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Abstract

From a public health perspective, a cost-benefit analysis of using bike/pedestrian trails in Lincoln, Nebraska, to reduce health care costs associated with inactivity was conducted. Data was obtained from the city's 1998 Recreational Trails Census Report and the literature. Per capita annual cost of using the trails was 209.28 U.S. dollars (59.28 U.S. dollars construction and maintenance, 150 U.S. dollars of equipment and travel). Per capita annual direct medical benefit of using the trails was 564.41 U.S. dollars. The cost-benefit ratio was 2.94, which means that every 1 U.S. dollar investment in trails for physical activity led to 2.94 U.S. dollars in direct medical benefit. The sensitivity analyses indicated the ratios ranged from 1.65 to 13.40. Therefore, building trails is cost beneficial from a public health perspective. The most sensitive parameter affecting the cost-benefit ratios were equipment and travel costs; however, even for the highest cost, every 1 U.S. dollar investment in trails resulted in a greater return in direct medical benefit.
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Health Promotion Practice
DOI: 10.1177/1524839903260687
2005; 6; 174 Health Promot Pract
Guijing Wang, Caroline A. Macera, Barbara Scudder-Soucie, Tom Schmid, Michael Pratt and David Buchner
A Cost-Benefit Analysis of Physical Activity Using Bike/Pedestrian Trails
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ARTICLE62April HEALTH PROMOTION PRACTICE / April 2005
A Cost-Benefit Analysis of Physical
Activity Using Bike/Pedestrian Trails
Guijing Wang, PhD
Caroline A. Macera, PhD
Barbara Scudder-Soucie, MEd
Tom Schmid, PhD
Michael Pratt, MD, MPH
David Buchner, MD, MPH
From a public health perspective, a cost-benefit analy-
sis of using bike/pedestrian trails in Lincoln, Nebraska,
to reduce health care costs associated with inactivity
was conducted. Data was obtained from the city’s 1998
Recreational Trails Census Report and the literature.
Per capita annual cost of using the trails was
U.S.$209.28 ($59.28 construction and maintenance,
$150 of equipment and travel). Per capita annual direct
medical benefit of using the trails was $564.41. The
cost-benefit ratio was 2.94, which means that every $1
investment in trails for physical activity led to $2.94 in
direct medical benefit. The sensitivity analyses indi-
cated the ratios ranged from 1.65 to 13.40. Therefore,
building trails is cost beneficial from a public health
perspective. The most sensitive parameter affecting the
cost-benefit ratios were equipment and travel costs;
however, even for the highest cost, every $1 investment
in trails resulted in a greater return in direct medical
benefit.
Keywords: environment; community; inactivity; economic
analysis
I
nactivity as an independent risk factor for many
chronic diseases, such as coronary heart disease,
obesity, diabetes, hypertension, some cancers, and
some mental disorders, has been investigated by many
researchers and summarized in the surgeon general’s
report on physical activity and health (Brown, Mishra,
Lee, & Bauman, 2000; Hassmen, Kiovula, & Uutela,
2000; Martinez et al., 1997; U.S. Department of Health
and Human Services [USDHHS], 1996). The economic
burden of physical inactivity has also been demon-
strated by several researchers (Colditz, 1999; Jones &
Eaton, 1994; Keeler, Manning, Newhouse, Sloss, &
Wasserman, 1989; Nicholl, Coleman, & Brazier, 1994;
Pratt, Macera, & Wang, 2000). One study estimated that
in 1994 U.S.$5.6 billion could be saved from the cost of
coronary heart disease alone if 10% of adults began a
regular walking program (Jones & Eaton, 1994). Another
study estimated that direct medical cost associated with
physical inactivity could be as high as $76.6 billion in
1987 (in year 2000 dollars) (Pratt et al., 2000). Despite
the importance of physical activity in reducing health
costs and morbidity and mortality from chronic dis-
eases, in the past decade, the prevalence of physical
inactivity remained around 30% for adults, and the
prevalence of achieving the recommended levels of
physical activity for health benefits remained around
25% (Centers for Disease Control and Prevention [CDC],
2001).
Because of the health and economic burden of physi-
cal inactivity, promoting physical activity has become a
public health priority. Studies have shown that lifestyle
interventions are as effective as structured interven-
tions in increasing physical activity (Dunn et al., 1999).
