Alistair Woodward

University of Auckland, Окленд, Auckland, New Zealand

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Publications (89)426.02 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Policy advisers are seeking robust evidence on the effectiveness of measures, such as promoting walking and cycling, that potentially offer multiple benefits, including enhanced health through physical activity, alongside reductions in energy use, traffic congestion and carbon emissions. This paper outlines the 'ACTIVE' study, designed to test whether the Model Communities Programme in two New Zealand cities is increasing walking and cycling. The intervention consists of the introduction of cycle and walkway infrastructure, along with measures to encourage active travel. This paper focuses on the rationale for our chosen study design and methods.
    BMC Public Health 09/2014; 14(1):935. · 2.08 Impact Factor
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: Bicycle use, despite its proven health and other benefits, is rarely part of everyday travel for many people due to the perceived risk of injury from collision crashes. This article investigated the role of physical vs. attention conspicuity in preventing bicycle crashes involving a motor vehicle in New Zealand.
    European journal of public health. 07/2014;
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    ABSTRACT: Tibet of China, with an average altitude of over 4000m, has experienced noticeable changes in its climate over the last 50years. The association between temperature and morbidity (most commonly represented by hospital admissions) has been documented mainly in developed countries. Little is known about patterns in China; nor have the health effects of temperature variations been closely studied in highland areas, worldwide.
    Science of The Total Environment 06/2014; 490C:838-848. · 3.26 Impact Factor
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    ABSTRACT: Human leptospirosis is an emerging infectious disease of global significance, and is endemic to several countries in the Pacific. Zoonotic transmission dynamics combined with diagnostic challenges lead to difficulties in prevention and identification of cases. The Federated States of Micronesia (FSM) lacks surveillance data for human leptospirosis. This hospital-based serologic survey sought to estimate the burden of leptospirosis, collect information relating to associated factors, and assess the leptospirosis point-of-care rapid diagnostic test (RDT) commonly used in FSM. A four-month hospital-based survey was conducted in Pohnpei State, FSM in 2011. Patients with undifferentiated fevers presenting to hospital were referred for enrolment by physicians. Consenting participants provided paired blood specimens 10-30 days apart, and responded to interview questions regarding demographics, clinical symptoms, exposure to animals, and environmental exposure. Blood samples were subjected to immunochromatographic RDT and confirmed by microscopic agglutination test (MAT). Of 54 participants tested by MAT, 20.4% (95% confidence interval [CI] 10.1-30.6%) showed serologic evidence of acute infection. Occupation student (odds ratio [OR], 17.5; 95% CI: 1.9-161.1) and recreational gardening (OR, 8.6; 95% CI: 1.0-73.8), identified by univariate logistic regression, were associated with infection. The local rapid diagnostic test (RDT) performed with a sensitivity of 69.2 (42.3-89.3 CI) and specificity of 90.0 (81.6-95.6 CI) compared to MAT. This study demonstrated a high burden of leptospirosis in Pohnpei. Further work is warranted to identify additional risk factors and opportunities to control leptospirosis in Pohnpei and other Pacific settings.
    BMC Infectious Diseases 04/2014; 14(1):186. · 3.03 Impact Factor
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    ABSTRACT: ABSTRACT: The Intergovernmental Panel on Climate Change (IPCC) released its latest report on March 31, 2014. This report was the second instalment of the Fifth Assessment Report, prepared by Working Group 2, on impacts, vulnerability, and adaptation to climate change. In this Comment, we, as contributors to the chapter on human health, explain how the IPCC report was prepared and highlight important findings.
    The Lancet 04/2014; 383(9924):1185-9. · 39.06 Impact Factor
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    ABSTRACT: The Intergovernmental Panel on Climate Change (IPCC) released its latest report on March 31, 2014. This report was the second instalment of the Fifth Assessment Report, prepared by Working Group 2, on impacts, vulnerability, and adaptation to climate change. In this Comment, we, as contributors to the chapter on human health, explain how the IPCC report was prepared and highlight important findings.
