Patterns and correlates of active commuting in adults with type 2 diabetes: cross-sectional evidence from UK Biobank.

OBJECTIVES: To describe the active commuting (AC) patterns of adults with type 2 diabetes and how these relate to physical activity and sedentary behaviour in UK Biobank. Social and environmental correlates of AC will also be explored. DESIGN: Cross-sectional analysis of a cohort study. SETTINGS: This is a population cohort of over 500 000 people recruited from 22 centres across the UK. Participants aged between 37 and 73 years were recruited between 2006 and 2010. PARTICIPANTS: 6896 participants with a self-reported type 2 diabetes diagnosis who reported commuting to work and had complete covariate data were included in the analysis. EXPOSURE MEASURES: Exposure measures were AC to work, measured as usual mode of transport. OUTCOME MEASURES: Outcome measures were weekly minutes of moderate to vigorous physical activity (MVPA), hours/day of sedentary time and participation in active travel. RESULTS: AC (reporting walking or cycling to work only) was reported by 5.5% of participants, with the great majority using the car to commute (80%). AC was associated with an additional 73 (95% CI 10.8 to 134.9) and 105 (95% CI 41.7 to 167.2) weekly minutes of MVPA for men and women, respectively. AC was associated with reduced sedentary time (ß -1.1, 95% CI -1.6 to -0.7 hours/day for men; and ß -0.8, 95% CI -1.2 to -0.3 hours/day for women). Deprivation and distance from home to work were identified as correlates of AC behaviour. CONCLUSIONS: Rates of AC are very low in adults with type 2 diabetes. However, AC offers a potentially sustainable solution to increasing physical activity and reducing sedentary behaviour. Therefore, strategies to improve the environment and encourage AC may help to increase population levels of physical activity and reduce the disease burden associated with type 2 diabetes.

The Local Food Environment and Fruit and Vegetable Intake: A Geographically Weighted Regression Approach in the ORiEL Study.

Studies that explore associations between the local food environment and diet routinely use global regression models, which assume that relationships are invariant across space, yet such stationarity assumptions have been little tested. We used global and geographically weighted regression models to explore associations between the residential food environment and fruit and vegetable intake. Analyses were performed in 4 boroughs of London, United Kingdom, using data collected between April 2012 and July 2012 from 969 adults in the Olympic Regeneration in East London Study. Exposures were assessed both as absolute densities of healthy and unhealthy outlets, taken separately, and as a relative measure (proportion of total outlets classified as healthy). Overall, local models performed better than global models (lower Akaike information criterion). Locally estimated coefficients varied across space, regardless of the type of exposure measure, although changes of sign were observed only when absolute measures were used. Despite findings from global models showing significant associations between the relative measure and fruit and vegetable intake (ß = 0.022; P < 0.01) only, geographically weighted regression models using absolute measures outperformed models using relative measures. This study suggests that greater attention should be given to nonstationary relationships between the food environment and diet. It further challenges the idea that a single measure of exposure, whether relative or absolute, can reflect the many ways the food environment may shape health behaviors.

Active commuting and obesity in mid-life: cross-sectional, observational evidence from UK Biobank.

BACKGROUND: Physical inactivity is a leading cause of obesity and premature mortality. We aimed to examine the relation between active commuting and obesity in mid-life using objectively measured anthropometric data from UK Biobank. METHODS: Cross-sectional, observational data from UK Biobank were used. These were collected from individuals aged 40-69 years who visited 22 assessment centres across the UK between 2006 and 2010. Self-reported commuting method was operationalised into seven categories, ordered to reflect typical levels of physical exertion. The outcomes assessed were BMI (based on objectively measured weight and height) and percentage body fat. Hypothesised confounders were income, area deprivation, urban or rural residence, education, alcohol intake, smoking, leisure physical activity, recreational walking, occupational physical activity, general health, and limiting illness or disability. We used sex-stratified multivariate linear-regression models. FINDINGS: Final complete case sample sizes were 72 999 men and 83 667 women for the BMI outcome and 72 139 men and 82 788 women for the percentage body fat outcome. Active commuting was significantly and independently associated with reduced BMI and percentage body fat for both sexes, with a graded pattern apparent across the seven commuting categories. In fully adjusted models, compared with their car-only counterparts, mixed public and active transport commuters had significantly lower BMI (men: ß coefficient -1·00 kg/m(2) [95% CI -1·14 to -0·87], p<0·0001; women: -0·67 kg/m(2) [-0·86 to -0·47], p<0·0001), as did cycling or cycling and walking commuters (men: -1·71 kg/m(2) [95% CI -1·86 to -1·56], p<0·0001; women: -1·65 kg/m(2) [-1·92 to -1·38], p<0·0001). Similarly, compared with car-only commuters, mixed public transport and active commuters had significantly lower percentage body fat (men: -1·32% [95% CI -1·53 to -1·12], p<0·0001; women: -1·10% [-1·40 to -0·81], p<0·0001), as did cycling or cycling and walking commuters (men: -2·75% [95% CI -3·03 to -2·48], p<0·0001; women: -3·26% [-3·80 to -2·71], p<0·0001). INTERPRETATION: This study is the first to use UK Biobank data to address the topic of active commuting and obesity and shows robust, independent associations between active commuting and healthier bodyweight and composition. These findings support the case for interventions to promote active travel as a population-level policy response for prevention of obesity in mid-life. FUNDING: UK Medical Research Council.

