procedures, a systematic review of current off-road driver assessments and the transfer of administration of driving assessment services from health to transport authorities

Shifting short motorized trips to walking: The potential of active transportation for physical activity in Montreal

Abstract
Objectives

To estimate the number of walking steps resulting from shifting short motorized trips to walking at a population level and determine the weight gain from not operating this transfer.

Methods

Analyses are based on data from the 2008 Origin-Destination Survey carried out in the Greater Montreal Area (Canada). This survey collects geocoded information on all trips (motorized or not) made by 5% of the population during a typical weekday. Using appropriate stride lengths for various population segments, short motorized trips were converted into steps to see how many steps per day could be performed by transferring these trips to walking. Until they are performed, these steps are accounted for “steps in reserve”.

Results

During a typical 2008 weekday, 7.72% of daily motorized trips were flagged as walkable. These trips account for 608 million steps, an average of 2380 daily steps per person. Shifting short motorized trips to walking would allow 8.33% of the population to increase its level of daily physical activity.

Conclusions

Shifting short motorized trips to walking offers a valuable opportunity for increasing daily physical activity and might also help reduce weight gain at a population level.

Parent safety perceptions of child walking routes

Abstract

Walking rates to school remain low for U.S. children in large part due to parent concern for child safety. Little research exists that identifies which features of streets and intersection lead parents to feel that walking is unsafe for their children. In this study, parent volunteers conducted an audit of streets and intersections leading to seven elementary schools in a suburban school district. Parents were most likely to feel concern about streets that lacked sidewalks or had sidewalks with obstructions. Wheelchair-accessible routes were seen as appropriate for walking children. Parents expressed concern over safety at intersections, particularly those involving large streets; traffic controls did not mollify their concern. These results support the use of appropriate behavior models for assessing walking choices, highlight the importance of well-maintained sidewalks and age-appropriate crossings for young families, and demonstrate the importance of including the public in street audits.

Crossing guard presence: Impact on active transportation and injury prevention

Abstract

Evaluation of increased crossing guard presence on the likelihood children using safe active transportation (AT) was conducted during the simultaneous hiring of multiple crossing guards. The primary study aim was to determine if increased crossing guard presence was associated with (1) an increased number of children walking/biking to school, (2) diminished parental safety concerns, (3) an increased likelihood of parents allowing their child to walk/bike to school, and (4) an increased number of children utilizing supervised routes.

A quasi-experimental study design was conducted at study intersections in experimental and control schools (matched by neighborhood, rate for risk of pedestrian injury, and socio-economic status). Only experimental schools received awareness campaigns and a newly positioned crossing guard. Measurements taken pre/post-guard placement assessed trends of AT rates among the school׳s population, and Parent Surveys were utilized to determine if crossing guard presence changed parental attitudes toward AT and/or perceptions of safety.

Pre/post-program implementation evaluation did not reveal significant changes in trends of AT; parental safety concerns; parental attitudes towards AT. Though experimental schools showed fluctuations in travel trends, no indication of either improvement or worsening of attitudes was found. Significant (noticeable) differences in pre/post-program implementation were identified in the fourth study aim, the number of children utilizing supervised routes vs. unsupervised routes. Also the control school showed no discernible changes from pre to post-program implementation.

Study findings demonstrate that increased crossing guard presence is most likely to influence safe behavior as indicated by the increased numbers of children engaging in predictable pedestrian behaviors through their use of supervised routes. Results suggest a prioritization towards engaging in and acknowledging safety before physical activity in areas with existing high rates of AT to and from school. Future studies will include longer observation periods, longer interventions, and lower rates of existing AT.

Gender and used/preferred differences of bicycle routes, parking, intersection signals, and bicycle type: Professional middle class preferences in Hangzhou, China

Abstract
Objective

To assess preference differences of females, bicyclists, bicyclists/non-bicyclists, and >3 days/week bicyclists about cycle tracks, surrounding environments, parking, signals, and bicycle type among middle class professionals in Hangzhou, a premier bicycling city in China.

Methods

Surveys were distributed to 1200 middle school students that 1150 parents/adults completed (95.8% completion rate). Multiple linear regression was used to study associations between frequency of bicycling and age, gender, education, income, obesity, and car ownership.

Results

Cycle tracks were a maximum of 15 feet wide, enabling side-by-side bicycling, with continuous landscaped islands a maximum of 7 feet wide between the road and the cycle track with trees over 40 years old. Almost all knew how to bicycle, 77% of men and 72% of women owned a car, and, of these car owners, 43.8% bicycled each week. Only 47.1% of men and 55.1% of women did not bicycle. Bicycling was deemed enjoyable due to the beautiful surrounding environment (52.7% strongly agreed/agreed). Gender differences were statistically significant for preferring bicycle signals (63.7% men, 69.1% women) and cycle tracks (53.9% men, 60.2% women). Used/preferred differences were statistically significant for bicycle signals (33.8% used versus 71.4% preferred), parking sheds (39.8% used versus 62.7% preferred) and cycle tracks (34.4% used versus 58.6% preferred). Percentages for overweight were significantly different between owning a car (28.8%) and not owning a car (21.0%).

Conclusions

Cities could test other city׳s innovations including parking sheds, bicycle signals, public bicycles, and wide-landscaped cycle tracks with trees between the cycle track and the road.

Impact on cycling behavior and weight loss of a national cycling skills program (AustCycle) in Australia 2010–2013

Abstract

From 2010 to 2013 AustCycle implemented a community-based national adult cycle training program across Australia funded by federal, state and local governments, workplaces and individuals. A primary aim for Commonwealth Health Department funding was reduction of risk factors for chronic disease.

Participants provided their demographic, cycling behavior data along with height and weight when registering with the program (n=4145), and provided feedback on the program immediately afterwards (n=2250). A 10% sample of participants who provided height and weight data at registration were contacted at three months (n=423) period, and then 12 months (n=125) and physical activity, cycling behavior and weight data were collected.

Feedback was extremely positive, with over 91% of participants highly rating their AustCycle experience. There were statistically significant improvements in cycling skills and confidence at three months, and small but statistically significant reductions in weight and body mass index (BMI) at three and 12 months among a sub-group of participants able to be contacted. There was a statistically significant association between lower BMI and total minutes cycled in the past week at the three month follow-up, after adjustment for age, sex and other physical activity, although there was likely to have been self-selection bias for this reporting.

Although there are limitations to the methodology, cycling skills programs can increase cycling among participants and appear to have the potential to reduce an important chronic disease risk factor in the community.

Estimating the health economic benefits of cycling

Abstract

This paper examines the health and economic benefits from the construction of a new segregated cycleway in Ireland. The health economic benefits were estimated using the World Health Organisation’s (WHO) Health Economic Assessment Tool (HEAT). This tool can be used to calculate the health economic benefits from an intervention (such as construction of a new cycling facility). The HEAT tool also offers research a transparent, coherent and standardized method of evaluating the health economic benefits of cycling investments. The data used for this tool was retrieved from a survey that was undertaken between December 2012 and January 2013 in a study area near Dublin, Ireland. In total, there were 845 responses to this survey. The results show that, if constructed, the cycleway would yield significant health and economic benefits.