For activities such as walking and cycling, availability
of sidewalks and bike/pedestrian trails may be an
important element needed to incorporate physical
activity into everyday life. Indeed, lack of accessible
facilities has been identified as a deterrent to a physi-
cally active lifestyle (Brownson et al., 2000; Corti, Don-
ovan, & Holman, 1997; King, 1991; King et al., 1995,
King et al., 1992; Linenger, Chesson, & Nice, 1991;
Sallis, Bauman, & Pratt, 1998; Sallis et al., 1990; Sallis,
Johnson, Calfas, Caparosa, & Nichols, 1997). It is dem-
onstrated that environments influence physical activity
behaviors (Craig, Brownson, Craag, & Dunn, 2002;
Owen, Leslie, Salmon, & Fotheringham, 2000).
Although a physical activity–friendly environment is
considered an essential component of community pro
-
motion efforts (Berrigan, & Troiano, 2002; Handy,
Boarnet, Ewing, & Killingsworth, 2002), physical envi
-
ronments are the least-studied category of influence on
physical activity, and research on the cost benefit of
174
Health Promotion Practice
April 2005 Vol. 6, No. 2, 174-179
DOI: 10.1177/1524839903260687
©2005 Society for Public Health Education
at SIENA COLLEGE LIBRARY on August 26, 2009 http://hpp.sagepub.comDownloaded from
environmental and policy interventions (such as trails)
is lacking (Sallis et al., 1998).
Several cost-benefit and cost-effectiveness studies of
physical activity programs have been published
(Hatziandreu, Koplan, Weistein, Caspersen, & Warner,
1988; Jones & Eaton, 1994; Lowensteyn, Coupal,
Zowall, & Grover, 2000; Robertson, Devlin, Gardner, &
Campbell, 2001; Robertson et al., 2001; Sevick et al.,
2000), yet none has examined the economics of envi-
ronmental facilities, such as bike/pedestrian trails. A
study suggested that construction of walking trails may
be a viable intervention strategy for physical activity
intervention (Brownson et al., 2000) but did not provide
any economic justification of such an intervention. In
the current study, a cost-benefit analysis of physical
activity through constructing and maintaining bike/
pedestrian trails in Lincoln, Nebraska, was conducted.
>
DATA AND METHODS
Construction and Maintenance of Trails
Construction and maintenance costs are usually
incurred to the community, local government, or other
organizations. The cost of construction and annual
maintenance costs of five bike/pedestrian trails in Lin-
coln, Nebraska, was obtained from a census report (Lin-
coln Recreational Trails Census Report, 1998) and per-
sonal communications with Lincoln’s Department of
Parks and Recreation. In addition to the cost informa-
tion, the investigators also identified the information
about surface types, date built, and length of each trail.
It is assumed that the trails could be used for an average
of 30 years, and the construction costs were allocated
evenly over that period. The annual total trail cost (con-
struction and maintenance) was adjusted to 1998
dollars.
Trail Use and Trail Cost per Use
The number of users for a day (July 12, 1998) on each
of the five trails was obtained from the census report
(Lincoln Recreational Trails Census Report, 1998). The
census began at 7:00 a.m. and concluded at 9:00 p.m.
that evening. The census volunteers, who worked 2-hr
shifts, counted cyclists, runners, walkers, skaters, and
miscellaneous users (such as persons with skateboards,
wheelchairs, horses, etc.). Because the census was con-
ducted on a Sunday in summer, the number of users
may be improper for the analysis. To determine if the
number of users from the census was acceptable, the
investigators looked at the number of users across a
week and found that the number of users was the lowest
on Saturdays and Sundays and the highest on Wednes-
days and Thursdays. In fact, the number of users on
Wednesday might be more than twice as high as the
number on Sundays in Missouri (a state adjacent to
Nebraska; personal communication). Based on this
information and Nebraska climate (3 to 4 months of
winter), it was believed that the number of users
reported in the census was acceptable for the analysis.
This number was multiplied by 365 days to derive the
number of uses of each trail during a year. The trail cost
per use was calculated by dividing annual total trail
cost by the number of trail uses per year.
Equipment and Travel
Trail users needed to buy some equipment to use the
trail for physical activity and had to travel to and from
the trails. Such expenses are usually borne by the trail
users, which were estimated at $100 per year in 1988
(Hatziandreu et al., 1988). This figure was inflated to
$150 in 1998. Ideally, the indirect cost of physical activ-
ity, such as the monetary value of time spent doing
physical activity, should be assessed because time is
one of the most often cited reasons for being physically
inactive (Sallis et al., 1990). However, it is assumed that
the majority of trail use was during leisure time. In addi-
tion, the current study included only direct medical
cost saving as the benefits and did not assess the benefit
to psychological well-being from physical activity.
Therefore, no indirect cost, such as time value, was
assessed for the current study.
