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Equity in walkable environments and active school transportation in Toronto, Canada: a cross-sectional study

Author(s): Rothman, Kunaratnam, Schwartz, Howard, Mitra, Saunders, Cloutier, Macpherson, Fuselli

Slidedeck Presentation:

Rothman Presentation _6B_Equity _Final

Abstract:

Background:

Active school transportation (AST) including walking, biking and skateboarding benefits children’s health. Social factors, including low income, visible minority status, and immigration have generally been associated with higher levels of AST. However, the mechanism through which social factors influence AST is not well understood, nor is how these factors interact with features of the built environment.

Aims:

This cross-sectional study examined the associations between AST in Toronto elementary schools by area level social factors (i.e. material deprivation, ethnic concentration, recent immigrants, visible minority) and the influence of Walk Score® on these associations.

Methods:

The sample included 105 publicly funded kindergarten to grade 8 schools in Toronto, Canada. Observational data collection was done to calculate the proportion of children arriving to school by active transportation (walking, biking, other). Neighbourhood-level social factors were obtained from the 2016 Canadian census and Ontario Marginalization index (ON-MARG) and Walk Scores® were obtained from its website using schools’ postal codes. Separate multivariable beta regressions models were used to calculate odds ratios between each social factor and AST rates, controlling for Walk Score® and multi-dwelling density (e.g., density of apartment, duplexes). Effect modification of Walk Score® and social factor on AST was examined through interaction terms and plot analysis.

Results:

The average prevalence of AST rates across all schools was 64% (range 24-99%). After controlling for Walk Score® and multi-dwelling density, the proportion of recent immigrants in a neighbourhood was associated with a school’s AST rate (OR=1.54, 95% CI=1.14-2.07, per 10% increase in population proportion). Being a new immigrant was associated with more AST independent of material deprivation No significant association was found between AST and material deprivation, proportion visible minority, or ethnic concentration in adjusted analyses. Walk Score® appears to modify the association between social factors and increasing odds of AST. At low and medium walkability scores there were substantial differences between AST by material deprivation, ethnic concentration, and recent immigrant status; however, at high walkability scores, these differences virtually disappeared.

Discussion:

Increasing population of recent immigrants was associated with more AST independent of material deprivation. There were stronger associations between social factors and increased AST in less walkable neighbourhoods.

Conclusions:

These results have important intervention and policy implications, as modifying the built environment to improve walkability may result in equalizing social disparities. Importantly, this strategy would also likely increase AST overall. Built environment shifts can therefore be made to provide safe, equitable environments for all children.