Pathways linking car transport for young adults and the public health in Northern Ireland: a qualitative study to inform the evaluation of graduated driver licensing

Manoeuvring rural mobility policy for active and sustainable travel

Promoting "slow mobilities" and low carbon transport alternatives, through supporting active and sustainable travel (AST, including walking, cycling, wheeling, and public transport), is a priority for both public health and net zero strategies. Using a situational analysis drawing on local and national documents and stakeholder interviews, we explore the policy ecology of local authority ambitions and practices for creating and implementing AST policy for rural communities. These are shaped by national agendas and messaging, as well as local concerns. Our analysis identified the ways in which stakeholders manoeuvre the friction points that inform, constrain, and shape the production and implementation of AST policy in the South West (SW) and North East (NE) of England. The marginality of rural concerns is reflected in a scarcity of funding, sitting alongside volatility in local and national decision making. Local contestation arises from these conditions, as turbulence in national government messaging shapes (and is shaped by) public and private responses to AST schemes. These friction points were found to operate on, and intersect at, different scales, requiring formal strategic and opportunistic tactical manoeuvres by those creating and implementing local policies, who are both bound by these forces, and work to challenge, resist, and facilitate them whilst managing contestation from communities and stakeholders. This study on AST policymaking contributes to broader literature across various disciplines on "slow mobilities" by offering a policy-oriented perspective. Our findings highlight that creating and implementing policy for rural mobility is a dynamic and demanding process, relying on the commitment and agility of local stakeholders.

Using natural experiments to evaluate population health interventions: a framework for producers and users of evidence

Background

There has been a substantial increase in the conduct of natural experimental evaluations in the last 10 years. This has been driven by advances in methodology, greater availability of large routinely collected datasets, and a rise in demand for evidence about the impacts of upstream population health interventions. It is important that researchers, practitioners, commissioners, and users of intervention research are aware of the recent developments. This new framework updates and extends existing Medical Research Council guidance for using natural experiments to evaluate population health interventions.

Methods

The framework was developed with input from three international workshops and an online consultation with researchers, journal editors, funding representatives, and individuals with experience of using and commissioning natural experimental evaluations. The project team comprised researchers with expertise in natural experimental evaluations. The project had a funder-assigned oversight group and an advisory group of independent experts.

Results

The framework defines key concepts and provides an overview of recent advances in designing and planning evaluations of natural experiments, including the relevance of a systems perspective, mixed methods and stakeholder involvement throughout the process. It provides an overview of the strengths, weaknesses, applicability and limitations of the range of methods now available, identifies issues of infrastructure and data governance, and provides good practice considerations.

Limitations

The framework does not provide detailed information for the substantial volume of themes and material covered, rather an overview of key issues to help the conduct and use of natural experimental evaluations.

Conclusion

This updated and extended framework provides an integrated guide to the use of natural experimental methods to evaluate population health interventions. The framework provides a range of tools to support its use and detailed, evidence-informed recommendations for researchers, funders, publishers, and users of evidence.

Study registration

This methodological project was not registered.

Funding

This project was jointly funded by the Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR), with project reference MC_PC_21009. The work is published in full in Public Health Research; Vol. 13, No. 3.

Changing mobility practices. Can meta-ethnography inform transferable and policy-relevant theory?

Social practice theories have attracted attention for their potential insights into how to change transport systems towards "healthier" states. However, most evidence is from small-scale qualitative case studies. We explored whether a synthesis of qualitative evidence on mobility practices in one country, informed by meta-ethnography and a Bourdieusian approach to practice, could produce theory that is of sufficient abstraction to be transferable, yet also capable of informing intervention planning. The synthesis identified three third order constructs: mobility practices result from habitus plus capital in fields; specific configurations of local mobility practices are shaped, but not determined, by material infrastructures and social structures; and changes in practice happen across a number of scales and temporalities. This body of evidence as a whole was then interpreted as an integrative "storyline": Mobility systems are complex, in that outcomes from interventions are neither unilinear nor necessarily predictable from aggregations of individual practice changes. Infrastructure changes may be a necessary, but not sufficient, condition for change. Moving systems towards "healthier" states requires changing habitus such that "healthier" practices align with fields, and that interventions take sufficient account of the power relations that materially and symbolically constrain or enable attachments to and changes in mobility practices. Meta-ethnography is a useful approach for integrating qualitative evidence for informing policy.

Associations Between Graduated Driver Licensing Restrictions and Delay in Driving Licensure Among U.S. High School Students

INTRODUCTION

Some of the most vulnerable groups of teens choose to delay driving licensure (DDL). We assessed longitudinal associations between state-level Graduated Driver Licensing (GDL) restrictions and DDL among U.S. high school students.

METHODS

Data from seven waves of the NEXT Generation Health Study (starting 10th-grade (2009-2010)), were analyzed in 2020 using Poisson regression. The outcome was DDL (delay vs. no-delay). Independent variables were driving restrictions (at learner and intermediate phases of licensure), sex, race/ethnicity, family affluence, parent education, family structure, and urbanicity.