Direct Health Benefit
The direct health benefit was measured using the
estimated difference in the direct medical cost for active
persons and their inactive counterparts (excluding per
-
sons with physical limitations). The medical cost may
be paid out of pocket, through insurance policies, or by
government programs. A study using a nationally repre
-
Wang et al. / COST-BENEFIT ANALYSIS OF PHYSICAL ACTIVITY 175
The Authors
Guijing Wang, PhD, is an economist at the Centers for Dis-
ease Control and Prevention in Atlanta, Georgia.
Caroline A. Macera, PhD, is a senior epidemiologist at the
Centers for Disease Control and Prevention in Atlanta,
Georgia.
Barbara Scudder-Soucie, MEd, is a health promotion spe-
cialist in the Physical Activities Program at the Nebraska
Health and Human Services System in Lincoln.
Tom Schmid, PhD, is coordinator of the Active Community
Environments (ACES) Workgroup at the Centers for Disease
Control and Prevention in Atlanta, Georgia.
Michael Pratt, MD, MPH, is medical officer at the Centers
for Disease Control and Prevention in Atlanta, Georgia.
David Buchner, MD, MPH, is chief of the Physical Activity
and Health Branch, Division of Nutrition and Physical
Activity, National Centers for Chronic Disease Prevention
and Health Promotion, Centers for Disease Control and Pre
-
vention in Atlanta, Georgia.
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sentative National Medical Expenditure Survey found
that, on average, active persons spent $330 (95% CI:
$214 to $446) less on medical care than did inactive per-
sons in 1987. Adjusted to 1998 dollars, this figure is
$564 (95% CI: $365 to $763) (Pratt et al., 2000).
In the National Medical Expenditure Survey, moder-
ate physical activity was defined as spending at least 30
min in moderate or strenuous physical activity three or
more times per week. It is assumed that all trail users
met this criterion if they used the trails three or more
times per week.
Cost-Benefit Ratios
A cost-benefit ratio was derived by dividing the
direct medical cost saving by the total trail costs (con-
struction, maintenance, equipment, and travel). The
cost-benefit ratio shows how much health benefit can
be achieved from a $1 investment in using a trail. If the
ratio is larger than one, then using a trail is cost-benefi-
cial. Otherwise, the return is less than the investment.
Sensitivity Analyses
Sensitivity analyses were conducted by worst- and
best-case scenarios for several key parameters. For the
costs of constructing and maintaining of the five trails
included in the census report, the most and least expen-
sive trails were used. Equipment and travel costs were
ranged from $0 to $300 ($150 below or above the
assumed average), the upper and lower bounds of the
95% CI of the direct health benefit were used, the life of
trails was varied from the assumed average by 20 years,
and the number of trail uses was varied by 50% from the
actual number.
>
RESULTS
Among the five trails, the average construction cost
per trail was $1.35 million (range: $0.95 million to $2.74
million). Allocated over a 30-year period, the average
annual construction cost per trail was $44,949 (range:
$3,184 to $91,334). Annual maintenance cost averaged
$15,445 (range: $7,040 to $26,183). Together, the annual
construction and maintenance costs averaged $60,494
per trail (range: $18,164 to $117,517) (Table 1).
During 1998, the trails were used an average of
225,351 person times (range: 58,035 to 597,870) (see
Table 1). Average trail cost per use was $0.27 (range:
$0.20 to $0.78).
The annual trail cost for a person to use a trail for 52
weeks, 3 times per week, and $0.27 each time is
52 × 3 × $0.27 = $42.12. Then adding $150 for equip-
ment and travel, the total annual cost per trail user rose
to $42.12 + $150 = $192.12. The annual direct health
benefit of using the trail was $564.41 in 1998. Thus, the
cost-benefit ratio was $564.41/$192.12 = 2.94, which
means that every $1 investment in using trails led to
$2.94 in direct medical benefit.
In all the sensitivity analyses, the cost-benefit ratio
was larger than one (see Table 2). Even in the most sen-
sitive worst-case scenario (high equipment cost), the
direct medical benefit outweighed the cost by more
than 65%.
