Alex Quistberg



Nominated From: University of Washington

Research Site: Peru

Research Area: Surgery/Emergency Medicine/Trauma

Primary Mentor: Jaime Miranda

Research Project

Motorization, Safety Concerns, and Active Transportation in Lima, Peru

Healthy, sustainable transportation is a key goal to achieving lifelong quality of life and health.1 Motorization is an important component of economic growth and development in low and middle-income countries (LMICs), but often is unaccompanied by similar growth and integration in the transportation system, such as road infrastructure, neighborhood design and regulations.2 This infrastructure is also often focused on motor vehicle speed and efficiency with only secondary, if any, consideration for pedestrians and cyclists.3 This imbalance has potentially negative consequences for health, including increased risk factors for chronic diseases, like obesity, due to substituting personal motor vehicle use for walking, biking and public transit and increasing pollution and an increased risk of motor vehicle collisions.4,5 The lifelong impact of increased motorization on children and adolescents is important to consider.6 Evidence from LMICs, primarily from China, indicates that the family acquisition of a motor vehicle nearly doubles the likelihood family members will become obese.7 In the US, currently less than 15% of youth walk or bike to school, whereas 40 years ago nearly 50% did so.8 Numerous studies have also demonstrated the link between a poor built environment (e.g., low walkability) and decreased walking and increased road injury.9

One reason why active and public transportation are potentially substituted for personal motor vehicle use globally are traffic and personal safety concerns.1 While usually distance and its estimated time-cost is usually the most important component of transportation mode, safety concerns are the second most important component.10 Research, mostly from high income countries, indicates, that especially for youth transport, concerns about safety can affect decisions to walk, bike or take public transit.1,4 Parents who believe their neighborhoods have too high crime rates or high motor vehicle speeds and volumes are significantly less likely to allow their children to walk or bike.11 Limited evidence in LMICs indicates that safety concerns may have an even stronger effect on physical activity.12 Much of the evidence for the relationship between safety concerns and physical activity has relied, however, on self-reported physical activity and safety data rather than objective measures like accelerometers and global positioning system (GPS) devices.13 There is a very limited understanding of how perceived or objective safety measures are related to where people actually walk, bike and take public transportation, both in high income and low/middle-income settings.14 Understanding the safety and other barriers and facilitators of active and public transit substitution can provide opportunities for designing potential interventions to increase physical activity while maximizing safety. The overall approach for this research will be to recruit adults who will complete surveys, a travel diary, wear accelerometers and GPS devices, and participate in semi-structured interviews. If the participant has children 6-18 years old living at home then one of them will also be invited to participate to form a dyad.

Specific Aims:

Aim 1: Examine impact of safety concerns on active transportation.
Hypothesis 1a Participants with more safety concerns will live in neighborhoods with low built environment safety and will walk, bike and take public transportation less.

Hypothesis 1b Participants with more safety concerns will substitute personal motor vehicle use for trips that potentially could have been completed with active and public transportation.

Aim 2: Determine the decision-making, barriers & facilitators of active transport and mobility. Objective 2a Examine transportation decision-making processes and choices.

Objective 2b Determine perceived barriers and facilitators to active transportation. Aim 3: Assess potential interventions to promote safe, active transportation. Objective 3 Establish interest in potential interventions (e.g., mapping tools) and delivery methods (e.g., mobile health [mHealth] application).





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