Health impacts of the Cambridgeshire Guided Busway: a natural experimental study

Abstract

BACKGROUND Improving transport infrastructure to support walking and cycling on the journey to and from work – active commuting – could help to promote physical activity and improve population health. AIMS To assess whether or not investment in new high-quality transport infrastructure was associated with an increase in active commuting; wider health impacts of changes in travel behaviour; determinants of the use and uptake of active commuting; and how changes in travel behaviour were distributed in the population and related to the wider social context. DESIGN The Commuting and Health in Cambridge study, comprising a quasi-experimental cohort study combined with both nested and supplementary in-depth quantitative and qualitative studies. SETTING Cambridgeshire, UK. PARTICIPANTS A cohort of 1143 adults living within 30 km of Cambridge, working in the city and recruited in 2009; and a separate sample of 1710 users intercepted on the Cambridgeshire Guided Busway in 2012. INTERVENTION The Cambridgeshire Guided Busway, comprising a new bus network using 22 km of guideway (segregated bus track) accompanied by a traffic-free path for pedestrians and cyclists, opened in 2011. MAIN OUTCOME MEASURE Change in time spent in active commuting from 2009 to 2012, using a self-reported measure validated using georeferenced combined heart rate and movement sensor data. METHODS A delay from 2009 to 2011 in completing the intervention entailed some changes to the original design and attrition of the cohort. A period of methodological and observational research on active commuting preceded the evaluation, which was based on a quasi-experimental cohort analysis together with the intercept and qualitative data. A graded measure of each participant’s exposure to the intervention, based on the proximity of the busway to his or her home, served as the basis for controlled comparisons. RESULTS Commuting practices were complex and shaped by various changeable social and environmental factors. Walking and cycling were often incorporated into longer commuting journeys made predominantly by car or public transport. In multivariable multinomial regression analyses, exposure to the intervention was associated with a greater likelihood of a large increase in the proportion of commuting trips involving any active travel [adjusted relative risk ratio (RRR) 1.80, 95% confidence interval (CI) 1.27 to 2.55], of a large decrease in the proportion of trips made entirely by car (RRR 2.09, 95% …