>
DISCUSSION
The current study is the first, as far as we know, to
report the economics of bike/pedestrian trails from a
public health perspective. It is noticed that trail cost
varied according to the surface type and length of the
176 HEALTH PROMOTION PRACTICE / April 2005
TABLE 1
Total Annual Trail Cost ($), Annual Number of Trail Users, and Trail Cost per Use in 1998
Annual Trail Cost
Construction Maintenance Total Annual No. of
Total Lincoln Construction +
Trail Uses
Trail Cost
Construction Recreational Maintenance No. of Uses
per Use
Cost Trails per day
(Lincoln Census (Lincoln Total
Recreational Report Recreational Annual
Trails Trails Trail Cost /
Census Census Annual
Report)/ Report) no. of
Data Source 30 Years 365 days Trail Uses
Trails:
Concrete, 2 bridges, 4.6 miles 91,334 26,183 117,517 597,870 0.20
Limestone chip, 0 bridges, 4.5 miles 3,184 14,980 18,164 84,680 0.21
Concrete, 3 bridges, 4.1 miles 59,608 11,828 71,436 299,300 0.24
Concrete, 0 bridges, 3.1 miles 50,656 17,196 67,852 86,870 0.78
Concrete, 1 bridge, 1.6 miles 19,962 7,040 27,002 58,035 0.47
Average 44,949 15,445 60,394 225,351 0.27
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trail. The least expensive of the five trails had a lime-
stone chip surface with no bridges, and the most expen-
sive trail had a concrete surface with two bridges. The
wide variation in expenses makes building trails feasi-
ble across various communities (high-income or low-
income, rural or urban areas). Local communities can
build different types of trails according to their budget
constraints.
The average trail cost per use, including construction
and maintenance costs, was only $0.27. Even the most
expensive trail was only $0.78 per use. This is substan-
tially lower than most admission fees to health club
facilities with exercise equipment, running tracks, and
swimming pools. The number of uses rose with the
length and quality of trails (surface type and number of
bridges). This observation suggests that longer and more
expensive trails may be more economically sound if
more people use them, although other features may also
stimulate people’s interest in using trails (e.g., location,
safety, and accessibility).
Of the total cost of using trails per person, less than
22% ($42 of $192) were building and maintaining
expenses. Therefore, the major part of the cost was the
cost of equipment and traveling to and from the trails.
Furthermore, the cost-benefit ratio was most sensitive
to the equipment and travel costs. Because these costs
are an important factor affecting the use of trails and
because trail users pay these costs out of their own
pockets, enhancing awareness of the health benefits of
physical activity among residents should be an impor-
tant component in public health intervention programs.
The cost-benefit ratio appeared not sensitive to the
total annual trail cost and the number of years the trail
could be used. Even for the most expensive trail and the
shortest life period, a $1 investment resulted in about a
$2 return. This finding indicates that as long as a trail
can be used for 10 years or more, the benefit
will outweigh the investment.
The estimates of cost-benefit ratios are con-
servative because only direct medical benefits
among people without physical limitations
were included; however, all trail costs (con-
struction, maintenance, equipment, and
travel) were included. Physical activity will
also yield indirect benefits to trail users, such
as increased quality of life and psychological
well-being. In fact, the current trails were
built as part of the community development
planning. The main purpose of building these
trails was not for health promotion or reduc-
tion of health care costs. Therefore, the health
benefit used for the analysis was a component
of the trail benefits. In addition, if the national
sample for the analysis of medical costs
included people with physical limitations,
the direct health benefit should be even big-
ger, which is in favor of a larger cost-benefit
ratio.
Several limitations should be mentioned. First, the
trail cost and use information were based on five trails.
The sample is too small to furnish a vigorous quantita-
tive analysis, so the representativeness of the cost and
use data is limited. The cost of construction and mainte-
nance of trails is believed to vary greatly across commu-
nities. In addition, certain trail information (e.g., qual-
ity of maintenance, appropriateness of joint use by
walkers and cyclists, and design of pedestrian cross-
ings) is lacking. The second limitation is that although
the direct medical benefit is from a nationally represen-
tative sample, the definition of physical activity may
not be comparable with the physical activity level
obtained by using trails. Using the trails three times a
week was used as a measure of moderate physical activ-
ity, which may not be comparable with the physical
activity measure in the National Medical Expenditure
Survey. Furthermore, the direct medical benefit was
derived from a national sample of people 15 years of age
or older; no information on the age of the trail users was
available. Finally, findings of this research should be
interpreted as estimates under the assumption that peo-
ple were using trails for the health benefits of physical
activity. Because there is a lack of information about
changes in physical activity behavior of the trail users,
the impact of trails on health promotion cannot be eval-
uated using more advanced models such as
transtheoretical models (Mettler, Stone, Herrick, &
Klein, 2000). Therefore, the cost-effectiveness of the
trails in promoting physical activity cannot be claimed.
