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IntroductionThere is limited research evaluating 20 mph speed limit interventions, and long-term assessments are seldom conducted either globally or within the UK. This study evaluated the impact of the phased 20 mph speed limit implementation on road traffic collisions and casualties in the City of Edinburgh, UK over approximately 3 years post implementation.MethodsWe used four sets of complementary analyses for collision and casualty rates. First, we compared rates for road segments changing to 20 mph against those at 30 mph. Second, we compared rates for the seven implementation zones in the city against paired control zones. Third, we investigated citywide casualty rate trends using generalised additive model. Finally, we used simulation modelling to predict casualty rate changes based on changes in observed speeds.ResultsWe found a 10% (95% CI −19% to 0%) greater reduction in casualties (8% for collisions) for streets that changed to 20 mph compared with those staying at 30 mph. However, the reduction was similar, 8% (95% CI −22% to 5%) for casualties (10% collisions), in streets that were already at 20 mph. In the implementation zones, we found a 20% (95% CI −22% to −8%) citywide reduction in casualties (22% for collisions) compared with control zones; this compared with a predicted 10% (95% CI −18% to −2%) reduction in injuries based on the changes in speed and traffic volume. Citywide casualties dropped 17% (95% CI 13% to 22%) 3 years post implementation, accounting for trend.ConclusionOur results indicate that the introduction of 20 mph limits resulted in a reduction in collisions and casualties 3 years post implementation. However, the effect exceeded expectations from changes in speed alone, possibly due to a wider network effect.

ABSTRACTPrevious research has illustrated the role of urban green and blue spaces in improving the economic, social, environmental, and health-related outcomes of urban populations. The Connswater Community Greenway is presented as a case study to assess the social value of an urban regeneration project. Using real-world data from two time points (2012 and 2017), our analysis focussed on eight key elements: property values; flood alleviation; tourism; biodiversity; climate change; health and wellbeing; crime; and employment and productivity. Using social return on investment analysis, we estimated the value of the Connswater Community Greenway over a 40-year horizon. The total value was estimated to be between £56.8m and £67m. After subtracting the costs (£42.2m), the net present value of the Connswater Community Greenway was £14.6m - £24.8m. The benefit-cost ratio was 1.34 – 1.59, meaning that for every £1 invested in the Connswater Community Greenway, the local economy gains between £1.34 and £1.59. Overall, the Connswater Community Greenway will provide a positive return on investment which will be realised after 30 years. Social return on investment analysis provides a framework for the incorporation of many multifunctional benefits of urban green and blue spaces into economic evaluation, providing a more complete analysis of value.

BackgroundEvidence regarding the effectiveness of 20 miles per hour (mph) speed limit interventions is limited, and rarely have long-term outcomes been assessed. We investigate the effect of a 20 mph speed limit intervention on road traffic collisions, casualties, speed and volume at 1 and 3 years post-implementation.MethodsAn observational, repeated cross-sectional design was implemented, using routinely collected data for road traffic collisions, casualties, speed and volume. We evaluated difference-in-differences in collisions and casualties (intervention vs control) across three different time series and traffic speed and volume pre-implementation, at 1 and 3 years post-implementation.ResultsSmall reductions in road traffic collisions were observed at year 1 (3%; p=0.82) and year 3 post-implementation (15%; p=0.31) at the intervention site. Difference-in-differences analyses showed no statistically significant differences between the intervention and control sites over time for road traffic collisions. There were 16% (p=0.18) and 22% (p=0.06) reductions in casualty rates at years 1 and 3 post-implementation, respectively, at the intervention site. Results showed little change in mean traffic speed at year 1 (0.2 mph, 95% CI −0.3 to 2.4, p=0.14) and year 3 post-implementation (0.8, 95% CI −1.5 to 2.5, p=0.17). For traffic volume, a decrease in 57 vehicles per week was observed at year 1 (95% CI –162 to −14, p<0.00) and 71 vehicles at year 3 (95% CI −213 to 1, p=0.05) post-implementation.ConclusionA 20 mph speed limit intervention implemented at city centre scale had little impact on long-term outcomes including road traffic collisions, casualties and speed, except for a reduction in traffic volume. Policymakers considering implementing 20 mph speed limit interventions should consider the fidelity, context and scale of implementation.

ABSTRACTEvidence supports the multi-functional nature of urban green space, and so economic evaluations should have a broad lens in order to capture their full impact. Given the evidence for a range of health, wellbeing, social and environmental benefits of such interventions, we modelled the potential social return on investment of a new urban greenway intervention in Belfast, Northern Ireland. Areas that the greenway was purported to impact upon included: land and property values; flood alleviation; tourism; labour employment and productivity; quality of place; climate change; and, health. The most recent and applicable evidence pre-development of the greenway for each area was summarised to obtain an ‘effect estimate’; this was then applied to available data for the greenway area and the impact estimated and monetised using various methods. To calculate the Benefit Cost Ratio all seven monetary benefits were summed, for both a worst case and best case scenario, and divided by the total investment cost. The Benefit Cost Ratio ranged from 2.88 to 5.81 (i.e. for every £1.00 invested in the greenway, there would be £2.00–6.00 returned). This is one of the first studies to conduct a social return on investment of a new urban greenway estimating the potential benefits.