RESULTS

Of 2525 eligible for licensure, 887 (38.9%), 1078 (30.4%), 560 (30.7%) reported DDL 1-2 years, >2 years, no DDL, respectively. Interactions between GDL restrictions during the learner permit period and covariates were found. In states requiring ≥30 hours of supervised practice driving, Latinos (Adjusted relative risk ratio [aRRR]=1.55, p<.001) and Blacks (aRRR=1.38, p<.01) were more likely to DDL than Whites. In states where permit holding periods were <6 months, participants with low (aRRR=1.61, p<.001) and moderate (aRRR=1.45, p<.001) vs. high affluence were more likely to DDL. Participants in single-parent households vs. both-biological parent households were also more likely to DDL (aRRR=1.37, p<.05). In states where permit holding periods were ≥6 months, participants with low (aRRR=1.33, p<.05) vs. high affluence were more likely to DDL. In states that allowed ≥3 passengers or no passenger restriction, participants living in non-urban vs. urban (aRRR=1.52, p<.05) areas were more likely to DDL, and in states that allowed only 1 or no passenger, participants living in non-urban vs. urban areas (aRRR=0.67, p<.001) were less likely to DDL.

CONCLUSIONS

Our findings heighten concerns about increased crash risk among older teens who age out of state GDL policies thereby circumventing driver safety related restrictions. Significant disparities in DDL exist among more vulnerable teens in states with stricter GDL driving restrictions.

Unraveling the (Uneven) Linkage? A Reflection on Population Aging and Suburbanization in a Mediterranean Perspective

A complex interplay between socioeconomic transformations and demographic dynamics has characterized the long-term development of European countries. As a characteristic example of such linkage, the present study focuses on the spatial relationship between metropolitan growth and population age structure. Preferences for urban and suburban locations reflect complex socioeconomic phenomena such as sprawl, class segregation, gentrification and filtering. However, the spatial linkage between sprawl and demographic transitions was relatively poorly analyzed, and should be more extensively investigated in relation with population dynamics and socioeconomic structures at local scale. By reviewing pertinent literature, this study outlines how space exerts a non-neutral impact on population age structures in Europe, shaping housing needs and influencing settlement patterns and processes of urban transformation. While suburban locations have concentrated younger families and larger households in Northern and Western Europe, the socio-demographic composition of new settlements is increasingly dominated by older inhabitants in the Mediterranean region. Results of this work suggest how discontinuous urban expansion was specifically associated with an elder, wealthy population with high standard of living and a preference for specific housing locations such as detached villas with gardens and swimming pools.

The public health implications of telematic technologies: An exploratory qualitative study in the UK

INTRODUCTION

Reducing motorised transport is crucial for achieving public health goals, but cars will continue to be essential for many in the medium term. The role of emerging technologies in mitigating the public health disadvantages of this private car use has been under-examined to date. Telematics are increasingly used by novice drivers in the UK to reduce insurance premiums. An exploratory study of novice drivers' experiences of telematics identified implications for public health that warrant urgent further research.

METHODS

An exploratory qualitative study, using semi-structured interviews with 12 drivers aged 17-25 in three regions of the UK (Aberdeenshire, Hertfordshire and London).

RESULTS

Telematics were acceptable to young drivers, and reported to mitigate some negative health consequences of driving (injury risks, over-reliance on car transport), without reducing access to determinants of health such as employment or social life. However, there were suggestions that those at higher risk were less likely to adopt telematics.

CONCLUSION

Market-based mechanisms such as telematics are potential alternatives to well-evaluated policy interventions such as Graduated Driver Licensing for reducing road injury risks for novice drivers, with a different mix of risks and benefits. However, claims to date from insurance companies about the contribution of telematics to public health outcomes should be evaluated carefully to account for biases in uptake.

Semiautomated text analytics for qualitative data synthesis

Approaches to synthesizing qualitative data have, to date, largely focused on integrating the findings from published reports. However, developments in text mining software offer the potential for efficient analysis of large pooled primary qualitative datasets. This case study aimed to (a) provide a step‐by‐step guide to using one software application, Leximancer, and (b) interrogate opportunities and limitations of the software for qualitative data synthesis. We applied Leximancer v4.5 to a pool of five qualitative, UK‐based studies on transportation such as walking, cycling, and driving, and displayed the findings of the automated content analysis as intertopic distance maps. Leximancer enabled us to “zoom out” to familiarize ourselves with, and gain a broad perspective of, the pooled data. It indicated which studies clustered around dominant topics such as “people.” The software also enabled us to “zoom in” to narrow the perspective to specific subgroups and lines of enquiry. For example, “people” featured in men's and women's narratives but were talked about differently, with men mentioning “kids” and “old,” whereas women mentioned “things” and “stuff.” The approach provided us with a fresh lens for the initial inductive step in the analysis process and could guide further exploration. The limitations of using Leximancer were the substantial data preparation time involved and the contextual knowledge required from the researcher to turn lines of inquiry into meaningful insights. In summary, Leximancer is a useful tool for contributing to qualitative data synthesis, facilitating comprehensive and transparent data coding but can only inform, not replace, researcher‐led interpretive work.