    The Lancet 04/2014; · 39.06 Impact Factor
  • Alistair Woodward, Simon Hales
    Australian and New Zealand Journal of Public Health 04/2014; 38(2):103-4. · 1.64 Impact Factor
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    ABSTRACT: Shifting to active modes of transport in the trip to work can achieve substantial co-benefits for health, social equity and climate change mitigation. Previous integrated modeling of transport scenarios has assumed active transport mode share and been unable to incorporate acknowledged system feedbacks. To compare the effects of policies to increase bicycle commuting in a car-dominated city and to explore the role of participatory modeling to support transport planning in the face of complexity. We used system dynamics modeling (SDM) to compare realistic policies, incorporating feedback effects, non-linear relationships, and time delays between variables. We developed an SD model of commuter bicycling through interviews and workshops with policy, community, and academic stakeholders. We incorporated best available evidence to simulate five policy scenarios over the next 40 years in Auckland, New Zealand. Injury, physical activity, fuel costs, air pollution, and carbon emissions outcomes were simulated. Using the simulation model we demonstrated the kinds of policies that would likely be needed to change a historical pattern of decline in cycling into a pattern of growth that would meet policy goals. Our model projections suggest that transforming urban roads over the next 40 years, using best practice physical separation on main roads and bicycle-friendly speed reduction on local streets, would yield benefits 10-25 times greater than costs. To our knowledge, this is the first integrated simulation model of future specific bicycling policies. Our projections provide practical evidence that may be used by health and transport policy-makers to optimize the benefits of transport bicycling while minimizing negative consequences in a cost effective manner. The modeling process enhanced understanding by a range of stakeholders of cycling as a complex system. Participatory SDM can be a helpful method for integrating health and environmental outcomes in transport and urban planning.
    Environmental Health Perspectives 02/2014; · 7.26 Impact Factor
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    Li Bai, Cirendunzhu, Alistair Woodward, Dawa, Xiraoruodeng, Qiyong Liu
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    ABSTRACT: Background Tibet, with an average altitude of more than 4,000 meters, is warming faster than anywhere else in China. However, there have been no studies in Tibet of the relation between ambient temperature and mortality. Methods We examined mean temperature and daily mortality in three Tibetan counties (Chengguan, Jiangzi and Naidong) using a distributed lag non-linear model (DLNM) based on 5,610 deaths that occurred in 2008–2012. We separately investigated hot and cold effects on non-accidental deaths, cardiovascular deaths, out-of-hospital deaths and vulnerability factors including age, sex and education. Results In all three counties, the effect of heat tended to be immediate, while the impact of cold lasted longer. The effects were consistent but modest in size and not statistically significant except for cumulative cold effects in Jiangzi (lag = 0–14, RR = 2.251, 95% CI = 1.054–4.849). Those who were more vulnerable to temperature extremes tended to be men, the elderly (over 65 years) and illiterate persons. We found stronger temperature effects on cardiovascular deaths than on all-cause mortality, and we also observed an increase in out-of-hospital mortality in one county. Conclusions This is the first study to investigate the temperature–mortality relationship in Tibet, and the findings may guide public health programs and other interventions to protect the population against extreme temperatures in a developing Tibet.
    Science of The Total Environment 01/2014; s 485–486:41–48. · 3.26 Impact Factor
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    ABSTRACT: Background Tibet of China, with an average altitude of over 4000 m, has experienced noticeable changes in its climate over the last 50 years. The association between temperature and morbidity (most commonly represented by hospital admissions) has been documented mainly in developed countries. Little is known about patterns in China; nor have the health effects of temperature variations been closely studied in highland areas, worldwide. Objective We investigated the temperature–morbidity association in Lhasa, the capital city of Tibet, using sex- and age-specific hospitalizations, excluding those due to external causes. Methods A distributed lag non-linear model (DLNM) was applied to assess the nonlinear and delayed effects of temperature on morbidity (including total emergency room visits, total and cause-specific hospital admissions, sex- and age-specific non-external admissions). Results High temperatures are associated with increases in morbidity, to a greater extent than low temperatures. Lag effects of high and low temperatures were cause-specific. The relative risks (RR) of high temperature for total emergency room visits and non-external hospitalizations were 1.162 (95% CI: 1.002–1.349) and 1.161 (95% CI: 1.007–1.339) respectively, for lag 0–14 days. The strongest cumulative effect of heat for lag 0–27 days was on admissions for infectious diseases (RR: 2.067, 95% CI: 1.026–4.027). Acute heat effects at lag 0 were related with increases of renal (RR: 1.478, 95% CI: 1.005–2.174) and respiratory diseases (RR: 1.119, 95% CI: 1.010–1.240), whereas immediate cold effects increased admission for digestive diseases (RR: 1.132, 95% CI: 1.002–1.282). Those ≥ 65 years of age and males were more vulnerable to high temperatures. Conclusion We provide a first look at the temperature–morbidity relationship in Tibet. Exposure to both hot and cold temperatures resulted in increased admissions to hospital, but the immediate causes varied. We suggest that initiatives should be taken to reduce the adverse effects of temperature extremes in Tibet.