ABSTRACTDirect observation of behaviour offers an unobtrusive method of assessing physical activity in urban spaces, which reduces biases associated with self-report. However, there are no existing observation tools that: (1) assess other behaviours that are important for people’s wellbeing beyond physical activity; (2) are suitable for urban spaces that typically have lower numbers of users (e.g. amenity green spaces) or that people pass through (e.g. green corridors); and (3) have been validated in Europe. MOHAWk (Method for Observing pHysical Activity and Wellbeing) is a new observation tool for assessing three levels of physical activity (Sedentary, Walking, Vigorous) and two other evidence-based wellbeing behaviours (Connect: social interactions; Take Notice: taking notice of the environment) in urban spaces. Across three studies, we provide evidence that MOHAWk is reliable and valid from 156 hours of observation by six observers in five urban spaces in the UK. MOHAWk can be used in policy or practice (e.g. by local authorities or developers), or in more formal institutional based research projects. This new tool is an inexpensive and easy-to-use method of generating wellbeing impact evidence in relation to the urban physical or social environment. A manual providing detailed instruction on how to use MOHAWk is provided.

Smoking prevention among adolescents is a public health challenge that is even more significant in low- and middle-income countries where local evidence is limited and smoking rates remain high. Evidence-based interventions could be transferred to low- and middle-income country settings but only after appropriate cultural adaptation. This paper aims to describe the process of the cultural adaptation of two school-based smoking prevention interventions, A Stop Smoking in Schools Trial and Dead Cool, to be implemented in Bogotá, Colombia. A recognized heuristic framework guided the cultural adaptation through five stages. We conducted a concurrent nested mixed-methods study consisting of a qualitative descriptive case study and a quantitative pre- and post quasi-experiment without a control. Contextual, content, training, and implementation modifications were made to the programs to address cultural factors, to maintain the fidelity of implementation, and to increase the pupils’ engagement with the programs. Modifications incorporated the suggestions of stakeholders, the original developers, and local community members, whilst considering the feasibility of delivering the programs. Involving stakeholders, original program developers, and community members in the cultural adaptation of evidence-based interventions is essential to properly adapt them to the local context, and to maintain the fidelity of program implementation.

A recent meta-narrative review investigating 20mph speed limits on public health outcomes reported inconclusive findings and the limited scope of liveability investigations. Consequently, we investigated the impact of 20mph speed limit interventions on liveability using the Microscale Audit of Pedestrian Streetscapes Liveability (MAPS-Liveability) via Google Street View (GSV).

Few observational studies have assessed the role of physical activity in oesophago-gastric cancer risk. This prospective cohort study aimed to assess the association between physical activity and risk of oesophageal or gastric cancer. A cohort of 359,033 adults aged 40–69 years were identified from the UK Biobank, which recruited participants between 2006 and 2010. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between self-reported levels of physical activity and screen-based sedentary behaviour and risk of oesophageal and gastric cancer were calculated using Cox proportional hazards models. During eight years of follow-up (mean?=?5.5), 294 oesophageal cancer and 217 gastric cancer cases were identified. Physical activity and screen-based sedentary behaviour levels were not associated with overall oesophago-gastric cancer risk. However, when compared with low levels, high physical activity levels were associated with a significantly reduced risk of gastric non-cardia cancer (HR 0.58, 95% CI 0.37–0.95). Moderate physical activity levels were associated with a 38% reduced risk of oesophageal adenocarcinoma (HR 0.62, 95% CI 0.43–0.89), although no dose-response association was apparent. Moderate, rather than high, physical activity levels were associated with the strongest reductions in oesophageal adenocarcinoma risk in this large UK prospective cohort.

Background Few observational studies have assessed the role of physical activity in oesophago-gastric cancer risk.Objective This prospective cohort study aimed to assess the association between physical activity and risk of oesophageal or gastric cancer.Methods A cohort of 359,033 adults aged 40–69 years were identified from the UK Biobank, which recruited participants between 2006 and 2010. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between self-reported levels of physical activity and screen-based sedentary behaviour and risk of oesophageal and gastric cancer were calculated using Cox proportional hazards models.Results During eight years of follow-up (mean = 5.5), 294 oesophageal cancer and 217 gastric cancer cases were identified. Physical activity and screen-based sedentary behaviour levels were not associated with overall oesophago-gastric cancer risk. However, when compared with low levels, high physical activity levels were associated with a significantly reduced risk of gastric non-cardia cancer (HR 0.58, 95% CI 0.37–0.95). Moderate physical activity levels were associated with a 38% reduced risk of oesophageal adenocarcinoma (HR 0.62, 95% CI 0.43–0.89), although no dose-response association was apparent.Conclusion Moderate, rather than high, physical activity levels were associated with the strongest reductions in oesophageal adenocarcinoma risk in this large UK prospective cohort.