Future research should focus on comprehensive data
collection efforts. In addition to the cost information
presented in the current study, behavioral and health
information of trail users are needed for conducting
comprehensive cost-effectiveness studies. These stud
-
ies will certainly aid policy makers in making informed
Wang et al. / COST-BENEFIT ANALYSIS OF PHYSICAL ACTIVITY 177
TABLE 2
Cost-Benefit Ratios of Extreme Cases of Physical Activity
Using Bike/Pedestrian Trails in 1998 (U.S. dollars)
Worst-Case Scenarios Best-Case Scenarios
Cost-Benefit Cost-Benefit
Variable Value Ratio Value Ratio
Cost of trail
construction
and
maintenance $0.78/use 2.08 $0.20/use 3.12
Equipment and
travel cost $300/year 1.65 $0/year 13.40
Direct health
benefit $365/year 1.90 $763/year 3.97
Life of trail 10 years 2.22 50 years 3.14
Number of
trail users 50% below 50% above
actual number 3.39 actual number 3.63
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decisions in resource allocations. Clearly, more data
and other methods are needed in this regard.
Several strengths of the current study should also be
mentioned. First, actual construction and maintenance
cost data for five trails were used. The five trails vary in
surface types, length, and number of bridges. Although
the results may not be generalized to the nation, the
variety of the trails covered in the current study should
enhance the generality at the local community level.
Second, all the direct costs and direct benefits were con-
verted to a per capita basis. Therefore, the costs and ben-
efits were comparable and an economic measure cost-
benefit ratio could be derived. Finally, sensitivity anal-
yses for all the five key parameters were conducted. The
ranges of the parameters may be wide enough to cover
all the possible situations.
>
CONCLUSIONS AND PUBLIC
HEALTH IMPLICATIONS
To promote physical activity at population level
presents a public health challenge. Building environ-
ments that are more favorable to physical activity
should facilitate the promotion. In fact, interventions
that attempt to change the environments to create
opportunities for physical activity have been strongly
recommended (Task Force on Community Preventive
Services, 2002). However, a potential barrier of creating
the opportunities is that building such environments is
resource intensive (Kahn et al., 2002). The current study
demonstrated that building bike/pedestrian trails might
fit a wide range of budget situations facing
communities.
The cost-benefit information presented in the current
study provides evidence that building bike/pedestrian
trails may be cost-beneficial. The resource expenses on
using the trails may be outweighed by the direct health
benefits alone. Moreover, the results show that the con-
struction and maintenance costs per use are low, and
the direct medical benefit of using trails is nearly three
times as high as the direct cost. Building trails may be a
cost-effective means for physical activity promotion at
the community level. This information should be useful
to policy makers and community organizations for deci-
sions in implementing such interventions.
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... books, salary costs of extra teaching staff, or free school meals) to resource-constrained schools and students (n = 3) [49,52,58], holistic pre-school and early school years' support to children and parents from deprived backgrounds [51], training teachers to become champions of child-centred education [54], and additional remedial education for academic underachievers [53]. Physical inactivity studies focused on built environment changes (n = 5) [32,33,35,36,39] such as construction of new/improved walking and cycling paths [32,35,39] or temporary closure of streets to motorised vehicles [36], altering the school environment (n = 2) [31,34], free leisure centre access [37], and mass media campaigns [38]. Obesity studies investigated school-based programmes that altered the food environment, the curriculum, opportunities for physical activity, and/or home-based activities (n = 3) [40][41][42], and community-based programmes that engaged local restaurants/takeaways and schools, and provided and promoted physical activity opportunities (n = 2) [43,44]. ...
... books, salary costs of extra teaching staff, or free school meals) to resource-constrained schools and students (n = 3) [49,52,58], holistic pre-school and early school years' support to children and parents from deprived backgrounds [51], training teachers to become champions of child-centred education [54], and additional remedial education for academic underachievers [53]. Physical inactivity studies focused on built environment changes (n = 5) [32,33,35,36,39] such as construction of new/improved walking and cycling paths [32,35,39] or temporary closure of streets to motorised vehicles [36], altering the school environment (n = 2) [31,34], free leisure centre access [37], and mass media campaigns [38]. Obesity studies investigated school-based programmes that altered the food environment, the curriculum, opportunities for physical activity, and/or home-based activities (n = 3) [40][41][42], and community-based programmes that engaged local restaurants/takeaways and schools, and provided and promoted physical activity opportunities (n = 2) [43,44]. ...
... Of these, nine studies [14,15,18,19,21,22,28,40,48] modelled long-term changes in either life-years gained, quality-adjusted life years (QALYs) gained, or deaths avoided. The remaining 18 studies [24][25][26][27]29,30,[34][35][36][37]39,[41][42][43][44]47,55,57] modelled future cost savings (often as a result of the modelled benefits) and presented ROIs from either societal or healthcare perspectives. Quality assessment findings are shown in Appendix C. The CHEC items that were least often satisfied were Q17: "Does the study discuss the generalizability of the results to other settings and patient/client groups?" ...
