Rees, Rebecca; Hollands, gareth; Stansfield, claire; Kwan, irene; Richardson, Michelle; Shemilt, Ian; Thomas, james; ... sowden, amanda; + view all Rees, Rebecca; Hollands, gareth; Stansfield, claire; Kwan, irene; Richardson, Michelle; Shemilt, Ian; Thomas, james; Sutcliffe, katy; sowden, amanda; - view fewer (2024) Interventions to increase active travel and improve health outcomes in different population groups: a multi-stage evidence synthesis [Protocol]. OSF

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Abstract

Background Active travel is defined as walking, cycling, wheeling (the use of mobility aids), or scootering activity, for the functional purpose of transport to a particular destination (i.e. getting from place to place), such as work, school or the shops (Public Health England 2016; Saunders et al, 2013). Physical activity generally (Warburton and Bredin, 2017), as well as active travel activity specifically (Dinu et al, 2019), have been directly linked to health benefits. Beyond potential benefits for population health, active travel also confers important co-benefits for planetary health (Rutter et al, under review). For example, it provides opportunities for replacing journeys that would otherwise have used more environmentally damaging modes. Reducing emissions from vehicles and road materials improves air quality with associated health as well as environmental benefits. Moreover, substantial reductions in land transport emissions are needed to meet Net Zero commitments (Marteau et al, 2022). The vital importance for population and planetary health of rapid modal shifts towards active transport is highlighted in numerous policy documents and reports including being central to two of the Lancet-Chatham House Commission’s recommendations for policy actions with the potential to improve population health post COVID-19 (Rutter et al, under review). However, levels of active travel in the UK do not reflect this emphasis, and are currently low. The most recent available data for Great Britain reports that in 2022, 323.8 billion vehicle miles were driven on roads of which cycle traffic only made up 3.9 billion. Furthermore, in England, 278 miles and 282 trips were travelled per person via walking or cycling modes versus 4192 miles and 502 trips as a car or van driver or passenger. In terms of recent trends, the most recent available Department for Transport data (suggests cycling traffic levels have decreased by 5.2% over the period of June 2022 to June 2023. while motor traffic levels have increased by 2.3% over the same period. Importantly, there is also substantial evidence that levels of active travel differ by population groups, including those subject to disadvantage and to health and environmental inequities (Sustrans et al, 2022). For example, in England in 2022, distance walked and cycled was negatively associated with income quintile (241 miles vs 319 miles for lowest and highest income groups respectively, although slightly more trips were taken by the former). Furthermore, a lower distance (and involving fewer trips) was walked and cycled by those who have never worked and the long-term unemployed, versus managerial and professional occupations (237 vs 354 miles respectively), as well as by those with a mobility difficulty versus no such difficulty (112 vs 302 miles respectively). A wide range of interventions have been developed and implemented at varying scales to attempt to increase the uptake and prevalence of active travel behaviours, applying both individual- and population-level approaches (Xiao et al, 2022; Love et al, 2019). Common types of active travel interventions encompass changes to the physical or built environment (including specific active travel infrastructure such as cycle or pedestrian paths or pavement improvements, and streetscape or public realm improvements (e.g. lighting, signage, greening, street furniture); marketing or information campaigns (e.g. education sessions); provision of skills training, equipment or structured opportunities (e.g. cycle training, cycle share or subsidy schemes, walking buses); and, incentives (e.g. financial or other rewards) (Cavill et al, 2019; Hansmann et al, 2022; Medeiros et al, 2021; Smith et al, 2017; Xiao et al, 2022). While active travel interventions, especially their impacts on physical activity outcomes, have been widely evaluated via primary outcome evaluation studies and at the level of evidence syntheses, this has been principally in relation to overall effects across populations. Differential impacts of interventions by population subgroups including those subject to disadvantage, have been relatively under-studied, including in a UK-specific context, despite such differences having the potential to reduce or exacerbate disparities in both levels of active travel and in health outcomes more generally. At present, there is weak evidence for positive health equity impacts of active travel interventions (Hansmann et al, 2022) and the potential for negative health equity impacts cannot be excluded (Luan et al, 2019). The scope of previous reviews has been relatively limited in terms comprehensively searching for and identifying relevant evidence, and the focus of investigations relatively narrow in terms of the range of population subgroups considered. It has been recognised in the Department of Health and Social Care (England) – the commissioners of this review and key stakeholders in its development – that the current evidence base is unable to optimally inform decision-makers in developing and implementing active travel interventions and policies that are both effective and equitable, including those aimed at specific communities and population subgroups. Without a comprehensive evidence-based assessment, there is a risk that interventions target whole populations inappropriately and/or target population subgroups ineffectively, and so risk widening existing health inequalities. Aims The overall aim of this research is to develop understanding of the potential public health impact of active travel interventions across different population groups, particularly those subject to disparities in health outcomes. This will be addressed via a multi-stage programme of work (see Figure overleaf). We will first produce a descriptive and high-level overview of the research evidence on differential impacts of active travel interventions (Evidence Map), followed by an in-depth assessment of their effectiveness (Effectiveness Review). The Evidence Map will help to refine the scope of the Effectiveness Review to make it optimally informative and efficient given available evidence, and contextualise the findings of the of the Effectiveness Review – e.g. by illustrating types of interventions for which data are not available. This programme of work aims to answer the following questions: Research question 1 (Evidence Map): What is the extent of current evidence evaluating active travel interventions targeting, or reporting outcomes for, different groups? Research question 2 (Effectiveness Review): What is the impact in different groups of evaluated interventions on i) active travel ii) health outcomes?

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