    Science of The Total Environment 01/2014; 490:838–848. · 3.26 Impact Factor
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: It is known that experience of a previous crash is related to incidence of future crashes in a cohort of New Zealand cyclists. This paper investigated if the strength of such association differed by crash involvement propensity and by the need for medical care in the previous crash. The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 and followed over a median period of 4.6 years through linkage to four national databases. The crash involvement propensity was estimated using propensity scores based on the participants' demographic, cycling and residential characteristics. Cox regression modelling for repeated events was performed with multivariate and propensity score adjustments. Analyses were then stratified by quintiles of the propensity score. A total of 801 (31.0%) participants reported having experienced at least one bicycle crash in the twelve months prior to the baseline survey. They had a higher risk of experiencing crash events during follow-up (hazard ratio (HR): 1.43; 95% CI: 1.28, 1.60) but in the stratified analysis, this association was significant only in the highest two quintiles of the propensity score where the likelihood of having experienced a crash was more than 33%. The association was stronger for previous crashes that had received medical care (HR 1.63; 95% CI: 1.41, 1.88) compared to those that had not (HR 1.30; 95% CI: 1.14, 1.49). Previous crash experience increased the risk of future crash involvement in high-risk cyclists and the association was stronger for previous crashes attended medically. What distinguishes the high risk group warrants closer investigation, and the findings indicate also that health service providers could play an important role in prevention of bicycle crash injuries.
    PLoS ONE 01/2014; 9(1):e87633. · 3.53 Impact Factor
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: Loss to follow-up, if related to exposures, confounders and outcomes of interest, may bias association estimates. We estimated the magnitude and direction of such bias in a prospective cohort study of crash injury among cyclists. The Taupo Bicycle Study involved 2590 adult cyclists recruited from New Zealand's largest cycling event in 2006 and followed over a median period of 4.6 years through linkage to four administrative databases. We resurveyed the participants in 2009 and excluded three participants who died prior to the resurvey. We compared baseline characteristics and crash outcomes of the baseline (2006) and follow-up (those who responded in 2009) cohorts by ratios of relative frequencies and estimated potential bias from loss to follow-up on seven exposure-outcome associations of interest by ratios of HRs. Of the 2587 cyclists in the baseline cohort, 1526 (60%) responded to the follow-up survey. The responders were older, more educated and more socioeconomically advantaged. They were more experienced cyclists who often rode in a bunch, off-road or in the dark, but were less likely to engage in other risky cycling behaviours. Additionally, they experienced bicycle crashes more frequently during follow-up. The selection bias ranged between -10% and +9% for selected associations. Loss to follow-up was differential by demographic, cycling and behavioural risk characteristics as well as crash outcomes, but did not substantially bias association estimates of primary research interest.
    Injury Prevention 12/2013; · 1.76 Impact Factor
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: Regular cycling plays an important role in increasing physical activity levels but raises safety concerns for many people. While cyclists bear a higher risk of injury than most other types of road users, the risk differs geographically. Auckland, New Zealand's largest urban region, has a higher injury risk than the rest of the country. This paper identified underlying factors at individual, neighbourhood and environmental levels and assessed their relative contribution to this risk differential. The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 and followed over a median period of 4.6 years through linkage to four national databases. The Auckland participants were compared with others in terms of baseline characteristics, crash outcomes and perceptions about environmental determinants of cycling. Cox regression modelling for repeated events was performed with multivariate adjustments. Of the 2554 participants whose addresses could be mapped, 919 (36%) resided in Auckland. The Auckland participants were less likely to be Maori but more likely to be socioeconomically advantaged and reside in an urban area. They were less likely to cycle for commuting and off-road but more likely to cycle in the dark and in a bunch, use a road bike and use lights in the dark. They had a higher risk of on-road crashes (hazard ratio: 1.47; 95% CI: 1.22, 1.76), of which 53% (95% CI: 20%, 72%) was explained by baseline differences, particularly related to cycling off-road, in the dark and in a bunch and residing in urban areas. They were more concerned about traffic volume, speed and drivers' behaviour. The excess crash risk in Auckland was explained by cycling patterns, urban residence and factors associated with the region's car-dominated transport environment.