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Dementia is a leading global cause of morbidity and mortality. Evidence suggests that tackling modifiable lifecourse risk factors could prevent or delay a significant proportion of cases. Population- and community-based approaches change societal conditions such that everyone across a given community is more likely to live more healthily. We systematically reviewed economic studies of population- and community-based interventions to reduce modifiable lifecourse risk factors for dementia. We searched Medline, EMBASE, Web of Science, CINAHL, PsycInfo, Scopus, Econlit, ERIC, the British Education Index, and Google, on 03/03/2022. We included cost-effectiveness, cost-benefit, and cost-utility studies, provided that the direct outcome of the intervention was a modifiable risk factor for dementia, and was measured empirically. Quality appraisal was completed using the Consensus on Health Economic Criteria checklist. A narrative synthesis was performed. We included 45 studies, from 22,749 records identified. Included studies targeted smoking (n = 15), education (n = 10), physical inactivity (n = 9), obesity (n = 5), air pollution (n = 2), traumatic brain injury (n = 1), and multiple risk factors (n = 3). Intervention designs included changing the physical/food environment (n = 13), mass media programmes (n = 11), reducing financial barriers or increasing resources (n = 10), whole-community approaches (n = 6), and legislative change (n = 3). Overall, interventions were highly cost-effective and/or cost-saving, particularly those targeting smoking, educational attainment, and physical inactivity. Effects were observed in high- (e.g. USA and UK) and low- and middle-income (e.g. Mexico, Tanzania, Thailand) countries. Further research into the direct effects of targeting these risk factors on future dementia prevalence will have important economic, social and policy implications.
... The relationship between health and cycling has been widely studied [12,13]. It is also known that the growth of cycling rates results in an increase in health benefits of the population of the country as a whole, which turns into a reduction in the mortality rate of the cycling population [14]. ...
... There are also other variables that influence this interaction studied by previous researchers. These variables are mainly based on traffic such as the opposing lane occupation [9,10], bicycle position and group configuration [11,12], and the presence of oncoming vehicles [13][14][15][16]. Knowing the risk perception of the cyclists is necessary to have a complete understanding of the overtaking maneuvers of cyclists. ...
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... The health benefits associated with physical exercise and mental well-being due to presence of parks and trails are well established in literature (Cleary et al., 2019;Janssen & LeBlanc, 2010;Reiner, Niermann, Jekauc, & Woll, 2013;Saxena, Van Ommeren, Tang, & Armstrong, 2005;Warburton, Nicol, & Bredin, 2006;Wood, Hooper, Foster, & Bull, 2017). Trails can be an effective method of improving societal health as Wang et al. (2005) discovered that each dollar invested in trail development in the US state of Nebraska yielded healthcare-related savings of $3 per trail user. When assessing the literature from an environmental perspective, trails are recognized as a prominent form of low carbon travel (Chapman, 2007;Weston & Mota, 2012), and serve as an important means of protecting and conserving heritage (Tomczyk, Ewertowski, White, & Kasprzak, 2017). ...
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... Alternative means of transportation, such as bicycling, mitigate some effects in urban centers 4,5 and reduce health problems such as obesity, hypertension, and cardiovascular diseases associated with active travel [6][7][8] . From a public health perspective, a cost-benefit analysis of bike/pedestrian in Lincoln, USA, showed that for every dollar invested in it, there is a return on investment of $2.94 in health 9 . Studies point out the high potential that the use of bicycles can have in increasing levels of physical activity and reducing morbidities in the population, generating lower individual costs, since people use less the private and public health insurance 8,10 . ...
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... In addition, non-motorized transportation is associated with increased physical activities (Librett et al. 2006). Infrastructure for active travel also yields economic benefits such as increased job creation (Garrett-Peltier 2011) and reduced medical expenditures (Wang et al. 2005). Because of these benefits, federal, state and local governments have increased funding in recent years for many programs to enhance non-motorized transportation systems. ...
Preprint
Data and models of nonmotorized traffic on multiuse urban trails are needed to improve planning and management of urban transportation systems. Negative binomial regression models are appropriate and useful when dependent variables are nonnegative integers with overdispersion like traffic counts. This paper presents eight negative binomial models for estimating urban trail traffic using 1,898 daily mixed-mode traffic counts from active infrared monitors at six locations in Minneapolis, Minnesota. These models include up to 10 independent variables that represent sociodemographic, built environment, weather, and temporal characteristics. A general model can be used to estimate traffic at locations where traffic has not been monitored. A six-location model with dummy variables for each monitoring site rather than neighborhood-specific variables can be used to estimate traffic at existing locations when counts from monitors are not available. Six trail-specific models are appropriate for estimating variation in traffic in response to variations in weather and day of week. Validation results indicate that negative binomial models outperform models estimated by ordinary least squares regression. These new models estimate traffic within approximately 16.3% error, on average, which is reasonable for planning and management purposes.