Change in commute mode and body-mass index: prospective, longitudinal evidence from UK Biobank.

BACKGROUND: Insufficient physical activity is a determinant of obesity and cardiovascular disease. Active travel to work has declined in high-income countries in recent decades. We aimed to determine which socioeconomic and demographic characteristics predicted switching to or from active commuting, whether switching from passive to active commuting (or the reverse) independently predicts change in objectively measured body-mass index (BMI), and to ascertain whether any association is attenuated by socioeconomic, demographic, or behavioural factors. METHODS: This study used longitudinal data from UK Biobank. Baseline data collection occurred at 22 centres between March, 2006, and July, 2010, with a repeat assessment at one centre (Stockport) between August, 2012, and June, 2013, for a subset of these participants. Height and weight were objectively measured at both timepoints. We included individuals present at both timepoints with complete data in the analytic sample. Participants were aged 40-69 years and commuted from home to a workplace on a regular basis at both baseline and follow-up. Two exposures were investigated: transition from car commuting to active or public transport commuting and transition from active or public transport to car commuting. Change in BMI between baseline and repeat assessment was the outcome of interest, assessed with bivariate and multivariate logistic regression models. FINDINGS: 502 656 individuals provided baseline data, with 20 346 participating in the repeat assessment after a median of 4·4 years (IQR 3·7-4·9). 5861 individuals were present at both timepoints and had complete data for all analytic variables. Individuals who transitioned from car commuting at baseline to active or public transportation modes at follow-up had a decrease in BMI of -0·30 kg/m2 (95% CI -0·47 to -0·13; p=0·0005). Conversely, individuals who transitioned from active commuting at baseline to car commuting at follow-up had a BMI increase of 0·32 kg/m2 (0·13 to 0·50; p=0·008). These effects were not attenuated by adjustment for hypothesised confounders. Change in household income emerged as a determinant of commute mode transitions. INTERPRETATION: Incorporation of increased levels of physical activity as part of the commute to work could reduce obesity among middle-aged adults in the UK. FUNDING: UK Medical Research Council.

Associations between active commuting, body fat, and body mass index: population based, cross sectional study in the United Kingdom.

OBJECTIVE: To determine if promotion of active modes of travel is an effective strategy for obesity prevention by assessing whether active commuting (walking or cycling for all or part of the journey to work) is independently associated with objectively assessed biological markers of obesity. DESIGN: Cross sectional study of data from the wave 2 Health Assessment subsample of Understanding Society, the UK Household Longitudinal Study (UKHLS). The exposure of interest, commuting mode, was self reported and categorised as three categories: private transport, public transport, and active transport. PARTICIPANTS: The analytic samples (7534 for body mass index (BMI) analysis, 7424 for percentage body fat analysis) were drawn from the representative subsample of wave 2 respondents of UKHLS who provided health assessment data (n = 15,777). MAIN OUTCOME MEASURES: Body mass index (weight (kg)/height (m)(2)); percentage body fat (measured by electrical impedance). RESULTS: Results from multivariate linear regression analyses suggest that, compared with using private transport, commuting by public or active transport modes was significantly and independently predictive of lower BMI for both men and women. In fully adjusted models, men who commuted via public or active modes had BMI scores 1.10 (95% CI 0.53 to 1.67) and 0.97 (0.40 to 1.55) points lower, respectively, than those who used private transport. Women who commuted via public or active modes had BMI scores 0.72 (0.06 to 1.37) and 0.87 (0.36 to 0.87) points lower, respectively, than those using private transport. Results for percentage body fat were similar in terms of magnitude, significance, and direction of effects. CONCLUSIONS: Men and women who commuted to work by active and public modes of transport had significantly lower BMI and percentage body fat than their counterparts who used private transport. These associations were not attenuated by adjustment for a range of hypothesised confounding factors.

New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity.