AbstractThis study uses simulation over real and artificial networks to compare the eventual adoption outcomes of network interventions, operationalized as idealized contagion processes with different sets of seeds. While the performance depends on the details of both the network and behaviour adoption mechanisms, interventions with seeds that are central to the network are more effective than random selection in the majority of simulations, with faster or more complete adoption throughout the network. These results provide additional theoretical justification for utilizing relevant network information in the design of public health behavior interventions.

Car travel is associated with increased risk of morbidity and mortality, physical inactivity, traffic collisions and casualties, and air and noise pollution. Effective interventions are required to reduce car use and change travel behaviour to sustainable modes. We conducted an umbrella review: 1) determine effective interventions and intervention components to reduce car use and change travel behaviour; and 2) determine where effective components are situated by level of delivery (micro-, meso- or macro-level).

Many studies have used the concept of ‘walkability’ to assess how conducive a neighbourhood is to physical activity, especially active travel. Studies in the United States and Australia have traditionally used a road-based network system of intersection density to derive a walkability index. However, other studies suggest that analyses based on footpath networks may provide a more robust basis for assessing the walkability of built environments in the European context as they better capture alternative opportunities for physical activity such as parks and greenways. To date, no studies have examined whether a road- or footpath-based network is more closely related to actual physical activity behaviour. Therefore, the aims of this paper were to examine associations between active travel and walkability indices based on both road- and footpath-based intersection density and to establish which measure provided the best fit to the data.

A supportive urban environment can prevent or delay the progress of cognitive decline. There is evidence for the existence of mechanistic pathways between the urban environment and cognitive decline, but the interrelations between these pathways are unclear. In this study, we aimed to map the mechanistic pathways by which urban environment factors affect cognitive decline in adults older than 50 years.

Liveability is a complex, multifaceted concept with various definitions, but with an agreed core set of features (e.g., safety, walkability). Typically, liveability is measured at the macro-level (city or regional-level), and has been used in advocacy by local populations. However, micro-level (street-level) liveability measurements could also/alternatively be used to identify modifiable environmental features impacting health and well-being. To date, no micro-level liveability tools exist. This study investigates the reliability and rater agreement of a new micro-level audit tool designed for use with Google Street View (GSV).

According to the biophilia hypothesis, humans have evolved to prefer natural environments that are essential to their thriving. With urbanization occurring at an unprecedented rate globally, urban greenspace has gained increased attention due to its environmental, health, and socioeconomic benefits. To unlock its full potential, an increased understanding of greenspace metrics is urgently required. In this first-of-a-kind study, we quantified street-level greenspace using 751 644 Google Street View images and computer vision methods for 125 274 locations in Ireland’s major cities. We quantified population-weighted exposure to greenspace and investigated the impact of greenspace on health and socioeconomic determinants. To investigate the association between greenspace and self-reported health, a negative binomial regression analysis was applied. While controlling for other factors, an interquartile range increase in street-level greenspace was associated with a 2.78% increase in self-reported “good or very good” health [95% confidence interval: 2.25–3.31]. Additionally, we observed that populations in upper quartiles of greenspace exposure had higher levels of income and education than those in lower quartiles. This study provides groundbreaking insights into how urban greenspace can be quantified in unprecedented resolution, accuracy, and scale while also having important implications for urban planning and environmental health research and policy.

Road traffic injuries are a leading cause of preventable death globally, but can be reduced by introducing speed lowering interventions such as 20 mph or 30 km/h speed ‘zones’ and ‘limits’. ‘Zones’ utilise physical traffic calming measures and ‘limits’ only utilise signage and lines. Transport is a social determinant of health and therefore such interventions may in/directly also impact on other health outcomes.

The workplace is ideal to encourage habitual physical activity, but little evidence exists on effective behaviour change interventions that lead to sustained behaviour. We aimed to address this gap by evaluating the effectiveness and cost-effectiveness of a loyalty-based intervention on physical activity in public sector employees.

BackgroundPhysical inactivity is a major public health concern and more innovative approaches are urgently needed to address it. So far, physical activity interventions have largely ignored the extent to which an individual's social network can affect physical activity behaviours. The sparse evidence base has mainly relied on self-reported, cross-sectional data for social networks. However, novel technologies and analytical techniques afford new and promising means to obtain and analyse these data.

BackgroundPhysical inactivity is a major public health concern, and more innovative approaches are urgently needed to address it. The UK Government supports the use of incentives and so-called nudges to encourage healthy behaviour changes, and has encouraged business sector involvement in public health through the Public Health Responsibility Deal. To test the effectiveness of provision of incentives to encourage adults to increase their physical activity, we recruited 406 adults from a workplace setting (office-based) to take part in an assessor-blind randomised controlled trial.