... for each dollar invested. The lower estimate is similar to results from a simulation that estimated medical cost savings in return for investing in parks and trails [82] and a comprehensive workplace wellness program [83]. This simulation suggests that if our effect sizes are replicated within a causal framework, increasing the diversity of tree planting may be a costeffective way to prevent cardiovascular disease. ...
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Enhanced immune functioning in response to biodiversity may explain potential health benefits from exposure to green space. Using unique data on urban forest biodiversity at the zip code level for California measured from 2014 to 2019 we test whether greater diversity of street trees is associated with reduced death from cardiovascular disease. We find that urban forests with greater biodiversity measured via the Shannon Index at the genus level are associated with a lower mortality rate for heart disease and stroke. Our estimates imply that increasing the Shannon Index by one standard deviation (0.64) is associated with a decrease in the mortality rate of 21.4 per 100,000 individuals for heart disease or 13% and 7.7 per 100,000 individuals for stroke or 16%. Our estimates remain robust across several sensitivity checks. A policy simulation for tree planting in Los Angeles based on our estimates suggests that if these relationships were causal, investment in planting for a more biodiverse set of street trees would be a cost-effective way to reduce mortality related to cardiovascular disease in urban areas.
... Instead, most studies focus exclusively on trail usage-"traffic"as the primary outcome. Methods most often used to collect trail usage include: (a) infrared sensor counters (8), (b) survey selfreport of nearby residents (9)(10)(11)(12)(13), and (c) in-person systematic observations (14). Like vehicular traffic counts, trail usage counts are used to estimate annual volume of traffic on trails based on a sample of daily counts, resulting in an estimated average annual daily traffic (AADT) on a trail (15,16). ...
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BACKGROUND: The benefits of physical activity in reducing morbidity and mortality are well-established, but the effect of physical inactivity on direct medical costs is less clear. OBJECTIVE: To describe the direct medical expenditures associated with physical inactivity. DESIGN: Cross-sectional stratified analysis of the 1987 National Medical Expenditures Survey that included US civilian men and nonpregnant women aged 15 and older who were not in institutions in 1987. Main outcome measure was direct medical costs. RESULTS: For those 15 and older without physical limitations, the average annual direct medical costs were $1,019 for those who were regularly physically active and $1,349 for those who reported being inactive. The costs were lower for active persons among smokers ($1,079 vs $1,448) and nonsmokers ($953 vs $1,234) and were consistent across age-groups and by sex. Medical care use (hospitalizations, physician visits, and medications) was also lower for physically active people than for inactive people. CONCLUSl0N: The mean net annual benefit of physical activity was $330 per person in 1987 dollars. Our results suggest that increasing participation in regular moderate physical activity among the more than 88 million inactive Americans over the age of 15 might reduce annual national medical costs by as much as $29.2 billion in 1987 dollars- $76.6 billion in 2000 dollars.
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Although personal determinants of exercise behavior have been studied extensively, few investigators have examined the influence of the physical environment on exercise habits. A random sample of 2,053 residents of San Diego, CA, were surveyed regarding exercise habits and other variables. A total of 385 exercise facilities in San Diego were classified into categories of either free or pay. After the addresses of respondents and facilities were located on a grid-map and coded, the density of exercise facilities around each respondent's home address was computed. Subjects who reported engaging in three or more exercise sessions per week reported a statistically greater density of pay facilities near their homes than did those who reported no exercise sessions, after controlling for age, education, and income. The finding suggests an association between proximity of exercise facilities and frequency of exercise.
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Objectives: To assess the effectiveness of a trained district nurse individually prescribing a home based exercise programme to reduce falls and injuries in elderly people and to estimate the cost effectiveness of the programme. Design: Randomised controlled trial with one year's follow up. Setting: Community health service at a New Zealand hospital. Participants: 240 women and men aged 75 years and older. Intervention: 121 participants received the exercise programme (exercise group) and 119 received usual care (control group); 90% (211 of 233) completed the trial. Main outcome measures: Number of falls, number of injuries resulting from falls, costs of implementing the programme, and hospital costs as a result of falls. Results: Falls were reduced by 46% (incidence rate ratio 0.54, 95% confidence interval 0.32 to 0.90). Five hospital admissions were due to injuries caused by falls in the control group and none in the exercise group. The programme cost $NZ1803 (£523) (at 1998 prices) per fall prevented for delivering the programme and $NZ155 per fall prevented when hospital costs averted were considered. Conclusion: A home exercise programme, previously shown to be successful when delivered by a physiotherapist, was also effective in reducing falls when delivered by a trained nurse from within a home health service. Serious injuries and hospital admissions due to falls were also reduced. The programme was cost effective in participants aged 80 years and older compared with younger participants.
