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Purpose. To provide evidence about the types of transportation infrastructure that support bicycling. Design. Population-based survey with pictures to depict 16 route types. Setting. Metro Vancouver, Canada. Subjects. 1402 adult current and potential cyclists, i.e., the "near market" for cycling (representing 31% of the population). Measures. Preference scores for each infrastructure type (scale from − 1, very unlikely to use, to +1, very likely to use); current frequency of use of each infrastructure type (mean number of times/y). Analyses. Descriptive statistics across demographic segments; multiple linear regression. Results. Most respondents were likely or very likely to choose to cycle on the following broad route categories: off-street paths (71%–85% of respondents); physically separated routes next to major roads (71%); and residential routes (48%–65%). Rural roads (21%–49%) and routes on major streets (16%–52%) were least likely to be chosen. Within the broad categories, routes with traffic calming, bike lanes, paved surfaces, and no on-street parking were preferred, resulting in increases in likelihood of choosing the route from 12% to 37%. Findings indicate a marked disparity between preferred cycling infrastructure and the route types that were currently available and commonly used. Conclusion. This study provides evidence for urban planners about bicycling infrastructure designs that could lead to an increase in active transportation.

We studied 2011 cycling mode share at the census-tract level in Montréal and Vancouver, Canadian cities with relatively high mode shares and diverse bike infrastructure. We examined whether mode share variability, for all commuters and male and female commuters separately, was related to proximity to any bikeway, proximity to four bikeway types, slopes on routes to bikeways, or commute times. Cycling mode shares at the census-tract level varied from 0 to 20.4%. About a third of cycle commuters were female, but this proportion approached parity with males in census tracts with mode shares of 7% and higher. A one-kilometer closer proximity to any bikeway was associated with four times higher cycling mode share. Proximity to cycle tracks was associated with higher cycling mode shares in both cities. Other bikeway types did not have similar associations in the two cities, and the pattern of results suggested that the networks formed may have been more important than specific bikeway characteristics. Uphill slopes to bikeways were associated with somewhat lower mode shares in bivariate analyses but not in adjusted models. Cycle commuting was most common in neighborhoods with intermediate average commute durations: 20 to 29 minutes. Our results suggest that cycle tracks and bikeways that form a connected network are associated with higher neighborhood cycling commute mode shares. These features appeared even more important to women, and their cycling (or not) was strongly related to overall cycling mode shares.

Boil water advisories (BWAs) are public notifications of drinking water qual- ity and are used as temporary, precautionary measures to protect the public from possible waterborne illnesses. In many Canadian jurisdictions, BWAs have been in place for months to years, leading to the concern that their use can be a substitute to the action needed for their removal. With lengthy or on-again-off-again BWAs, there is concern that the public will become com- placent and not comply with the BWA. Research on BWAs is scarce, and little evidence is available to support practical decision-making by the two groups of key players responsible for BWA management – government regulatory of- ficials and water suppliers.Part III of this Guidance Document focuses on managing risks to water secu- rity. The purpose of this protocol is to guide the overall management of boil water advisories, by acting as an information resource and by introducing a basis for consistency. It includes steps to take and factors to consider taking into account when deciding to issue and rescind boil water advisories. ; Medicine, Faculty of ; Population and Public Health (SPPH), School of ; Reviewed ; Graduate

Despite variation in Canadian privacy laws between provinces and territories, increasing legislative protection of personal privacy has imposed restrictions on health research across the country. The effects of these restrictions on patient recruitment include increased study costs, durations, and decreased participation rates. Low participation rates can jeopardize the validity of research findings and the accuracy of measures of association by introducing non-response, or participation bias. We constructed simulations to assess potential effects of non-response bias on the accuracy of measures of association in a hypothetical case-control study. Small biases that alter the probability of selecting an exposed case can lead to dramatic inflation or attrition of the odds ratio (OR) in case-control studies. ORs are more unstable and subject to error when the true probability of selecting an exposed case is greater, such that strong positive associations are subject to error even at low levels of bias. Well-powered, population-based epidemiological research is a cornerstone of public health. Therefore, when weighing the benefits of protecting personal privacy, the benefits of valid and robust health research must also be considered. Options might include special legislative treatment of health research, or the use of an "opt-out" (vs. the current "opt-in") construct for consent in confidential research.

OBJECTIVES: Privacy legislation has limited options for recruiting subjects to health studies. Policy changes are motivated by assumptions about public attitudes towards participation, yet surveys of attitudes have rarely been done. We investigated public willingness to participate in health research and how willingness was affected by various factors. METHODS: A survey of adults randomly selected from the telephone directory was conducted in British Columbia, Canada. Mailed self-administered questionnaires asked about willingness to participate in health research and the influence on willingness of the method of subject selection, the organization making the contact, and other factors. RESULTS: There were 1,477 respondents (58% of eligible); 85% were willing to participate in health research at least sometimes. The organization making the contact influenced comfort about participation: 10% of respondents felt uncomfortable if contacted by a university, 12% if by a hospital, 26% if by government, and 55% if by private research firms. Factors most positively influencing choice to participate were future health benefits to society (87%) and oneself (87%), and receiving a copy of the study results (81%). CONCLUSIONS: Participation in health research appears to be viewed favourably by members of the public, and participation may be highest when university or hospital-based researchers are able to contact subjects directly using information from government databases.