National and local policies to improve diet in low-income US populations include increasing physical access to grocery stores and supermarkets in underserved neighborhoods. In a pilot study that evaluated the impacts of opening a new supermarket in a Philadelphia community considered a "food desert"-part of the Pennsylvania Fresh Food Financing Initiative-we found that the intervention moderately improved residents' perceptions of food accessibility. However, it did not lead to changes in reported fruit and vegetable intake or body mass index. The effectiveness of interventions to improve physical access to food and reduce obesity by encouraging supermarkets to locate in underserved areas therefore remains unclear. Nevertheless, the present findings suggest that simply improving a community's retail food infrastructure may not produce desired changes in food purchasing and consumption patterns. Complementary policy changes and interventions may be needed to help consumers bridge the gap between perception and action. The replication of our findings in other settings and research into the factors that influence community residents' receptivity to improved food access are urgently required.

Investigating the effect of the London living wage on the psychological wellbeing of low-wage service sector employees: a feasibility study.

BACKGROUND: Working poverty has become a major public health concern in recent times, and low-paid, insecure employment has been widely linked to poor psychological wellbeing. The London Living Wage (LLW) campaign aims to ensure employees receive adequate pay. The objective of this study is to investigate whether working for a LLW employer predicted higher levels of psychological wellbeing among low-wage service sector employees. METHODS: Workplace interviews were conducted with 300 service sector employees in London; 173 of whom were in LLW workplaces. Positive psychological wellbeing was measured using the Warwick-Edinburgh Mental Wellbeing Scale. Multivariate linear regression was used to assess whether working for a LLW employer was associated with greater psychological wellbeing, adjusting for hypothesised confounding and mediating factors. RESULTS: After adjustment, respondents working for LLW employers had wellbeing scores 3.9 units higher on average than those who did not (95% CI: 1.8, 6.0). These empirical results are complemented by methodological findings regarding the difficulties associated with accessing the study group. CONCLUSIONS: Those who worked for a LLW employer had significantly higher psychological wellbeing on average than those who did not. This was shown to be irrespective of any differences in the socioeconomic or demographic composition of these two groups.

Do perceptions of the neighbourhood food environment predict fruit and vegetable intake in low-income neighbourhoods?

The aim of this study is to investigate the extent to which perceptions of the quality, variety and affordability of local food retail provision predict fruit and vegetable intake. Secondary analysis of baseline data from the Philadelphia Neighbourhood Food Environment Study was undertaken. This study investigating the role of the neighbourhood food environment on diet and obesity comprised a random sample of households from two low-income Philadelphia neighbourhoods, matched on socio-demographic characteristics and food environment. The analytic sample comprised adult men and women aged 18-92 (n=1263). Perception of the food environment was measured using five related dimensions pertaining to quality, choice and expense of local food outlets and locally available fruits and vegetables. The outcome, portions of fruits and vegetables consumed per day, was measured using the Block Food Frequency Questionnaire. Results from multivariate regression analyses suggest that measured dimensions of perceived neighbourhood food environment did not predict fruit and vegetable consumption. Further investigation of what constitutes an individual's 'true' food retail environment is required.

Do labour market status transitions predict changes in psychological well-being?

BACKGROUND: The objective of this study was to establish the direction of causality in the relationship between labour market status and psychological well-being by investigating how transitions between secure employment, insecure employment, unemployment, permanent sickness and other economic inactivity predict changes in psychological well-being over a 16-year period. METHOD: This study used data from the British Household Panel Survey (1991-2007). Psychological well-being was measured using the 12-item General Health Questionnaire (GHQ-12). Fixed effects models were utilised to investigate how transitions between labour market statuses predicted GHQ-12 score, adjusting for current labour market status and a range of covariates. RESULTS: After taking account of the contemporaneous effects of joblessness on psychological well-being, and the impact of a range of confounding factors, experiencing a transition from employment to joblessness was significantly predictive of poorer psychological well-being. Transitions into employment were not found to have equal and opposite effects: the positive effects of moving into work from unemployment were not as large as the negative effects of job loss. Transitions between secure and insecure employment did not independently predict changes in psychological well-being. CONCLUSIONS: A causal relationship between labour market status and psychological well-being is indicated.

Do local unemployment rates modify the effect of individual labour market status on psychological distress?

This study investigates whether the unemployment rate of the area in which an individual lives affects their level of psychological distress, and the extent to which this is dependent on their own labour market status. Data were taken from the British Household Panel Survey (1991-2008) and longitudinal multiple membership multilevel modelling was carried out in order to account for the complex hierarchical structure of the data. The results suggest that living in an area with a high unemployment rate, defined by the claimant count, confers a degree of protection against the negative psychological effects of unemployment. However, psychological distress levels among unemployed people were still significantly and substantially higher than among their securely employed counterparts.