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Background:Because most adults in industrialized countries do not meet physical activity guidelines, population-wide interventions are needed. Environmental and policy interventions are based on ecological models of behavior and have the potential to influence entire populations. Ecological models are particularly applicable to physical activity because the behavior must be done in specific physical settings. Cross-sectional data indicate that environmental and policy variables are associated with physical activity behaviors of young people and adults.Method: Seven published evaluations of environmental and policy interventions to increase physical activity were reviewed.Results: Two studies showed that placing signs encouraging stair use can be effective. Quasi-experimental evaluations provided limited evidence that broad environmental changes can be effective. Large-scale policy interventions are currently being conducted in several countries.Proposed Model: A model describing the development of policy and environmental interventions is proposed, in the hope of stimulating more research in this area. Advocacy or planning groups identify and work with agencies that control policies and environments that can be altered to increase physical activity. Educational and policy/environmental interventions are seen as complementary.Conclusion: Lack of conceptual models and the inherent difficulties of evaluation have hampered research on environmental and policy interventions. Further research is needed, and practitioners and researchers should work together to evaluate programs.
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Introduction: Environmental and policy approaches to promote physical activity, such as walking trail construction and promotion, are being widely recommended, yet sparse data exist on their effectiveness. In conjunction with ongoing community-intervention projects in Missouri, walking trails are being built, promoted, and evaluated. Objectives include determining: (1) patterns and correlates of walking, (2) the availability of places to walk and perform other forms of physical activity, (3) the extent of walking trail use and possible effects on rates of physical activity, and (4) attitudes toward the trails and their uses.Methods: In 12 rural counties in Missouri we used a cross-sectional telephone survey to ask a population-based sample of residents aged >18 years (n = 1269) some standard and specially developed questions about walking behaviors, knowledge, and attitudes.Results: Only 19.5% of respondents were classified as regular walkers. About one third of respondents (36.5%) reported having access to walking trails in their area, and 50.3% reported having access to indoor facilities for exercise. Among persons with access to walking trails, 38.8% had used the trails. Groups who were more likely to have used the walking trails included women, persons with more education, those making $35,000 or more per year, and regular walkers. Among persons who had used the trails, 55.2% reported they had increased their amount of walking since they began using the trail. Women and persons with a high school education or less were more than twice as likely to have increased the amount of walking since they began using the walking trails.Conclusions: Walking trails may be beneficial in promoting physical activity among segments of the population at highest risk for inactivity, in particular women and persons in lower socioeconomic groups.
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The intervention strategies that have been applied in the physical activity area show promise in enhancing physical activity participation, particularly in the short-term. However, most systematic study has occurred on personal and interpersonal levels of intervention, with variable effect sizes reported. Few studies have evaluated the specific effects of potentially important demographic factors such as gender, race, and age on intervention success. Although the importance of tailoring interventions to meet the needs of specific population segments has been stressed, the best ways of doing so remain unclear. In addition, most intervention studies have focused on the frequency component of exercise participation, with less emphasis placed on studying other aspects of physical activity such as intensity, duration, or exercise format.
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Inactivity is the risk factor with potentially the greatest public health impact, according to the 1989 U.S. Preventive Services Task Force report. Our study reports changes in subjects' physical fitness level after simple changes aimed at enabling community members to adopt more easily active lifestyles. Simple environmental and social alterations occurred at a San Diego Naval air station. We administered to a cohort of active-duty personnel from within this community (n = 1,609) both a physical readiness test (PRT) and a lifestyle questionnaire at baseline and at one year. The PRT consisted of a 1.5-mile timed run, sit-ups, push-ups, and percentage body fat components, and the questionnaire addressed demographics, current exercise behavior, and attitudes toward exercise. We took similar measures within a comparison community cohort (n = 217) and within a Navy-wide sample cohort (n = 546). Both overall PRT category and 1.5-mile run time improved significantly (P less than .05) over time in the intervention community (0.3 category points and 18 seconds, respectively). The increase was significantly greater (P less than .01) than in either the control community or the Navy-wide sample. Subgroup analysis showed that, in the intervention community, 12.4% failed the overall fitness test in 1987, but only 5.1% failed in 1988. Similarly, the 1.5-mile run failures decreased from 8.4% to 4%. Reported leisure time kilocalorie expenditure showed no significant improvement. This simple program successfully improved fitness performance. The improvement was distributed throughout the community and included those who were substandard at baseline. Similar programs could easily be adopted in a variety of communities.