    Environmental Health 12/2013; 12(1):106. · 2.71 Impact Factor
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    ABSTRACT: Improving social circumstances (eg, an increase in income, finding a job or moving into a good neighbourhood) may reduce tobacco use, but robust evidence on the effects of such improvements is scarce. Accordingly we investigated the link between changing social circumstances and changing tobacco smoking using repeated measures data. 15 000 adults with at least two observations over three waves (each 2 years apart) of a panel study had data on smoking status, family, labour force, income and deprivation (both neighbourhood and individual). Fixed effects regression modelling was used. The odds of smoking increased 1.42-fold (95% CI 1.16 to 1.74) for a one log-unit increase in personal income among 15-24-year-olds, but there was no association of increased smoking with an increase in income among 25+ year olds. Moving out of a family nucleus, increasing neighbourhood deprivation (eg, 1.83-fold (95% CI 1.18 to 2.83) increased odds of smoking for moving from least to most deprived quintile of neighbourhoods), increasing personal deprivation and moving into employment were all associated with increased odds of smoking. The number of cigarettes smoked a day changed little with changing social circumstances. Worsening social circumstances over the short run are generally associated with higher smoking risk. However, there were counterexamples: for instance, decreasing personal income among young people was associated with decreased odds of smoking, a finding consistent with income elasticity of demand (the less one's income, the less one can consume). This paper suggests that improving social circumstances is not always pro-health over the short run; a more nuanced approach to the social determinants of health is required.
    Tobacco control 09/2013; · 3.85 Impact Factor
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    ABSTRACT: Tibet, average altitude more than 4,000 meters, is warming faster than anywhere else in China. The increase in temperatures may aggravate existing health problems and lead to the emergence of new risks. However, there are no actions being taken at present to protect population health due to limited understanding about the range and magnitude of health effects of climate change. The study was a cross-sectional survey of 619 respondents from urban Lhasa, Tibet in August 2012 with the aim to investigate public perceptions of risk, heat experiences, and coping resources. The study suggests that actions are needed now to minimize downside effects of rapid warming in Tibet, because of increasing human exposure to high temperatures and uneven distribution of the resources needed to cope.
    Environmental Health 08/2013; 12(1):71. · 2.71 Impact Factor
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    ABSTRACT: In 2009, residents of Lhasa city, Tibet Autonomous Region (TAR), China reported large numbers of mosquitoes and bites from these insects. It is unclear whether this was a new phenomenon, which species were involved, and whether these mosquitoes had established themselves in the local circumstances. The present study was undertaken in six urban sites of Chengguan district Lhasa city, Tibet. Adult mosquitoes were collected by bed net trap, labor hour method and light trap in August 2009 and August 2012. The trapped adult mosquitoes were initially counted and identified according to morphological criteria, and a proportion of mosquitoes were examined more closely using a multiplex PCR assay. 907 mosquitoes of the Culex pipiens complex were collected in this study. Among them, 595 were females and 312 were males. There was no significant difference in mosquito density monitored by bed net trap and labor hour method in 2009 and 2012. Of 105 mosquitoes identified by multiplex PCR, 36 were pure mosquitoes (34.29%) while 69 were hybrids (65.71%). The same subspecies of Culex pipiens complex were observed by bed net trap, labor hour method and light trap in 2009 and 2012. The local Culex pipiens complex comprises the subspecies Cx. pipiens pipiens, Cx. pipiens pallens, Cx. pipiens quinquefasciatus and its hybrids. Mosquitoes in the Cx. pipiens complex, known to be, potentially, vectors of periodic filariasis and encephalitis, are now present from one season to the next, and appear to be established in Lhasa City, TAR.
    Parasites & Vectors 08/2013; 6(1):224. · 3.25 Impact Factor
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: OBJECTIVE: To estimate the incidence and risk of medically or police attended bicycle crashes in a prospective cohort study in New Zealand. METHOD: The Taupo Bicycle Study involved 2590 adult cyclists recruited from the country's largest cycling event in 2006 and followed over a median period of 4.6years through linkage to four administrative databases. Incidence rates with Poisson distribution confidence intervals were computed and Cox regression modelling for repeated events was performed. RESULTS: The 66 on-road crashes and 10 collisions per 1000 person-years corresponded to 240 crashes and 38 collisions per million hours spent road cycling. The risk increased by 6% and 8% respectively for an extra cycling hour each week. There were 50 off-road crashes per 1000 person-years. Residing in urban areas and in Auckland (region with the lowest level of cycling), riding in a bunch, using a road bike and experiencing a previous crash predicted a higher risk. Habitual use of conspicuity aids appeared to lower the risk. CONCLUSION: The risk is higher in urban areas and where cycling is less common, and increased by bunch riding and previous crashes. These findings alongside the possible protective effect of conspicuity aids suggest promising approaches to improving cycle safety.