Background: Studies of water-related gastrointestinal infections are usually directed at outbreaks. Few have examined endemic illness or compared rates across different water supply and sewage disposal systems. We conducted a cohort study of physician visits and hospitalizations for endemic intestinal infectious diseases in a mixed rural and urban community near Vancouver, Canada, with varied and well-characterized water and sewage systems. Methods: Cohort members and their disease events were defined via universal health insurance data from 1995 through 2003. Environmental data were derived from municipal, provincial, and federal government sources. Logistic regression was used to examine associations between disease events and water and sewage systems, socio-demographic characteristics, and temporal factors. Results: The cohort included 126,499 individuals and approximately 190,000,000 person-days. Crude incidence rates were 1,353 physician visits and 33.8 hospitalizations for intestinal infectious diseases per 100,000 person-years. Water supply chlorination was associated with reduced physician visit incidence (OR: 0.92, 95% CI 0.85-1.0). Two water systems with the highest proportions of surface water had increased incidence (ORs: 1.57, 95% CI 1.39-1.78; and 1.45, 95% CI 1.28-1.64). Private well water and well depth were not associated with increased risk, likely because of residents' awareness of and attention to water quality. There was increased crude incidence with increasing precipitation in the population served by surface water supplies, but this trend did not remain with adjustment for other variables. Municipal sewer systems were associated with increased risk (OR: 1.26, 95% CI 1.14-1.38). Most socio-demographic variables had predicted associations with risk: higher rates in females, in the very young and the elderly, and in residents of low income areas. Increased duration of area residence was associated with reduced risk (OR, duration ≥ 6 years: 0.69, 95% CI 0.60-0.80 vs. < 1 year: 1.16, 95% CI 1.03-1.30). Conclusions: This large cohort study, with objective data on exposures and outcomes, demonstrated associations between endemic infectious intestinal diseases and factors related to water supply, sewage disposal, socio-demographics, and duration of residency. The results did not always follow prior expectations based on studies examining outbreaks and single systems, and underscore the importance of studying factors associated with endemic disease across water and sewage system types. ; Applied Science, Faculty of ; Civil Engineering, Department of ; Pathology and Laboratory Medicine, Department of ; Population and Public Health (SPPH), School of ; Science, Faculty of ; Non UBC ; Medicine, Faculty of ; Resources, Environment and Sustainability (IRES), Institute for ; Reviewed ; Faculty

Abstract Background Studies of water-related gastrointestinal infections are usually directed at outbreaks. Few have examined endemic illness or compared rates across different water supply and sewage disposal systems. We conducted a cohort study of physician visits and hospitalizations for endemic intestinal infectious diseases in a mixed rural and urban community near Vancouver, Canada, with varied and well-characterized water and sewage systems. Methods Cohort members and their disease events were defined via universal health insurance data from 1995 through 2003. Environmental data were derived from municipal, provincial, and federal government sources. Logistic regression was used to examine associations between disease events and water and sewage systems, socio-demographic characteristics, and temporal factors. Results The cohort included 126,499 individuals and approximately 190,000,000 person-days. Crude incidence rates were 1,353 physician visits and 33.8 hospitalizations for intestinal infectious diseases per 100,000 person-years. Water supply chlorination was associated with reduced physician visit incidence (OR: 0.92, 95% CI 0.85-1.0). Two water systems with the highest proportions of surface water had increased incidence (ORs: 1.57, 95% CI 1.39-1.78; and 1.45, 95% CI 1.28-1.64). Private well water and well depth were not associated with increased risk, likely because of residents' awareness of and attention to water quality. There was increased crude incidence with increasing precipitation in the population served by surface water supplies, but this trend did not remain with adjustment for other variables. Municipal sewer systems were associated with increased risk (OR: 1.26, 95% CI 1.14-1.38). Most socio-demographic variables had predicted associations with risk: higher rates in females, in the very young and the elderly, and in residents of low income areas. Increased duration of area residence was associated with reduced risk (OR, duration ≥ 6 years: 0.69, 95% CI 0.60-0.80 vs . < 1 year: 1.16, 95% CI 1.03-1.30). Conclusions This large cohort study, with objective data on exposures and outcomes, demonstrated associations between endemic infectious intestinal diseases and factors related to water supply, sewage disposal, socio-demographics, and duration of residency. The results did not always follow prior expectations based on studies examining outbreaks and single systems, and underscore the importance of studying factors associated with endemic disease across water and sewage system types.