    Preventive Medicine 05/2013; · 3.50 Impact Factor
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    Sandar Tin Tin, Alistair Woodward, Shanthi Ameratunga
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    ABSTRACT: BACKGROUND: Bicycling, despite its health and other benefits, raises safety concerns for many people. However, reliable information on bicycle crash injury is scarce as current statistics rely on a single official database of limited quality. This paper evaluated the completeness and accuracy of crash data collected from multiple sources in a prospective cohort study involving cyclists. METHODS: The study recruited 2438 adult cyclists from New Zealand's largest mass cycling event in November 2006 and another 190 in 2008, and obtained data regarding bicycle crashes that were attended by medical personnel or the police and occurred between the date of recruitment and 30 June 2011, through linkage to insurance claims, hospital discharges, mortality records and police reports. The quality of the linked data was assessed by capture-recapture methods and by comparison with self-reported injury data collected in a follow-up survey. RESULTS: Of the 2590 cyclists who were resident in New Zealand at recruitment, 855 experienced 1336 crashes, of which 755 occurred on public roads and 120 involved a collision with a motor vehicle, during a median follow-up of 4.6 years. Log-linear models estimated that the linked data were 73.7% (95% CI: 68.0%-78.7%) complete with negligible differences between on- and off-road crashes. The data were 83.3% (95% CI: 78.9%-87.6%) complete for collisions. Agreement with the self-reported data was moderate (kappa: 0.55) and varied by personal factors, cycling exposure and confidence in recalling crash events. If self-reports were considered as the gold standard, the linked data had 63.1% sensitivity and 93.5% specificity for all crashes and 40.0% sensitivity and 99.9% specificity for collisions. CONCLUSIONS: Routinely collected databases substantially underestimate the frequency of bicycle crashes. Self-reported crash data are also incomplete and inconsistent. It is necessary to improve the quality of individual data sources as well as record linkage techniques so that all available data sources can be used reliably.
    BMC Public Health 05/2013; 13(1):420. · 2.08 Impact Factor
  • Alistair Woodward, Jamie Hosking, Shanthi Ameratunga
    The New Zealand medical journal 01/2013; 126(1374):7-9.
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    ABSTRACT: INTRODUCTION: Few studies have measured the effect of tobacco bans on secondhand smoke (SHS) exposure in prisons. From June 1, 2011, the sale of tobacco was prohibited in New Zealand prisons. One month later, the possession of tobacco was banned. We studied the indoor air quality before and after this policy was enforced. METHODS: We measured indoor-fine-particulate (PM(2.5)) concentrations using a TSI SidePak photometer. The instrument was placed in a staff base of a New Zealand maximum-security prison, adjacent to four 12-cell wings. Measurements were made before the sales restriction, during this period, and after the ban. Data were summarized using daily geometric means and generalized least squares regression. RESULTS: A total of 7,107 observations were recorded at 5-min intervals, on 14 days before and 15 days after implementation, between 24 May and 5 August. Before the policy was implemented, the geometric mean was 6.58 μg/m(3) (95% CI = 6.29-6.58), which declined to 5.17 μg/m(3) (95% CI = 4.93-5.41) during the sales ban, and fell to 2.44 μg/m(3) (95% CI = 2.37-2.52) after the smoking ban. Regression analyses revealed an average 57% (95% CI = 42-68) decline in PM(2.5) concentrations, comparing the before and after periods.Conclusions:Our study showed a rapid and substantial improvement in indoor air quality after tobacco was banned at a prison. We conclude that prisoners have reduced their smoking in line with the ban, and that a significant health hazard has been reduced for staff and prisoners alike.
    Nicotine & Tobacco Research 05/2012; · 2.48 Impact Factor

Publication Stats

1k Citations
426.02 Total Impact Points

Institutions

  • 1924–2014
    • University of Auckland
      • • Section of Epidemiology and Biostatistics
      • • School of Population Health
      • • Department of Medicine
      Окленд, Auckland, New Zealand
  • 2012
    • Umeå University
      Umeå, Västerbotten, Sweden
  • 1924–2007
    • University of Otago
      • Department of Public Health (Wellington)
      Dunedin, Otago, New Zealand